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Cerebral Palsy (CP)

  • When I was a few weeks old, my dad and mom noticed I was not progressing like their friends' kids and, after the medical exam, doctors told my parents I would be a vegetable. To this day, I don't know what kind of vegetable I'm supposed to be!

    --Rick Hoyt, an adult patient with cerebral palsy at Boston Children's Hospital

    When you hear the term “cerebral palsy,” you may envision a specific illness with very particular symptoms. But did you know that cerebral palsy (CP) is actually a broad term that covers several different disorders? This means that kids with CP have a wide variety of symptoms and experiences—and many different abilities.

    Cerebral palsy is a chronic condition (occurring throughout a child’s lifetime) that:

    • involves some type of injury or disruption to the brain
    • affects communication between the brain and the muscles
    • causes uncoordinated movements and postures

    Sometimes, CP occurs as a complication of another condition, like premature birth, low birthweight or neurological trauma. However, it often occurs for no identifiable reason. 

    • For some kids, cerebral palsy only affects their legs. This is called diplegia.
    • Other children only have symptoms on one side of the body. This is known as hemiplegia.
    • CP can cause muscle tone to be too high (this is called spasticity) or too low (which causes problems with balance).
    • Children with cerebral palsy can experience involuntary muscle movements, referred to as dyskinetic movements.
    • And some kids with CP have rigidity in their legs or arms. This is called dystonia.
    • Although CP is a lifelong condition that can’t be reversed, there are many ways to medically and surgically manage the disorder and its symptoms.

    The information on the following pages will help you learn the basics about CP and know what to expect in the days and months ahead. 

    How Boston Children's Hospital approaches cerebral palsy

    Here in Boston Children's Hospital Cerebral Palsy Program, we’re dedicated to helping kids and adults with CP enjoy a great quality of life. 

    Since “cerebral palsy” is actually a term that covers several different types of brain injury, it's important to seek treatment from experts who understand:

    • that a child's CP symptoms might not match any given “textbook” example
    • that many parts of a child’s body may be affected by CP
    • how and why other medical conditions can occur alongside CP
    • the vital role of orthopedic support in helping kids with CP 

    Our program provides interdisciplinary evaluation and treatment for children with cerebral palsy and other neuromuscular conditions. We combine expertise in orthopedic surgery and neurosurgery, among several other specialties, to improve the functional capabilities of more than 2,000 patients of all ages each year.

    Our team is dedicated to delivering knowledgeable, compassionate care in a family-centered atmosphere. We are focused on maximizing your child’s functional independence, stability and quality of life while offering support for your entire family. 

    Cerebral palsy:
    Reviewed by Brian Snyder, MD, PhD, and Benjamin Warf, MD

    © Boston Children's Hospital; posted in 2011

    Contact Us

    Cerebral Palsy Program
    Boston Children's Hospital

    300 Longwood Ave.
    Fegan 2
    Boston MA 02115
    617-355-6021

  • Cerebral palsy (CP) is a broad term that describes a group of neurologic (brain) disorders. In all of its forms, CP:

    • is a lifelong condition
    • affects the communication between the brain and the muscles
    • causes a permanent state of uncoordinated movement and posturing
    • is believed to result from an episode or injury that causes a lack of oxygen to the brain (but in many cases, no exact cause can be found)

    Children with CP often have one or more associated medical conditions, such as:

    • learning disabilities and developmental delays
    • bone problems, including scoliosis
    • asthma and other respiratory problems
    • speech and communication impairment

    While the specific brain injury or issue responsible for CP doesn't progress or worsen over time, your child’s symptoms may change as he ages. Monitoring and managing these symptoms requires multidisciplinary collaboration by experts in several specialties.

    When your child is treated in Boston Children's Hospital’s Cerebral Palsy Program, he has access to all of Boston Children’s subspecialists. Depending on your child’s circumstances, he may be seen by experts in our Orthopedic Center, Neurosurgery Department and Physical Therapy and Occupational Therapy Services, among others. You and your family also have full access to our extensive support services, including counseling, educational materials and community resources.

