Gray Matter Grows in Brains of Children with Cerebral Palsy Following Therapy, Study Finds

BIRMINGHAM, Alabama — What’s a little gray matter between researchers?
A lot, it seems, as University of Alabama at Birmingham scientists become the first to show that a certain type of rehabilitation can remodel the brains of children by adding gray matter.
The findings are published today in the journal Pediatrics.

The study focused on 10 children who were given Constraint-Induced Movement (CI) therapy over a course of three weeks. One MRI was taken three weeks before the therapy; one right before therapy started; and the last one after it was over, said Chelsey Sterling, a graduate student in medical psychology and first author of the study.

“Following therapy we saw increases in the kids’ gray matter in the sensorimotor cortices  and in the hippocampus,”  Sterling said. “We don’t know exactly the cause, but it is correlated with improvements in motor skills.”

Gray matter is part of the central nervous system and is made up of neurons, glial cells and dendrites
One of the study’s co-authors, Gitendra Uswatte, described gray matter as the brain’s computer chips, and the therapy adds circuits to those chips.

Constraint-Induced Movement therapy was pioneered by Edward Taub in stroke rehabilitation. Taub is a university professor in the UAB Department of Psychology and co-author of this study.
CI therapy involves constraining the good limb so that the subject is forced to use the impaired limb.
For this study, researchers focused on children who had hemiparetic cerebral palsy, or CP that primarily affects one side of the body, Taub said.

The children’s good arm was placed in a cast to induce the restraint.
But the restrain aspect is only one small part of CI therapy, Taub said.
Successful therapy also involves the continuation of work at home involving family members to help the child focus on daily living activities: brushing their teeth, combing their hair and putting on shoes.
It’s not always easy, Taub chuckled, remembering when one child was asked to do something.
The child responded: “I have CP. Hasn’t anyone told you!”

While the study found a correlation between the increased gray matter and improved motor skills, it’s too early to which one caused the other, researchers said.
“The brain change could cause the motor improvement or the motor improvement could cause the brain change,” Taub said.
Uswatte is preparing to embark upon a study which may get closer to answering that question.
In the pending study, researchers would combine CI therapy with the administration of Prozac, or fluoxetine.

The study, he hopes, “will go some way to showing there is a causal relationship.”
Unfortunately, Uswatte said, the $2 million grant for the study is on hold due to sequestration – that series of automatic budget cuts directly caused by Congress not agreeing on a budget.
“There’s lots of research that is ready to go that can help people and help patients that can’t be done because of the stalemate over the budget,” Uswatte said.

Hyperbaric Oxygen Therapy: Does it Work for Children with Cerebral Palsy?

Hyperbaric Oxygen Therapy: Does it Work?

By John Lehman
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Hyperbaric Oxygen Therapy (HBOT) is commonly used to treat scuba divers with the bends, but recently, the therapy has been used to treat certain types of cerebral palsy, as well. Opinions vary as to whether or not HBOT is an effective treatment for children with cerebral palsy. Some research has shown improvements in motor, verbal and visual skills. However, others feel there isn’t enough conclusive data to recommend it to people with cerebral palsy. We’ll review both sides of the argument to help you decide if HBOT is the right treatment for your child.

What is Hyperbaric Oxygen Therapy?

When using HBOT, the patient enters a specialized room or a glass chamber designed for manipulating air pressure. The procedure is painless and patients can wear comfortable clothes, listen to the radio, read or watch television while inside the room. The average session lasts roughly an hour, including decompression once the session has finished.
Once the patient is inside, the room is sealed and the air pressure within is raised to a point where the patient is breathing 100 percent oxygen. In comparison, the air you are breathing right now contains approximately 20 percent oxygen. Increasing the air pressure in this way allows for the lungs to take in three times as much oxygen as they normally would. With more oxygen intake within the body, damaged or disabled cells can be regenerated and potentially given a second chance to become functional again.

Are There Any Risks?

As with any medical procedure, risks do exist when using HBOT. Patients undergoing HBOT may experience barotrauma, a form of ear damage related to changes in pressure. The medical practitioner on site should be able to advise you on how to reduce health issues related to compression and decompression, which should prevent this from occurring. Other issues associated with HBOT include oxygen toxicity, headaches or fatigue. Thankfully, these risks are not very common.

Does it Really Work?

