A-Z List


Cerebal Palsy

Journal Articles



Control of Athetic Tremors

Top

Palmer, M. F., & Zerbe, L. E. (1954). Control of athetic tremors by sound control. In E., Pololsky (Ed.). New York: Philosophical Library.
UWEC Call #: ML3920.P752

In their study, Palmer & Zerbe examined a subject who had cerebral palsy, no intelligible speech, poor locomotion, and who was unable to dress himself. In September of 1943, his right hand assumed some degree of relaxation. Tension athetosis disappeared and a true vermiform movement of the right hand began, which was particularly marked in the index finger. Most typically, the finger went into a slight extensor contraction, was held there temporarily, then moved downward, with each joint moving in turn proximodistally until the finger was depressed with considerable force on the tambour. Lateral movements as well as vertical movements were represented. Palmer et al. studied the effect of musical tones and rhythms, primarily those of the violin, on this tremor. The subject was seated in a school desk chair where he could not see the recording style or the experimenters. A large tambour was inserted into the inkwell of the desk. The subject's forearm was strapped to the desk to avoid involuntary movements of his arm. His finger was placed directly on the tambour. Palmer et al. found two very distinct groups of sound stimuli represented in the experiment: a more or less heterogeneous group and a homogenous group consisting of very sharp explosive isolated sound surges.


Blissymbolics

Top

Herman, F. (1985). Music therapy for the young child with cerebral palsy who uses Blissymbolics. Music Therapy, 5, 28-36.

This article described children whose communication difficulties are such that they cannot properly express themselves either through speech, facial expressions, or hand movements. The group was made up of six children with cerebral palsy who are confined to wheelchairs, have little or no hand control, and are non-speaking due to involved speech musculature. Blissymbolics is their mode of communication. They have a weekly music therapy session and attend a wheelchair dance program designed for children with lower functioning ability. In the music therapy sessions, they begin with the children telling the therapist (by Blissymbolics) how they feel and they improvise it into a song. Each child then tells their "news of the day" and at the end they create a song with everyone's news included. The children then get to tell a story while music is played. The final minutes of the session were used for the children to reflect on their feelings about what they have experienced. Listening and responding in a group is a shared experience and can help the children discover their common bond of feeling with each other and the people they know. These sessions helped these children to communicate this awareness and bring them out of the isolation created due to the handicapping condition.

Birdenshaw-Fleming, L. (1993). Music for All. Toronto: Gordon V. Thompson.
UWEC Call #: ML3920.B52 1993

Cerebral palsy is an irreversible, non-progressive condition caused by damage to the brain at birth. Depending on the area of the brain that is damaged, the person with cerebral palsy has varying degrees of control over trunk, limb, and head movement. The challenge is to find alternate means of communication for each person. Blissymbolics is one method of communication. It is a method based on common words, letters, and certain ideas represented by symbols. Blissymbolics can be used to sing a song or in discussing lyrics.


Children

Top

Arnheim, D. D., & Schneider, W. A. (1979). The Clumsy Child. St. Louis, MO: C. V. Mosby.
UWEC Call #: RJ.506.P68A76

This excerpt from a book describes dance therapy as a tool to use to assist an individual's emotional and physical integration. It assists participants in finding self-expression through nonverbal communication, increases self-awareness, and increases positive self-esteem. Programs that emphasize rhythmic movement provide an important tool in psychotherapy because of the strong relationship between motor behavior and feelings. Emotional disturbances adversely alter muscular tension levels. Habitual body behavior patterns can reduce abdominal muscle tension levels. A child who is both tense and emotionally withdrawn can be gradually encouraged to open up and learn to be more expressive physically. In the cerebral palsied child, dance therapy would be difficult to accomplish. They could learn to dance with wheelchairs and make friends.

Schnieder, E. H. (1968). Music therapy for the cerebral palsied. In E. T. Gaston. (Ed). New York: Macmillan.
UWEC Call #: ML3920.B52. 1993

This research study suggests implications for the use of music with cerebral palsied children. The study suggested that when music is used as a background stimulus for purposes of improvement or for purposes of relaxation, careful consideration should be given to the differential diagnoses of cerebral palsy. The study also suggested that the value of music as a background stimulus in a group situation would seem to be dependent on the disability, age of the children, and the degree to which the music is stimulating. These two considerations were essential to the successful use of music or musical activities with cerebral palsied children. It was indicated that the differential diagnoses of cerebral palsy may give a clue to the reactions of the child to various types of music, but the possibility exists that not all diagnosed children will react in the same way. They concluded that music therapy is valuable for cerebral palsied children.

