Linda Overmeyer's daughter, Haley Overmeyer, was born on Jan. 9, 2005, at Memorial Hospital and was treated at her birth by Dr. William Keenan, according to the complaint filed Dec. 31 in St. Clair County Circuit Court. Keenan is alleged to have been negligent in his treatment by failing to appropriately resuscitate Haley, by failing to appropriately and properly intubate her and by failing to appropriately monitor her, the suit states.

Because of Keenan's alleged negligence, Haley suffered from cerebral palsy, neurological defects, developmental delays, hearing and visual problems, great physical and mental anguish, tremendous physiological consequences, tremendous pain and suffering, loss of sleep and loss of life's pleasures and enjoyments, according to the complaint.

She also incurred medical costs and has been subjected to unnecessary medical and health care evaluations, the suit states. Linda claims she incurred medical expenses, also. St. Louis University and Memorial Hospital were negligent through the actions of their employee, according to the complaint. "That Memorial Hospital owed plaintiff a duty of care to use the skill and care ordinarily used by a reasonably well qualified physician," the suit states.

In the six-count suit, Linda is seeking a judgment in excess of $200,000, plus costs.

Source: http://www.stclairrecord.com/news/216703-memorial-slu-and-doctor-sued-over-childs-cerebral-palsy

www.LegalView.com, a prominent and respected online legal resource has re-issued its medical malpractice information portal which will provide timely information to people who have been injured through errors made by medical practitioners and institutions.  The portal also helps victims find lawyers who specialize in this area of activity. 

According to statistics published by the site, medical errors and negligence account for approximately 225,000 deaths annually in the U.S., and millions of injuries.  A common condition that can result from medical malpractice is cerebral palsy that affects infants.  C.P. is a neurological disorder that can occur due to errors by health providers to women during labor and delivery, which affect movement and muscle coordination. 

C.P. is a static condition.  Once a child has it, it remains for life.Medical malpractice can also result from a shortage of qualified care providers in nursing homes and hospitals, or a doctor’s misdiagnosis of a patient under their care, or a delayed call to a competent medical professional by someone like a nurse who mistakenly assumed a situation was within his or her competence.  

In malpractice, the injury need not be only physical.  Any psychological harm that is caused by an act of negligence on the part of a medical professional  which compromises the health or safety of their patient can qualify as medical malpractice.

LegalView.com encourages victims of medical malpractice who have suffered unwarranted pain and injury through a doctor’s error to seek legal redress by contacting a legal firm who can direct them to a competent and experienced medical malpractice attorney. As a first step the experienced attorney will help the victim decide if in fact they really have a reasonable claim.

Throughout the U.S., medical malpractice is defined as the failure of a physician, hospital or employee of a hospital, to render medical services, or to exercise reasonable care, skill or knowledge, ordinarily used under similar circumstances. According to a recent article in Medical News Today, there are many inconsistencies in the current system of reporting incidents of medical malpractice.

It is for this reason that it is important for people who feel they have been inadequately or incompetently treated by a medical professional so they can be instructed as to how to develop a case so that they can receive financial compensation for the pain and suffering they and or members of their family were forced to endure through no fault of their own.

Hyderabad, November 16: The twin cities have nearly 15,000 children having Cerebral Palsy (CP), where mentally challenged children have trouble controlling their body muscles.

Either they end up in a wheel chair or somehow manage to walk but only with the help of crutches or braces. With advancing age, the infirmity becomes even more complex to manage.

State-wide, the number of children with CP is at a whopping 1.5 lakh. Countrywide, the number is at 40 lakh. These and several other facts and methods to manage the ailment were brought out by Dr. A.K. Purohit, Head of Neurosurgery, Nizams Institute of Medical Sciences (NIMS), marking Children’s Day here on Friday.

“Early detection, intervention and management of the ailment are the only way out.CP children require attention from paediatricians, neurologists, neurosurgeons, physiotherapists and rehabilitation specialists,” Dr. Purohit says. To give psychological support to families having CP children, Dr. Purohit has written a book Cerebral Palsy Gyan Kosh in Hindi. 

Gianna Jessen is 31 years old whose life and survival has been the subject of intense media interest in light of the debate that she sparked during the recent U.S. presidential campaign. She was born in California in 1977 to a mother who tried, albeit unsuccessfully, to undergo an abortion. At the age of 17, when many girls her age were planning what they would be wearing on prom night, Gianna’s mother, who was six weeks pregnant, decided to end her pregnancy and her unborn baby’s life by submitting to an injection of saline solution whose purpose was to burn the embryo she was carrying.  Demonstrating a fierce will to survive, even at that tender age, Giana, diagnosed with Cerebral Palsy and numerous other disabilities because of the attempted abortion, managed to survive when the odds were decidedly against her.

