Mental Health and Cerebral Palsy

Did you know that 1 in 4 people with CP has a behavior/mental health condition?

I often hear privately from parents and adults with CP about their struggles with mental health. There is no shame in bringing these issues forward, and many clinicians believe mental health concerns are under-recognized and under-treated among people with CP.

In CP, people struggle with behavioral/mental health conditions for a variety of reasons. They could even be related to several sources that exacerbate each other. So when working through these issues, it’s a good idea to have your medical team do some detective work. Some sources of behavioral/emotional imbalance may include:

1. Unaddressed pain (many potential sources here!)
2. Insomnia (sometimes due to pain as well)
3. Frustration with having a disability
4. Side effects from medication–Maya actually takes an epilepsy medication that can cause an increase in aggressive behavior and/or anger
5. Chemical imbalance related to the initial brain injury
6. A tendency to get overwhelmed more quickly than most people. I have noticed and heard from Maya that her nervous system gets overloaded by things that don’t intellectually make sense to her.
7. Diet. Maya has strong behavioral reactions to certain foods. Although this may not be the case for everyone, over time we have observed positive changes in behavior by removing certain foods from Maya’s diet. I’d like to see more research in this area since there are many people talking about possible connections between the gut and brain. Until then, we are going to go with what we have seen work for Maya. It doesn’t hurt her to stay away from certain foods, and from what we have observed, it definitely has helped.

We found great relief as a family by acknowledging that we needed help finding ways for Maya to manage her emotions and find relief from them. For her we have needed to address multiple potential sources of interference in her mental health that related to pain, medication side-effects, insomnia and what I would refer to as “nervous system sensitivity”. We are still working through some of these issues. There are many resources to address these sources of behavioral/emotional conditions.

One recent surprise and source of relief came from our new dog Jenny. Jenny has a tremendous calming effect on Maya. Maya told us the other day, “Mom and Dad, I can’t believe how much Jenny helps me calm down.”

Michele, CP Daily Living and CP NOW nonprofit


The diversity of the CP Community and the many conditions they face


There are many people who do not understand the diversity of experiences, conditions and in some cases medical complexity that make up the CP community. I have heard people’s confusion in my own conversations with friends, family members and strangers who often think CP is a similar experience for everyone. I also have seen people in CP groups on social media trying to support one another but missing vital information to offer the right kind of insight. It is critical that in discussing CP people provide background information about what CP looks and feels like in their experience. As an example, you need to know something about an individual’s motor function, type of movement disorder and treatment goals before discussing treatments that fall under the broad category of CP.

The one commonality that people with CP share is that each person has had either an early brain injury or a one-time disturbance in brain development (EDBI) that has led to varying degrees of problems with motor function, muscle coordination and balance. But the conditions and problems individuals may face do not usually end with movement. The EDBI may have lead to other conditions that impact daily life. These conditions, and how severely they affect the individual and family, often become embedded in conversations about CP and how it is portrayed and discussed. It’s important to keep this in mind when talking about “Cerebral Palsy” and to have clarity (when appropriate) about what that means to the person speaking.

Some of the conditions that someone with CP may face include:

1. Epilepsy-Affects approximately 40 percent of individuals with CP according to the CDC, medications often have side effects exacerbating other conditions, some of which are listed below:
2. Communication difficulties including speech and hearing-Some people with CP have a lot to say but no way to communicate despite the diversity of communication devices on the market.
3. Learning difficulties-There may be a diversity of barriers to learning and it’s important that these components are identified and addressed individually. For instance, there may be medications interfering with processing, the child may be tired from sleep disturbances, epilepsy may interfere with learning and visual and hearing impairments may also cause problems. 
4. Intellectual disabilities-Some people with CP have intellectual disabilities. At the same time some people with CP may be incorrectly perceived as having an intellectual impairment or a more severe intellectual impairment because of their posture, or the difficulty they may have with speaking. 
5. Sensory integration impairments-There is so much to learn and understand here but people with CP may have difficulty organizing and acting upon the information coming through their sensory centers (i.e vision, hearing, touch, vestibular).
6. Visual processing disorders (how visual info is processed by the brain)-Visual processing disorders like cortical visual impairment (CVI) can cause significant problems with learning and can be easily missed by educators. 
7. Ocular impairments (how the eyes mechanically work)-People with CP may need glasses and may have problems coordinating eye movements. 
8. Behavioral or psychological conditions such as anxiety disorders, depression and bi-polar disorder-The mental health of people with CP is often overlooked but it’s becoming clearer to clinicians and researchers that this is an area that needs more attention. 
8. Problems with eating/swallowing-Some individuals may have difficulty coordinating and using the muscles needed to eat and swallow food which may require adjustments to the textures of the foods they eat, using a straw for liquids (Maya does this) or having a feeding tube
9. Bowel and bladder dysfunction-In CP the muscles throughout the body can be affected including the ones that control bowel and bladder functions. Constipation is very common and can be hard to manage. There can also be problems with bladder control or urinary tract health that also relates to the muscle control in those areas. 
10. Changes to the onset of puberty-When the infant brain has been injured or disturbed during development, this can also mean that the pituitary gland which controls puberty has been affected as well. Increasing numbers of children with disabilities are experiencing early or late onset puberty. 
11. Sleep disorders–These can be severe and exacerbate other conditions like behavioral issues and learning and also affect the rest of the family. 
12. Chronic PAIN–A big issue among people with CP, especially for adults with CP.
13. Muscle/bone problems that lead to contractures–muscles fixed in a rigid position–and scoliosis-These may require treatments and/or surgical interventions.
14. Hydrocephalus-fluid on the brain.

