Cerebral Palsy Law Blog : Cerebral Palsy Lawyer & Attorney : Burke & Eisner Law Firm : Medical Malpractice Lawyers & Attorneys

Dystonia-choreoathetosis affects approximately 10 percent of all cerebral palsy patients and it is notoriously difficult to treat. However, a new study by French researchers shows promise for treating this form of cerebral palsy.

Using what is known as bilateral pallidal deep brain stimulation (BP-DBS), researchers were able to improve motor symptoms in 8 out of 13 cerebral palsy patients who participated in the trial. Improvement in motor functioning was based on a movement rating scale and ranged from 21 to 55 percent, with an average of 24.4 percent. The researchers also found that the deep brain stimulation helped to reduce pain.

Deep brain stimulation involves the use of an implantable device that operates similar to a pacemaker. Whereas a pacemaker uses electrical currents to help regulate heartbeat, deep brain stimulation uses electrical impulses to help the brain control movement in the body.

Although the initial results are promising, researchers made sure to point out that the study was small and additional research is necessary – particularly with regard to treating cerebral palsy symptoms in children.

 

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Intensive locomotion therapy is a relatively new area of research in treating cerebral palsy symptoms in children, and clinical studies involving the Pediatric Lokomat® have so far shown positive results.
 

What is the Pediatric Lokomat?
 

The Pediatric Lokomat is essentially a robotic treadmill training device. Unlike manual treadmill training that requires the assistance of a physical therapist, the Pediatric Lokomat uses robotic gait orthoses and harnesses to guide a child through the session. The device monitors the patient’s movements and can be adjusted to meet individual needs.

The Pediatric Lokomat is appropriate for children over the age of four with cerebral palsy and other gait-impaired patients.

Clinical research projects involving the Pediatric Lokomat can be found at various hospitals across the United States. Your child’s medical providers may be able to provide you more information regarding this particular type of therapy.

 

 

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Engineers at MIT are finding that robot-based therapy can aid limb movement in children affected by cerebral palsy symptoms. Previous research has focused on how robotics can assist adults who have suffered stroke, but scientist Hermano Igo Krebs and colleagues wanted to test the therapy on children, whose brains are more impressionable.
 

Right now research is focused on using robotics to help children with cerebral palsy reach and grasp objects. According to the researchers, the robotic treatments are able to accomplish a couple of things:

• To reduce impairment
• To enable and create neural connections

One in 278 children in the United States has cerebral palsy, according to the Centers for Disease Control and Prevention (CDC) and research into treatments is ongoing.

 

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Ankle foot orthoses (AFOs) are types of braces commonly used to treat certain cerebral palsy symptoms – for instance, AFOs may be used to support weak limbs or they may be used to hold contracted muscles in a normal position.

Fit is everything when it comes to AFOs. In fact, achieving optimal results depends on the proper fit and alignment of the brace. But how, as a parent, can you determine whether or not your child’s brace fits properly? Registered Orthotic Assistant and Certified Fitter of Orthotics, Loretta Sheldon, answers this question in a  new article on eParent.com.

In the article, Sheldon provides a number of tips and things to look for when evaluating the fit of your child’s brace, including:

• The space between the heel and the heel cup
• Toe length and extra room for growth
• Brace height and width

Sheldon also discusses brace habituation (adjusting to wear) and working with your clinician. If an AFO has been recommended for your child, this article will prove a helpful resource.




 

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Food and Drug Administration officials are warning about potentially fatal side effects associated with the use of Botox for treating muscle spasticity, particularly in children with this cerebral palsy symptom. Children with spastic cerebral palsy are sometimes treated with Botox, though the drug is not approved in the U.S. for this use.

The FDA said in a statement that some children given Botox for muscle spasticity have experienced symptoms of botulism. In some cases the symptoms have led to hospitalization and even death, according to the FDA.

Botulism symptoms may occur when the toxin spreads from the site of injection and include:

• Loss of muscle strength
• Difficulty speaking or hoarseness
• Vision problems
• Trouble breathing or swallowing
• Loss of bladder control

The agency is now requiring a bold black box warning on the labels of Botox and related botulinum toxin products. Parents of children with cerebral palsy who have questions or concerns about the risks associated with Botox should discuss this new warning with their physicians.



 

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Botox is sometimes used to reduce muscle spasticity, a rather common cerebral palsy symptom. But research suggests that it may also help reduce the risk of hip dislocation, which is a problem in some children with cerebral palsy.

Traditionally braces have been used to prevent hip dislocation, but one study compared the use of braces to the use of Botox injections in 16 patients between 9 months and 4 years of age. According to the researchers, some of the patients benefitted from the Botox injections. However, the authors add that more extensive studies need to be done.