    What causes cerebral palsy?

    Cerebral palsy is believed to occur when there is either abnormal development or damage—for example, trauma or another episode that cuts off the supply of oxygen—to the areas in the brain that control motor function. In many children with CP, the exact cause of their disorder cannot be identified.

    Although CP often emerges without a specific cause, certain risk factors have been linked to the disorder. They include:   

    • premature birth
    • very low birthweight (especially in babies weighing less than 1,000 grams, or 2.2 lbs.)
    • brain hemorrhages (bleeding within the brain)
    • brain trauma
    • complications of labor and delivery
    • some viruses affecting the mother during pregnancy, including cytomegalovirus (CMV)
    • chemical/substance abuse by the mother during pregnancy
    • some infections affecting the mother during pregnancy, including rubella (German measles), toxoplasmosis and urinary tract infections or kidney infections 

    Is CP common? Does it affect some groups of children more than others?

    Cerebral palsy affects about 2 to 3 out of every 1,000 babies. It is somewhat more common in:

    • boys than girls
    • multiple births than single births
    • African-Americans than other ethnicities

    What are the symptoms of cerebral palsy?

    It’s important to note that each child with CP may have different symptoms, ranging from muscle weakness and poor motor control to muscle tightness (called spasticity) in the arms or legs and muscle stiffness (including clenched fists). 

    Cerebral palsy is classified according to the kind of motor function the child experiences, as follows:  

    • spastic diplegia ("di" means two): spastic movements of the arms or legs. (this is also sometimes called paraplegia)
    • spastic quadriplegia ("quad" means four): spastic movements in all four limbs (both arms and legs)
    • spastic hemiplegia ("hemi" means half): spasticity affecting one half, or one side, of the body (for example, the right arm and right leg)
    • spastic double hemiplegia: spasticity in both sides of the body, although the extent of shaking is different on one side compared to the other
    • athetoid: involuntary, uncontrolled and purposeless movements
    • dystonia: rigidity and poor tone throughout the muscles 

    Children with CP may also have additional problems, including:

    • seizures
    • vision loss or impairment
    • hearing loss or impairment
    • speech impairment
    • learning disabilities
    • behavioral problems
    • developmental delays
    • respiratory problems, such as asthma and aspiration
    • bowel control problems
    • bladder control problems
    • bone abnormalities, including scoliosis
    • gastroesophageal reflux (GERD)
    • constipation

    Babies with CP are often slow to reach developmental milestones, such as learning to roll over, sit, crawl or walk. They may also have certain reflexes present—for example, the Moro reflex, automatically extending the arms when placed on the back with legs tilted—past the time these reflexes normally disappear.

    Since the symptoms of CP may resemble other conditions, it is a must to talk to a qualified physician to make an exact diagnosis and recommend the right treatment plan for your child. 

    Questions to ask your doctor

    You and your family play an essential role in your child’s treatment for cerebral palsy. It’s important that you share your observations and ideas with your child’s treating clinician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations. 

    You’ve probably thought of many questions to ask about your child’s condition and prognosis. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you will have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you. (If your child is old enough, you can encourage him or her to write down questions, too.)
     

    Initial questions to ask your doctor might include: 
    • How did you arrive at this diagnosis?
    • Are there any other conditions my child might have instead?
    • Does my child require further testing at this time?
    • What is my child’s prognosis?
    • What medications will you prescribe and what are the possible side effects?
    • Does my child need a brace, walker or other equipment at this time?
    • Does my child need surgery, and if so, what procedure do you recommend and why?
    • What role should I play in my child’s treatment?
    • How should I talk to my child about this condition and the long-term outlook?
    • How should I explain my child’s condition to family members and teachers?
    • How can I talk about my child’s condition to his classmates and other kids?
    • How can I make sure my child is receiving the emotional support he needs?
    • What changes do I need to make to my child’s home and school routines?
    • What other resources can you point me to for more information?