Rudenberg, M. (1982). Music Therapy for Handicapped Children: Orthopedically Handicapped. Washington, DC: National Association for Music Therapy.

This book discusses techniques used with severely handicapped children with cerebral palsy. It also discusses the challenge of music therapy with the severely handicapped. The book describes positions most effective with cerebral palsied children while performing music therapy sessions (i.e. normalize muscle tone, align body so that the head and trunk are symmetrical without extremities twisted or turned abnormally, encourage smooth, steady movements rather than quick, jerky movements). The book states that head alignment is the first gross motor milestone. The book discusses four "special techniques" used in dealing with severely orthopedically handicapped clients. They are Neuro-Developmental Treatment, Sensory Integration, controlled sensory stimulation, and the use of symbols. The music therapist uses some of these techniques in the session.

Bixler, J. W. (1968). Music therapy practices for the child with cerebral palsy. In E. T. Gaston, (Ed.). New York: Macmillan.
UWEC Call #: ML3920.M897C.3

In his article, Bixler states that a music therapist in a hospital school works to help the child with cerebral palsy. A music therapist acts as both an educator and as a music therapist. As a music educator, one plays the role of a public school teacher and is interested in children who may some day be able to go to public schools. According to Bixler, one of the biggest problems of the child with cerebral palsy is the difficulty of belonging to a group and making a positive contribution to it. A study of the experiences of physically handicapped children clearly shows a difference in socialization between these children and their non-handicapped peers of similar socioeconomic status. The reasons for these differences are primarily mobility and communication. This problem of group relationship presents a challenge to the music therapist because music is a meaningful activity that can thrive in a group setting. Bixler states that music can be used to demonstrate rhythms to the cerebral palsied child who cannot hear. Music can be used as a creative tool with these children. Music paired with drama may be used to improve the behavior of a cerebral palsied child. Visual cues can be used to establish neuro-motor patterns, which involve playing instruments by reading symbol cues.

Ford, S. C. (1984). Music therapy for cerebral palsied children. Music Therapy Perspectives, 1, 8-13.

This article states that structured music experiences can contribute to the children's cognitive, physical, emotional, expressive, and social development. Basic characteristics of the disorder are presented. In the area of cognition, music provides auditory stimulation. Listening experiences can increase auditory perception. This area can be developed using musical games. Music often arouses physical response. This article describes uses of "functional therapy" to increase mobility, then endurance, and finally coordination of the affected part of the body. Music is important in the area of socialization because once children are drawn into a musical group, they are able to participate fully and equally with other members of the group. They love games and dances set to music.

Berel, M. (1993). Music therapy and music education for the handicapped. St. Louis, MO: MMB Music.
UWEC Call #: ML3920.M8976

Music was used in different forms to catch the attention of preschool children with cerebral palsy. To capture the children's attention, Marianne Berel dressed up on holidays (Halloween, Thanksgiving) and sang songs to the children. The response of the children was to experience the role in each costume/singing session. The children were motivated to pay attention through the connections with sounds at all levels and because of their quick reactions to "make believe."


Electromyography Biofeedback

Top

Scartelli, J. P. (1982). The effect of sedative music on electromyography biofeedback assisted relaxation training of spastic cerebral palsied adults. Journal of Music Therapy, 19, 210-218.

This study suggests that biofeedback training can be beneficial to the relaxation process. Relaxation can be vital to the education of muscle tissue due to neuromuscular disorders such as cerebral palsy or stroke. In treating the cerebral palsied adult, the immediate concerns of the therapist involve hypertonus of the striated muscles due to damage in the motor cortex of the brain and atrophy of the muscle tissue. In the study, one group of subjects received EMG biofeedback relaxation training only while the second group received similar treatment with a sedative instrumental music background. Each subject received three twenty-minute training sessions per week for five weeks. The results showed a mean thirty-two percent decrease in muscle tension in those receiving only EMG biofeedback. Those receiving EMG biofeedback training with sedative background music had a mean decrease of sixty-five percent. The researchers concluded that the music/biofeedback combination was successful to some extent because the sample size was not large enough.