I share this information not to dwell on the negative aspects of what can occur when someone has had an EDBI, but to illustrate the complexity and range of the disorders that one may experience. It’s very important to me and to Maya that people don’t get so caught up in her differences that they cannot connect with her as they would any other child. For this reason, I do my best to focus on Maya’s strengths, but there are days where I struggle to support her body’s most basic functions like sleeping, going to the bathroom, or trying to keep seizures at bay. I think it’s important for people to understand these issues as well. Some families struggle and worry every day about helping their children eat, drink, sleep, breathe and remain comfortable in their bodies, and they often don’t have the energy to advocate for themselves.  Other individuals may be facing great pain and are concerned about losing function, including the ability to walk, and still others may feel their barriers to communication impact their participation and quality of life more than any other symptom or condition with which they are coping. I am committed to educating people about early brain injury and CP, and ensuring that people’s strengths are recognized while also acknowledging the diversity of concerns individuals face that need to be considered when mobilizing change for the direction of research, treatment and quality of life.

**To learn more about the work I am doing for the CP community please join me on Facebook and visit CP NOW, our fundraising organization focused on education, support and funding pilot studies. Pilot studies are the first phase of scientific research where new and innovative ideas are brought forth for initial safety and efficacy testing. The CP community is in great need of new ideas and treatments, and before researchers can go on to secure larger grants or federal dollars, they need to find money for pilot studies which often comes from private organizations like ours.


What is that new gait trainer Maya has been using? It’s called the Up and Free and its fantastic!

**Please note that I have not been paid nor have I bartered to discuss the Up and Free. I just think it’s an awesome piece of equipment and it’s worked so well for Maya that I wanted to share it in case it may work well for some of your children or for adults with CP who follow our blog.
I had been eyeing the Up and Free for several years at the annual American Academy for Cerebral Palsy conference. I would try it out each year and then leave the conference  thinking that we needed to find something similar to it for Maya. I didn’t initially pursue purchasing it because we didn’t have an easy way for Maya to try it out and it was likely going to be a struggle to get it covered by our insurance plan. But, over the last few years as we tried one gait trainer after another, I saw that nothing came close to the features offered by the Up and Free. What I didn’t know was if those features would work as well in practice for Maya as they did in theory and with me trying it out.
This past Spring Maya yelled at me that she didn’t want to use her walker anymore because she felt too unstable in it. I couldn’t blame her  since we had trouble with it being very prone to tipping. I decided it was time to try the Up and Free. By this time, Mr. Razon the engineer developer of the Up and Free, knew me fairly well and we had a comfortable rapport. We paid to have the Up and Free shipped to our home on a trial basis. If there was a demo near us we would have had our regular equipment vendor make these arrangements, but it was proving too difficult to locate one and I figured we waited long enough to get started. I have learned to get to know equipment and work with it for a while before getting excited and investing money in a new purchase so I always stick to my rule of trying equipment for a few weeks before we buy it. Too often we have seen items that have initially appeared to be a great fit in the first few hours or days but turn out to be not what we thought. Our initial trial made us feel comfortable in moving forward with our purchase and after many months, it has met and even exceeded my expectations. With the help of our therapy team we have made minor adjustments along the way, but I can confidently say it is one of the best equipment purchases we have ever made.
The Up and Free addresses several issues we have faced in helping to facilitate exercise and walking for Maya. Maya is primarily a wheelchair user and a GMFCS IV (according to the gross motor scale for CP). She has lots of problems with balance and stamina so it’s not easy to find opportunities for her to exercise and practice walking–something she is very motivated to work on. Every gait trainer we have tried has either been too bulky, provided too little support or didn’t provide support in the right places for her.
Here are the unique features we have discovered with the Up and Free:
1. It has a dynamic seat (it moves up and down as she moves) attached to a piston which means that as Maya walks we can offload some of her weight which has allowed her to increase her strength and stamina over time. With her old walkers she had a very hard time making progress and petered out after about 20 minutes. 
2. The design allows Maya to practice squats and other strength building exercises at home. This is really helpful because most of the time we give up on exercises because of the energy it takes to get her set up to do them. 
3. The wide frame easily fits around Maya’s wheelchair and has worked well around our toilet so she can practice transferring into it and work on transferring in general. Transfers are something we need to work on especially as Maya gets older and she is motivated to practice with the Up and Free. She wants to be able to transfer into it and then move about the house. 
4. The frame–although large is much more stable than her last walker and she feels secure in it. At the same time the security doesn’t come with extra weight like we have seen with other gait trainers. It also glides smoothly along door frames which prevents her from getting stuck and allows her to self-correct without much assistance. 
5. Maya has had more exercise and strength building opportunities with this piece of equipment than any other we have tried. She loves it and for the first time in her life she has enjoyed observing her surroundings from a new vantage point. This year she was so excited to walk beyond the few houses surrounding ours and see everyone’s holiday decorations. She doesn’t care to cruise around the neighborhood in her wheelchair so this was new for her. 
FINALLY–I got pretty choked up a few weeks ago when Maya walked a half of a mile in her Up and Free. I really didn’t think that was possible. Even if Maya is not a full-time walker, it’s deeply fulfilling for her to meet goals she sets for herself.  With all this talk about the importance of getting kids and adults with CP moving in any way possible I am relieved to find a way to support Maya’s body so she can exercise longer, bear weight and break a sweat!! Like I said, in the past she could walk for about 20 minutes and now she can walk exponentially farther and for an hour! Although it isn’t as portable as I would like (you have to break it down and hang onto some long screws), we regularly take it to the gym and have taken it to the park a few times.
Here is video of Maya using her Up and Free from a couple of weeks agoupandfree. You can see that I provide some support in helping her move forward. A caregiver or therapists can also provide support from behind as the individual walks.
Are you interested in learning more about the Up and Free?
There is a list of hospitals and therapy centers that have them where you may be able to try them out. Eli Razon, the developer of the Up and Free has been connecting me with families in different states to find out how some have gotten insurance to cover the cost. I am told that some state Medicaid programs will cover it (ours would not, but private insurance paid some), some private insurance programs are covering it, and some schools and therapy centers are purchasing them. Here is the Easy Walking website where you can learn more:

