Cerebral Palsy


Last week I received a request from MarkNS asking about cerebral palsy therapy when viewed from neuroplasticity. Sounds good, let’s look at that.

I did not know much about cerebral palsy prior to this post, but strangely I do know an ultimate fighter with it…  Cerebral palsy is a multi-faceted disorder that comes in all shapes in sizes, many of which are outside the scope of this post. When looked at with a simplistic view, cerebral palsy is a movement disorder caused by damage to the motor cortex of the brain.

Brain damage. “Irreversible. Permanent.” <–Wrong! The most common form of brain damage associated with neuroplasticity is in stroke patients. This is where the greater body of research can be found. It would seem that for many years all signs pointed to “you’re screwed”.  That is, until Edward Taub came onto the scene.

Taub, through deafferentation experiments on monkeys, invented a new form of therapy, Constraint Induced (CI) Therapy (Simple or Advanced explanation, I recommend the advanced if you have the time as I will only touch lightly on it). The premise of this therapy focuses on a phenomenon called “learned non-use”. In essence, after losing a degree of control in one limb you then compensate with the other to pick up the slack. (e.g. after a stroke affecting the left side, you would use your right side that much more.) When this compensation occurs the neural pathways begin to weaken, leading to even further non-use.

So we know how to lose it, now how do we get it back? CI Therapy essentially forces the affected limb to switch roles. By restraining the “good” limb and using only the “bad” one,  the patient begins to build motor control on the weaker side. It turns out this not only builds character but rebuilds the pathways!

So that’s all fine and dandy for strokes, but what about cerebral palsy? There’s an app for that. Unfortunately the only data I could find was done on children with hemiparesis associated with cerebral palsy. The good news is that the children responded amazingly well to the therapy and sustained the results afterwards. The range of effectiveness is still limited for the moment. CI Therapy has come a long way and it would be a safe assumption that it will continue on.

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About James R

A twice-over senior at the University of Minnesota - Morris. View all posts by James R

16 responses to “Cerebral Palsy

  • Franklin Percival

    Dear Rev. Frost,

    I am most impressed by your open-mindedness. Spasticity/Cerebral Palsy is something of which I received a diagnosis when I was 8 years old; do the mathematics, I am now 60!

    It was found by EEG (wish I’d kept the traces, they’d have made great wall-paper, though not of standard width), but it would seem to me that certain parts of the brain are not so damned plastic as you would like to believe.

    I suspect that if you have your brain traumatically damaged at age seven, there are certain things you will never recover, because you have never learned them. Only my view, mind.

    Franklin.

  • Meno

    Well, technically, CNS (as opposed to PNS, but let’s not get off topic onto glia being evil bastards that prevent axonal regeneration in the CNS), brain damage per se is permanent, but functional damage isn’t. Like your advanced version says, ipslateral areas grow bigger, and contralateral ones are recruited. Probably, the former is the dendritic trees of whatever’s left after the stroke expanding, and the latter re-recruitment of contralateral nurons to do ipslateral processing (it would be interesting to see how a callosotomy affects the efficacy of CI treatment). My guess is that the latter process is the main driver of the CI effectiveness. So yeah, the brain’s cool, and indeed can compensate, however, the dead area never really regains function. Also, food for thought: could we compensate for bilateral stroke by using unrelated cortical areas (a la lesioning primary visual cortex and the MGN in a fetus, and the brain rewires the now-worthless primary auditory real estate to be visual cortex)? In any case, keep writing! We need MOAR neuroscience!!!

  • MosesZD

    Ok. I want you to succeed. So I’m going to be critical and hold you standards that, maybe you think are not “fair.” But I’m not interested in “fair,” but, as I said, in your success.

    1. Punctuation and grammar are important. Even for scientists. My wife is a scientist and she has me review each and every paper she writes and makes virtually every editorial change I suggest for the sake of clarity. I’ll forgo marking-up your post. But, please, write, read, edit. Then, set it aside for a few hours and go back and repeat the process. It will help tremendously.

    2. Your style is too casual. Way to casual. We’re not duking it out in a futile blog-war or arguing about football. Rather you’re describing something technical to an audience and need to convey technical information in a coherent, accessible manner.

    You were so scattered I really didn’t get anything from your post. And while I don’t expect you to write like there is a stick in your bum… Remember what you are writing and to whom you wish to convey this information.

    3. This whole post feels like you just threw it together. That you didn’t care. Maybe you did and you were trying to be hip and destroyed that truth for an artificial conveyance of “cool.” I just don’t know.

    4. Perhaps, though, you were just over excited. If you really were excited, and that caused the presentation difficulties, don’t lose it. But, please, learn to channel your excitement, it will help your writing remain focused.

    5. You really need to review what you learned in high school and/or your freshman composition course. You’re mixing ideas in your paragraphs. Some of which are non sequiturs. Look a pony! That’s a tough read.

    • GotTheBlues

      “Punctuation and grammar are important.”

      If you are going to be hard on the kid, perhaps you should set an example in your critique. Your own grammar and punctuation is unacceptable.

      Try critiquing the actual meat of the post. It’s for a science class, after all.