General

Top

Levin, K. A. (1964). Cerebral Palsy. London: E&S Livingstone.
UWEC Call #: RC.388L48

This excerpt describes the use of music and movement with cerebral palsied children. The teachers kept records and record players at a reachable height for the children. The children were encouraged to move to the rhythm of the music. To give the children some experience with fluent, rhythmic movements, therapists would dance around the room while holding the child in the folded up position, exaggerating the beat of the music as they went. It was found that the children relaxed well when swung to the sound of the music with one therapist holding the child's arms and another holding the child's legs. The session ended with the playing of a soothing melody while the children were shown how to assume relaxing neurological postures and to pretend to go to sleep on the well-heated floor.


Head Positioning

Top

Wolfe, D. E. (1980). The effect of automated interrupted music on head positioning of cerebral palsied individuals. Journal of Music Therapy, 17, 184-206.

This study investigated the effect of interrupted music/silence and interrupted music/tone on the head posturing of persons having cerebral palsy. Selection of subjects was made based on recommendations given by classroom teachers. The experimenter then observed each designated child and noted head positioning behavior to make sure that each designated child was capable of extending the head in an upright position. The experimenter also contacted the physical therapist presently treating each selected student. Subjects were selected from five different educational and/or residential settings: a preschool for children with handicaps, a public school setting for people classified as mentally retarded, a public school classroom for people classified as profoundly retarded, and two residential centers for people classified as profoundly retarded. They ranged in age from 3 to 37 years old. Music selections were made through consultation with a music therapist and with specific classroom teachers working with each subject. A mercury switch head device was used to monitor erect head position. Mercury switches were attached to a cloth headband and were placed around the subject's head. Each switch was connected to a common receptor, which is connected to a relay mechanism. Results indicated that head control improved during the treatment conditions for four subjects. One subject seemed to respond to the music/tone condition. The remaining subjects showed minimal improvement in head posturing throughout the experiments.


Instrumental Music Training

Top

Herron, C. J. (1975). Some effects of instrumental music training on cerebral palsied children. Journal of Music Therapy, 7, 55-58.

The purpose of this study was to examine the possibility of improving the muscular coordination of cerebral palsied children by teaching them to play the Hohner Melodica, which is a wind instrument with a piano-like keyboard. The cerebral palsied subjects were special education students from age nine to eleven. Two were males with athetoid cerebral palsy, one was a male with spastic cerebral palsy, and one was a female with tremor cerebral palsy. Each subject was given a thirty-minute lesson twice a week for twelve weeks. The melodicas were equipped with a flexible tube with one end attached to half of a Hohner Vista mouthpiece and the other half of the mouthpiece attached to the instrument. This allowed the child to place the instrument on the table instead of holding it in his or her hands. A five minute video tape was made of each subject while engaged in this activity at four different intervals: after one week, after three and a half weeks, after seven and a half weeks, and after twelve weeks of instruction. Improvement in muscular coordination, breath support, and musical performance achievement varied with individual subjects.


Muscle Control

Top

Arnheim, D. D., & Schneider, W. A. (1979). The Clumsy Child. St. Louis, MO: C. V. Mosby.
UWEC Call #: RJ.506.P68A76

This excerpt from a book describes dance therapy as a tool to use to assist an individual's emotional and physical integration. It assists participants in finding self-expression through nonverbal communication, increases self-awareness, and increases positive self-esteem. Programs that emphasize rhythmic movement provide an important tool in psychotherapy because of the strong relationship between motor behavior and feelings. Emotional disturbances adversely alter muscular tension levels. Habitual body behavior patterns can reduce abdominal muscle tension levels. A child who is both tense and emotionally withdrawn can be gradually encouraged to open up and learn to be more expressive physically. In the cerebral palsied child, dance therapy would be difficult to accomplish. They could learn to dance with wheelchairs and make friends.

Rudenberg, M. (1982). Music Therapy for Handicapped Children: Orthopedically Handicapped. Washington, DC: National Association for Music Therapy.

This book discusses techniques used with severely handicapped children with cerebral palsy. It also discusses the challenge of music therapy with the severely handicapped. The book describes positions most effective with cerebral palsied children while performing music therapy sessions (i.e. normalize muscle tone, align body so that the head and trunk are symmetrical without extremities twisted or turned abnormally, encourage smooth, steady movements rather than quick, jerky movements). The book states that head alignment is the first gross motor milestone. The book discusses four "special techniques" used in dealing with severely orthopedically handicapped clients. They are Neuro-Developmental Treatment, Sensory Integration, controlled sensory stimulation, and the use of symbols. The music therapist uses some of these techniques in the session.

