| Investigators from many fields of medicine and health | | | | preterm infants who will develop cerebral palsy. If |
| are using their expertise to help improve the | | | | these screening techniques are successful, doctors |
| treatment and diagnosis of cerebral palsy. Much of | | | | will be able to identify infants at risk for cerebral |
| their work is supported through the NINDS, the | | | | palsy before they are born. |
| National Institute of Child Health and Human | | | | Noninvasive methods to record the brain activity of |
| Development (NICHD), other agencies within the | | | | unborn babies in the womb and to identify those with |
| federal government, nonprofit groups such as the | | | | brain damage or abnormalities would also be a |
| United Cerebral Palsy Research and Educational | | | | valuable addition to the diagnostic tool kit. Another |
| Foundation, and other private institutions. | | | | NINDS-funded study focuses on the development of |
| The ultimate hope for curing cerebral palsy rests with | | | | fetal magnetoencephalography (fMEG) - a technology |
| prevention. In order to prevent cerebral palsy, | | | | that would allow doctors to look for abnormalities in |
| however, scientists have to understand normal fetal | | | | fetal brain activity. |
| brain development so that they can understand what | | | | Epidemiological studies - studies that look at the |
| happens when a baby's brain develops abnormally. | | | | distribution and causes of disease among people -- |
| Between conception and the birth of a baby, one cell | | | | help scientists understand risk factors and outcomes |
| divides to form a handful of cells, and then hundreds, | | | | for particular diseases and medical conditions. |
| millions, and, eventually, billions of cells. Some of these | | | | Researchers have established that preterm birth |
| cells specialize to become brain cells, and then | | | | (when a baby is born before 32 weeks' gestation) is |
| specialize even further into particular types of | | | | the highest risk factor for cerebral palsy. |
| neurons that travel to their appropriate place in the | | | | Consequently, the increasing rate of premature births |
| brain (a process that scientists call neuronal migration). | | | | in the United States puts more babies at risk. A large, |
| Once they are in the right place, they establish | | | | long-term study funded by the NIH is following a |
| connections with other brain cells. This is how the | | | | group of more than 400 mothers and their infants |
| brain develops and becomes able to communicate | | | | born between 24 and 31 weeks' gestation. They are |
| with the rest of the body -- through overlapping | | | | looking for relationships between preterm birth, |
| neural circuits made up of billions of interconnected | | | | maternal uterine infection, fetal exposure to infection, |
| and interdependent neurons. | | | | and short-term and long-term health and neurological |
| Many scientists now think that a significant number of | | | | outcomes. The researchers are hoping to discover |
| children develop cerebral palsy because of mishaps | | | | environmental or lifestyle factors, or particular |
| early in brain development. They are examining how | | | | characteristics of mothers, which might protect |
| brain cells specialize and form the right connections, | | | | preterm babies from neurological disabilities. |
| and they are looking for ways to prevent the | | | | While this research offers hope for preventing |
| factors that disrupt the normal processes of brain | | | | cerebral palsy in the future, ongoing research to |
| development. | | | | improve treatment brightens the outlook for those |
| Genetic defects are sometimes responsible for the | | | | who must face the challenges of cerebral palsy |
| brain malformations and abnormalities that cause | | | | today. An important thrust of such research is the |
| cerebral palsy. Scientists funded by the NINDS are | | | | evaluation of treatments already in use so that |
| searching for the genes responsible for these | | | | physicians and parents have valid information to help |
| abnormalities by collecting DNA samples from people | | | | them choose the best therapy. A good example of |
| with cerebral palsy and their families and using genetic | | | | this effort is an ongoing NINDS-supported study that |
| screening techniques to discover linkages between | | | | promises to yield new information about which |
| individual genes and specific types of abnormality - | | | | patients are most likely to benefit from selective |
| primarily those associated with abnormal neuronal | | | | dorsal rhizotomy, a surgical technique that is |
| migration. | | | | increasingly being used to reduce spasticity (see |
| Scientists are scrutinizing events in newborn babies' | | | | Surgery). |
| brains, such as bleeding, epileptic seizures, and | | | | Similarly, although physical therapy programs are used |
| breathing and circulation problems, which can cause | | | | almost universally to rehabilitate children with cerebral |
| the abnormal release of chemicals that trigger the | | | | palsy, there are no definitive studies to indicate which |
| kind of damage that causes cerebral palsy. For | | | | techniques work best. For example, |
| example, research has shown that bleeding in the | | | | constraint-induced therapy (CIT) is a type of physical |
| brain unleashes dangerously high amounts of a brain | | | | therapy that has been used successfully with adult |
| chemical called glutamate. Although glutamate is | | | | stroke survivors and individuals who have traumatic |