HBOT is a controversial treatment for those with cerebral palsy. Within the last decade, many studies have been conducted and results have varied. In 1999, a study was published by researchers at McGill University to test the effectiveness of HBOT in children with cerebral palsy. The study took 25 children with cerebral palsy, who each underwent 20 sessions of HBOT over a month-long period. Follow-up tests concluded that 67 percent of the children showed improvement in movement and a reduction in muscle spasticity.
However, a study from Canada in the late 1980’s was met with skepticism. The study gathered 473 children afflicted with spastic cerebral palsy and administered 20 one-hour sessions of the therapy to 230 children within the group. Upon reevaluation after six months, roughly 75% of the treated children had improved balance and a lowered frequency of convulsions.
The controversy stems from the remaining 243 children who were grouped into a placebo study. Unlike standard placebo studies, these 243 children were treated with a reduced version of HBOT, using 1.3 atmospheres of pressure as opposed to the 1.7 atmospheres of pressure used for the original 230. This has led some researchers to claim that the study did not use a true placebo. An article written by Pierre Marois provides further details regarding this controversy.
Even today, research is ongoing in regards to the effectiveness of HBOT for cerebral palsy. While more studies are published demonstrating improvement in the quality of life for those treated, others point out that the treatment does not cure cerebral palsy and that the effects of HBOT are not permanent. HBOT can also be a costly procedure and, therefore, may not be available for all families whose children have cerebral palsy. In any case, it’s best to speak to your child’s doctor about HBOT to see if the treatment is worth trying for your child.

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Sensory Therapies for Children with Cerebral Palsy and other developmental delays

More avenues of hope for children with Cerebral Palsy and other developmental and behavioral disorders! This is a technical article and may have to be read twice to properly soak up all the information. The basics are that children with CP have major issues detecting and reacting to sensation. This can be as simple as knowing when to react when you put your hand on a hot stove. This research hopes to unlock areas of the brain that can be better trained and seasoned to sensation. Through this, the patient can begin to sense things correctly and in turn coordinate their motor functions appropriately.

For more information please read this article:

http://www.cpfamilynetwork.org/in-the-news/sensory-therapies-for-cerebral-palsy

Hydrocephalus as it Relates to Cerebral Palsy

By Lee Vander Loop

Hydrocephalus is a Latin word meaning “water on the brain.” About 75% of children with hydrocephalus will have some form of motor disability. This can be in the form of cerebral palsy.

The best analogy I can think of to describe the relation between cerebral palsy andhydrocephalus is the swelling that can happen after you hurt your knee. The swelling is caused by fluid your body creates in response to the injury. Maybe over days and weeks your knee begins to feel better and the swelling goes down, but then you notice an area around your knee that feels like watery Jell-O. This is a result of your body’s inability to absorb all of the fluid it created in response to the injury. Your physician would likely put in a tube to drain the fluid and relieve the pressure to prevent damage to the surrounding tissue.

Now think of your knee as the human brain and the injury is due to oxygen deprivation (asphyxia) or another source of birth trauma.

In almost all cases of severe head and brain trauma, there’s swelling of the brain, also known asbrain edema.  The excess fluid causes pressure to build up between the brain and skull.  This pressure can further damage the brain.

Cerebrospinal Fluid

Cerebospinal fluid (CSF) is a clear and watery liquid that completely surrounds the brain and spinal cord tissue. The liquid circulates throughout the brain before being reabsorbed into the blood through the ventricles, a series of cavities in the brain. CSF protects the brain and spinal cord against any jarring forces, acting as a shock absorber.  Scientists report CSF is also a potent mixture of proteins that supports brain cell development.

When there’s severe insult to the brain due to birth injury, the brain swells. Although the initial swelling may subside, the injury may result in damage to one or more ventricles, causing a blockage or damage to tissue responsible for absorption.  Since the body is constantly making CSF, any delayed absorption or obstruction results in the buildup of fluid, causing the ventricles to balloon. This, in turn, leads to pressure on surrounding brain matter, pushing aside the soft tissue of the brain and leading to further cerebral damage.

Causes of Hydrocephalus

Hydrocephalus may be congenital or acquired. It occurs in approximately 1 of every 1,000 live births in the U.S., or 10,000 babies per year.  About 50% of the cases are congenital, arising from genetic abnormalities or events that occur during fetal development, such as:

• Fetal brain tumor
• Dandy Walker Syndrome
• Meningitis
• Spina bifida

Acquired hydrocephalus develops at the time of birth or at some point afterward. This type of hydrocephalus can affect individuals of all ages and is caused by head trauma, brain hemorrhage, or disease such as brain cancer or meningitis.

Treatment

Hydrocephalus is manageable. The most common treatment involves surgical placement of a shunt system. Using tubes, this system redirects the flow of fluid from an area of buildup to the abdominal cavity where it can be absorbed as part of the circulatory process. A valve within the shunt system allows doctors to adjust the flow to normalize pressure. Doctors insert a tube long enough to accommodate the child’s growth, thus eliminating the need for another surgery.