    FAQ

    Q: Will my child be OK?
    A:
    Although cerebral palsy is a lifelong condition that can’t be reversed, children with CP can lead rich, fulfilling lives with the right medical and surgical management. These benefits are augmented by family support and services like physical therapy and occupational therapy. 

    Q: Does CP get worse as time goes on?
    A: Although the brain injury that causes CP does not get worse over time, symptoms can become more serious and complicated as a child ages. 

    Q: Can changes to my child’s diet help manage his cerebral palsy?
    A: Although dietary modifications can’t cure CP or eliminate its symptoms, a proper diet is hugely important for kids with cerebral palsy. Since many children with CP have difficulty chewing and swallowing, parents need to take extra care to ensure they’re consuming enough nutrients and calories. Your treating clinician can give you more specific recommendations for your child’s situation.

    Q: Is my child at risk for other health complications as he ages?
    A:
    While every child’s cerebral palsy is different, having CP does place a child at risk of developing other health problems later in life. These can include:

    • increased spasticity
    • joint pain and discomfort or arthritis
    • dental problems (since it can be very difficult for a person with cerebral palsy to remain still during a dental exam or treatment, there is a higher risk of undetected dental disease)

    Talk to your treating clinician about your child’s specific symptoms and prognosis. Good medical management is key in helping your child enjoy an optimal quality of life.

    Q: Can Children’s diagnose and treat cerebral palsy in newborns?
    A:
    Our Fetal-Neonatal Neurology Program evaluates, diagnoses and formulates treatment plans for newborns and babies whose neurological problems are present at birth or emerge in early infancy.

    Q: Will my child definitely need supportive equipment, such as a walker or brace?
    A:
    Not every child with cerebral palsy will require a wheelchair, walker or brace. These devices, like any other medical treatment, are prescribed to address the symptoms and circumstances of a specific patient. 

    Q: Will my child definitely need surgery?
    A:
    Surgery can be very helpful for children with serious difficulties with spasticity, muscle contracture, deformities and other symptoms of CP. However, as with any other treatment option, your treating clinician is the best source of information and recommendations for managing your child’s particular symptoms. 

    Q: Is there a cure for cerebral palsy?
    A: Unfortunately, cerebral palsy is a lifelong condition for which there presently is no cure. Boston Children’s clinicians are engaged in ongoing research in hopes of one day curing—and possibly preventing—this disorder.

    Children's journal project lets kids, families talk about their experiences with CP

    Children diagnosed with cerebral palsy—as well as their parents, siblings and caregivers—can share their thoughts, feelings, concerns and hopes. The Cerebral Palsy Experience Journal gives patients, loved ones and health professionals a new way of making their voices heard while helping others facing similar situations.

    One patient's story

    Meet Rick, an athlete with cerebral palsy who learned how to speak...without being able to talk.

  • How is cerebral palsy diagnosed?

    A child is usually diagnosed with CP when she’s 6 to 12 months old, since this is the time when she starts missing developmental milestones like walking and controlling her hand and head movements.

    The process of diagnosing cerebral palsy begins with a physical examination. During the initial exam, a developmental pediatrician obtains a complete history of the mother’s pregnancy and the child’s birth and infancy.

    Next, your child will have these diagnostic tests:

    • a neurologic examination to evaluate your child’s reflexes and motor functions
    • X-rays, which use invisible electromagnetic energy beams to produce images of internal tissues, bones and organs
    • feeding and swallowing studies, which assess how well your child chews, drinks liquids and swallows
    • an electroencephalogram (EEG), a procedure that records the brain's continuous electrical activity through electrodes attached to the scalp
    • a gait laboratory analysis to evaluate the walking pattern of the child
    • Magnetic Resonance Imaging (MRI), which uses a combination of large magnets, radiofrequency waves and a special computer to create detailed pictures of organs and structures within the body
    • Computerized Tomography (CT) scans, which use x-rays and computer technology to produce cross-sectional images of any part of the body (including bones, muscles and organs)
    • genetic studies, which screen for conditions that tend to run in families
    • metabolic tests, which detect the absence or insufficiency of specific enzymes (for example, particular amino acids, vitamins or carbohydrates) necessary to maintain normal body functions

    Spotlight on: Gait Laboratory

    Boston Children's Cerebral Palsy Program refers some patients with complex walking problems to a special Gait Laboratory on the grounds of nearby Spaulding Rehabilitation Hospital.