Palmer, M. F., & Zerbe, L. E. (1954). Control of athetic tremors by sound control. In E., Pololsky (Ed.). New York: Philosophical Library.
UWEC Call #: ML3920.P752

In their study, Palmer & Zerbe examined a subject who had cerebral palsy, no intelligible speech, poor locomotion, and who was unable to dress himself. In September of 1943, his right hand assumed some degree of relaxation. Tension athetosis disappeared and a true vermiform movement of the right hand began, which was particularly marked in the index finger. Most typically, the finger went into a slight extensor contraction, was held there temporarily, then moved downward, with each joint moving in turn proximodistally until the finger was depressed with considerable force on the tambour. Lateral movements as well as vertical movements were represented. Palmer et al. studied the effect of musical tones and rhythms, primarily those of the violin, on this tremor. The subject was seated in a school desk chair where he could not see the recording style or the experimenters. A large tambour was inserted into the inkwell of the desk. The subject's forearm was strapped to the desk to avoid involuntary movements of his arm. His finger was placed directly on the tambour. Palmer et al. found two very distinct groups of sound stimuli represented in the experiment: a more or less heterogeneous group and a homogenous group consisting of very sharp explosive isolated sound surges.

Wolfe, D. E. (1980). The effect of automated interrupted music on head positioning of cerebral palsied individuals. Journal of Music Therapy, 17, 184-206.

This study investigated the effect of interrupted music/silence and interrupted music/tone on the head posturing of persons having cerebral palsy. Selection of subjects was made based on recommendations given by classroom teachers. The experimenter then observed each designated child and noted head positioning behavior to make sure that each designated child was capable of extending the head in an upright position. The experimenter also contacted the physical therapist presently treating each selected student. Subjects were selected from five different educational and/or residential settings: a preschool for children with handicaps, a public school setting for people classified as mentally retarded, a public school classroom for people classified as profoundly retarded, and two residential centers for people classified as profoundly retarded. They ranged in age from 3 to 37 years old. Music selections were made through consultation with a music therapist and with specific classroom teachers working with each subject. A mercury switch head device was used to monitor erect head position. Mercury switches were attached to a cloth headband and were placed around the subject's head. Each switch was connected to a common receptor, which is connected to a relay mechanism. Results indicated that head control improved during the treatment conditions for four subjects. One subject seemed to respond to the music/tone condition. The remaining subjects showed minimal improvement in head posturing throughout the experiments.

Herron, C. J. (1975). Some effects of instrumental music training on cerebral palsied children. Journal of Music Therapy, 7, 55-58.

The purpose of this study was to examine the possibility of improving the muscular coordination of cerebral palsied children by teaching them to play the Hohner Melodica, which is a wind instrument with a piano-like keyboard. The cerebral palsied subjects were special education students from age nine to eleven. Two were males with athetoid cerebral palsy, one was a male with spastic cerebral palsy, and one was a female with tremor cerebral palsy. Each subject was given a thirty-minute lesson twice a week for twelve weeks. The melodicas were equipped with a flexible tube with one end attached to half of a Hohner Vista mouthpiece and the other half of the mouthpiece attached to the instrument. This allowed the child to place the instrument on the table instead of holding it in his or her hands. A five minute video tape was made of each subject while engaged in this activity at four different intervals: after one week, after three and a half weeks, after seven and a half weeks, and after twelve weeks of instruction. Improvement in muscular coordination, breath support, and musical performance achievement varied with individual subjects.