Symptoms

When severe birth trauma results in hydrocephalus, evidence of a fluid buildup may be present within days. There may be an appearance of puffiness or swelling at the temples, at the bridge of the nose, or possibly around the eyes. A newborn may need the use of a ventilator to help relieve pressure until the swelling can be assessed and brought under control. Diagnosing the condition early and treating it quickly can help limit any long-term problems. But long-term effects mostly depend on what caused the fluid buildup, how bad it got, and how the baby responded to treatment.

A very visible sign of hydrocephalus is an enlarged head. This occurs because the bones of the skull are not yet fused, and so the head can stretch and grow in an attempt to bring down the pressure of the cerebrospinal fluid.  Symptoms of hydrocephalus in an infant also may include vomiting, sleepiness, irritability, an inability to look upward, and seizures.

Symptoms in older children and adults include headache, nausea, vomiting, and blurred vision. There may be problems with balance, delayed development in walking or talking, and poor coordination. If the cerebrospinal fluid pressure remains high for prolonged periods, blindness can occur in the older child or adult.

If left completely untreated, hydrocephalus can cause the brain stem to become so compressed that the heart can stop or breathing may cease. The compression of the cerebellum, while not as serious as a compressed brain stem, may lead to problems with swallowing, speaking, and breathing, or it can cause cerebral palsy to develop in fetuses and infants.

Diagnosis

Many diagnostic tools are available to aid physicians and neurologists in the diagnosis of hydrocephalus, including:

• Cerebral angiography, which is a test used to detect blockages of the arteries or veins.  Images are taken after a dye is injected into the area.
• Ultrasonography (USG) uses sound waves to take pictures of soft tissue organs deep within the body.
• Computed tomography, also known as a CT scan, takes two-dimensional images of organs, bones, and tissue.  Neurological CT scans are used to view the brain and spine.
• Magnetic Resonance Imaging (MRI) uses computer-generated radio waves and a magnetic field to produce detailed images of body structures including tissue, organs, bones, and nerves.
• Cerebrospinal fluid analysis involves the removal of a small amount of fluid for testing and to measure intracranial pressure.
• Electroencephalography (EEG) monitors brain activity through the skull.  EEG is used to help diagnose certain seizure disorders, brain tumors, brain damage from head injuries, inflammation of the brain and/or spinal cord, and metabolic and degenerative disorders that affect the brain.

More cerebral palsy information and other valuable resources for parents, families, caregivers and others are available from Cerebral Palsy Family Network.

How to Spot a Brain Shunt Malfunction

By Tenia R. Johnson, writing for the CP Family Network

My six-year old son Braden has spastic quadriplegia cerebral palsy caused by complications of a premature birth (27 weeks gestation). He spent two months in the neo-natal intensive care unit (NICU) before we could bring him home.

At about six months of age, Braden developed a brain bleed, which led to a condition called hydrocephalus. Hydrocephalus causes the head to swell up like a balloon and affects brain development. To treat this condition, Braden underwent a ventriculoperitoneal (VP) shunt. During this surgery, a small hole is drilled into the skull so that a small tube can fit inside. The tube runs down the neck and chest and into the stomach cavity, allowing fluids to drain from the brain to the stomach. A small pump is inserted under the skin at the back of the head to help move the fluid.

Needless to say, this was a very scary surgery. Little did I know that we would have to endure surgical revisions four times within a nine-month period because of problems with the tubing and with drainage. I’m sharing my experience in hopes that others parents of children with brain shunts can learn from our journey.

What to Look For

For most children, a clear sign that a VP is not working is a painful headache. Because Braden could not communicate his pain to me, I quickly had to learn to look for other symptoms. Signs that a VP shunt is not working may vary from child to child. However, contact a doctor immediately if your child:

• Is not eating well
• Seems unusually sleepy or lethargic
• Seems unusually weak
• Vomits during feeding
• Experiences seizures

Braden experienced all of these symptoms. The first time Braden’s shunt malfunctioned he went into a tonic-clonic seizure. The second time he went into a partial seizure and his breathing was compromised. The third time he wouldn’t eat and kept vomiting. The last time he showed no obvious symptoms, but my maternal instinct and past experience told me something wasn’t right. Braden had revision surgeries after each of these episodes. In the last surgery, the neurosurgeon chose to drill a separate hole and insert a second tube into Braden’s brain to avoid the risk of a fatal bleed from removing the first tube.

It has been five months since the last revision and Braden is doing well, although memories of those tough months are still fresh on our minds. Now, when we come to the ER, they know us by name. I cannot say that each surgery gets easier; they certainly don’t. However, I have relied on the strength of my family and my strong faith in God to get me through the tough times.

I love my son Braden very much and have learned so much from him. I am his voice, and after dealing with his medical issues for six years, I’m only getting better and stronger. Thank you, Braden. Mommy loves you.