By pure chance, the abortionist was not present when Gianna was born, for had he been present, there is almost no chance that she would have lived.  An experienced nurse quickly sent Gianna for emergency care at a local neonatology intensive care department where the doctors kept her alive, assuming that there was no chance she could.  Weighing only 2 pounds there was little hope, and when she did “make it” she was placed in foster care.  The diagnosis was she would probably never be able to walk or crawl, lift her head or sit up by herself.

Eventually, demonstrating a fierce sense of personal drive, she eventually learned to sit up, crawl, then stand. She learned to walk with leg braces and a walker by the time she was four years old. Physical therapy became a routine in her life, and after undergoing four surgical procedures, she learned to walk unassisted.

Walking led to walking faster and eventually she overcame the obstacles and started running.  Running led to racing, led to competitions and she soon entered marathons (26.2 miles) a rare achievement for a person who started out in life on such shaky ground.

What does this have to do with America’s dazzling president-elect – himself a “poster image” of excellent health?  Little other than the fact that according to Ms. Jessen, early in his political career, Mr. Obama was unwilling to support legislation which would have protected the lives of “botched abortions”.  Gianna views Mr. Obama’s opinions on the matter as being seriously detrimental to the chances of people like her surviving if they manage to do so by some miraculous means. 

Gianna went so far as to publicize her concerns about Mr. Obama’s legislative record, and her views, and the candidate’s positions were widely viewed as opposing campaign advertisements. The advertisements and attendant publicity resulted in public statements, accusations and denials becoming part of their outspoken debate.

As Gianna sees it, Mr. Obama has lost his sense of objectivity due to political ambition and expediency, as reflected in his attack on her during the campaign. All she asked of him publicly was to support medical care and protection for infants who survive abortion. Gianna claims that Obama voted against such legislative protection and care four times even though the U.S. Senate voted 98-0 in favor of a bill identical to the one Obama opposed. Again, according to Ms. Jessen, in the words of Mr. Obama’s own misleading ad, his position is totally unacceptable. In defending his position, Mr. Obama said that the question of when babies should receive human rights was above his pay grade. Gianna’s response to that very wishy-washy explanation: That type of vacillation in public policy almost left her to die. No one should have to go through what she experienced.

Giana can’t understand why when a leading candidate for president admits that for the last five years, Obama has deviated from the truth about a vote he once made? And why doesn’t the media- especially the left-wing liberal press challenge him on the very sensitive issue.

Mr. Obama claimed that he would have supported his state’s version of the Born Alive Infant Protection Act if it had included a clause intended to protect abortion rights guaranteed by Roe v. Wade. However there is documentation proving that Mr. Obama voted against a version of the Born Alive Infant Protection Act that did contain language which would protect abortion rights identical to the bill that passed 98-0 in the U.S. Senate.

Researchers at Adelaide's Women's & Children's Hospital and the University of Adelaide, Australia, have made a world-first discovery that links viral infection with high blood pressure during pregnancy and pre-term birth.

The research findings are a major step forward in unravelling the mystery of the cause of high blood pressure in pregnancy.

The research has been conducted by the South Australian Cerebral Palsy Research Group, based in the University of Adelaide's School of Paediatrics & Reproductive Health and the Women's and Children's Hospital Microbiology & Infectious Diseases Department.

Their work demonstrates, for the first time, that exposure to viral infection -- especially viruses of the herpes group -- may be associated with pregnancy-induced hypertensive disease (pre-eclampsia) and also with pre-term birth.

The research discovered the presence of viral nucleic acid in heel-prick blood samples from 1326 newborn babies, taken over a 10-year period. More than 400 of these babies were diagnosed with cerebral palsy.

"This is an exciting finding and further studies are now required to look at the link between viral exposure in pregnancy and genetic susceptibility to adverse pregnancy outcomes, such as high blood pressure, premature delivery and cerebral palsy," says Professor Alastair MacLennan, leader of the research group.

Pregnancy hypertension (high blood pressure) occurs in up to 10% of first pregnancies throughout the developed world, such as in the UK, the United States and Australia. When untreated, it can lead to uncontrolled epileptic fits of eclampsia with loss of baby and mother. It is a common cause of maternal death in Third World countries.

The cause of high blood pressure in pregnancy has been an enigma for decades and a holy grail for many researchers.

The Adelaide research group has already demonstrated a link between viral infection in pregnancy, genetic mutations in genes controlling inflammatory and blood clotting processes, and the development of cerebral palsy.

