need advice! cerebral palsy

[pianoannie]

(I posted this on another piano site, so sorry if this is a duplicate for you).


If anyone here has experience teaching students with CP or other conditions that limit dexterity, I'd appreciate your input.

Here's my situation: I had my first lesson with a 6 y.o. girl yesterday. Her brother transferred to me several months ago, so I've known the family for a while. I had never noticed any physical limitations in the girl, and nothing was ever mentioned to me.

At the first lesson, while doing my typical intro stuff, ie wiggling particular fingers, "making O's", etc, the girl said "I can't make my LH fingers move very well." At first I thought it was just typical left-handed difficulty in a young RH'd child, but then her brother (sitting in the adjacent room) called out to me "Oh, she has CP on her left side."

Wham!! Nice little surprise. So then I didn't know how much to do with her LH at this lesson, as I didn't want to embarass her or do anything that would be
physically uncomfortable.

When the mom arrived to pick up the kids, I spoke with her privately about it for just a few minutes. I asked about physical therapy, but the dr has said that the girl's cp isn't serious enough to need that. Hmmm....her fingers seemed pretty affected. For example, to "make O's" she had to use her RH to get her LH fingers to press together. To try to press a single key with a LH
finger, she used her RH to hold the finger and press.

Now, it could be that some of it is just LH awkwardness, and with a gentle approach, she will do fine. But I really don't know how to proceed. The mom actually seemed surprised that I asked about it, and that it wasn't even
significant enough that I should know about it. So I feel out of place suggesting that, perhaps her condition is worse than they think. I mean, what do I know after one lesson?

Also, I'm not sure that the Faber Piano Adventures primer materials I bought for her will be the best thing, but I don't know what else might be more suitable.

I'll certainly be doing some research, but I welcome any comments.

Thanks! pianoannie

[bernhard]

I have no first hand experience with this sort of student. However I do believe that piano playing maybe highly therapeutical in a case like this.

Naturally both your expectations and your goals will have to be adapted accordingly (and you may consider if you want to take such an assignment).

Normal methods (e.g. Faber and Faber) are probably out of question since your course will have to be tailored to this student. However tiresome and stressful such an assignment may prove to be it also has the potential to be highly satisfying and personally fulfilling.

You may find the sites below helpful (there are thousands more):

https://epilepsyontario.org/client/EO/EOWeb.nsf/web/Cerebral+Palsy+and+Epilepsy
(general information about cerebral palsy)

https://pianoeducation.org/pnompair.html
(Lots of good advice for teaching the piano to cerebral palsy students)

https://www.eroplay.com/sfweekly050201/nightcrawler.html
(The weird and inspirational tale of Frank Moore)

Good luck!

Best wishes,
Bernhard.

[janice]

Perhaps the mom is in serious denial about her daughter's limitations.  This is not uncommon.  I really really really really think that she is in denail regarding the scope of her daughter's limitations.  Maybe she has grown to "accept" the fact that her daughter has cerebral palsy, but she has not yet accepted the severity.  And I am not criticizing her at all.  Some people never reach the point of true "acceptance", while some take years and years.  Also, maybe in some sort of weird way she thinks that you can "reverse" these limitations.

One thing that you can try with her is making up exercises where the LH will play in a "mirror image" of the RH. Someone else here will have to come up with ideas that build on what I just said.  I do know that if you put both thumbs on D (right above middle C) and play chromatically, with the LH descending, and the RH ascending, that you will have a "mirror image" (sometimes I do this as part of a warm-up).The third fingers are the only fingers that will land on a black key.  I suggested "mirror image" playing from a theory (from a Physical Therapy standpoint) that doing this might somehow "re-wire" the brain to accept movement from the affected side as "normal" movement.

Anyway, someone else will have to come up with these "mirror image" excercises.

Oh hey, perhaps you could have her play on a keyboard rather than a piano.  The keys are so much easier to play than keys of a regular piano.  A person with no limitations might not really notice much of a difference, but to a person with limitations, the difference is HUGE (and it's a wonderful difference!)  You can get a tabletop keyboard like Casio brand.

Hope this helped.

[pianoannie]

Thanks Bernhard, for the website suggestions.  I've been reading through them and have found them very informative.
And thanks Janice for your suggestions.  I had already decided to try using a keyboard instead of a piano, and I like your idea about the mirror image exercises.

I think I'll be able to accomplish some things with this girl, but it's going to necessitate a LOT of customized pieces and exercises, which I don't have a quick way to do.  The things I'm thinking of could involve many extra hours a week to write out, or I could invest in software to print out music, but either way, I don't charge enough to justify these extras.  I don't feel like I can now tell the mom that this girl's lessons will cost a lot more (seeing how the mom doesn't even think the cp is significant enough to mention to me).  But I am afraid I could grow to resent all the extra time this could require of me.  I bet I've spent at least 6 hours the past 3 days in research and in talking with an occupational therapist.

I'm trying to view this as a learning opportunity for me, and as an opportunity to bring the joy of music to this very sweet little girl, but if I'm honest with myself, I'm not sure I am happy to have had this challenge put upon me unknowingly.  I'm afraid I may not have the time, creativity, or qualifications to really teach this girl in the best way possible.  But I will certainly try.

I welcome any and all further suggestions anyone has.

[Swan]

The mom actually seemed surprised that I asked about it, and that it wasn't even
significant enough that I should know about it.

Perhaps the mom is in serious denial about her daughter's limitations.

Another alternative, is perhaps the mother doesn't realise what it takes to actually play the piano.  Does she play herself?  Is she doesn't, then chances are she doesn't realise the effort it takes to make individual movement of the fingers.

