TUESDAY, Sept. 17, 2002 (HealthDayNews) -- Doctors now have a new tool to assess cerebral palsy, a crippling birth defect that afflicts about 550,000 people in the United States.
The condition -- really an umbrella term for a brain injury that typically occurs before birth -- causes a wide range of mental and motor defects with an equally broad spectrum of severity. As a result, it's difficult for doctors and physical therapists to counsel parents of children with cerebral palsy (CP) on what to expect.
However, Canadian researchers have developed new motor development charts for babies with the condition. These trajectories should give parents a better sense of their child's outlook, at least for the muscular aspects of their ailment such as walking.
When they hear their child has CP, parents almost invariably ask two questions, says lead study author Dr. Peter L. Rosenbaum, a pediatrician at McMaster University in Hamilton, Ontario: "How bad is it?" and "Will they walk?"
In earlier research, Rosenbaum and his colleagues developed guidelines for the first question, with a system similar to cancer typing. Before that measure, doctors and parents had to contend with "meaningless" words like moderate, mild and severe, Rosenbaum says.
With the new tool, "because the curves describe motor function by level, we can have a reasonable guess of the child's pattern of mobility," he explains. On the five-track chart, "if it's one or two, you can be pretty sure they're going to walk, but for a child who's a four we would probably be recommending early in therapy that they should get some wheels" (a wheelchair) in addition to other interventions, he says.
Experts caution, however, that the charts aren't iron-clad. A child heading down one path might do better or worse than expected. What's more, they plot motor function only, not emotional, behavioral or social development.
Rosenbaum's group report their findings in tomorrow's Journal of the American Medical Association. They created the charts with data from 657 children with CP, aged 1 to 13, who were followed for up to four years.
Dr. Murray Goldstein, medical director of the United Cerebral Palsy Research Foundation, says the curves will also help scientists developing therapies for CP.
Many treatments are widely used without solid evidence that they work, Goldstein says. However, having a baseline trajectory of motor development can help researchers compare the effect of an intervention with what would otherwise happen naturally.
Treatment planning will also benefit from the new curves, says Dr. Stephen L. Kinsman, director of pediatric neurology at the University of Maryland School of Medicine. "If somebody isn't likely to ever walk, it doesn't make sense to put them in a study" of an experimental drug designed to help children with a better prognosis.
Yet, Kinsman is wary of making too much of the new tool, especially since some children won't follow the precise path of the curve they're on -- and because they (the charts) only describe one aspect of CP. "Let's be careful how we use this," he adds.
What To Do
For more on cerebral palsy, try United Cerebral Palsy Research Foundation or the National Institute of Neurological Disorders and Stroke.