    The Gait Laboratory's services include:

    • high-speed movie cameras that record your child's steps
    • electronic monitors that measure muscle activity during walking 
    • computerized data evaluation to help determine the extent of walking issues and the optimal treatment approach

    For more information, please call 617-573-2203.

  • Since cerebral palsy affects different children in different ways, your child's treatment plan will depend on several factors, including:

    • her age, overall health, and medical history
    • the type of CP she is experiencing
    • the extent of her symptoms
    • her tolerance for specific medications, procedures or therapies
    • the expected course of her cerebral palsy
    • you and your family's preferences for treatment 

    CP is a lifelong condition that is not correctable, so managing the disorder is focused on:

    • preventing or minimizing physical deformities
    • improving and enhancing mobility and motion to the greatest possible extent
    • maximizing your child's capabilities to succeed at home, at school and in the community

    Medication

    While medication can't treat or cure cerebral palsy itself, it can be helpful in managing certain symptoms of CP. Medications we may prescribe include:

    • antispasmodics, which reduce muscle spasms and relax tightness in the muscles
    • anticonvulsants, which can treat seizures in children who experience them as a side effect of CP
    • anticholingerics, which can help children who experience dystonia (rigidity) and uncontrollable drooling

    Your treating clinician will tell you whether medication is safe and advisable for your child—and, if so, which drugs and dosages are recommended. Medications should only be taken exactly as prescribed by your child's doctor.

    Learn more about commonly prescribed medications.

    Non-surgical interventions

    Management of cerebral palsy usually includes several non-surgical aids, such as:

    • seating and positioning aids (used to help the child sit, lie, or stand). These include:
      • wheelchairs
      • walkers
      • ergonomic chairs that promote correct posture
    • orthotics (used to prevent deformity and to provide support or protection for the limbs and torso). These devices can include braces and splints. Learn more about the NOPCO Orthotics Shop at Boston Children's.
    • special eating utensils: forks, spoons and knives designed for kids with fine motor skill difficulties
    • special writing utensils: pens and pencils with grips and handles designed for kids with fine motor skill problems
    • communication aids (used to help children who may be hard to hear or understand, or who have difficulty communicating with others). These can include:
      • special books and posters with pictures the child can point to in order to indicate a request or answer a question
      • alphabet boards that can be used to spell out messages
      • computers with adaptive programs and functions—such as speech-recognition software—for children with disabilities

    Surgical interventions

    In some cases, surgery can be a helpful option for managing symptoms of CP.

    Orthopedic surgery

    Boston Children's orthopedic surgeons have many years of expertise in treating CP symptoms that impact the skeleton and muscles—namely, spasticity and muscle contractures. While not always necessary, we may recommended surgery if your child's muscle spasms are severe enough to cause problems with movement, balance and coordination.

    Likewise, surgery can help reduce spasticity in the legs by elongating or releasing the contracted muscles and tendons that are too short.

    Surgical procedures are also used to treat:

    • curvatures in the back (scoliosis)
    • hip dislocations
    • ankle and foot deformities

    Neurosurgery

    Some children with CP have pain and spasms severe enough to warrant neurosurgical intervention. Children's neurosurgeons specialize in procedures that can help control both the pain and the spasms caused by CP, including:

    • implantation of the baclofen pump, a device that administers precise dosages of the muscle relaxant baclofen into the child's spinal column
    • selective dorsal rhizotomy, an operation that cuts certain nerves in the spine to reduce spasticity and improve the child's movement and posture

    Please read the Family Education Sheet on the baclofen pump.

    It's important to carefully discuss any recommended surgical procedure with your child's treating clinician. Our orthopedic surgeons and neurosurgeons are always available to answer questions and address any concerns you may have. 