The group has also found an association between several hereditary gene mutations with changes in inflammatory proteins that may cause dysfunction and constriction of the blood vessels of the placenta and brain, thus causing the rise in blood pressure in pregnancy. If not controlled, this can be lethal.

"We are just beginning to understand the interaction and importance of exposure to viruses and genetic susceptibility to infection both in pregnancy and the newborn," says Associate Professor Paul Goldwater, the virologist of the team.

Children with cerebral palsy benefit significantly from horse-riding therapy, US researchers have found.

Preliminary findings in the research found continued improvement in the children even three months after their last riding session.

Thee Human Performance Laboratory at the Washington University School of Medicine occupational therapy department said it was in the final phases of data-gathering for the study, funded by the Horses and Humans Research Foundation's 2006 research grant.

Researchers measured the trunk and head stability of children with cerebral palsy after 12 weeks of horse-riding therapy.

Head researchers Jack Engsberg and Tim Shurtleff hypothesised that if trunk stability improved, then functional use of the arms and hands might also show improvement because the foundation (the trunk) and the visual and vestibular (balance and movement) sensory systems are more stable.

The team used a motorised barrel and video motion capture to challenge and measure the changes in motor control of the trunk that might have been learned on a horse.

"Our VMC system is the same technology that is used to animate movies and video games," says Shurtleff.

"It uses six cameras that 'see' small reflective markers on anatomical landmarks of the head, trunk, arms and hands. VMC enables very precise and objective measurement of the movement of the body and its parts."

The children were tested before and after participating in 12 weeks of horse riding sessions and then, again, after another three months of not riding horses.

The team reports that so far the group of 11 children has shown a significant difference in testing before the riding therapy began, and after its completion.

"On average they have reduced movement at the head and upper trunk by one-third of their pre-hippotherapy movement while being challenged by the reciprocating movement of the barrel," reports Shurtleff.

"We can also show that their control of their heads has improved significantly, and that the range of motion of the head (highest and lowest head angles compared to the horizontal) and their movement variability (standard deviation of all angles through the timed test) decreased significantly.

"They also do not drop their heads as much forward - another significant result."

Eight of the children have also come back for their last test (three months after therapy treatments ended).

"Preliminary results show that all these changes have persisted and remain statistically significant after the three-month washout period after they stopped riding horses," Shurtleff continues.

"We will be able to confirm this in the coming months, but the take-home message is that we think we will be able to show with objective measures that hippotherapy improves motor control of the head and trunk and that the improvement sticks with them."

Shurtleff expressed his thanks to the Horses and Humans Research Foundation for funding the project and believes that the results will provide valuable objective evidence for the efficacy of hippotherapy as well as validating this measurement methodology for future studies.

The Horses and Humans Research Foundation is a nonprofit organization that exists to facilitate universal understanding and appreciation of the significant influence of horses on humans.

Its primary goal is to support, promote and fund scientific research that explores the claimed, yet unsubstantiated benefits of equine-assisted activities, leading to the discovery of the most effective methods and techniques for conducting thousands of existing and future programmes.

The secondary goal is to educate the public - including parents, donors, insurance companies and physicians - on research findings so that horse-assisted activities programmes become more accessible to those in need.

Source: http://www.horsetalk.co.nz/news/2008/01/138.shtml

Source: http://www.eadt.co.uk/content/eadt/news/story.aspx?brand=EADOnline&category=News&tBrand=EADOnline&tCategory=news&itemid=IPED20%20Jan%202008%2023%3A25%3A18%3A237

Most of the brain injuries which cause cerebral palsy can be prevented when doctors and other health care professionals properly monitor the mother and fetus during pregnancy and delivery.

NJ, January 06, 2008 - Cerebral palsy is a birth injury which is almost always preventable. It is caused by brain injury to a baby during pregnancy, childbirth, or shortly after birth, which affects muscle control and can cause learning disabilities. With proper medical care and therapy, some children with cerebral palsy can lead fairly normal lives, but most children require life-long care.

Causes:

Most of the brain injuries which cause cerebral palsy can be prevented when doctors and other health care professionals properly monitor the mother and fetus during pregnancy and delivery. Doctors should always be on the lookout for the conditions and circumstances which can cause birth brain injury. Causes of birth brain injury include:

· Infection in mother or baby during pregnancy

· Toxicity from inappropriate medications during pregnancy

· Kidney and urinary tract infections in the mother

· Rh incompatibility

· Lack of oxygen

· Bleeding in the brain

· Severe jaundice

· Stroke

· Failure to respond to fetal distress

· Umbilical cord strangulation

· Unreasonable delay in performing a c-section

· Inappropriate use of forceps

· Failure to treat infant seizures

Symptoms and effects of cerebral palsy:

Cerebral palsy will affect each child differently, but there are some common problems which it is known to cause. These include:

· Impaired speech

· Learning disabilities

· Visual impairment

· Hearing impairment

· Difficulty walking

· Incontinence

· Difficulty eating

· Drooling

· Limited motor skills

· Paralysis

· Seizures

Types of cerebral palsy:

Different types of cerebral palsy have different physical effects on a child.

