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Below are some links and addresses of organizations that are helping to find cures and help in the development of Cerebral Palsy. We've also found information for you regarding the CP Research.

FACT SHEET

October 2006

Cerebral Palsy Research: What’s Next?

By Murray Goldstein, DO, MPH

(credit UCP)

SUMMARY: For more than a decade, the monthly Research Fact Sheets authored by the staff of the UCP Research and Educational Foundation have documented the steady increase in knowledge about cerebral palsy (CP)---its prevention, its causes, its pathologies and its treatments. Some have reported the spectacular results of research; others have documented the less spectacular but nevertheless important step by step advances for preventing developmental brain damage and for restoring lost function. As has been said previously, we have learned more about cerebral palsy and its causes and treatment in the past two decades than we learned in the previous one hundred years. The search for the answers to the why, how and what of damage to the developing brain and its consequences are topics of major attention to ever increasing parts of the research community. The Foundation is the research community’s patron and partner---a truly productive relationship.

What is on the horizon that will have major impact on prevention and treatment? There are many exciting research areas being explored and choosing among them for special attention is perilous. However, here are a selected few that will come to fruition in the near future and will have significant impact:

Detecting the threatened brain: CP is most often caused by damage to the developing brain of the fetus in utero and of the infant during and shortly after the birthing process. In order to prevent brain damage, it is essential to be able to detect that the brain is being threatened before the damage becomes permanent. Methods of brain monitoring are now being developed that can evaluate the normal activity and threatening changes of the fetal brain prior to birth. In the reasonably near future, we will be able to monitor the functioning and loss of function in the brain of the fetus while still in the mother’s uterus! Experimental methods to do this in the new born infant in the nursery are presently available and are being refined so they become practical. These advances in technology are on the realistic horizon; however the issue is how will we know when to use them? There are four million live births in the USA every year. The screening of all fetuses and infants is impractical. What are the warning signs that will trigger the use of these technologies before it is too late? How do we identify the infants at risk in order to make the use of these brain monitoring technologies practical? Clinical investigators are hard at work addressing these problems and are beginning to solve them. There is every reason to believe that the presence of a threat to the brain of the fetus and infant will be able to be recognized and damage prevented or arrested before it is too late.

 

Marshalling brain plasticity: The human brain is constantly changing as it reacts to the environment or to structured learning. This occurs at all ages, but most aggressively during childhood and adolescence. It is already known that in response to brain injury, other centers and pathways in the brain can assume functions normally proscribed to the injured areas. These changes are referred to as brain plasticity. Function restoring changes in brain activity can be stimulated and can become permanent---thus providing for a return of some lost function following brain injury. I use the modifier “some” because the recruited areas often are not as efficient in performance as the areas they have replaced. However, the return of function is permanent and can be sharpened with training and experience. This is often seen following stroke and traumatic brain injury in the adult. The knowledge gained in the treatment of those adult injuries is now being evaluated when applied to the sensory losses and motor control deficits following injury to the developing brain that occurs with cerebral palsy. Also, by utilizing brain imaging the specific brain changes that result from structured periods of training can be monitored. Applying these methodologies, clinical investigators are exploring the development of the most efficient ways of reprogramming the injured young brain and diminishing the loss of function leading to disability. Utilizing techniques to foster brain plasticity—particularly in the young—the development of improved function following brain injury is an achievable goal.

Assistive Technology: Modern electronics, nanotechnology and miniaturized wireless electrodes offer the promise of permitting both the" lame to walk and the mute to speak”. From both biological and engineering viewpoints, there is every reason to believe that assistive technologies can provide for restitution of many of the lost functions of performance associated with CP such as grasping, walking and communicating. I am not as confident about swallowing---but perhaps that also. An engineering specialty---bioengineering—has been established to achieve these goals and is already presenting working models of the needed developments. The models still require refinements and alterations, but they work under guarded conditions. As engineers, biologists and clinicians work together; these devices will become available and promise to have a major impact on quality of life for those with a major loss of function.