Making decisions about vehicle modifications for passengers with disabilities

Please note that this blog post is for educational purposes only. The costs listed here are approximations of what different options for conversions and vehicle modifications may cost. Costs will vary depending on when you read this post, your location, the accessories chosen, the dealers you use and more. Check with your dealer for exact pricing and warranty information. I have not received any incentive or payments to highlight the products or companies included here. What I have shared is based on what products I was presented with during my search and what I found through my own research.


It’s been over a year now since we bought our new vehicle and lift for transporting Maya’s wheelchairs. Before that purchase, I was driving a Subaru Forrester and we were lifting Maya’s small wheelchair in and out of the trunk. This was adequate at the time but it became clear that Maya needed a much bigger and heavier wheelchair, possibly with power. There was no way we could continue to lift a wheelchair that big and heavy into and out of the trunk. So, off we went trying to figure out how to upgrade.

We went through many stages of thinking through what we should do, how much money we should spend, and how to balance our immediate needs with Maya’s needs at the time and in the future. I am sure a lot of you struggle with these same issues. When deciding on equipment, furniture, or other support, we think about how long Maya may need certain kinds of support and how many thousands of dollars we are comfortable investing given the possibility that she may not need them later. For others you may already know what your child needs but cannot afford those supports without great sacrifice so you are waiting as long as possible to make those big changes.

Over the course of a year before we made our final decision, we considered all possibilities, including full conversion vans/cars, manual ramps, power ramps, external lifts, internal lifts and even valet seats (vehicle seats that turn). The decision making process was so confusing that we even delayed the purchase of Maya’s new wheelchair and its power features so we wouldn’t be forced to decide what type of vehicle to buy before we were ready. It is so important for parents, therapists and vendors to understand that when a family is deciding whether or not to purchase a power chair or to buy a very heavy wheelchair, they are simultaneously faced with the need upgrade or modify one of their family vehicles. This can create two extremely expensive and complicated decisions you have to make at the same time, while trying to manage the daily living of a child with CP.

There are many ways to solve these problems and lots of different options for you and your family. You will need to decide whether to make small adjustments to your car along the way or buy a fully converted vehicle instead, which allows your child to ride in her wheelchair without transferring.

Here are some of the major options to consider:

  1. A full conversion where your child rides in his or her wheelchair
  1. A lift for transporting the child’s chair on the outside or inside of the vehicle (lots of decisions to make within this category)
  1. Purchasing a new versus a used conversion vehicle
  1. Purchasing a larger vehicle that you can have converted. **You will need to check with a reputable mobility expert to determine the vehicle eligibility requirements for modifications.
  1. Some families choose to purchase portable manual ramps. You may wish to investigate this option too but given the negative feedback I received about how difficulty these were to maneuver from other families and our mobility consultant, we chose to bypass this option and I have not covered them here.

New conversion mini-vans often run between $42,000-55,000 and up depending on the vehicle, it’s options and the type of conversion. Smaller vehicles that have been converted like the Kia Soul, start at about $31,000 new (As I was writing this post I saw an online price of 29,995 for one with 12,700 miles).  Lifts cost an average of $1000-$4500 installed. These are all expensive investments but given that back injuries can occur when trying to lift your child or wheelchair into and out of the car and those associated costs, it is important to carefully weigh the different factors involved in your situation. Take a breath though because there are lots of used vehicles  with modifications that are for sale as well. Just be sure to do your research and evaluate the warranty information carefully both with regard to the vehicle manufacturer’s warranty, which conversion systems the car manufacturer approves and the warranty for the conversion itself.

In order to figure out whether to pursue a full or a partial vehicle modification here some things to consider:

  • If your child rides in her chair will you take her more places?

This question carried a lot of weight for me. I find myself skipping errands or short and potentially fun stops for her because I am feeling the strain of transferring. Without a doubt I thought I would take her more places if we had a fully converted vehicle because that would mean no additional transfers in and out of the car. But, after driving a converted van for a weekend I didn’t feel as strongly about it. Perhaps it was because I wasn’t used to the process but fiddling with the tie downs was discouraging to me as well. This experience led me to think that if we purchased a fully converted vehicle, I would want a docking system that was as easy to use as possible (and there are some out there like the EZ Lock). If you are already investing lots of money in vehicle modifications make sure you consider all aspects of your purchase. Something like the locking mechanism for the chair may make a big difference for you on a daily basis. 