Spastic:

Spastic cerebral palsy is the most common form. It makes the muscles too tight causing stiff jerky movements. This can affect different parts of the body:

· Monoplegia affects only one arm or one leg

· Diplegia affects both arms or both legs

· Hemiplegia affects the arm and leg on one side of the body

· Triplegia affects both arms and one leg or both legs and one arm

· Quadriplegia affects both arms and both legs

Ataxic:

Having the opposite effect of spastic cerebral palsy, ataxic cerebral palsy causes the muscles to be weak and can cause difficulty walking and maintaining balance.

Athetoid:

In athetoid cerebral palsy the muscles alternate between being too weak and too tight. This can cause involuntary movements and make it difficult to stay upright.

Caring for a child with cerebral palsy:

Children with cerebral palsy require extensive medical treatment, therapy and long-term care. Physical, emotional, and cognitive impairment can range from mild to extreme, requiring a variety of treatment methods and approaches. Children with cerebral palsy often require:

· Physical therapy

· Speech therapy

· Occupational therapy

· Psychological treatment

· Surgery

· Medications to prevent seizures

· Full time in-home care or institutionalization

Source: http://www.24-7pressrelease.com/view_press_release.php?rID=38388

In some people muscles become very stiff and weak, and can affect their control of movement, others have some loss of control of their posture and tend to make unwanted movements, while others have problems with balance and speech.

Many people with cerebral palsy are hardly affected, others have problems walking, feeding, talking or using their hands. Some are unable to sit up without support and need constant enabling.

Some are of higher than average intelligence, others have moderate or severe learning difficulties. Most, like most able-bodied people, are of average intelligence.

Cerebral palsy is most commonly the result of failure of a part of the brain to develop, either before birth or in early childhood.

This is sometimes because of a blocked blood vessel, complications in labour, extreme prematurity or illness just after birth. Infections during pregnancy, or infancy and early childhood, can also cause the condition.

A special “gripper“ plate is designed to be attached to a bigger table. Wheel chair mobility can be severely limited which studies have shown have caused both physical and mental anguish to a Cerebral Palsy sufferer.

This lack of space has other negative manifestations as the required space needed for exercise is paramount in the treatment of the disease. It can be surmised that low income families with small apartments suffer much more than their rich counterparts.

If lack of space is acute laws have been enacted to ensure minimalistic maneuvering room for a Cerebral Palsy patient.

Source: http://www.lifesite.net/ldn/2007/oct/07102602.html

Researchers at Columbia University Medical Center have released the results of their latest study that shows the possibility that repeated courses of a drug normally used to improve the chance of survival in premature infants before they are born, may also have a detrimental effect by increasing the risk of cerebral palsy in those very same children it was designed to save.

The drug that was the subject of the study is a corticosteroid by the name of betamethasone. It is given to women who are at risk of having a premature baby in order to speed up the development of the baby's immature lungs. One course of the steroid treatment has been shown to be able to reduce the neonatal mortality rate and improve the lung function with very little risk to the infant.

It was the accepted practice for the obstetrician-gynecologist to frequently repeat the course of treatment using the steroids once a week for as long as 10 or 11 weeks, if the woman was still pregnant after she has received the first treatment. That is until the year 2000 when a panel from the National Institute of Health that was concerned with the lack of any information regard in the safety for this repeated dosing, suggested that the repeated courses of treatment should only be administered only to patients who were participants in clinical trials.

One of the first of the clinical trials set out to examine what the long term effects of the treatment was on the children. In the trial, the women who were still pregnant a week after their first treatment with corticosteroids were split into two groups, One group got further treatments, the other group got a placebo and this continued until the babies were born.

The study was conducted by members of the NIH-sponsored Maternal-Fetal Medicine Network. They followed a total of 556 infants who were at the Morgan Stanley Children's Hospital of New York-Presbyterian Hospital/Columbia as well as in 12 other sites across the country.

