In March Harvey Brunt and I attended the 5th Annual Australasian Academy of Cerebral Palsy and Developmental Medicine Conference. As the name suggests the conference was based around medical professionals exchanging new ideas and peer reviewing the latest literature on the causes and consequences of Cerebral Palsy. However, I was pleased to see that the 3 days were not exclusively medical nor was it all pitched purely in medical jargon. There was a definite shift to acknowledging the social and psychological ramifications of Cerebral Palsy and seeking ways to address these. Here is a brief write up of three of the talks I attended. I have the abstracts and references if anybody would like to investigate them further.

Botax Review

A series of reviews and audits into the safety and effectiveness of Botox and similar treatments have recently been performed. The results confirmed that Botox is safe and effective across all Gross Motor Function Classification Scale (GMFCS) levels

However, as with all medical interventions side effects can be expected and can range from mild (needing simple intervention) to severe (requiring ongoing observation and intervention). Between 1 – 5 % of individuals who are given Botox experience side effects. These may include muscle weakness, flu like symptoms, respiratory symptoms and incontinence. People most at risk of complications and the more severe side effects are those who have more involved and complex Cerebral Palsy as well as those with pre existing conditions such as lung problems and poor bladder control.

CP Satisfaction and Social Networking

Measuring the impact of Cerebral Palsy on social development has become increasingly important to researchers. One of the most consistent findings is that the more involved the CP the greater the risk of social difficulties. Protective factors against feeling social isolated include having a clear understanding of what Cerebral Palsy is, being fully informed of and having an active say in the range and type of treatment options being offered (e.g. when considering Botox or surgery) and having access to equipment (such as adaptive trikes) so that a person with CP can join in group activities independently.

Unsurprisingly, the social impact of CP is most acutely felt in adolescence and adulthood when peer relationships are being formed outside of the family unit. Whilst teenagers with CP are accessing tools like the Internet and Social networking sites in the same way as people without CP there are some limitations and barriers to this, which require further exploration. It is also agreed that more sophisticated ‘universal tools’ need to be developed and funded so that people with all types and levels of CP can benefit.

Neuroplasticity and Cerebral Palsy

Neuroplasticity seems to be the fashionable scientific word of the decade. It essentially means the ability of the brain to find ways to compensate for injuries that have occurred in stroke events. Current research by prominent neurologists seems to indicate that there may be something to the hype with conditions like Cerebral Palsy. The essential premise of this research is that the brain lesion that instigated Cerebral Palsy may not be a static injury. This means that the earlier treatments aimed at increasing movement and mobility are implemented the more functional the effected limb becomes. Results are drawn primarily from people with hemiplegia symptoms (one affected side) although all types of CP are being investigated.

Within these studies it was strikingly evident that focusing simply on the effected limb was extremely detrimental and that a typically functioning limb can develop significant impairments if it is not taught to work in conjunction with the less able side. This discredits older practices such as strapping the non-affected side. It has become evident that although neuroplasticity does remain active through the lifespan it is not nearly as pronounced beyond the age of eight. This is when the brain starts shaping and settling itself into the final structures of adulthood. Therefore developing early interventions that are feasible outside the lab and clinical practice is crucial for instance, teaching play routines and cot placement to encourage movement of both sides.

Here is the list of the studies I used in my research write up.

Social Networking

How are children and adolescents with physical disabilities using the
internet? Implications for social networking Parimala Raghavendra

The psychological health of children with cerebral palsy Allan Colver,
Jimmy Chong, Ray Russo, Rebecca Slykerman

Botox Review

BONT-A treatment is safe in children with GMFCS level IV and V cerebral
palsy Katherine Langdon

Botulinum toxin adverse effects and health status in children with cerebral
palsy in all GMFCS levels Stephen O¹Flaherty

Neuroplasity

Clinical applications of advanced brain imaging Janet Eyre,

Ross Flood rflood@cpsociety.org.nz