I have shared my crystal ball images with you: brain monitoring of the fetus and infant as an important step for the prevention of permanent brain damage; the utilization of brain plasticity for restructuring the brain to restore function; and the development of bioengineering technologies to improve activities of daily living. There are certainly others that could have been included. However, the above are dramatic examples of new developments coming to fruition in the reasonably near future as research on cerebral palsy continues to receive the attention it so rightly deserves.

What Research Is Being Done?
(credit: NICHD)

Investigators from many fields of medicine and health are using their expertise to help improve the treatment and diagnosis of cerebral palsy.  Much of their work is supported through the NINDS, the National Institute of Child Health and Human Development (NICHD), other agencies within the federal government, nonprofit groups such as the United Cerebral Palsy Research and Educational Foundation, and other private institutions.

The ultimate hope for curing cerebral palsy rests with prevention. In order to prevent cerebral palsy, however, scientists have to understand normal fetal brain development so that they can understand what happens when a baby’s brain develops abnormally. 

Between conception and the birth of a baby, one cell divides to form a handful of cells, and then hundreds, millions, and, eventually, billions of cells. Some of these cells specialize to become brain cells, and then specialize even further into particular types of neurons that travel to their appropriate place in the brain (a process that scientists call neuronal migration).  Once they are in the right place, they establish connections with other brain cells.  This is how the brain develops and becomes able to communicate with the rest of the body -- through overlapping neural circuits made up of billions of interconnected and interdependent neurons.

Many scientists now think that a significant number of children develop cerebral palsy because of mishaps early in brain development. They are examining how brain cells specialize and form the right connections, and they are looking for ways to prevent the factors that disrupt the normal processes of brain development.

Genetic defects are sometimes responsible for the brain malformations and abnormalities that cause cerebral palsy.  Scientists funded by the NINDS are searching for the genes responsible for these abnormalities by collecting DNA samples from people with cerebral palsy and their families and using genetic screening techniques to discover linkages between individual genes and specific types of abnormality – primarily those associated with abnormal neuronal migration. 

Scientists are scrutinizing events in newborn babies’ brains, such as bleeding, epileptic seizures, and breathing and circulation problems, which can cause the abnormal release of chemicals that trigger the kind of damage that causes cerebral palsy.  For example, research has shown that bleeding in the brain unleashes dangerously high amounts of a brain chemical called glutamate.   Although glutamate is necessary in the brain to help neurons communicate, too much glutamate overexcites and kills neurons. Scientists are now looking closely at glutamate to detect how its release harms brain tissue.  By learning how brain chemicals that are normally helpful become dangerously toxic, scientists will have opportunities to develop new drugs to block their harmful effects.

Scientists funded by the NINDS are also investigating whether substances in the brain that protect neurons from damage, called neurotrophins, could be used to prevent brain damage as a result of stroke or oxygen deprivation.  Understanding how these neuroprotective substances act would allow scientists to develop synthetic neurotrophins that could be given immediately after injury to prevent neuron death and damage.

The relationship between uterine infections during pregnancy and the risk of cerebral palsy continues to be studied by researchers funded by the NIH.  There is evidence that uterine infections trigger inflammation and the production of immune system cells called cytokines, which can pass into an unborn baby’s brain and interrupt normal development.  By understanding what cytokines do in the fetal brain and the type of damage these immune system cells cause, researchers have the potential to develop medications that could be given to mothers with uterine infections to prevent brain damage in their unborn children. 

Approximately 10 percent of newborns are born prematurely, and of those babies, more than 10 percent will have brain injuries that will lead to cerebral palsy and other brain-based disabilities.   A particular type of damage to the white matter of the brain, called periventricular leukomalacia (PVL), is the predominant form of brain injury in premature infants.  NINDS-sponsored researchers studying PVL are looking for new strategies to prevent this kind of damage by developing safe, nontoxic therapies delivered to at-risk mothers to protect their unborn babies.

Although congenital cerebral palsy is a condition that is present at birth, a year or two can pass before any disabilities are noticed.  Researchers have shown that the earlier rehabilitative treatment begins, the better the outcome for children with cerebral palsy.  But an early diagnosis is hampered by the lack of diagnostic techniques to identify brain damage or abnormalities in infants. 