The researchers found that by the time they were 2 to 3 years old, the children from the two groups were all physically and neurologically identical, except for the fact that 6 out of the 248 children who were in the group that received the multiple doses of treatment, had been diagnosed with cerebral palsy. In the placebo group, 1 out of the 238 children had cerebral palsy. Each of the mothers of the 6 children from the corticosteroid group who had cerebral palsy had received a minimum of 4 treatments with the drug.

The difference between the number of children in each group with cerebral palsy is not that significant, but since the weekly courses had no long term benefit and had the potential to harm the child, they suggest that doctors do not administer weekly doses.

The lead researcher was Ronald Wapner, M.D., professor of obstetrics and gynecology, Columbia University Medical Center and attending obstetrician and gynecologist at New York-Presbyterian Hospital/Columbia.

Source: Columbia University Medical Center

As the principal and staff at West Hernando Middle School gear up for the new school year, the excitement on campus is tainted by a hint of disappointment, even uncertainty.

The school, which has received A's from the state, got a failing grade from the feds for the fifth straight year.

The problem, everyone agrees, is the method used to test more than two dozen special needs students. The federal government doesn't care about the test Florida uses. And its opinion counts.

Under the federal No Child Left Behind law, schools must show adequate yearly progress among all student groups, including minority, low-income and special needs students.

But how do you accurately measure the academic progress of students with cerebral palsy, Down's syndrome and autism?

How can a school consistently get A's from one agency and still be considered a failure?

Confused?

This summer, West Hernando Middle principal Joe Clifford has spent a lot of time on the phone with officials in Tallahassee and Washington. He's trying to get his school out of academic purgatory.

The stakes are high for him and his staff. He could be removed, the school reorganized and/or taken over by the state.

But more important is the fate of the students. West Hernando Middle is a low-income "center school" charged with educating some of Hernando County's most severely medically and developmentally handicapped middle school students. Other schools get special ed kids, but West Hernando has those with cerebral palsy, autism, Down's syndrome.

It's a responsibility that Clifford and his staff won't back down from. He points to successes like Kyle Chapman, a 16-year-old with cerebral palsy. Kyle, who heads to Central High this fall, uses a wheelchair and can't speak but communicates with his eyes and by facial expressions. During his four years at West Hernando, he had the chance to work with nondisabled schoolmates doing science and history projects. Kyle has gone with his classmates to football games and the movies, much to the delight of his parents.

"They've allowed my child to be as close to being a normal teenager as he will ever be," said Terry Chapman, Kyle's dad.

Unfortunately, Kyle's growth isn't the kind of progress that No Child Left Behind measures.

The law is up for reauthorization this fall. Many educators would prefer to see it die or be radically changed.

Meanwhile, Clifford and his staff are doing their best to comply while they celebrate the little victories. They're not necessarily the kind the feds will measure as they consider "adequate yearly progress."

But that doesn't mean they're any less important.

Source: http://www.sptimes.com/2007/08/19/Columns/Progress_is_more_than.shtml

AUSTRALIA will have one of the world's best tools for research into cerebral palsy from next week with the launch of a national register to record all cases. The scheme will, in time, create the world's largest databank of cerebral palsy cases, which should not only help researchers narrow the causes of the condition, but also help improve treatments for families.

Cerebral palsy -- a permanent disability that affects movement, caused by damage to the developing brain usually before birth -- affects about 700 babies in Australia each year and costs taxpayers $1 billion annually.

The national register will be launched on Tuesday by professor Fiona Stanley, who started Australia's first state-based cerebral palsy register in Western Australia in 1976, and has been lobbying for a national scheme ever since.

Details of babies with cerebral palsy will only be entered onto the register with the written consent of families involved.

Its creation has the backing of the Spastic Centre, which is encouraging parents to join. Spastic Centre CEO Rob White says there is "still a lot we don't know" about cerebral palsy. "We have a big job ahead of us and we're committed to it, but we need everyone's help," White says. "Potentially, the answer to preventing CP lies in the hands of Australians joining the register."

It is estimated that a child is born with CP in Australia every 18 hours. However, there is no test parents can have to let them know their child has suffered cerebral palsy, there is no cure, and in most cases the individual cause remains a mystery.

There are thought to be as many as 45 factors that can cause CP. However, Stanley says it is now thought to almost always have its origins during the pregnancy, not as a result of asphyxia during childbirth -- a finding she says has come "too late to save obstetrics". Many specialist obstetricians have been deterred from continuing to practise because of the sky-high legal payouts to cerebral palsy patients, who argued successfully in court that their injuries were the result of the negligence of the doctor in charge of their birth.

The most famous example of this was Sydney woman Calandre Simpson, who won over $14 million from doctor's insurer United Medical Protection in 2001.