Dileo, C., & Wigram, T. (1997). The effect of vibro acoustic therapy on multiply handicapped adults with muscle tone and spasticity. Cherry Hill: Jeffrey Books.
UWEC Call #: ML3930.M925

This study investigated the effect of vibro acoustic therapy in reducing muscle tone in patients with spasticity. Dileo and Wigram hypothesized that Sedative music in combination with a pulsed low frequency sinusoidal tone of 44 hertz would have a greater effect in reducing muscle tone in cerebral palsied subjects than sedative music alone, and that sedative music and a pulsed low frequency sinusoidal tone of 44 hertz would have a greater effect on blood pressure than sedative music alone. Three male and seven female subjects who were residents in a large mental hospital took part in the experiment. Ages ranged from 28 to 77 years old and they were diagnosed as profoundly handicapped. The majority of the subjects had flexor-spasm in arms and legs and adductor spasm causing difficulty in separation of the legs. Blood pressure, heart rate, and range of movement were measured before and after the trials. Results indicated improved range of movement in all subjects. There was an indication that systolic blood pressure was reduced but there were wide variations in the data on diastolic blood pressure. When pulsed low frequency sinusoidal tones were used in conjunction with sedative music, a greater reduction in muscle tone and an improved range of movement was achieved than when music alone was used. The difference in blood pressure was not significant.


Neurophysical Treatment

Top

James, M. R. (1986). Neurophysical treatment of cerebral palsy. Music Therapy Perspectives, 3, 5-8.

This article discussed two case studies in which music therapists performed treatments on cerebral palsied clients. In the first case study, the objective was to develop protective equilibrium responses. The music therapist turns on a tape recorder and places the client in a prone position on top of a vestibular ball. When the music began, the therapist rocked the client to the beat of the music. After the client became relaxed, the therapist rocked the client to a position where she was off balance. This position was maintained until the client responded motorically or when 30 seconds elapsed. Results showed appropriate protective equilibrium responses on five out of five trials. The client gradually took less time to achieve a relaxed posture, and her reactions to being placed off balance occurred sooner. In the second case study, the objective was to increase the average duration of the time the client didn't maintain a primitive reflex posture, from six out of twenty minutes to twelve out of twenty minutes, for five trials. After placing the client on a rocking board, the therapist turned on the tape recorder. The therapist rocked the client to the beat of the music. The client was to remain in each of the following positions for five minutes: 1. Lying supine with arms and legs extended, 2. Lying prone with arms and legs extended, and 3. Sitting upright, on top of her legs with the therapist holding her arms extended. Results indicated that while lying in a supine position on a floor mat, the client maintained a posture other than a primitive reflex for an average of fourteen out of twenty minutes for five trials. Data collection also revealed improved eye contact and verbalizations as well as general alertness of the client.


Orthopedically Challenged

Top

Rudenberg, M. (1982). Music Therapy for Handicapped Children: Orthopedically Handicapped. Washington, DC: National Association for Music Therapy.

This book discusses techniques used with severely handicapped children with cerebral palsy. It also discusses the challenge of music therapy with the severely handicapped. The book describes positions most effective with cerebral palsied children while performing music therapy sessions (i.e. normalize muscle tone, align body so that the head and trunk are symmetrical without extremities twisted or turned abnormally, encourage smooth, steady movements rather than quick, jerky movements). The book states that head alignment is the first gross motor milestone. The book discusses four "special techniques" used in dealing with severely orthopedically handicapped clients. They are Neuro-Developmental Treatment, Sensory Integration, controlled sensory stimulation, and the use of symbols. The music therapist uses some of these techniques in the session.


Relaxation

Top

Arnheim, D. D., & Schneider, W. A. (1979). The Clumsy Child. St. Louis, MO: C. V. Mosby.
UWEC Call #: RJ.506.P68A76

This excerpt from a book describes dance therapy as a tool to use to assist an individual's emotional and physical integration. It assists participants in finding self-expression through nonverbal communication, increases self-awareness, and increases positive self-esteem. Programs that emphasize rhythmic movement provide an important tool in psychotherapy because of the strong relationship between motor behavior and feelings. Emotional disturbances adversely alter muscular tension levels. Habitual body behavior patterns can reduce abdominal muscle tension levels. A child who is both tense and emotionally withdrawn can be gradually encouraged to open up and learn to be more expressive physically. In the cerebral palsied child, dance therapy would be difficult to accomplish. They could learn to dance with wheelchairs and make friends.

Schnieder, E. H. (1968). Music therapy for the cerebral palsied. In E. T. Gaston. (Ed). New York: Macmillan.
UWEC Call #: ML3920.B52. 1993

This research study suggests implications for the use of music with cerebral palsied children. The study suggested that when music is used as a background stimulus for purposes of improvement or for purposes of relaxation, careful consideration should be given to the differential diagnoses of cerebral palsy. The study also suggested that the value of music as a background stimulus in a group situation would seem to be dependent on the disability, age of the children, and the degree to which the music is stimulating. These two considerations were essential to the successful use of music or musical activities with cerebral palsied children. It was indicated that the differential diagnoses of cerebral palsy may give a clue to the reactions of the child to various types of music, but the possibility exists that not all diagnosed children will react in the same way. They concluded that music therapy is valuable for cerebral palsied children.