If your child has cerebral palsy, you may wish to talk to your doctor about the risk of hip dislocation. Each child is unique, so the treatment options for your child will depend on his or her particular circumstances.  

 

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The use of orthotic devices such as braces have been shown to improve cerebral palsy symptoms in children with diplegia, but little evidence shows whether certain braces are better than others. That’s why researchers decided to develop a study comparing the effectiveness of two different types of braces: hinged vs. dynamic-ankle foot orthoses.

Study Results
The study, which is published in the Journal of Bone & Joint Surgery, involved 15 children with spastic diplegic cerebral palsy and specifically sought to determine whether one type of brace was more effective at improving gait and motor function than the other.

The results showed that both types of braces led to significant improvements in gait and there was little difference between the two in this regard. However, neither of the braces seemed to have a significant impact on motor functioning.

A Brief Word on Orthotics
Orthotics are intended to support weak muscles and reduce the risk of joint deformity, and orthotics vary according to the area in need of support. If you have questions about whether an orthotic device is right for your child, contact your primary care physician and ask for a referral to a pediatric orthopedic specialist.

See Also: Cerebral Palsy Symptoms

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Many families are familiar with the traditional treatments used to manage cerebral palsy symptoms, such as surgery, medication and physical therapy. However, some families are turning to holistic therapies to help alleviate the symptoms their child experiences.

While it is important to remember that each child is unique and will respond differently to different therapies, some holistic alternatives parents may wish to consider include:

• Acupuncture – This is a non-painful form of ancient Chinese medicine that involves the insertion of extremely fine needles at various points on the body to relieve pain. Studies involving acupuncture and cerebral palsy have shown that some children who received this therapy experienced a marked improvement with regard to their individual symptoms.
• Reflexology and massage therapy – Massage has a beneficial effect on the body for people with a wide range of conditions, including cerebral palsy.
• Biofeedback – Electromyograph (EMG) is an increasingly common form of biofeedback in which electrodes are used to measure muscle tension and relax tense muscles. It is sometimes used to alleviate the symptom of muscle spasticity in individuals with cerebral palsy.
• Nutritional awareness – Processed foods that are high in preservatives or additives may worsen your child’s cerebral palsy symptoms. Consulting a nutritionist may help you find foods that will not only lessen such symptoms, but also provide your child with other health benefits.

Other alternative therapies that may help to ease your child’s cerebral palsy symptoms include:  yoga, which can help with movement; sensory integration, which is used to stimulate the senses and help children to interact better with their environment; and listening/music programs, which have been effective in improving auditory processing and communication skills.

Of course, alternative therapies such as these are not necessarily intended to replace a child’s traditional medical care. However, many families are beginning to take a more integrated approach to treatment, incorporating both traditional and alternative therapies.

See also: What is Cerebral Palsy

                Cerebral Palsy Symptoms

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Posted by Cerebral Palsy Lawyer, David Austin

The San Antonio Military Medical Complex (SAMMC) is the only Department of Defense facility to provide comprehensive cerebral palsy treatment to children and adults with the condition. In fact, the facility’s spasticity clinic has been named a center of excellence for the treatment of cerebral palsy.

Medical specialists at the facility’s Adult and Pediatric Spasticity Clinic take a multidisciplinary approach to treatment to help reduce cerebral palsy symptoms. According to Major and pediatric neurologist Dr. Brian Faux, each patient is treated by a team of specialists that includes “pediatricians, orthopedic surgeons, physical, occupational and speech therapists, social workers, neurologists, neurosurgeons, educators and nutritionists.”

One particular treatment available at the clinic is medical pump implantation; the pump delivers a continuous dose of medication to ease some of the symptoms associated with cerebral palsy. Since 2003, the clinic has implanted 15 medical pumps into children.

"I would like to see children with cerebral palsy being implanted at a much younger age, before they start losing muscle and are wheelchair bound. It's important that we get the word out that we offer this treatment," Dr. Faux said.

SAMMC was formerly known as Wilford Hall Medical Center and the website can be accessed here.

 

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A federally funded study will test whether a controversial therapy known as HBOT (hyperbaric oxygen therapy) can help to ease symptoms of cerebral palsy. Forty-eight children with cerebral palsy will participate in study and receive the therapy for free at Wright-Patterson Air Force Base in Ohio.

 

Patients undergoing HBOT receive high concentrations of oxygen in a pressurized chamber. It’s believed that the high dose of oxygen can help revitalize damaged brain cells, which are at the root of cerebral palsy.

 

The therapy is already approved for use in individuals suffering from decompression sickness (the “bends”), carbon monoxide poisoning and radiation injuries. However, the use of HBOT in the treatment of neurological disorders like cerebral palsy is controversial.