  • If you don’t choose a full vehicle modification at the beginning, you may be able to have your vehicle modified later.

You can discuss this with your sales consultant. If you don’t know who to talk to, begin by searching for dealers on the National Mobility Equipment Dealers Association (NMEDA). The answer will depend on the type of vehicle you have, if conversions are available for it, and the mileage (perhaps other things too). It is my understanding that most companies that perform vehicle modifications have guidelines for how many miles a used vehicle can have as part of the criteria for determining if it can be modified.

  • If you get a fully converted vehicle, do you choose rear or side entry? 

The rear entry is less expensive because it requires less modification of the vehicle. Setting this aside it’s important to consider the parking situations where you live. Are you in an urban area where you will be parallel parking a lot? Is the vehicle’s bottom clearance an issue where you live? If so, there is more clearance in a rear entry converted vehicle. Some people (myself included) are concerned about side entry vehicles because of the possibility of someone parking in the striped area next to your vehicle making it impossible to get back into your vehicle unless you move it to another location. Others don’t like the idea of entering and exiting the rear of the vehicle because of the space required to deploy the ramp and because of traffic that may be coming behind the vehicle. This can be a tough decision to make.

The interior space also differs for rear and side entry vehicles. Interior considerations relate to trunk space, which type of conversion will accommodate the user’s wheelchair and height, where other passengers may want to sit and where the individual in the wheelchair is going to sit in the vehicle. I was told that side entry vehicles tend to be more popular in part because it allows an adult wheelchair user to drive the vehicle or have access to ride as a front passenger.

Also, don’t get used to the factory seats when you are looking into these modifications because, with most of these modifications, you will be forfeiting some of your factory made seats. I wasn’t so thrilled about this especially since they didn’t feel as comfortable as the regular seats to me. Just remember there are going to be significant tradeoffs with a converted vehicle and you have to get comfortable with this reality from the beginning. It’s really important to see the different options in person and ask about trying out the vehicle you are interested in for a few days. Take your time through this process!  By driving the vehicle and taking your child in and out, you will experience and understand things about the vehicle you hadn’t even realized were so important. For instance, after trying a side entry van for a weekend, I realized that the back row seats felt awkward to me because my feet did not touch the floor when I was sitting there. I realized that the floor is dropped in the side entry modification process, allowing headroom for the wheelchair user, but at the same time making the back row of seats further off the floor.

  • Is there funding for vehicle adaptations and conversions?

Yes. There are some grant programs, especially for veterans, and some allowances for vehicle modifications through state Medicaid waiver programs. In addition, some car manufacturers offer small rebates for vehicle modifications when you purchase a new vehicle. Many dealers offer vehicle financing. You will find some funding resources listed at the bottom of the blog post.

We definitely thought hard about these. They seemed like the perfect solution. But then I heard the price for what I wanted and it was half the cost of a full conversion. We still may pursue something like this later.

Keep in mind that if you are purchasing a vehicle to modify with valet style seats, you need to be sure that your selection is compatible with your vehicle and in which passenger’s seats they can be installed. As an example, our Ford Transit Connect only has the option for a front passenger valet seat which will not work for Maya at this time.

  • What if we had a lift in the back that can take away the heavy lifting of her chairs in and out of the vehicle?

There were a few options when it came to lifts but it was not nearly as overwhelming to determine which one we wanted compared to thinking through a full vehicle conversion. Lifts can be placed on the inside or outside of a vehicle and there are several options for how chairs can be loaded and secured. These options weren’t cheap but they certainly were exponentially less expensive than a vehicle conversion. If we decided to purchase a lift I wouldn’t feel bad about the money we invested.


What did we decide?

We decided against a full conversion and instead purchase a Ford Transit Connect and a Big Lifter that could accommodate Maya’s manual and power wheelchairs. It became clear to us that Maya was making enough progress in her transfers that spending less money for this combination, rather than a full conversion, would meet our needs at least for a few years.

I’ve been very happy with the decision so far. I love that the Transit Connect handles more like my small SUV than the minivans I test drove. It has lots of room and a great back up camera. The only drawback is that it doesn’t have as many options as other popular minivans on the market like the power sliding doors and trunk (maybe the newer models have them?). I don’t mind especially since the price was great and we were potentially saving for a full vehicle conversion down the road.

The Big Lifter by Bruno (about $1500.00 plus installation–depending on the options you choose and we had a $1000.00 rebate from Ford) was a great choice as well. I wanted an internal lift and storage system (not on the outside of the vehicle), a system that maximized trunk space and the option to use the lift with more than one chair. It wasn’t as easy to use as the JOEY platform lift (about $2500.00 plus installation–depending on options chosen) but I preferred having the lift installed on the side of the trunk instead of having it centered. By the way, I am highlighting Bruno lifts here only because those were the ones introduced to me in the showroom.

There are others manufacturers you may wish to consider as well including: Adapt-Solutions / BraunAbility / Harmar / Pride Mobility Products Corp. / Prime-Time Specialty Vehicles, Inc. / Vantage Mobility International, LLC (VMI)

After more than a year now I can say that both the vehicle and the lift have suited us well.  I have lots of trunk room and have been able to add her walker, gait trainer, or bike back there even with Maya’s wheelchair. We also got to keep our factory made second row of seats. When the trunk of the vehicle is open I am protected from the rain (we don’t have snow here) while I hook in the straps. The Big Lifter isn’t ideal (at all) on an incline or hill but we don’t have much of an issue where we live. There is still a lot of physical labor for me to transfer Maya in and out of our vehicle but for now we are happy with our little car van. It’s fun to drive and very practical as well.

