Helping children and young adults living with cerebral palsy and other neuromotor movement disorders

Cerebral palsy, the most common childhood disability, affects 8,000 to 10,000 children in the United States each year. A brain disorder of movement and posture, cerebral palsy hampers a child’s ability to exert normal control of muscle tone and coordinated movements, affecting either both sides of their bodies or primarily one side of the brain and the opposite side of the body. A range of factors – including fetal stroke, maternal or fetal infections, random mutations that affect brain development, birth asphyxia, or injury – can cause the disorder during fetal development, delivery, or the first few years of childhood. More than 750,000 children and adults in the United States now live with the disorder.

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Research Sheds Light on New Therapies

For many years, cerebral palsy was considered a static condition with only limited opportunities to teach children to use their impaired arms or legs. Research supported by the National Institutes of Health over the past several decades, however, has led to a new understanding of the brain’s capacity for functional reorganization through focused, intensive training that taps into neuroplasticity processes intrinsic to the nerve cells of the brain throughout life, even after brain disease or injury. The directors of the Fralin Biomedical Research Institute‘s Neuromotor Research Clinic located on Virginia Tech‘s Health Sciences and Technology Campus in Roanoke, VA, Dr. Sharon Ramey and Dr. Stephanie DeLuca, pioneered the use of a high-intensity therapeutic intervention that has allowed children with weakness on one side of their bodies — a hallmark of one form of cerebral palsy known as hemiparesis — to make large, rapid, and enduring gains in their everyday neuromotor skills.

High-intensity Constraint-Induced Movement Therapy

This therapy was first developed for adult stroke patients. The therapy is based on studies of the effects of prolonged disuse by parts of the brain that may occur after peripheral nerve injury or a stroke. Such disuse can lead to further weakening of the synaptic networks in the affected area of the brain and ongoing debilitation. Neurorehabilitation researchers have discovered, however, that an environment that compels the affected area of the brain to become active can lead to a strengthening of functional activity in the neural network. The Fralin Biomedical Research Institute in Roanoke, Virginia has funding from the NIH to carry out a multi-site randomized controlled clinical research trial to evaluate the most effective parameters for increasing brain function in children with cerebral palsy.

Results

Interestingly, the researchers have been finding benefits of the therapy beyond movement and posture, as the children have also developed a greater confidence and ability to have meaningful interactions. This ongoing research is an important example of how NIH-supported research built on basic discoveries is being translating into new, safe, and highly effective treatments for children who would otherwise be relegated to a life with limited options.

“Besides better movement, we’ve seen children get much better in a language and cognition, and we’ve seen improvements in their social and emotional development. For a family looking at a lifetime ahead of them with a child who has had a stroke, these changes in multiple aspects are perhaps the most profound and consequential transformation.”

Sharon Landesman Ramey, Ph.D. • Professor, Neuromotor Research Clinic Co-Director