"The first question a parent has when they have a diagnosis of cerebral palsy is: why did it happen to my child?" Stanley says. "That's the question we are asking with this National Cerebral Palsy Register."

The question was particularly pressing because existing state-based registers show CP incidence are becoming more common, Stanley says."We know it's (due to) increased survival of babies who would have died (before the era of paediatric intensive care)," she says. "But otherwise we don't know -- and we need to know." 



The other questions parents asked when told their baby has cerebral palsy are, is there anything else they could have done to prevent the condition, and what can they do to improve their baby's outcome. 



"They ask 'should I be in an early intervention program', or 'should we have Botox (for the baby)'," Stanley says. 



"What a national register would do is enhance research into management."



Although Western Australia and some states already have registers, a linked national scheme is important because of the relative scarcity of CP as a condition. 



Only about two babies per 1000 are born with cerebral palsy. With a relatively small 10 per cent share of the nation's annual 260,000 birth rate, Western Australia's CP register only has a pool of 25,000 births annually from which to base its register. 



While nobody wants more cases of cerebral palsy, researchers need larger samples from which statistically significant results can be derived. 



Western Australia's 30-year-old register is significantly older than those of other states. Victoria's register has been going for about half that time, while South Australia's register is about 10 years old. NSW and Queensland both have registers, but they have been running for less time. 



Stanley says putting all this data together "will have immediate benefits". "It will take a while for the register to get up," she says. "But it's a great model -- if we can do this for cerebral palsy, and we already do this for cancer, we can do it with other diseases, such as diabetes and other things that are rarer. 



"I think the parents of children with cerebral palsy deserve this register -- they are often neglected, and it's really important for services that we give (governments) accurate numbers (on people affected)."

Source: http://www.theaustralian.news.com.au/story/0,25197,22141645-23289,00.html

Women who want to ensure the neurological health of their unborn children would do well to avoid stress.

A new study conducted in mice suggests repeated exposure to even mildly stressful situations can increase the risk for cerebral palsy in the developing fetus.

The research was conducted in France by investigators who exposed pregnant mice to disrupted cycles of light and dark throughout their pregnancies. These mice were compared to a control group of mice that did not experience the ongoing stress. All of the developing fetuses were subjected to a form of brain injury similar to that seen in cerebral palsy in humans.

Upon birth, the brains of the newborn mice were examined to see if prenatal stress had any impact on the lesions. The lesions were about twice as large in the mice in the stress group than in the mice in the non-stress group.

The damage persisted as well. After the mice reached adulthood, the investigators tested their ability to navigate through a water maze, finding the mice exposed to stress in the womb performed significantly worse than mice not exposed to stress.

"Determining the impact of gestational stress on the incidence of cerebral palsy would be of paramount interest," study author Pierre Gressens, M.D., Ph.D., was quoted as saying. "Limiting stress during human pregnancy might prove to be a cost-efficient way to reduce the human, emotional, social and economic burden of cerebral palsy."

Source: http://www.drkoop.com/newsdetail/93/8016616.html

As a treatment for muscle stiffness in children with cerebral palsy, shots of botulinum toxin A, best known by the brand name Botox, are safe and produce measurable improvements in function, according to a new study. However, patients and their families may not perceive the improvements as very meaningful.

The muscles of people with cerebral palsy are often stiff, contract spontaneously and over-react to stimulation, a characteristic called spasticity. Injection of Botox helps to reduce spasticity and allows the person a greater degree of control over muscle movement.

Since the first report on the use of Botox to treat spasticity in children with cerebral palsy was published in 1993, there have been more than 100 articles addressing the intervention, note Dr Kristie Bjornson, of Children's Hospital and Regional Medical Center in Seattle, and colleagues.

However, impact of the treatment has been difficult to assess because of the scarcity of reliable measures of spasticity and problems in measuring changes in function in children with disabilities.

In a controlled study, Bjornson's team examined the effects of Botox shots versus placebo in 33 children with spastic diplegia - a form of cerebral palsy where both the arms and legs have abnormal stiffness. Outcomes were measured at baseline and 3, 8, 12, and 24 weeks after injection.

Overall, results showed that the physiologic and mechanical effects of treatment with Botox are "genuine and measurable" in children with spastic diplegia cerebral palsy.

"However, these effects may not create enough change in the patients' function or the families' perception of function to register as a meaningful improvement in their societal participation," the authors note.

"It is possible that these changes were too subtle to be recognised with conventional satisfaction measures," they write.

The investigators say their findings suggest that expectations about Botox shots should be realistic.