Scartelli, J. P. (1982). The effect of sedative music on electromyography biofeedback assisted relaxation training of spastic cerebral palsied adults. Journal of Music Therapy, 19, 210-218.

This study suggests that biofeedback training can be beneficial to the relaxation process. Relaxation can be vital to the education of muscle tissue due to neuromuscular disorders such as cerebral palsy or stroke. In treating the cerebral palsied adult, the immediate concerns of the therapist involve hypertonus of the striated muscles due to damage in the motor cortex of the brain and atrophy of the muscle tissue. In the study, one group of subjects received EMG biofeedback relaxation training only while the second group received similar treatment with a sedative instrumental music background. Each subject received three twenty-minute training sessions per week for five weeks. The results showed a mean thirty-two percent decrease in muscle tension in those receiving only EMG biofeedback. Those receiving EMG biofeedback training with sedative background music had a mean decrease of sixty-five percent. The researchers concluded that the music/biofeedback combination was successful to some extent because the sample size was not large enough.

James, M. R. (1986).  Neurophysical treatment of cerebral palsy. Music Therapy Perspectives, 3, 5-8.

This article discussed two case studies in which music therapists performed treatments on cerebral palsied clients. In the first case study, the objective was to develop protective equilibrium responses. The music therapist turns on a tape recorder and places the client in a prone position on top of a vestibular ball. When the music began, the therapist rocked the client to the beat of the music. After the client became relaxed, the therapist rocked the client to a position where she was off balance. This position was maintained until the client responded motorically or when 30 seconds elapsed. Results showed appropriate protective equilibrium responses on five out of five trials. The client gradually took less time to achieve a relaxed posture, and her reactions to being placed off balance occurred sooner. In the second case study, the objective was to increase the average duration of the time the client didn't maintain a primitive reflex posture, from six out of twenty minutes to twelve out of twenty minutes, for five trials. After placing the client on a rocking board, the therapist turned on the tape recorder. The therapist rocked the client to the beat of the music. The client was to remain in each of the following positions for five minutes: 1. Lying supine with arms and legs extended, 2. Lying prone with arms and legs extended, and 3. Sitting upright, on top of her legs with the therapist holding her arms extended. Results indicated that while lying in a supine position on a floor mat, the client maintained a posture other than a primitive reflex for an average of fourteen out of twenty minutes for five trials. Data collection also revealed improved eye contact and verbalizations as well as general alertness of the client.


Vibro-Acoustic Therapy

Top

Herman, F. (1985). Music therapy for the young child with cerebral palsy who uses Blissymbolics. Music Therapy, 5, 28-36.

This article described children whose communication difficulties are such that they cannot properly express themselves either through speech, facial expressions, or hand movements. The group was made up of six children with cerebral palsy who are confined to wheelchairs, have little or no hand control, and are non-speaking due to involved speech musculature. Blissymbolics is their mode of communication. They have a weekly music therapy session and attend a wheelchair dance program designed for children with lower functioning ability. In the music therapy sessions, they begin with the children telling the therapist (by Blissymbolics) how they feel and they improvise it into a song. Each child then tells their "news of the day" and at the end they create a song with everyone's news included. The children then get to tell a story while music is played. The final minutes of the session were used for the children to reflect on their feelings about what they have experienced. Listening and responding in a group is a shared experience and can help the children discover their common bond of feeling with each other and the people they know. These sessions helped these children to communicate this awareness and bring them out of the isolation created due to the handicapping condition.

Birdenshaw-Fleming, L. (1993). Music for All. Toronto: Gordon V. Thompson.
UWEC Call #: ML3920.B52 1993

Cerebral palsy is an irreversible, non-progressive condition caused by damage to the brain at birth. Depending on the area of the brain that is damaged, the person with cerebral palsy has varying degrees of control over trunk, limb, and head movement. The challenge is to find alternate means of communication for each person. Blissymbolics is one method of communication. It is a method based on common words, letters, and certain ideas represented by symbols. Blissymbolics can be used to sing a song or in discussing lyrics.