    Physical and occupational therapy

    Physical therapy—either alone or in combination with orthotic devices like a brace or splint—can be extremely beneficial in preventing muscle contractures by stretching your child's spastic muscles. Many children receive regular physical therapy to take part in stretches, strengthening exercises and play activities that can help them improve their:

    • flexibility
    • endurance
    • mobility

    Learn more about physical therapy at Boston Children's.

    Occupational therapy is very helpful in giving children with cerebral palsy independence, confidence and essential life skills. The occupational therapist will use exercises, games and training to help your child:

    • develop better fine motor skills for holding and grasping objects
    • improve hand-eye coordination
    • use adaptive computer programs and other technologies to improve communication
    • learn techniques for anger and stress management
    • master basic skills, such as:
    • bathing
    • feeding themselves
    • getting dressed

    Learn more about occupational therapy at Boston Children's

    Speech, swallowing and communication therapy

    Speech therapy allows many children with CP improve difficulties with communication, swallowing and feeding. A speech therapist can work with your child to:

    • more easily form words through better mouth movements
    • learn and follow sign language
    • use communication aids, like adaptive computer programs and specialized picture books
    • strengthen the tongue
    • improve chewing and drinking ability

    Learn more about the Department of Otolaryngology and Communication Enhancement at Children's.

    Treatment in the Boston Children's Cerebral Palsy Program

    The Boston Children's Hospital Cerebral Palsy Program is devoted to providing knowledgeable, compassionate care in a family-centered atmosphere. We are focused on maximizing your child's functional independence, stability and quality of life while offering support for your entire family. 

    Here at Boston Children's, your child will be treated by an expert, interdisciplinary team that may include the following people:  

    • developmental pediatricians: family practitioners who provide medical care for infants, children and adolescents, and can refer patients to specialists in various medical fields
    • orthopedic surgeons: surgeons who specialize in treating conditions involving the muscles, ligaments, tendons and bones
    • neurologists: physicians who specialize in understanding and treating conditions affecting the brain, spinal cord and nerves
    • neurosurgeons: surgeons who perform operations to address brain and spinal cord disorders and diseases
    • ophthalmologists: physicians who diagnose and treat eye and vision problems
    • pediatric dentists: specialists who examine and care for a child's teeth, gums and mouth
    • neuroscience nurses: nursing professionals with specialized training in treating conditions affecting the brain, spine and nerves
    • orthotists: specialists who make braces, splints and other corrective and support devices
    • physical therapists: specialists who help kids improve or maintain movement and mobility with exercises and other therapies
    • speech therapists: health professionals who evaluate, diagnose and treat speech, language and swallowing problems
    • occupational therapists: specialists who help kids learn new life and self-care skills, developmental exercises and activities
    • audiologists: health professionals who diagnose and treat hearing loss and impairment
    • child psychiatrists, psychologists and social workers: specialists who assess, identify and treat mental and behavioral health problems, emotional and psychosocial issues and stress affecting children and families 

    Coping and support

    When your child has cerebral palsy, your family is dealing with many different concerns and worries. Not only are you focused on meeting all of your child's medical needs; you are also grappling with a significant emotional and psychological toll that affects every member of your family. 

    In addition to the clinical information offered on this page, Children's has several other resources designed to give your family comfort, support and guidance. 

    Patient and family resources at Boston Children's

    Boston Children's Augmentative Communication Program provides comprehensive evaluation and treatment services for children with conditions that affect their communication and learning abilities. Please call 781-216-2209 to learn more. 

    The Cerebral Palsy Experience Journal is an online collection of stories, photos and anecdotes from children with cerebral palsy, their families and their clinicians. 

    Boston Children's Center for Continence of Urine and Bowel (CUB) is a multidisciplinary program that treats and supports children with bowel and bladder control problems related to neuromuscular, spinal and other disorders. Please call 617-355-6055 for more information. 

    Boston Children's Clinical Genetics Program provides diagnostic services and genetic counseling for patients and families with birth defects and other developmental problems. Please call 857-218-4637 to learn more. 