Source: http://uk.reuters.com/article/healthNews/idUKCOL56010920070705

Most children aged 8-12 years with cerebral palsy will have similar quality of life (QoL) to other children. The findings should guide social and educational policy to ensure that disabled children participate fully in society, conclude authors of an Article published in this week's edition of The Lancet. Professor Allan Colver, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Newcastle, UK and colleagues selected 1,174 children with cerebral palsy in seven European Countries, of which 818 participated in the study. Of these, 318 with severe intellectual impairment could not self-report (and will be subject to a separate study later), but 500 children self-reported their QoL using KIDSCREEN, an instrument which assesses quality of life across 10 categories. The researchers found that for children with cerebral palsy, type and severity of impairments did not affect QoL for in six KIDSCREEN categories: psychological wellbeing, self-perception, social support, school environment, perception of financial resources, and social acceptance. However they found that specific impairments were associated with poorer QoL in four catgories. Children with poorer walking ability had poorer physical wellbeing; children with intellectual impairment had lower moods and emotions and less autonomy, and children with speech difficulty had poorer relationships with their parents. Further they found that pain reduced children's QoL across all categories. The authors say: "Whereas specific domains of QoL with cerebral palsy are associated with specific impairments, QoL on most aspects of life is not associated with impairments and is therefore likely to be determined largely by social and environmental factors, although these might differ between children with cerebral palsy and those with no disability." From the point of view of a non-disabled adult, it may seem surprising that children with cerebral palsy view their QoL as similar to children in the general population. However from the child's perspective, their impairment is incorporated in their sense of self from birth, and they embrace growth, development and living with the same excitement as non-disabled children. The authors say: "Parents can be upset when their child is diagnosed with cerebral palsy, but they can now be reassured that most children with cerebral palsy who are capable of providing information when 8-12 years old experience similar QoL to that of other children their age." They conclude by saying that there is widespread acceptance of the need for disabled children to be integrated fully into society. They say: "The change now needed concerns attitudes. Pity and sorrow should not be directed to disabled children because our findings indicate they experience most of life as do non-disabled children. Therefore, maximum effort is needed to support the social and educational policies that recognise the similarity between the lives of disabled children and those of other children, and that ensure their rights as citizens, rather than as disabled children, to participate in society as fully as other children." In an accompanying Comment, Dr Olaf Dammann, Department of Pediatrics, Tufts-New England Medical Center, Boston, USA and Dr Michael O'Shea, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA, say: "The efforts of Dickinson and colleagues to understand quality of life in children with cerebral palsy are commendable. Their findings offer both reassurance to parents of children with this disorder and potential strategies to clinicians seeking to improve the quality of life for affected children. "Moreover, in their study Dickinson and colleagues provide food for thought for clinicians who offer guidance to parents of newborn babies at risk of cerebral palsy."