Here are a few pictures of our Big Lifter in action:




Additional resources–

Helpful articles:

Vehicle Insurance and Mobility Adapted Vehicles-an article from Disabled World

An article from Edmunds on choosing a ramp for your wheelchair van

Five questions to consider when choosing a conversion vehicle

Have Wheelchair Will Travel blog’s post on Car Modification

Car modification companies and mobility dealers :

NMEDA National Mobility Equipment Dealers Association–Dealer locator

AMS Vans

BraunAbility and their Help Me Decide Guide-manufacturer

Bruno-Car lifts, valet seats (vehicle seats that turn and may go up and down)-manufacturer

Freedom Motors USA

Mobility Works

Nor-Cal Vans-Conversions for Ford Transit Connect–Rear entry only at this time

Rollx Vans

The Mobility Resource

Vantage Mobility International-resource center

Vehicles designed specifically for wheelchair users:

MV-1-A vehicle built from the ground up with wheelchair users in mind

Kenugru–affordable electric vehicle for a single wheelchair users/driver–designed by a wheelchair user

Funding resources:

Ride Away-Alternative Funding Sources

The Mobility Resource-Van Grants for all 50 States Can I Find Help to Make My Vehicle Accessible?

Wheelchair accessible vehicles and manufacturer mobility programs (this is not an exhaustive list):

Honda Mobility Assistance

Toyota Mobility

GM Mobility

**Check with your dealer for information about more car manufacturer programs like these








Voice Dream–The reading app that just saved us $2700.00

Voice Dream 2
After more than two years of observing how Maya sees and reads, and almost pulling the trigger on a $3000.00 desktop magnifier/CCTV, we found an app called Voice Dream that addresses Maya’s visual processing and tracking needs!! Woohoo!! This was after a process that included lots of internet research, app trials, device trials and homemade tricks and tips that weren’t enough. And guess what? It only cost us $9.99. Yes. I. am. totally. serious. Here is a nice review/overview of the Voice Dream Reader. 
I have written several posts about Maya’s visual impairments  both ocular–how the eye functions, and cortical–how information is sorted once it gets to the brain. We have struggled to find a way for Maya to read comfortably and independently. The sloppiness of our process has led her to become increasingly irritated with reading and I felt like we were in real trouble of her becoming stuck and sliding backward with her reading skills. From creating homemade view finders, to manually wrestling with the iPad so that her touch wouldn’t lead to an unintentional swipe, to page magnifiers and highlighters of all kinds, we have tried a lot.  
I was finally prepared to move forward with purchasing a desktop magnifier/CCTV device. We trialed one in our home last week and I was so thrilled by its capability. I posted a picture on my personal fb page of Maya using it successfully and expressing my relief. My friends and family were thrilled and oohed and aaahed over the technology. But one of my friends whose daughter is older and also has CP and a visual impairment, gently asked if I had considered using the iPad and the various apps that are compatible with it. Have I?!! Yes, and they either had terrible reviews, didn’t do what we wanted or were buggy. Hrumph, I thought to myself. I finally feel like I am confident enough to move forward and now I have more suggestions. That’s what many of us love and don’t love about Facebook right? But I knew this woman knows her stuff and I felt compelled to follow this one last lead.  She asked me if we were using Bookshare, a free online free library for kids in the US (but also available internationally) who have documented visual impairments or disabilities that make it hard to read. I signed Maya up last year for Bookshare but after trying it myself I felt it wasn’t the answer for her. It certainly was a great free digital library but she needed more visual support than their online reader offered. I still decided to go back and check out their website again because this was a huge investment and I didn’t want to miss anything. How many times did I say to myself that there must be an app out there that can do what we need. And guess what? I found something there this time I had not seen before; a reader Bookshare suggested called Voice Dream. I tried it all afternoon and it didn’t act buggy, was compatible with the Bookshare library, had good reviews and had THE two non-negotiable functions Maya needs: the capability to isolate individual lines of text with black surround, and an option for her to freeze the screen for tracking with her finger. BINGO! This app has it and text to speech to boot. It also has text to speech options with voices that sound like real people instead of machines. 
At this time Maya is in a Montessori educational setting which means that her needs for visually accessing a blackboard or walls in the room or worksheets is almost zero–something desktop magnifiers and cameras are great for. When the time comes, and she is in a more traditional classroom, we will revisit the technology options at that time. For now we’ll hang on to the money we just saved and invest in a new iPad with a bigger screen and save the rest for other equipment Maya needs.
I know it feels really good to diligently do your research and finally feel like you have made a confident decision. I was there. I was done. But this time, by following a friend’s suggestion I found something new that met our needs and offered us an enormous savings. This decision also allows Maya to continue to use her iPad, a piece of technology she is very comfortable with, that’s portable and that she can navigate on her own.
It is often confusing to sort through the pros and cons of technology and equipment purchases, and it’s easy to get derailed by finding the first thing that meets your needs (and then some) or that looks really cool. I have developed a simple strategy to help me remain focused and that includes making a categorical list for purchases. I detail what Maya needs to get out of the technology or device, what we as her caregivers may need, what features may be non-negotiable and which features we would like for her or us to have but that we could live without. Perhaps I will add another strategy to my list and that is to ask fellow parents on Facebook one more time before making big purchases.  This strategy led me to Voice Dream combined with Book Share and it’s a great solution for our family for right now. And to think that the developer got started on this as a hobby.
**The photos at the top illustrate one of the features of Voice Dream Reader which is to isolate lines of texts. The highlighting you see in yellow occurs when the text to speech option is activated.