    The hospital's Complex Care Services deliver essential medical care to children with birth defects, genetic disorders and other multifaceted health care needs. For more information, please call 617-355-6162.

    The Gait Laboratory uses state-of-the-art diagnostic technologies to evaluate children with complex walking difficulties. Call 617-573-2203 for more information. 

    The Behavioral Medicine Clinic helps children who are being treated on an outpatient basis at the hospital—as well as their families—understand and cope with their feelings about:

    • being sick
    • facing uncomfortable procedures
    • handling pain
    • taking medication
    • preparing for surgery
    • changes in friendships and family relationships
    • managing school while dealing with an illness
    • grief and loss 

    Boston Children's Psychiatry Consultation Service provides several services, including:

    • short-term therapy for children admitted to one of our inpatient units
    • parent and sibling consultations
    • teaching healthy coping skills for the whole family
    • educating members of the medical treatment team about the relationship between physical illness and psychological distress 

    Boston Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information. 

    The Boston Children's chaplaincy is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members—representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions—who will listen to you, pray with you and help you observe your own faith practices during your child's treatment. 

    Throughout the hospital, you'll find clinicians trained in integrative therapies that can make your child feel more comfortable, learn to shift focus away from pain and enjoy some peaceful moments during what may be an anxious time. 

    Boston Children's International Center is a dedicated resource for patients and families from countries outside the United States. The center can provide assistance with everything from reviewing medical records to setting up appointments and locating lodging. Contact the center by phone at 01-617-355-5209 or via e-mail at international.center@childrens.harvard.edu.

    Helpful links

    Please note that neither Boston Children's Hospital nor the Cerebral Palsy Program at Boston Children's unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.

    Helpful links for parents and families

    Helpful links for teens

    Helpful links for younger children

  • Collaborating to build robotic clothing for children with CP

    Countless scientific epiphanies never leave the bench – unless there’s the kind of serendipitous encounter that set Boston Children’s Hospital psychologist Gene Goldfield on a path he never expected to follow.

    One in eight babies are born prematurely, putting them at greater risk for cerebral palsy, an inability to fully control their muscles. Goldfield saw these children being wheeled around the hospital, and was convinced that they did not have to be wheelchair-bound.

    During early infancy, he knew, the developing brain naturally undergoes a rewiring of its circuits, including those that control the muscles. Could some type of early intervention encourage more typical motor development by replacing damaged circuits with more functional connections?

    At Boston Children’s Innovators’ Forum, Goldfield discussed his envisioned solution: the use of programmable robots to promote new brain connectivity and improve mobility.

    Read the full story in Boston Children's Vector blog.

    Groundbreaking hypothermia treatment may have implications for CP

    Research at Boston Children's Hospital is leading to many clinical innovations in potentially preventing cerebral palsy in infants. One of the leading causes of cerebral palsy may be a lack of oxygen at birth, or hypoxic-ischemic encephalopathy (HIE).  Premature infants are particularly at risk to experience hypoxic-ischemic episodes. 

    Since 2007, Anne Hansen, MD, MPH, medical director of the NICU, and Janet Soul, MD, CM, associate director of the Neonatal Neurology Program, have been offering newborn patients a new hypothermia treatment that may prevent or minimize the long-term consequences of brain injuries caused by HIE, including cerebral palsy.  The hypothermia treatment involves placing an infant onto a cooling blanket, which quickly brings down the body temperature. The cooling likely reduces brain damage, by lowering the overall energy needed for the brain to function and by slowing down the enzyme pathways in the brain that lead to death of the brain cells. Boston Children's is the first and only hospital in Massachusetts to offer this protocol.

    Clinical Innovation: Tabletop therapy technology

    tabletop therapy

    The problem
    By the time some patients get to the Cerebral Palsy Program at Boston Children's Hospital, they're already uncomfortable, anxious and in no mood for the frustrating and sometimes painful stretching and dexterity exercises involved in their therapy.

