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New Therapy Shows Promise Against Cerebral Palsy

Technique offers good results for children with spastic hemiparesis

FRIDAY, Feb. 6, 2004 (HealthDayNews) -- A form of physical therapy used successfully on stroke patients shows promise in treating children with a type of cerebral palsy called spastic hemiparesis, researchers report.

Cerebral palsy describes a group of chronic conditions that affect body movement and muscle coordination. It is caused by damage to one or more areas of the brain, and usually occurs in the womb.

Spastic hemiparesis affects an arm or leg on one side of the body. Spastic cerebral palsy is the most common type of cerebral palsy, accounting for 70 percent to 80 percent of the cases. Spastic hemiparesis makes up some 20 percent to 30 percent of these cases.

The new treatment technique, called constrained-induced movement (CI) therapy, was pioneered by Edward Taub, director of the Taub Therapy Clinic and a professor of psychology at the University of Alabama at Birmingham. It was first developed to treat stroke patients.

Generally, stroke patients lose normal function on one side of the body. In CI therapy, the strong arm or leg is immobilized, forcing the patient to use the weaker limb. Studies have shown repeated exercises restore substantial function in the weaker limb. It works by "rewiring the brain," Taub explains.

Now Taub's team has extended its research to children with spastic hemiparesis. A study on the work appears in the February issue of Pediatrics.

Like stroke, spastic hemiparesis affects one side of the body, and Taub speculated the same mechanisms at work in stroke were involved in this form of cerebral palsy.

In the new study, 18 children, ranging in age from 7 months to 8 years, were divided into two groups. One group was started on CI therapy, while the other children were given standard rehabilitation.

Taub believes children with spastic hemiparesis learn not to use their weak arm because it doesn't work very well. CI therapy is designed to teach them to use the weaker limb.

To do this, children in the CI group had their strong arm placed in a light cast. The cast extended from the shoulder to just beyond the fingertips. The children remained in the cast for 21 days. Every day for six hours, they received intensive therapy disguised as play.

During CI therapy, the children were forced to do things that were just at the limit of their motor ability, says Taub. "And through reward and encouragement we kept them improving just beyond the point that they were capable of. This is called shaping -- getting improvement in small increments," he explains.

Before and after the trial, the researchers used standardized questionnaires and evaluations of videotaped sessions to chart the children's progress.

"The results were dramatic," Taub says. All the children in the CI group showed substantial improvement. "The younger the child, the more dramatic the improvement, with entirely new patterns of movement and behavior that the child had never exhibited before," he adds.

For example, children used their weaker arm to crawl, pick up objects and pop soap bubbles with a single finger. "Their movement isn't normal," Taub notes. "But it is substantially improved."

The lesson is that "the central nervous system of children is enormously plastic and is capable of reorganizing itself to adapt to impairments if a treatment procedure like CI therapy is applied," Taub says.

Taub's group followed the children for six months and saw the gains in motor ability remained. Taub is starting another study with a new group of children and intends to follow them for two years.

"This technique offers parents and their children hope," Taub says.

Jack Engsberg, director of the Human Performance Laboratory at Washington University, says "if CI can be shown to help these kids with cerebral palsy, I'm all for it."

Engsberg adds "the CI concept is clever, and the application to cerebral palsy is encouraging for this disability and potentially other neurological disorders. I hope the long-term follow-up study shows that these children continue to use their more involved limb."

Dr. Murray Goldstein, medical director of the United Cerebral Palsy Research and Educational Foundation, adds that most of the evidence from animal and stroke studies shows this technique improves performance.

"I think there is evidence that CI is helpful in spastic hemiparesis, and it is potentially an important contribution to physical therapy. But there is more research needed before it becomes standard therapy," Goldstein says.

Goldstein's concern is whether the improvement seen after therapy will remain significant over a long period. However, it is a very promising beginning, he adds.

More information

For more on cerebral palsy, check with United Cerebral Palsy or the National Institute of Neurological Disorders and Stroke.

SOURCES: Edward Taub, Ph.D., director, Taub Therapy Clinic, and professor, psychology, University of Alabama at Birmingham; Jack R. Engsberg, Ph.D., director, Human Performance Laboratory, Washington University School of Medicine, St. Louis; Murray Goldstein, D.O., M.P.H., medical director, United Cerebral Palsy Research and Educational Foundation, Washington, D.C.; February 2004 Pediatrics
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