Virginia Tech Carilion neurorehabilitation research offers hope to children with cerebral palsy

Senior therapists at the VTCRI Neuromotor Research Clinic flank a young patient

Researchers led by Sharon Ramey and Stephanie DeLuca have pioneered the use of a therapeutic intervention for children with cerebral palsy that was first developed for adult stroke patients. The therapy results in a dramatic functional recovery of the impaired side of the brain and a persistent recover of control of the impaired side of the body. Pictured above with a patient are Mary Rebekah Trucks (left) and Dory Wallace, senior therapists in the VTCRI Neuromotor Research Clinic.

Cerebral palsy, the most common childhood disability, affects 8,000 to 10,000 children in the United States each year. A brain disorder of movement and posture, cerebral palsy hampers a child’s ability to exert normal control of muscle tone and coordinated movements, affecting either both sides of their bodies or primarily one side of the brain and the opposite side of the body. A range of factors – including fetal stroke, maternal or fetal infections, random mutations that affect brain development, birth asphyxia, or injury – can cause the disorder during fetal development, delivery, or the first few years of childhood. More than 750,000 children and adults in the United States now live with the disorder.

For many years, cerebral palsy was considered incurable and permanent, with only limited opportunities to teach children to live with their disabilities, which could affect other functions, such as hearing and speech, and, in less than half the cases, cognitive capacity and intellectual abilities. Research supported by the National Institutes of Health over the past several decades, however, has led to a new understanding of the brain’s capacity for functional reorganization through focused, intensive training that taps into neuroplasticity processes intrinsic to the nerve cells of the brain throughout life, even after brain disease or injury.

NIH-supported researchers led by Drs. Sharon Ramey and Stephanie DeLuca, now at the Virginia Tech Carilion Research Institute and the Virginia Tech Carilion School of Medicine, have pioneered the use of a therapeutic intervention for children with cerebral palsy that was first developed for adult stroke patients. The therapy is based on studies of the effects of prolonged disuse by parts of the brain that may occur after peripheral nerve injury or a stroke. Such disuse can lead to further weakening of the synaptic networks in the affected area of the brain and ongoing debilitation. Neurorehabilitation researchers have discovered, however, that an environment that compels the affected area of the brain to become active can lead to a strengthening of functional activity in the neural network.

Ramey and DeLuca first applied this therapy in children with the type of cerebral palsy that primarily affects one side of the brain. The researchers limited the use of the unaffected side of the brain by applying a cast to the arm controlled by that side of the brain and providing intensive therapy for several weeks during the child’s daily routine. The therapy resulted in a dramatic functional recovery of the impaired side of the brain and a persistent recovery – for many months and even years after the therapy – of control of the impaired side of the body.

Ramey and DeLuca now conduct their work at a research clinic at the Virginia Tech Carilion Research Institute in Roanoke, Virginia, where they – along with collaborators at the University of Virginia and Ohio State University – have funding from the NIH to carry out a multisite randomized controlled clinical research trial to evaluate the most effective parameters for increasing brain function in children with cerebral palsy. Working with colleagues at the research institute, Ramey and DeLuca are also using sophisticated functional brain imaging to understand better the effects of the therapy and to discover the most effective parameters that will ensure optimal functional brain reorganization to enhance motor performance.

Interestingly, the researchers have been finding benefits of the therapy beyond movement and posture, as the children have also developed a greater confidence and ability to have meaningful interactions. This ongoing research is an important example of how NIH-supported research built on basic discoveries is being translating into new, safe, and highly effective treatments for children who would otherwise be relegated to a life with limited options. These therapies not only significantly reduce costs to society, but also enable the children to realize their full potential in life.


References

Ramey SL, Coker-Bolt P., DeLuca, S.C. (2013). Handbook of Pediatric Constraint-Induced Movement Therapy (CIMT): A Guide for Occupational Therapy and Health Care Clinicians, Researchers, and Educators. Bethesda, MD: The American Occupational Therapy Association.

DeLuca SC, Case-Smith J, Stevenson R, Ramey SL. (2012). Constraint-induced movement therapy (CIMT) for young children with cerebral palsy: Effects of therapeutic dosage. J of Ped Rehab Med, 5:133–42. doi: 10.3233/PRM-2012-0206.

Case-Smith J, DeLuca SC, Stevenson R, Ramey SL. (2012). A multi-center randomized clinical trial of pediatric constraint-induced therapy in children with cerebral palsy. J of Occup Therapy, 66(1):15–23. PMID: 22389937