Research funded by the NINDS is using imaging techniques, devices that measure electrical activity in the brain, and neurobehavioral tests to predict those preterm infants who will develop cerebral palsy.  If these screening techniques are successful, doctors will be able to identify infants at risk for cerebral palsy before they are born.        

Noninvasive methods to record the brain activity of unborn babies in the womb and to identify those with brain damage or abnormalities would also be a valuable addition to the diagnostic tool kit.  Another NINDS-funded study focuses on the development of fetal magnetoencephalography (fMEG) – a technology that would allow doctors to look for abnormalities in fetal brain activity.

Epidemiological studies – studies that look at the distribution and causes of disease among people -- help scientists understand risk factors and outcomes for particular diseases and medical conditions.  Researchers have established that preterm birth (when a baby is born before 32 weeks’ gestation) is the highest risk factor for cerebral palsy.  Consequently, the increasing rate of premature births in the United States puts more babies at risk.  A large, long-term study funded by the NIH is following a group of more than 400 mothers and their infants born between 24 and 31 weeks’ gestation.  They are looking for relationships between preterm birth, maternal uterine infection, fetal exposure to infection, and short-term and long-term health and neurological outcomes.  The researchers are hoping to discover environmental or lifestyle factors, or particular characteristics of mothers, which might protect preterm babies from neurological disabilities.     

While this research offers hope for preventing cerebral palsy in the future, ongoing research to improve treatment brightens the outlook for those who must face the challenges of cerebral palsy today. An important thrust of such research is the evaluation of treatments already in use so that physicians and parents have valid information to help them choose the best therapy. A good example of this effort is an ongoing NINDS-supported study that promises to yield new information about which patients are most likely to benefit from selective dorsal rhizotomy, a surgical technique that is increasingly being used to reduce spasticity (see Surgery).

Similarly, although physical therapy programs are used almost universally to rehabilitate children with cerebral palsy, there are no definitive studies to indicate which techniques work best.  For example, constraint-induced therapy (CIT) is a type of physical therapy that has been used successfully with adult stroke survivors and individuals who have traumatic brain injury and are left with a weak or disabled arm on one side of the body.  The therapy involves restraining the stronger arm in a cast and forcing the weaker arm to perform 6 hours of intensive “shaping” activities every day over the course of 3 weeks.  The researchers who conducted the clinical trials in adult stroke survivors realized CIT’s potential for strengthening children’s arms weakened by cerebral palsy. 

In a randomized, controlled study of children with cerebral palsy funded by the NIH, researchers put one group of children through conventional physical therapy and another group through 21 consecutive days of CIT.   Researchers looked for evidence of improvement in the movement and function of the disabled arm, whether the improvement lasted after the end of treatment, and if it was associated with significant gains in other areas, such as trunk control, mobility, communication, and self-help skills. 

Children receiving CIT outperformed the children receiving conventional physical therapy across all measures of success, including how well they could move their arms after therapy and their ability to do new tasks during the study and then at home with their families.  Six months later they still had better control of their arm.  The results from this study are the first to prove the benefits of a physical therapy.  Additional research to determine the optimal length and intensity of CIT will allow doctors to add this therapy to the cerebral palsy treatment toolbox. 

Studies have shown that functional electrical stimulation is an effective way to target and strengthen spastic muscles, but the method of delivering the electrical pulses requires expensive, bulky devices implanted by a surgeon, or skin surface stimulation applied by a trained therapist.  NINDS-funded researchers have developed a high-tech method that does away with the bulky apparatus and lead wires by using a hypodermic needle to inject microscopic wireless devices into specific muscles or nerves.  The devices are powered by a telemetry wand that can direct the number and strength of their pulses by remote control.  The device has been used to activate and strengthen muscles in the hand, shoulder, and ankle in people with cerebral palsy as well as in stroke survivors.   

As researchers continue to explore new treatments for cerebral palsy and to expand our knowledge of brain development, we can expect significant improvements in the care of children with cerebral palsy and many other disorders that strike in early life.