 

Research has yet to prove the effectiveness of HBOT for easing the symptoms of cerebral palsy in kids, and this study may shed some light on whether it’s a therapy worth pursuing for this purpose.

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A two-year-old girl has made “remarkable” progress since undergoing an experimental cerebral palsy treatment at Duke University in May. The treatment involved the use of the toddler’s own umbilical cord blood, which her parents had stored with a private company after she was born.

 

Chloe Levine was diagnosed with hemiplegic cerebral palsy after her parents noticed she was dragging her right leg while trying to crawl and having difficulty holding her bottle in her right hand.

 

When the family heard about the experimental research at Duke University, they decided to enroll Chloe. As part of the treatment, doctors injected Chloe with her own stem cells to repair damaged brain tissue. The results, according to her parents, were almost immediately apparent.

 

“She can walk, run and do sign language with her right hand,” her father said. “Her therapist said she’s made a 50 percent recovery.”

 

Cord blood contains a certain type of stem cell, which researchers are looking into for possible therapeutic properties. 

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Yoga has become extremely popular in recent years, in part because of the large number of celebrities who promote the practice. Though yoga is primarily practiced by adults, children with cerebral palsy and other disabilities may also benefit from practicing yoga.

 

Several Ways Yoga Helps

 

Yoga is an ancient physical and mental tradition that originated in India. The practice of yoga involves the use of various asanas (postures) and breathing techniques to facilitate relaxation and meditation. In children with cerebral palsy, yoga provides a couple of significant benefits:

• Improves muscle tone – particularly in children with spastic cerebral palsy, which is characterized by high muscle tone. Holding certain postures stretches muscles and tendons, helping to relieve overall stress and tightness.
• Muscle resistance and strengthening – in children with hypotonia (low muscle tone), yoga postures can be used to create resistance and help strengthen loose or flaccid muscles.
• Realignment of spine – yoga can stretch and realign the spine, reducing pressure on the nerves and improving movement and coordination.

 

Practicing yoga may also help children with cerebral palsy feel a greater sense of independence. Parents interested in learning more about yoga for special needs children should visit the Yoga for the Special Child website

 

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In recent years, Botox has gained increasing popularity as an effective cerebral palsy treatment. Though the Food and Drug Administration has not approved Botox for treating cerebral palsy, physicians have found in useful in controlling limb spasticity.

Botox, as most people are aware, is derived from a dangerous toxin. When injected into muscles, botulinum toxin causes the muscles to relax, thereby relieving spasms. However, medical treatments involving Botox often require much higher doses of the deadly toxin than cosmetic treatments.

Severe & Deadly Side Effects in Cerebral Palsy Patients

These higher doses can result in a greater risk of serious and potentially deadly side effects such as breathing problems and respiratory failure. In February, the FDA announced that it had received reports of hospitalizations and deaths in patients treated with Botox for both approved and unapproved uses.

The most severe reactions, according to the agency, occurred in children treated with Botox for limb-spasticity associated with cerebral palsy. The FDA emphasized that Botox has not been proven safe or effective for treating spasticity in cerebral palsy patients under age 12.

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For those of you following the botix news and investigation here is a quick link to an article.  Allegan has received a subpoena concerning the promotion of Botox.

NEW YORK (Reuters) - Allergan Inc said on Monday that it received a subpoena from the U.S. Department of Justice investigating the promotion of Botox, a drug best known for its cosmetic use.

The drug maker said authorities were seeking documents regarding promotional, educational and other activities relating to Botox.

Allergan said it believes the subpoena is related to alleged off-label promotion of Botox to treat headaches.

Botox, which is best known for smoothing facial wrinkles, is not approved as a headache treatment.

Although Allergan is conducting trials to investigate the use of the drug to treat headaches, the company said that its policy is to comply with all applicable laws, rules and regulations in promoting its products.

But it noted that doctors are free to prescribe the drug for uses not approved by the U.S. Food and Drug Administration.

Source:  Reuters.com

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Botox has been used in Children to treat spasticity.  This recent news is something all parents should look at before considering using botox to treat spasticity in children with cerebral palsy.

The Food and Drug Administration issued a warning that Allergan's Botox and Botox Cosmetic as well as Solstice Neuroscience's Myobloc have been linked to adverse reactions including respiratory failure and death, following treatment of a variety of conditions using a wide range of doses.

The agency said the reactions may be related to overdosing and were found in both FDA-approved and nonapproved usages, but there is no evidence that they're related to any defect in the products.

The most severe adverse effects were found in children treated for spasticity in their limbs associated with cerebral palsy, which isn't an FDA-approved use of botulism toxins in children or adults.