O-R-E-O cookie milestone!


This afternoon Maya called me from the other room and asked me to come watch her do something. She was all smiles and she showed me that she is finally able to twist Oreo cookies apart. I would say that is definitely a cool childhood milestone but perhaps one I wasn’t expecting and one I didn’t know she was working on. She said this was actually the second time she had done it and that the first was to offer her friend half when she was over our house the other day. How sweet is that?!! It also points to how motivating peers can be. 

As Maya grows I am beginning to see what opens windows for her to make meaningful progress. Her fine motor skills have always been quite basic until this past year and a half. So what’s the change? From what I can tell it’s the combination of her motivation combined with activities/practice she enjoys:

1. Beginning piano (I never thought that one was going to be possible).

2. Having lots of small beads to work with in her Montessori school. Even these made me frustrated but they were combined with math learning which she is so passionate about.

3. Her love of card playing.

These fine motor changes make a lot of sense and align with what researchers are discovering about CP and how to create new motor pathways. They are finding that our kids and adults are having the greatest success in learning new skills when there are purposeful goals attached to the movements the therapists are working on. The motivation piece is something known to be important for all learning and is often mentioned as a key component for neuroplastic changes.

Here’s to our Oreo cookie milestone and the milestones you and your family members are reaching! Don’t be afraid to try something new and remember (this took me a while) that you can break everything down into VERY small components for your child to begin to piece together new skills.



Maya’s view of herself means more than any disability scale


After hearing me talk about a friend whose child has CP Maya asked me (and in the car of all places), “Is my CP severe Mom?” And then in 30 seconds or less here is what ran through my head: “OMG is she really asking me this question?”, “I can’t lie to her”, “I am always honest with her”, “This is a really important question and I don’t want to screw up the answer!!”, “I’m totally doomed to say the wrong thing here!”.  And then I said, “Well, Maya, like I always tell you, how you view a circumstance depends on how you are looking at it. Some people need more support than you and others need less. Also, when it comes to CP you have to be clear about what skills you are referring to. There are some ways CP may affect you but not others and vice versa.”  After I said this much, I paused and thought maybe I should ask her how she sees herself before I tell her how I see her or how the gross motor function scales (GMFCS) etc see her. “So what do you think Maya?” “Do you think you have a ‘severe’ form of CP?” To which she replied, “No, mom I don’t. There are lots of things I can do.” 

For those of you who follow my posts closely you will know that Maya has had her emotional ups and downs lately about what she can’t do. She has been less receptive to us redirecting her to to look at her strong suits. But, regardless of what has been feeling recently, she clearly still has some really positive self-perceptions too! We have always strived to approach and convey to Maya our deep acceptance and love for her, encourage her and gently help her to focus on what IS available to her. I think some of this has sunk in over time. After she shared her feelings with me and I agreed, I could hear her exhale with relief and realized what an important conversation this was for both of us.


Maya shapes her identity as a young girl with cerebral palsy


Lately, Maya has been crying a lot about having cerebral palsy.  She has cried about having to use a wheelchair, about not being able to move her body the way she wants and about lacking the independence and freedom she desires. She is also frustrated with her epilepsy, her restricted diet and problems with her vision.

Over the years, Maya has gone through a few phases of defining herself and how she relates to having cerebral palsy. When she was between four and five years old she went through a period when she thought everyone who looked in her direction was thinking something negative about her being a wheelchair user. We took Maya to the mall during that time and helped her practice interacting with strangers—yes we really did this. She learned that people weren’t always concerned about her using a wheelchair—some would even say this to her. To move past this belief and her anger, she had to be willing to explore the possibility that her ideas of how others were perceiving her may be inaccurate—and they often were.  This was not easy at her young age.

From that period of time Maya transitioned into a phase of pride and positivity about having cerebral palsy-a strategy she still uses on occasion today. Her approach to coping with feeling different was to rely on her outgoing nature. She would immediately introduce herself to people and explain why she was using a wheelchair. This was her way of her taking the lead on any concerns or questions people had about her. On occasion she would ask her dad, me or personal caregiver to explain things on her behalf.

In the last six months I have seen a change in Maya’s perspective. She seems to be realizing that, for the foreseeable future, she is going to be a wheelchair user who will require assistance for daily tasks. This realization has triggered the increased crying spells.

The different phases that Maya has gone through in terms of her self definition are the same issues all people go through during their development. Maya’s issues are more complicated because of the added dimension of having a disability.

I believe that Maya’s struggles to come to terms emotionally with having CP are normal, although the specifics vary from person to person. Because she is very self aware and intuitive, which, on the one hand, helps her sort through her feelings, she experiences her feelings deeply. As a parent, it is tough and downright painful to see her grieve about her condition, her identity and how others may perceive her.