    Innovative solution
    Developer Paolo Bonato, PhD, director of the Motion Analysis Laboratory at Spaulding Rehabilitation Hospital (SRH), led a multidisciplinary team from SRH and the Harvard School of Engineering and Applied Sciences, collaborating with Donna L. Nimec, MD, and Brian Snyder, MD, PhD, both from Boston Children's Orthopedic Center, to develop a system that would be fun for children to use, but also deliver legitimate therapeutic value. The result is like a giant iPad, programmed with custom-developed games and activities that encourage the principal elements of cerebral palsy therapy. (Patients stretch by reaching for the keys of a virtual piano, and they coordinate both of their hands by capturing animated butterflies.) Games can be designed around specific goals, such as range-of-motion or increased visual skills.

    Implications
    When patients at Boston Children's Cerebral Palsy Program tested the tabletop, their response was overwhelmingly positive. The project is still in development, but the team envisions a system in which hospitals maintain progress records for each patient who uses the system. Patients and their families would be able to track their progress and plan therapy goals, giving kids something positive to look forward to at therapy time.

    Other research underway

    Simon Manning, MD and colleagues in Boston Children's Department of Neurology and Neurobiology Program are investigating drug treatments for reducing the neurological conditions caused by HIE, including cerebral palsy.

    • When given within 48 hours of the hypoxic-ischemic episode, one drug called topirimate, reduced neuromotor abnormalities in animal models. 
    • Another drug, memantine, normally used to treat Alzheimer's, reduces the white-matter injury after a hypoxic-ischemic episode.  While this drug has only been tested in animals models, it holds promise to reduce brain damage in premature infants, including cerebral palsy.

    Others are investigating how to prevent or reduce periventricular leukomalacia (PVL), which refers to damage and softening of the white matter, the inner part of the brain that transmits information between the nerve cells and the spinal cord, as well as from one part of the brain to another.   Infants who experience PVL are at a higher risk of developing cerebral palsy.

    • Neurologist Paul Rosenberg, MD, PhD has shown that Vitamin K may boost newborns antioxidant mechanisms and reduce effects of PVL.  He is also testing other enzymes that may prove protective.
    • Joseph Volpe, MD, neurologist-in-chief emeritus at Boston Children's, has been trying to discern what factors lead to PVL through monitoring infants, as well as laboratory and animal studies.  Once Volpe and his team figures out the cause, they can begin tackling how to stop it.
    • Neurologist Adre du Plessis, MD, believes PVL's root cause comes from impaired regulation of blood flow in the brain.  He's been monitoring premature babies at length searching for predictors of PVL and disturbances in blood flow.  Predicting which babies are most at risk will help refine neonatal care, minimize brain damage and provide grounds for testing the drugs mentioned above. 

    While these treatments and studies do not offer a cure for children who already have the condition, this continued research may reduce the future number of cases of cerebral palsy and other neo-natal neurological conditions.

    Clinical trials

    Boston Children’s is known for pioneering some of the most effective diagnostic tools, therapies and preventive approaches in pediatric orthopedics, neurology, orthopedic surgery and neurosurgery. A significant part of our success comes from our commitment to research—and to advancing the frontiers of mental health care by conducting clinical trials.

    Boston Children’s coordinates hundreds of clinical trialsat any given time.Clinical trials are studies that may involve:

    • evaluating the effectiveness of a new drug therapy
    • testing a new diagnostic procedure or device
    • examining a new treatment method for a particular condition
    • taking a closer look at the causes and progression of specific diseases 

    Boston Children’s is involved in several multi-site clinical trials and studies with promise for diagnosing and treating neuromuscular disorders. While children must meet strict criteria in order to be eligible for a clinical trial, your child may be eligible to take part in a study. Before considering this option, you should be sure to:

    • consult with your child’s treating physician and treatment team
    • gather as much information as possible about the specific course of action outlined in the trial
    • do your own research about the latest breakthroughs relating to your child’s condition 

    Taking part in a clinical trial at Children’s is entirely voluntary. Our team will be sure to fully address any questions you may have, and you may remove your child from the medical study at any time. 

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