| necessary in the brain to help neurons communicate, | | | | brain injury and are left with a weak or disabled arm |
| too much glutamate overexcites and kills neurons. | | | | on one side of the body. The therapy involves |
| Scientists are now looking closely at glutamate to | | | | restraining the stronger arm in a cast and forcing the |
| detect how its release harms brain tissue. By learning | | | | weaker arm to perform 6 hours of intensive |
| how brain chemicals that are normally helpful become | | | | "shaping" activities every day over the course of 3 |
| dangerously toxic, scientists will have opportunities to | | | | weeks. The researchers who conducted the clinical |
| develop new drugs to block their harmful effects. | | | | trials in adult stroke survivors realized CIT's potential |
| Scientists funded by the NINDS are also investigating | | | | for strengthening children's arms weakened by |
| whether substances in the brain that protect neurons | | | | cerebral palsy. |
| from damage, called neurotrophins, could be used to | | | | In a randomized, controlled study of children with |
| prevent brain damage as a result of stroke or | | | | cerebral palsy funded by the NIH, researchers put |
| oxygen deprivation. Understanding how these | | | | one group of children through conventional physical |
| neuroprotective substances act would allow scientists | | | | therapy and another group through 21 consecutive |
| to develop synthetic neurotrophins that could be | | | | days of CIT. Researchers looked for evidence of |
| given immediately after injury to prevent neuron | | | | improvement in the movement and function of the |
| death and damage. | | | | disabled arm, whether the improvement lasted after |
| The relationship between uterine infections during | | | | the end of treatment, and if it was associated with |
| pregnancy and the risk of cerebral palsy continues to | | | | significant gains in other areas, such as trunk control, |
| be studied by researchers funded by the NIH. There | | | | mobility, communication, and self-help skills. |
| is evidence that uterine infections trigger inflammation | | | | Children receiving CIT outperformed the children |
| and the production of immune system cells called | | | | receiving conventional physical therapy across all |
| cytokines, which can pass into an unborn baby's brain | | | | measures of success, including how well they could |
| and interrupt normal development. By understanding | | | | move their arms after therapy and their ability to do |
| what cytokines do in the fetal brain and the type of | | | | new tasks during the study and then at home with |
| damage these immune system cells cause, | | | | their families. Six months later they still had better |
| researchers have the potential to develop | | | | control of their arm. The results from this study are |
| medications that could be given to mothers with | | | | the first to prove the benefits of a physical therapy. |
| uterine infections to prevent brain damage in their | | | | Additional research to determine the optimal length |
| unborn children. | | | | and intensity of CIT will allow doctors to add this |
| Approximately 10 percent of newborns are born | | | | therapy to the cerebral palsy treatment toolbox. |
| prematurely, and of those babies, more than 10 | | | | Studies have shown that functional electrical |
| percent will have brain injuries that will lead to | | | | stimulation is an effective way to target and |
| cerebral palsy and other brain-based disabilities. A | | | | strengthen spastic muscles, but the method of |
| particular type of damage to the white matter of the | | | | delivering the electrical pulses requires expensive, |
| brain, called periventricular leukomalacia (PVL), is the | | | | bulky devices implanted by a surgeon, or skin surface |
| predominant form of brain injury in premature infants. | | | | stimulation applied by a trained therapist. |
| NINDS-sponsored researchers studying PVL are | | | | NINDS-funded researchers have developed a |
| looking for new strategies to prevent this kind of | | | | high-tech method that does away with the bulky |
| damage by developing safe, nontoxic therapies | | | | apparatus and lead wires by using a hypodermic |
| delivered to at-risk mothers to protect their unborn | | | | needle to inject microscopic wireless devices into |
| babies. | | | | specific muscles or nerves. The devices are powered |
| Although congenital cerebral palsy is a condition that | | | | by a telemetry wand that can direct the number and |
| is present at birth, a year or two can pass before | | | | strength of their pulses by remote control. The |
| any disabilities are noticed. Researchers have shown | | | | device has been used to activate and strengthen |
| that the earlier rehabilitative treatment begins, the | | | | muscles in the hand, shoulder, and ankle in people |
| better the outcome for children with cerebral palsy. | | | | with cerebral palsy as well as in stroke survivors. |
| But an early diagnosis is hampered by the lack of | | | | As researchers continue to explore new treatments |
| diagnostic techniques to identify brain damage or | | | | for cerebral palsy and to expand our knowledge of |
| abnormalities in infants. | | | | brain development, we can expect significant |
| Research funded by the NINDS is using imaging | | | | improvements in the care of children with cerebral |
| techniques, devices that measure electrical activity in | | | | palsy and many other disorders that strike in early |
| the brain, and neurobehavioral tests to predict those | | | | life. |