The agency is currently reviewing safety data from clinical studies submitted by the drugs' manufacturers, as well as post-marketing adverse event reports and medical literature.

Sources:

The Street.com | Consumer Affairs

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I was recently asked about Frenkel's exercise and it's effectiveness for Treating Ataxic Cerebral Palsy.  We cannot specifically recommend treatment for people.  That is something that you have to work with your doctors on.

I did take the time to find a post a few links that relate to Frenkels exercises.

National Ataxia Foundation

International Network of Ataxic Friends-- Exercise

A Digitized Book on Google on Tabetic Ataxia by  Frenkel Tweet this

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If you are into reading scientific studies on the efficacy of surgery to improve muscle strength in patients with a cerebral palsy diagnosis then here is a new one.

Muscle strength changes following multi-level surgery in cerebral palsy and the impact of rehabilitation on functional recovery are largely unknown. The aim of this study was to quantify lower limb muscle strength changes in children with spastic diplegia after multi-level orthopaedic surgery and to compare the efficacy of progressive resistance strengthening (RS) versus active exercise (AE).Twenty children with spastic diplegia (mean age 12.5 years) participated in this prospective randomised controlled trial

This is a link to the introduction.  To read the full article you will already have to have a reader that gets you into Elsevier.

Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy Tweet this

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For those readers who want the latest in scientific studies, here's one that studied "the reliability of popliteal angle measurement"  This method is used to measure hamstring contracture in cerebral palsy patients

I'll let the conclusion speak for itself:

Measurements in the CP group seemed to be less reliable than measurements in the control group. Intraobserver reliability is reasonable for both groups, but lower in CP patients than in controls. Interobserver reliability of both visual estimates and goniometrical measurements is poor. No significant differences in reliability have been found between visual estimation and goniometric measurement. Because of poor interobserver reliability of popliteal angle measurement, this should not be the only variable in clinical decision making in CP patients.

Source:  Journal of Pediatric Orthopaedics
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I've previously posted about how I admire technology advances and how it assists accident victims, particularly those with a brain injury.  See my Wii entry.  Today I read about a young lady in the UK who is using technology to enable her to communicate.  In many case when you are dealing with cerebral palsy, you have a person who understands everything that is happening, but cannot communicate because of limitations on their muscle control.

Natalie is able to speak via a voice facility, text, email, play CDs, send and receive picture messages, and write shopping lists.


Demonstrating her new state-of-the-art technology, Natalie, 21, of Rampside, said: “It’s fab — having a communication aid has changed my life.

Her next quote gets right to the heart of the matter.  This is what can make technology great.  It gives people the chance to drastically improve their life.

“Being able to communicate is a basic human right. It is about being able to communicate the sort of choices that most people can take for granted. It is about being able to communicate a simple ‘yes’ or ‘no’.”

Source:  NorthWest Evening Mail Tweet this

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I was fascinated when I saw this this morning.  I am a real technology geek.  I love to see new creative uses of existing products.

The video game that couldn't stay on store shelves at Christmas is fast earning a second life as a useful tool in helping victims of debilitating diseases and accidents get back on their feet.

...

"In therapy, it allows patients to work on weight bearing and increasing coordination, increasing strength and stability, increasing fine and gross motor skills," she says. "Any of the games can be used to address problem solving, attention, short-term and long-term memory, decision making and scanning."

Check out the full article at USA Today.com
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While scanning through some news stories on Cerebral Palsy, I came across this brief article from UPI.  It is trying to bring treatment into the home.  This is a great use of the internet.

Cerebral palsy therapy hits the Internet

ANN ARBOR, Mich., April 5 (UPI) -- A University of Michigan program is providing movement-based therapy for adults with cerebral palsy via the Internet.

The program, called ULTrA, requires a home computer and Internet connection, and uses streaming video to connect patients. It allows adult cerebral palsy patients to connect to "virtual trainers" and real-life experts at the Motor Control Lab to complete movement-based therapy programs. The program also collects data to determine how well the in-home therapy is working.

"We're targeting a growing yet neglected segment of the population ... to essentially bring our lab and experts into the patients' homes to engage them in a movement-based training program," Susan Brown, director of the Motor Control Lab at the university, said in a statement.

Link to the Article:

http://www.upi.com/ConsumerHealthDaily/view.php?StoryID=20070405-115907-8379r Tweet this

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A number of articles are out today covering a new study, that reviewed a number of other studies that looked into episiotomies. Their conclusion was that episiotomies were not necessary in routine deliveries.

Sources:

MSNBC.com
ABCNews.com
Chicago Sun-Times.com

Update: 5/9/05 Detroit News Article

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