Many students will integrate very well at school. Others may have various difficulties from time to time. Common sense and experience will see you through most of these, but we hope this page will help address a few specific difficulties that may crop up.
School ethos and attitudes are also critically important. The student will find it much easier to cope with both physical and learning difficulties if he or she feels secure and integrated in school life.
Ongoing problems can also, of course, be talked through with the student and his or her parents. They have probably been coping with hemiplegia for many years, and may have developed strategies for dealing with most problems.
In this article
Getting around school
Having hemiplegia means having limited use of one arm and hand and possibly poor balance and co-ordination. This can cause difficulties in various areas:
- Opening doors.
- Climbing stairs.
- Carrying a heavy schoolbag.
- Carrying sports equipment.
- Carrying a lunch tray.
- Use of a locker.
- Extra time to collect books between classes.
- Help from other students.
In addition some students have visuo-spatial problems and may have initial difficulties finding their way around school. Clear signposting of rooms, laboratories, etc. (with teachers’ names) will help them.
- Face the teacher.
- Face the board or demonstration area.
- Be away from the main aisle or door, to minimise distraction.
- Have adequate space for the affected arm.
- Have unrestricted movement of the dominant arm.
Writing and drawing
Children with congenital hemiplegia may never be able to use their affected hand. If they are lucky, their dominant hand may be the one which would be their preferred writing hand anyway. It is also easier if the non-affected hand is the right as our writing system goes from left to right, easiest for a right-hander.
More problems arise if the non-affected hand is the left one and the child would (or might – you can’t know for sure) have been naturally right-handed. These children tend to have even more problems with left to right directionality than non-disabled left-handers.
Children with hemi may also struggle with:
- Stabilising of paper.
- Drawing of graphs, diagrams, etc.
- Setting out of work.
- Poor co-ordination affecting handwriting.
- A4 is easier to manage than A3.
- Use of a keyboard can ease problems with handwriting and setting out of work. Make sure the child has enough space to work and place their affected hand flat on the table.
- Blobs of ‘blu-tack’ can help anchor paper. However, some children find it easier to work on paper which is at an angle to the end of the desk. Try using a clipboard which the child can adjust to the angle they require and then hold down with their affected arm.
- Loose leaf notebooks or sheets attached to clipboards may be easier to manage than exercise books.
- A magnetic board, used with rulers and geometry instruments also backed with magnetic strips, can help with drawing graphs, diagrams etc. Pre-prepared diagrams and graphs may also be helpful. If the child has visual spatial difficulties, consistent colour coding of columns and other spaces specific aspects of maths will help.
- Tasks may need to be broken down into more manageable units and extra time may be needed.
The student may feel more self-conscious or clumsy during practical work and may need encouragement to participate.
- Model making.
- Conducting experiments.
- Safety factors (the affected limb may have reduced sensitivity).
- Pairing with another student.
- Modification of equipment.
- Extra time to complete tasks.
Help with learning disabilities
Because of their physical limitations, most students with hemiplegia experience some difficulty and frustration at school and may need a little more time and attention to achieve their full potential.
Some young people with hemiplegia have general or specific learning difficulties which may be slight or severe, and which can be more frustrating and disabling than their obvious physical ones.
Teachers and parents need to be aware how tiring problem solving is for children with hemiplegia. Children with hemi need to constantly think about what they are doing and how they will do it. Some children with visual perceptual issues may need to start from scratch every time they encounter the same problem. This can also result in emotional and sometimes behavioural problems, as the children tend to avoid tasks where they experience difficulty compared to their classmates, so gain no practical experience to build on. This can lead to a sense of frustration and failure.
Short concentration span
To avoid overloading the brain, people make cognitive maps all the time to decide what information to keep and what to discard. Children with hemi seem to have difficulty deciding what to keep and what to discard. Sometimes they attend to minute peripheral details rather than discarding irrelevant information, and then miss the main points of a task. They may also suffer with:
- Difficulty settling down to tasks.
- Frequent lapses of attention.
- Tendency to be easily distracted.
- Seating: sit the child square on to the board or face to face, to avoid having to turn toward stimuli. In group work, sit the child in the middle or front of the group.
- Break down tasks into smaller units.
- Focus on short sessions of concentrated effort.
Short term memory problems
- Poor retention of information or instructions.
- Difficulty in sequencing a series of instructions or objectives.
- Give clear instructions, written if necessary.
- Give clear, written goals for all tasks, to help students to develop personal organisational skills.
- Encourage students to draw up a work plan for each task.
Many of the learning problems outlined above can be alleviated by the use of a computer. We have advice on how to make keyboard adaptations which will help children with hemi.
Using a keyboard may:
- Help students with poor handwriting skills.
- Help develop the ability to present work effectively.
- Help develop personal organisational skills.
- Help dyslexic students correct spelling.
One of the hidden effects of hemiplegia is mental fatigue, also called ‘neuro’ or ‘cognitive’ fatigue. Following the injury which causes hemiplegia, the brain re-wires through a process called neuroplasticity. This is an amazing adaptation but the brain works harder to carry out the same actions or thought processes. It is estimated that a child with hemi uses three times as much energy as their peers. Being at school is just genuinely more tiring for a child with hemi. Even with skills and aptitude, they may need longer to complete their work. If children worry about not keeping up, that will also tire them emotionally.
Emotional and Behavioural Challenges
Children with hemiplegia may encounter emotional or behavioural challenges.
Physical fitness is, if anything, more important for people with disabilities than for their able-bodied peers. It is important to get and stay active.
- Poor balance.
- Weakness of affected limbs.
- Visual impairment.
- Poor hand eye co-ordination.
- A flexible approach, e.g. head starts, development of underarm serving techniques.
- Developing skills in weak areas, e.g. hand-eye co-ordination, balance, weight-bearing.
- Encouragement to try new sports e.g. sailing, fencing, contact sports. See our directory of Sports Bodies.
- Extra time for dressing / undressing.
Help with growing up
Whole school support
In general, support from the whole school, from teachers and fellow students is vital if the student is to fulfil his or her potential.
Striking a balance
It is important to strike a balance between under- and over-reacting, to create a safe environment where the student can ask for help without losing face, or, equally, be challenged to reach heights he or she may not have dreamed of. Success even in one area can be an enormous boost to confidence.
Talking to parents
Many parents will be only too happy to discuss any difficulties their child might be experiencing. Similarly, some schools have found it helpful for a parent to come and talk to staff before their son or daughter comes to the school.