In trying to help Maya, and myself, navigate the emotional terrain of CP, I have learned some approaches that are helpful. One major insight is that it is not helpful to try to alter or challenge Maya’s perceptions when she is upset. Although it is tempting to tell her to “look on the bright side,” it doesn’t work. She needs to have the space to feel and grieve without being “hushed.” It takes strength for me to hold her and be quiet, allowing her raw emotion to surface.  I resist the urge to immediately reshape her point of view. Later, when she is calmer, I talk with her about new ways of viewing herself and the world.

For instance, I recently discussed with her that, despite how different she may feel, most people on this planet have some sort of struggle that they are coping with too—you just can’t see theirs as easily as you can see hers. She sat with that idea for a while and seemed to be considering the truth of this statement. I also reminded her that she has talents that others do not have and that her talents will allow her to help herself and others have a better life. I went on to mention the many possibilities for her future citing some adults with CP who have a diversity of lives and professions. She breathed a deep sigh of relief. I could see that despite her being only 9, she had been thinking the doors were closing in on her—yikes!  I try to balance acceptance of Maya’s feelings with hope about her future.

Maya told me she realizes she has been very emotional recently about having CP. I told her it was ok and I know she needs to get these feelings out so that she can face them and we can work through them together. But one really important thing she has repeatedly taught me is that she has an extraordinary ability to move on once her feelings are expressed and acknowledged. I had been so worried about her, especially after we had a rough visit to the local children’s museum last week with her young cousin who at 18 months is able to do more physically than Maya can. When I checked in with later that day and said I was sorry it was a rough DAY for her she corrected me. She said “No Mom, it wasn’t a rough day. It was a rough morning and then I was fine. I had a good day.” Wow, she told me! I took that as a positive sign that she is working through her feelings and letting them go rather than getting stuck in them. When and if I see Maya getting stuck or spending lots of her day feeling emotional we will seek the assistance of her psychologist.

For now, as her parent, I see it as my job to help her move toward accepting herself as she is. I am working to ensure that her commentary within herself about her self-worth is an ongoing reminder that she is loved, loveable, and equal to everyone else. And despite the obstacles she faces, she is blooming!




Wheelchair users are not all the same



Perhaps it seems obvious but wheelchair users are individuals with a diversity of feelings, perspectives and ideas. This still holds true for wheelchair users who have CP too. No matter what commonality you can wrap around a group of people it is still important to honor and acknowledge them as individuals. 

This point was highlighted for us today when we took Maya to her favorite local restaurant. The owner is someone we have chatted with before and today he mentioned being a part of a local upcoming racing event where wheelchair users are pushed by a partner runner. It’s a fantastic effort and experience for many. However, he assumed that as a wheelchair user Maya would automatically enjoy participating. I said a couple of times that we have offered this opportunity to her and even tried once to have her ride during a race I participated in several years ago. I explained to him that she just doesn’t enjoy the experience. He didn’t get it. He went on to say why other wheelchair users liked it etc. Clearly, he was well-intended and we tried to explain this to Maya.

When he walked away Maya became very angry. Then her anger turned to tears and she cried very hard. It was the kind of cry that makes the most stoic of parents want to cry as well. She said, “It isn’t fun for me to ride in a race.” “I want to be the one running or using my walker!” She went on to express even deeper feelings and her point was that riding in a race was an intense reminder of what she couldn’t do but would like to. It hurts to even recount the experience here.

So, I guess my point is that it’s easy to assume that what is fun or appealing for one wheelchair user must be fun for all, but that is not the case. And over time I have learned from Maya that her reason for saying “No” to an activity may have feelings behind it that I have not considered. Maya offered an important reminder of this today. When the owner came by our table she tried explaining her feelings to him. I don’t know if he understood what she was getting at, but I was proud of her for sharing her point of view.

Not easy stuff–for any of us.


Strategies for creating balance when your child has CP–It’s tough!

Creating balance in your life when you have a child with cerebral palsy or any other chronic health condition can be difficult. Ever since my daughter’s diagnosis of CP eight years ago, I have struggled with the ongoing tension between wanting to seize opportunities to encourage her greatest improvement and not making our life all about therapy and treatment. For many years when she was very young, there was great uncertainty about her developmental path, and during this time it was difficult for me to find much balance in daily life. As her primary caregiver I kept seeing all of the activities and peer interactions she was missing out on and I felt I needed to fight harder and “shout louder” against her CP and the confusing tide of signals her brain was sending her muscles.  I figured it was better to sacrifice parts of my daughter’s childhood and a few years of mine and my husband’s life, than to miss what I understood were “critical opportunities” to help her have the best possible future.

The difficulty in creating a balanced lifestyle when a child has had a brain injury or disturbance in brain development often relates to the confusion of dealing with an unknown future. This is because no one can tell you with certainty how much potential for change your child has. For my daughter’s toddler years I felt like I was in a race without a finish line, wondering how many areas of development I could support to keep her development as close to her same-aged peers as possible. As she got older, however, I slowly let go of this thinking as I saw that my daughter continued to get further behind even as I pushed the daily limits of her energy and the energy of our family. You may be in a similar position. You may often feel like there are not enough hours in the day to meet your needs and your child and family’s basic needs. You may also have people tell you that “you must take care of yourself” which sounds like a nice idea that you will get to some day in the far off distance. There are however a few tips and tricks that may shift your approach to caring for your child and free up some of your emotional and mental energy and maybe even some of your time.