Research

Investigators from many arenas of medicine and health are researching treatment and prevention of cerebral palsy. Much of their work is supported through the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Child Health and Human Development, other agencies within the federal government, not-for-profit groups such as the United Cerebral Palsy Research Foundation, and private institutions.

Mayo Clinic in Minnesota offers patients the services of the Motion Analysis Laboratory which incorporates the latest computerized technology to analyze motion, forces and muscle activity and determine what treatment will provide the greatest benefit for patients with movement disorders such as cerebral palsy. Two studies researching cerebral palsy treatments are:

• Gait Study — A computerized analysis of the motion and forces exerted on various joints when people walk. It is commonly used for patients with cerebral palsy, polio, stroke, multiple sclerosis or balance problems. Results are used to select nonsurgical or surgical treatment methods, and to evaluate treatment effectiveness in producing a more normal gait.
  
   
• Electromyography — This equipment analyzes muscle activity while a person walks to determine if a muscle is working at the right time and at the right level. Results are used to prescribe care for patients with cerebral palsy, myelomeningocele or stroke.

Mayo Publications

See a list of publications by Mayo Clinic doctors on cerebral palsy on PubMed, a service of the National Library of Medicine.

British researchers are starting clinical trials to determine the effectiveness of osteopathy for treating children with cerebral palsy. Previous research has shown osteopathy to be effective in treating numerous other afflictions, but studies involving children with cerebral palsy is scant.

Osteopathy emphasizes the interrelationships of the body's systems – including muscular, skeletal, and nervous -- and focuses on bringing those systems into balance. Osteopathic medicine is one of the fastest growing areas of medicine today.

“This is an exciting area where little high-quality research has been carried out,” said lead researcher Professor Stuart Logan. “It is also one of the few studies where parents have been involved in all stages, including the design and supervision of the research.”

The new study will involve 150 children between the ages of five and 12 who are afflicted with cerebral palsy and will be conducted by researchers from the Peninsula Medical School in Exeter, the UCL Institute of Child Health at Great Ormond Street Hospital, and the London Osteopathic Centre for Children.

Cerebra, a charity for children with brain injuries, is funding the research.

Does your child have cerebral palsy? If you suspect that your child developed cerebral palsy as a result of medical malpractice, you may be eligible to seek compensation to cover the costs associated with a lifetime of treatment. Please contact us today to learn more.

 

Organizations

Epilepsy Foundation 4351 Garden City Drive Suite 500 Landover, MD   20785-7223 postmaster@efa.org http://www.epilepsyfoundation.org Tel: 301-459-3700 800-EFA-1000 (332-1000) Fax: 301-577-2684	March of Dimes Birth Defects Foundation 1275 Mamaroneck Avenue White Plains, NY   10605 askus@marchofdimes.com http://www.marchofdimes.com Tel: 914-428-7100 888-MODIMES (663-4637) Fax: 914-428-8203
Easter Seals 230 West Monroe Street Suite 1800 Chicago, IL   60606-4802 info@easter-seals.org http://www.easter-seals.org Tel: 312-726-6200 800-221-6827 Fax: 312-726-1494	United Cerebral Palsy (UCP) 1600 L Street, NW Suite 700 Washington, DC   20036 national@ucp.org http://www.ucp.org Tel: 202-776-0406 800-USA-5UCP (872-5827) Fax: 202-776-0414
Children's Hemiplegia and Stroke Assocn. (CHASA) 4101 West Green Oaks Blvd., Ste. 305 PMB 149 Arlington, TX   76016 info437@chasa.org http://www.chasa.org Tel: 817-492-4325	Children's Neurobiological Solutions (CNS) Foundation 1726 Franceschi Road Santa Barbara, CA   93103 fia@cnsfoundation.org http://www.cnsfoundation.org Tel: 866-CNS-5580 (267-5580) 805-965-8838

 The Cerebral Palsy Network©1997/2014. All graphics are the exclusive property of CPN, unless otherwise indicated. Contact Cerebral Palsy Network   for further information. Last updated 04/23/14