    • synapse

      Your criticisms are off the mark. His style is perfectly fine for a science blog targeting to a general audience, particularly one of young people. His grammar and punctuation are appropriate for his style; honestly, if he had used strictly correct grammar, it would detract from his youth-oriented, informal style. (That said, everyone makes mistakes, and maybe the guy could use a review of commas.)

      Also, I had no problems comprehending his post. In particular, it was not too scattered: he sets up a problem, explores previous research, and specifically relates that research to his particular problem.

      What did you think of his science?

    • Pete

      I love how you have copied and pasted large portions of your comments to multiple blogs.

      Nice Job!

  • David Bennett

    If you’re going to only have one link you may be better with it being a systematic review or meta-analysis if available.

    And there is here: http://www.ncbi.nlm.nih.gov/pubmed/19729391

    Might also be worth stating the limitations of the evidence base, short term follow up for one and that the procedure can be pretty unpopular with the participants: http://www.ncbi.nlm.nih.gov/pubmed/20222769

  • echidna

    Done well (content): good choice of topic. It doesn’t get more interesting than brain function.

    Done well (style): the description of the therapy used to get compensation happening is interesting.

    To improve (content): Even in a blog, be precise with the science. [“Irreversible. Permanent.” <–Lies.] As Meno pointed out, the damage is permanent. The interesting point you are making is that with good therapy, other, undamaged areas of the brain can be used to take over functions, although you leave us dangling still with the question of how effective therapy is for cerebral palsy.

    To improve (style): This is a blog – the story about the ultimate fighter is a personal element that will hook us in. The comment "Back on topic!" is jarring.

  • L. S.

    Didn’t know you were taking devo too!

    I would’ve subscribed long ago.

    Looking forward to future blagging.

    BTW, I agree with some of the above commentators, in that I’d rather see you tell the story in your style rather than reading the drab version that I could just as easily get by looking up your references.

  • MarkNS

    Thanks for looking into this. CP is a condition that has long been virtually ignored by researchers. Probably due to the idea that brain damage is permanent.
    As you saw in your own research, there is essentially nothing in the way of treatment for spastic quadriplegia or paraplegia like my daughter has. Society has long just tried to shuffle people with severe CP off to institutions for warehousing.

  • synapse

    I haven’t looked into cerebral palsy treatments specifically, but I know that a lot of “treatments” given to people to “restore brain plasticity” are not supported well by evidence. In particular, a small initial study will often produce amazing results that go away in larger trials with better controls. What is the overall quality and quantity of the evidence to support constraint-induced therapy, in cerebral palsy or stroke? Is there any degree of anatomical recovery (some people have made claims about spine motility and growth in V1 after retinal lesions) or is it purely functional?

  • Equisetum

    “Punctuation and grammar are important.”

    Yes, they are.

    “Way to casual.”

    Everyone knows that ‘to casual’ is a transitive verb, and you have no direct object. I assume what you wanted to write was “Way to casual that blog entry, Dude! But in my opinion you should have formalled it a bit more.”

    As for the post itself, I think it’s fine. It presents the subject, and gives a good, quick explanation (sufficient for a blog post) with references if you want to read more. The style is good, personal.

  • Tim

    This was personally interesting to me, as my middle daughter has CP. Thank you for the information!

  • LRA

    Thought I just leave a comment on your interesting post!

    Years ago, I was working in a lab in which we (simple version) grew up rat embryonic neurons on plastic film in medium and applied them to the surface of ablated rat brains with the hope of learning more about how to provide healthy neurons to the damaged surface of a cortex (similar to what happens in CP). These studies were about the chemical environment of neurons and how to get around the problem of the body blocking new neuronal growth. Long story short, brain and spinal chord damage may be reversible if (1) we can prevent the chemical environment that causes scarring in the brain/spinal chord, (2) we can manipulate the environment to encourage neuronal growth using neurotropic factors (like BDNF), and (3) we can encourage appropriate neuronal synaptic connections to restore a network that functions properly.

    Lots of research has been done in this area and a search of pubmed might be useful if you wish to see what’s going on. I think there may be more research available on spinal chords, but I’m sure there is plenty of research on traumatic brain injury as well.
    :D Hope that’s helpful!

  • Franklin Percival

    Dear Equisetum #9

    … way to casualise (yuk!), is just possibly permissible in written English as the use of a neologistic transitive verb. Otherwise, will you please return to your grammar notes.

    Anyway, Rev. Frost, I’ve just checked my medical notes, and the 1957 brain damage was then diagnosed as being to my right upper parietal lobe, with the possibility of damage to the left cerebellum. I have an ‘intention tremor’, meaning that if I do not have to think or lack time to think, I react appropriately and very quickly indeed (think an object about to fall into boiling water, or 2k Hg in a toppling U-tube) – just don’t ask me to catch a ball.

    Subsequent MRI scans have also indicated slight damage to the right temporal lobe.

    I just wish I had the time and patience to properly bone up on neurology.

    All the very best to you.

  • Mary P

    As a non scientist I like the casual tone. Although I read many technical articles I also like the easy reads. Grammar is important and so are the word used. “Irreversible. Permanent.” <–Lies. would be stronger, in my opinion, if it read "Irreversible. Permanent." Wrong! Quite different connotations.

    I agree with Meno and echidna that this would be an improvement to the post.

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