CP Research Topics

Emily Schmidlin

The first two studies were presented at the International Conference on Cerebral Palsy, Quebec City, Canada, May 2003.

“Success in life for older adolescents with cerebral palsy: A qualitative study” by G. King, Thames Valley Children’s Centre, London, Ontario, Canada (and others).

The objectives of this study were to examine how older adolescents with CP view success in life and to examine the factors that help or hinder them in attaining these life goals. The authors completed interviews with 10 adolescents between ages 18 and 20 who were in transition between high school and further education or entering employment.

The participants overwhelmingly defined success in terms of being happy in life. Happiness was linked to meeting personal goals, feeling fulfilled, and enjoying what one did in life. The three psychosocial factors related to achieving success (and happiness) in life were being believed in by others, believing in oneself, and being accepted by others (belonging).

Adolescents with CP appear similar to adolescents without disabilities in terms of their desires in life. Service providers should strive to be aware of particular aspirations and needs of each individual with whom they work, and should work in partnership with adolescents, with the goals defined by the adolescents themselves. Service providers also should be informed about strategies to foster feelings of success in children and adolescents with disabilities, including strategies to help children to accept themselves, and strategies for encouraging others to accept them and believe in their strengths.

“Neuropsychological effects of hyperbaric oxygen therapy on children with cerebral palsy” by P. Hardy, Experimental Neuropsychological Research Group, University of Montreal, Montreal, Canada (and others).

The objective of this study was to determine if 40 hyperbaric oxygen (HBO) therapy treatments would improve attention, working memory, and impulse control, and to evaluate if any observed changes would persist three months after the end of the intervention. The authors recruited 111 children with CP between the ages of 4 and 12 years. They were randomly allocated to HBO or placebo groups and received 40 treatments over a two month period. HBO treatment consisted of an exposure to 100% oxygen at 1.75 atmospheric pressure. The placebo treatment was 1.3 atmospheric pressure with standard (20%) oxygen.

In both groups, visual working memory was significantly and similarly improved upon completion of therapy and these gains persisted in both groups after three months. In the auditory mode, children treated with HBO showed significant improvement in self control and attention, but their performances did not differ from those in the placebo group. Overall, for all outcomes, no statistical difference was found between the two treatments.

This study showed that HBO did not produce greater therapeutic effects than a small increased pressure on the cognition of children with CP. However, improvements were clinically important in both cases. This provides some evidence of a combination of factors that could be explored in rehabilitation.

What Other Medical Disorders Are Associated With Cerebral Palsy?

Many individuals who have cerebral palsy have no associated medical disorders. However, disorders that involve the brain and impair its motor function can also cause seizures and impair an individual's intellectual development, attentiveness to the outside world, activity and behavior, and vision and hearing. Medical disorders associated with cerebral palsy include:

Mental impairment. About one-third of children who have cerebral palsy are mildly intellectually impaired, one-third are moderately or severely impaired, and the remaining third are intellectually normal. Mental impairment is even more common among children with spastic quadriplegia.
Seizures or epilepsy. As many as half of all children with cerebral palsy have seizures. During a seizure, the normal, orderly pattern of electrical activity in the brain is disrupted by uncontrolled bursts of electricity. When seizures recur without a direct trigger, such as fever, the condition is called epilepsy. In the person who has cerebral palsy and epilepsy, this disruption may be spread throughout the brain and cause varied symptoms all over the body -- as in tonic-clonic seizures -- or may be confined to just one part of the brain and cause more specific symptoms -- as in partial seizures.

Tonic-clonic seizures generally cause patients to cry out and are followed by loss of consciousness, twitching of both legs and arms, convulsive body movements, and loss of bladder control.

Partial seizures are classified as simple or complex. In simple partial seizures, the individual has localized symptoms, such as muscle twitches, chewing movements, and numbness or tingling. In complex partial seizures, the individual may hallucinate, stagger, perform automatic and purposeless movements, or experience impaired consciousness or confusion.

Growth problems. A syndrome called failure to thrive is common in children with moderate-to-severe cerebral palsy, especially those with spastic quadriparesis. Failure to thrive is a general term physicians use to describe children who seem to lag behind in growth and development despite having enough food. In babies, this lag usually takes the form of too little weight gain; in young children, it can appear as abnormal shortness; in teenagers, it may appear as a combination of shortness and lack of sexual development. Failure to thrive probably has several causes, including, in particular, poor nutrition and damage to the brain centers controlling growth and development. In addition, the muscles and limbs affected by cerebral palsy tend to be smaller than normal. This is especially noticeable in some patients with spastic hemiplegia, because limbs on the affected side of the body may not grow as quickly or as large as those on the more normal side. This condition usually affects the hand and foot most severely. Since the involved foot in hemiplegia is often smaller than the unaffected foot even among patients who walk, this size difference is probably not due to lack of use. Scientists believe the problem is more likely to result from disruption of the complex process responsible for normal body growth.
Impaired vision or hearing. A large number of children with cerebral palsy have strabismus, a condition in which the eyes are not aligned because of differences in the left and right eye muscles. In an adult, this condition causes double vision. In children, however, the brain often adapts to the condition by ignoring signals from one of the misaligned eyes. Untreated, this can lead to very poor vision in one eye and can interfere with certain visual skills, such as judging distance. In some cases, physicians may recommend surgery to correct strabismus. Children with hemiparesis may have hemianopia, which is defective vision or blindness that impairs the normal field of vision of one eye. For example, when hemianopia affects the right eye, a child looking straight ahead might have perfect vision except on the far right. In homonymous hemianopia, the impairment affects the same part of the visual field of both eyes. Impaired hearing is also more frequent among those with cerebral palsy than in the general population.
Abnormal sensation and perception. Some children with cerebral palsy have impaired ability to feel simple sensations like touch and pain. They may also have stereognosia, or difficulty perceiving and identifying objects using the sense of touch. A child with stereognosia, for example, would have trouble identifying a hard ball, sponge, or other object placed in his hand without looking at the object.

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#12083104