Responding to a CP Diagnosis

In order to fully implement some of these simple strategies, it is helpful to understand why CP is so difficult to manage and to evaluate the ways you are coping with your child’s CP diagnosis. With many health conditions a diagnosis offers guidance to parents about what they can expect as their child grows. This information allows parents to begin to set down emotional roots, start to cope with their child’s present symptoms and prepare for known future conditions. A diagnosis like cerebral palsy (CP) is different because the developmental path is often unclear and will vary from one individual to another. The diagnosis of CP allows families to access services, health benefits, and provides them with a name for their child’s symptoms, but it does not offer parents the deeply desired road map they are often searching for. This uncertainty can create extraordinary emotional strain as well as anxiety and confusion because parents are unsure of what changes they can help foster in their child and what circumstances they will ultimately need to accept.

Here are some examples of how parents may respond to a CP diagnosis in both action and emotion:

  1. Blame themselves
  2. Deny that their child is having difficulty
  3. Aggressively fight the diagnosis and symptoms through constant and intensive therapy planning—this is not always a bad thing but balance is
  4. Constantly search the internet for new and experimental treatments
  5. Repeatedly ask others–doctors, therapists and other parents–to make predictions about their child

These are understandable feelings and normal ways of coping with the diagnosis, but each of them has pitfalls that are important to be aware of. As an example you may be spending so much time searching for answers on the internet that your relationship with your spouse begins to suffer, or you find unreliable hope in a remedy found online that will cost your family lots of money and disappointment.

This journey isn’t easy, and it’s different for everyone, however, we all face fears and even guilt that lead us to try to do whatever we can to help our children. Be easy with yourself, and if you feel you have been pushing too hard, know that it’s ok. As parents we do the best we can with what we know, understand, and realize at any given time. For those of you who are feeling out of balance you may find the following list of insights and tips helpful in thinking about how to approach caring for your child:

  1. Pay attention to how much intellectual and personal energy you are giving towards finding answers for your child. Be sure to carve out times during the day to simply be with your child, other family members, or spouse without thinking about CP or without focusing on how your child is moving, speaking, walking, etc.
  1. Don’t sacrifice reason and good sense to help your child. Before trying a new therapy, make a list of the sacrifices the treatment will require you and your family to make. Weigh the emotional and financial costs and the physical, safety, and unknown risks the treatment will present against the possible benefits for your child. Remember that a treatment without any known risks does not mean it is risk free. Discuss these issues with people you trust and your child’s medical team. Set time commitment and financial limits and discuss expectations.
  1. Your child will have his or her own developmental timeline. When you compare your child to other same aged peers, you may subliminally approach your child with disappointment and s/he may perceive this as something s/he is doing wrong. Focus on the positive points, the things that are working and the small, incremental steps that lead to putting larger developmental pieces together.
  1. Assess and honor your child’s physical and cognitive energy limits each day.These may change daily. You know your child best. Don’t be afraid to speak up if you think what is best for your child is different from what the experts advise.
  1. Be aware of what is driving your approach to your child’s therapy/developmental support program. Be honest with yourself and look out for guilt, fear, and hopelessness that are motivating you to push your child and other family members in unhealthy ways. For many parents the realization that your motivations may not align with what is best for your child is part of the emotional journey that is a necessary step on our the way to accepting the CP diagnosis. Remember, it’s your child who has to ultimately participate in the therapy and integrate all of the information that comes from your therapy planning. Looking back I understand that I was driven to find better ways of helping my child because accepting the status quo wasn’t equating with the progress I envisioned. I felt that I couldn’t stand idly by, watching and waiting. I had to do whatever I could to potentially make her path easier.
  1. Creating a balanced schedule becomes easier as your child’s developmental picture becomes clearer. Over time, as you and your professional team have had a chance to observe your child, you will have a better understanding of how to focus your time and which therapies and treatments work best for your child.
  1. Focus on what your child does well and what they like. Integrate interests with opportunities for development. Maya loves horseback riding and because it doesn’t feel like therapy to her, it provides both enjoyment and therapeutic benefit. The riding facility we go to compares therapeutic horseback riding to sneaking broccoli into cookies and I couldn’t agree more!
  1. There is no secret cure for CP and when there is a major treatment breakthrough it won’t be a secret. I am not discouraging you from trying to create a program that works for your child, but just be sure to give other aspects of your life and your child’s life attention as well.

Over the last eight years it has become much easier to accept that my daughter has a disability. I now spend much less of my time and energy thinking about how to make her symptoms of CP go away and focus more helping her plan and achieve her individual goals in a timeline that is best for her. I feel optimistic and hopeful rather than hurried and guilty. I look for smaller developmental changes, still hoping for the larger ones, but perhaps not counting on them. I celebrate her triumphs alongside her. We spend much more time laughing and having fun. Looking back I cannot say that I would have approached her diagnoses differently, but I wish I had chosen an easier route. In order for me to arrive at the place of acceptance I am now, I believe I had to experience and accept the limits of my power. By doing so I learned to accept what I reasonably could not change, yet still remain open to and hopeful for new possibilities and technology that may increase my daughter’s participation in life. To my surprise I also learned that many times my daughter will spontaneously put together new skills during prolonged breaks from therapy, at times when we are focused on enjoying life instead of obsessively tuning into things like how she is using her hands or holding her head.

Coming to terms with a diagnosis like CP is not always about grief. Sometimes it’s about celebrating our children’s victories and talents, and ensuring that they have the support they need at home and in society, to ensure that those strengths can come forward and can be shared with the world.

2012-11-24 Isle of Palms 142 (1)