FACT SHEET

October 2006

Cerebral Palsy Research: What’s Next?

By Murray Goldstein, DO, MPH

SUMMARY: For more than a decade, the monthly Research Fact Sheets authored by the staff of the UCP Research and Educational Foundation have documented the steady increase in knowledge about cerebral palsy (CP)---its prevention, its causes, its pathologies and its treatments. Some have reported the spectacular results of research; others have documented the less spectacular but nevertheless important step by step advances for preventing developmental brain damage and for restoring lost function. As has been said previously, we have learned more about cerebral palsy and its causes and treatment in the past two decades than we learned in the previous one hundred years. The search for the answers to the why, how and what of damage to the developing brain and its consequences are topics of major attention to ever increasing parts of the research community. The Foundation is the research community’s patron and partner---a truly productive relationship.

What is on the horizon that will have major impact on prevention and treatment? There are many exciting research areas being explored and choosing among them for special attention is perilous. However, here are a selected few that will come to fruition in the near future and will have significant impact:

Detecting the threatened brain: CP is most often caused by damage to the developing brain of the fetus in utero and of the infant during and shortly after the birthing process. In order to prevent brain damage, it is essential to be able to detect that the brain is being threatened before the damage becomes permanent. Methods of brain monitoring are now being developed that can evaluate the normal activity and threatening changes of the fetal brain prior to birth. In the reasonably near future, we will be able to monitor the functioning and loss of function in the brain of the fetus while still in the mother’s uterus! Experimental methods to do this in the new born infant in the nursery are presently available and are being refined so they become practical. These advances in technology are on the realistic horizon; however the issue is how will we know when to use them? There are four million live births in the USA every year. The screening of all fetuses and infants is impractical. What are the warning signs that will trigger the use of these technologies before it is too late? How do we identify the infants at risk in order to make the use of these brain monitoring technologies practical? Clinical investigators are hard at work addressing these problems and are beginning to solve them. There is every reason to believe that the presence of a threat to the brain of the fetus and infant will be able to be recognized and damage prevented or arrested before it is too late.

Marshalling brain plasticity: The human brain is constantly changing as it reacts to the environment or to structured learning. This occurs at all ages, but most aggressively during childhood and adolescence. It is already known that in response to brain injury, other centers and pathways in the brain can assume functions normally proscribed to the injured areas. These changes are referred to as brain plasticity. Function restoring changes in brain activity can be stimulated and can become permanent---thus providing

Research Fact Sheet: Cerebral Palsy Research: What’s Next?

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for a return of some lost function following brain injury. I use the modifier “some” because the recruited areas often are not as efficient in performance as the areas they have replaced. However, the return of function is permanent and can be sharpened with training and experience. This is often seen following stroke and traumatic brain injury in the adult. The knowledge gained in the treatment of those adult injuries is now being evaluated when applied to the sensory losses and motor control deficits following injury to the developing brain that occurs with cerebral palsy. Also, by utilizing brain imaging the specific brain changes that result from structured periods of training can be monitored. Applying these methodologies, clinical investigators are exploring the development of the most efficient ways of reprogramming the injured young brain and diminishing the loss of function leading to disability. Utilizing techniques to foster brain plasticity—particularly in the young—the development of improved function following brain injury is an achievable goal.

Assistive Technology: Modern electronics, nanotechnology and miniaturized wireless electrodes offer the promise of permitting both the”lame to walk and the mute to speak”. From both biological and engineering viewpoints, there is every reason to believe that assistive technologies can provide for restitution of many of the lost functions of performance associated with CP such as grasping, walking and communicating. I am not as confident about swallowing---but perhaps that also. An engineering specialty---bioengineering—has been established to achieve these goals and is already presenting working models of the needed developments. The models still require refinements and alterations, but they work under guarded conditions. As engineers, biologists and clinicians work together; these devices will become available and promise to have a major impact on quality of life for those with a major loss of function.

I have shared my crystal ball images with you: brain monitoring of the fetus and infant as an important step for the prevention of permanent brain damage; the utilization of brain plasticity for restructuring the brain to restore function; and the development of bioengineering technologies to improve activities of daily living. There are certainly others that could have been included. However, the above are dramatic examples of new developments coming to fruition in the reasonably near future as research on cerebral palsy continues to receive the attention it so rightly deserves.