1. Physical limitations can include:

   • Stamina

   • Pushing, pulling, pressing

   • Muscular control, coordination, balance, speed

   • Ambulation, standing, stooping, bending, climbing

   • Writing, driving

   • Bowel and bladder, pulmonary, pain

   • A personal care attendant for daily living activities (eating, cooking, dressing, personal hygiene)

2. Language and communication (75% of the cases will have some affected language communication disorders):

   • Hearing disorders

   • Auditory and visual comprehension disorders

   • Distractibility

   • Weakness or incoordination of speech mechanism

3. Psychosocial limitations can include:

   • Cognition (verbal perception, verbal reception, verbal expression, visual perception, visual motor)

   • Memory

   • School achievement

   • Acquisition retention, interpretation and application of information

   • Social isolation

   • Egocentricity (dependency and self-centeredness)

   • Lack of initiation in taking responsibility

4. Complications:

   • Contractures (joint limitations)

   • Bowel and bladder incontinence

   • Dental problems

   • Osteoporosis

   • Degenerative joint disorders due to poorly aligned joints

   • Scoliosis

   • Respiratory infections due to inefficient swallowing and compromised cough reflex

5. Other commonly associated problems or disabilities:

   • Learning disabilities (visual/auditory processing)

   • Mental retardation

   • Visual and hearing problems

   • Independent living skills

   • Seizures

   • Fatigue

   • Problem-solving deficits

   • Lack of support systems

Generally, because of the diffuse nature of this disability, the individual will have many functional limitations and the connection between functional limitations and vocational problems is easy to make. The counselor can show the difficulties the individual has had in past vocational endeavors because of the specific functional limitations, or show how the limitations will impact on the person's vocational choices in the future. In addition, preparation for employment (attainment of post-secondary training, for example) may be quite difficult. The counselor might also tie limitations to the general area of vocational goals stated by the client. There is a host of ways to make this connection.

If the individual has a seizure disorder, all of the limitations associated with seizure disorders and working with machinery, driving, etc. must be taken into account. Generally, you will find that physical problems will be the easiest for which to establish vocational impediments. The cognitive and psychosocial issues are equally important in establishing vocational impediments and reasonable expectation. The major cognitive and psychosocial issues relate to memory, attention, ability to acquire vocational skills, communication and language, family support, community opportunities, and realistic vocational choices. A general consideration relates to the fact that, in most cases, individuals with cerebral palsy have restricted social opportunities and, therefore, may appear to be somewhat dependent and egocentric. In addition, the counselor needs to be sensitive to a family dynamic of protection of the individual from some of the problems in daily living.

It is important to assess the extent of physical limitations as they relate to the necessary skills in jobs for which the individual may qualify. When individuals lack the necessary functional ability for jobs they might be qualified for, the counselor needs to look at potential training programs that might allow the individual to enter occupations consistent with limitations. The key at that point is an assessment of whether the individual has the aptitude to complete the necessary training.

Another major issue in determining impediments to employment is the support/expectations of the family, and their willingness to allow the individual to experience increasing levels of independence and separation from the family.