I was going to mention the electronic keyboard too.  Melodies are played with the right hand and an autoaccompaniment can be played with the left.  These accompaniments only need one finger to press C for C chord, G for G chord etc.  These days you can get some pretty fangle dangle gismos with great intros, drum fills, and endings.  

All the best with your student.

[pianoannie]

I was going to mention the electronic keyboard too.  Melodies are played with the right hand and an autoaccompaniment can be played with the left.  These accompaniments only need one finger to press C for C chord, G for G chord etc.  These days you can get some pretty fangle dangle gismos with great intros, drum fills, and endings.  >>>

Oh wow, I hadn't even thought about the chord accompaniments that my keyboards can do (I seldom use that function so it hadn't occurred to me).  Yes, mine can do some pretty big-sounding stuff!  That is a great idea, if I come to find that her LH is too limited to even play real chords with her fingers.  I think she'll be able to at least press one key to do the auto-chord changes.  Thank you for that suggestion!!!  That makes me even think of another possibility for books...perhaps there are books for keyboards that have just a RH melody with chord symbols for the LH.  That might be a great place to start!!  I'm feeling much better about this situation.
Keep those ideas coming!


All the best with your student.

[ChristmasCarol]

My sympathies on that moment when you realize there is something serious going on and the parent is in denial.  Wouldn't hurt to go to a CP website and seek advice from there.   Have you ever heard of Meir Schneider's book 'Handbook for Self-Healing'?  It is a detailed book on techniques to work on the self through serious conditions suchs MS, CP, Arthrytis, etc.  There's a chapter for musicians.  This will demonstrate for you the safety in pursuing progress and ease your mind.  I know someone who works with horses and special needs kids and also teaches lessons to healthy kids.   Time and again the parents do not say a word before making the appointment.  I think they are overwhelmed and hope that whatever you are teaching will help them parent this child better.

I have a little girl who - and I'm not exaggerating - cannot look at music and play the correct hand.  She switches it every single time.  Mom says, nope no dyslexia here.

Good luck

[alan22]

My sympathies on that moment when you realize there is something serious going on and the parent is in denial.  Wouldn't hurt to go to a CP website and seek advice from there.   Have you ever heard of Meir Schneider's book 'Handbook for Self-Healing'?  It is a detailed book on techniques to work on the self through serious conditions suchs MS, CP, Arthrytis, etc.  There's a chapter for musicians.  This will demonstrate for you the safety in pursuing progress and ease your mind.  I know someone who works with horses and special needs kids and also teaches lessons to healthy kids.   Time and again the parents do not say a word before making the appointment.  I think they are overwhelmed and hope that whatever you are teaching will help them parent this child better.

I have a little girl who - and I'm not exaggerating - cannot look at music and play the correct hand.  She switches it every single time.  Mom says, nope no dyslexia here.

Good luck

yes denial my sympathies are also with u buddy it must be quite painful for for being there and facing all those things.... hats off to u..........

Chino physical therapy

[DeusExMachina]

Hi. I have taught a number of students with conditions that affect their hands and fingers. I found that (and this is just from my experience) 1) parents sometimes deliberately don't tell the teacher about any condition because they are afraid that the teacher will reject the student, and 2) piano lessons are far cheaper than therapy. Both of thoses instances put you in a very awkward situation. I've had parents tell me that a doctor recommended piano lessons (?).  Being a mother, I think this mother knows full well what her childs limitations are.

One the brighter side, teaching students with muscular, spastic or other problems has taught me much about teaching. I currently have a student with dysgraphia who has been with me for almost 6 years now. By teaching him relaxation techniques, he has overcome his dysfunction amazingly, and I consider this to be one of my greatest accomplishments in my career despite the fact that he plays elementary pieces.

You will have to focus on hands seperately most likely, and maybe always.

I have had 2 students with CP. It took them 6 months to just be able to press one key with the correct finger. The farthest we got was having each of them play a 5-finger scale (I used Dorian) at which time I would play softly next to them in a little duet. We played our duets in the regular student recital. Their mother was thrilled.

You do need to do your own assessmnet, of course. I would focus mainly on large muscle groups for now. You can start by having her simply move her fist up and down to a steady beat. Allow her to use her hand as she is most comfortable. Then progress to the keyboard, having her move her whole hand as a unit while pressing down a cluster of keys. You can mark the keys with tape, or stickers to show her the boundries if you like. Then after she gets comfortable, choose the most likely finger to be able to aim at a key, and let her simply practice aiming at the key. Large muscle groups.

You should start getting an idea of any possible dexterity you might be able to coax from her.  If her 2nd finger sort of sticks out, then use that one. Or maybe the thumb. CP is, from my experience, the most difficult thing to train. You may have to only use the bare minimum that she has and try to use your imagination as to how she can use the keyboard.

You might have to compose a piece for her that uses "tone clusters" ala Henry Cowell. But why not? You can do something with tone clusters, I'm sure. And how about pressing down the 3 black keys at once, then move to the group of 2 black keys? Get a whole tone pattern going.
Name it something clever, and you can compose just about anything for her. You can play the other part for her while she learns hands seperately. You'll know in due time if she will ever be able to play hands together. This doesn't matter as long as she is not frustrated and she's learning a love for music. Goals change entirely when you have a student with a disability.

Teach her to press a cluster of notes to be soft or loud. Even this amount of control may be a huge step for her. Teach her high and low. Combine these concepts into a game or piece. Name it Big Dark Clouds and Puffy White Clouds, etc. She will love you for this!

I hope this gets you started at least. Good luck!