Source: http://www.news-medical.net/?id=27037

When life throws a curveball at a child with a disability, the Cerebral Palsy KIDS Center helps them sock it right back. The center on Eastern Parkway does that for about 300 children a week on an outpatient basis with help from the WHAS Crusade for Children, which kicks off its 54th annual appeal on radio and TV this weekend. The KIDS Center is a can-do kind of place that demonstrates how the donations people put in the boots of the firefighters from nearly 200 departments this weekend can dramatically change children's lives. The center is one of the many agencies, hospitals and projects in Kentucky and Southern Indiana that the WHAS Crusade for Children financially supports. It has raised $118 million since 1954. Most parents never dream they'll need anything like the KIDS Center. "The parents are pretty devastated when they come to see us," said David Ramer, executive director of the center. When they find out they're going to have a baby, they start planning right away on what colors to paint the baby's room and what name (to choose)," he said. "They never plan what they'd do if they had a problem. We're that planner for them." It's not easy and usually heartbreaking when parents first meet with the center's staff. "They're often not past tears and crying," Ramer said. He compared it to the stages dying people go through. "But instead of mourning a death, they're mourning the death of a perfect child. So they go through the anger, the guilt, until they understand and start accepting. That's when we can really start working with them," Ramer explained. Attitude is the first disability the center has to deal with. "When they come here, they're focused on the disability," Ramer said. "They have been told their child will not ever be able to do this or that . so they're looking at the negative side. Our first order of business is to turn that around . to begin helping them to see the abilities the child has . to try to get them to focus on possibilities and potential." "It felt like getting hit in the gut," said Jennifer Greulich, who with her husband, Don, learned their son, J.R., had cerebral palsy when he was a year old and couldn't sit up. "They didn't give you a lot of hope 30 years ago," said Greulich, who was a special education teacher working under a Crusade grant at a Bardstown, Ky., school at the time. "He was 4 or 5 years old when he started here in 1979," said Ramer, who has been at the center for 28 years himself. "J.R. has a severe form of palsy. He could walk but very awkwardly. He could talk, but it was difficult to understand him," Ramer recalled. "He had just about every therapy and program the Crusade helped fund over the years." Today, the young man is a university graduate and a chief financial officer at a local engineering firm, Ramer said. "My parents didn't know where to go," J.R. Greulich remembered. "It's made a huge difference in my life as well as my parents' because we were all learning at the same time and because no one knew what the future would hold." He is also now on the board of directors of the non-profit, private center. "I feel like whenever you are successful at what you do it's always important to give back because the center had given so much to me and my family," he said. "The center gave us the hope and him the confidence to keep trying," said Greulich's mother The Crusade has contributed more than $650,000 to the center and given it a grant every year since its beginning nearly a half century ago. "The Crusade support is so valuable," Ramer said, "because it supports programs that can basically help these people get through uncharted waters." The center has a hard-working staff of 28 people, including university-educated therapists and specialists. It helps children through age 21, but the major emphasis is from birth through 6. The average staffer has been there for eight years, but some have been on board for 15 or 20 years. They work with speech, physical therapy and other treatments and get the parents as well as the children to join in the process. At times, the center works with second generations of families. "When I was 9 or 10, I was clumsy, falling down and had a lot of pain," recalled Robynn Jones of Lanesville, Ind. Testing revealed she had a mild case of cerebral palsy, and she was referred to the center for help. She went on to graduate from college, marry, have two kids and adopt two foster kids who are now being helped by the center. Her 8-year-old daughter, Tori, had severe cerebral palsy from infancy, but the Joneses took her in as a baby and adopted her. The center's work, along with some medical procedures, has literally helped put the little girl on her feet. "She wasn't really walking at all, but now she can walk with a walker," her mother said. "She's made a lot of progress." Tori was on stage for last year's Crusade telethon. Jones and her husband, Doug, also adopted Phoenix, a boy with a brain injury who is 4. He's also involved in therapy and group exercises at the center, which helps children with all sorts of problems, from cerebral palsy to autism, brain injury, Down syndrome and spina bifida. "The Crusade is a vital part of helping keep the center current," Jones said. "We try to help the children come as close as they can to the skills they should have at their age," Ramer explained. Therapists teach children how to sit in a chair, to walk and talk . to feed and dress themselves . to make them as independent as possible." This year, Crusade funds built a special playground with equipment such as a wheelchair glider to help children learn skills outside where they can have some fun while learning. The center grew out of a grassroots agency formed in 1952 "because there was nothing in the community at all for kids with these kinds of disabilities," Ramer said. WHAS did a telethon for the fledgling center in 1952 and '53 that went on to expand into the Crusade for Children. It wasn't until the 1970s that the federal government stepped in and told states that their public schools had to provide an education for children with disabilities and special needs. "In the 1950s and '60s everybody was kind of on their own .," Ramer said. "The kids just stayed at home." A lot of that has changed because of a lot of people and agencies, including the Crusade, but the need is greater than ever "and our caseload keeps growing," Ramer said. The center doesn't turn children away. The parents pay for treatment on a sliding scale according to their income. Many can't afford anything, but they still get a helping hand, which is why the Crusade hopes people will put something in the outstretched hands of volunteers this weekend.

South Australian research which found a link between cerebral palsy and exposure to herpes viruses has been recognised as among the most significant of the past year by an international panel of neuroscientists. Work by the South Australian Cerebral Palsy Research Group, a joint initiative of the University of Adelaide and the Women's and Children's Hospital, is included in the latest progress report of the Dana Alliance for Brain Initiatives, which highlights the top findings in brain research. The research, which was earlier published in the British Medical Journal, supports the theory that exposure to certain viral infections shortly before and after birth can trigger brain da mage and the development of cerebral palsy. The group, led by Professor Alastair MacLennan, the Head of the University's Discipline of Obstetrics and Gynaecology, has since found common genetic susceptibility factors in children with cerebral palsy that may increase their vulnerability to exposure to infection that can da mage the developing brain before and after birth. The research was the only work on cerebral palsy to be recognised in the prestigious Dana Alliance report. Research scientist Dr Catherine Gibson was awarded her PhD for her contribution to the project and subsequently was named South Australia's Young Investigator of the Year for 2006. The study involved 443 children with cerebral palsy and 883 control babies born to Caucasian mothers between 1986 and 1999. Small dried blood samples taken within a few days of birth were used to test for the presence of neurotropic viruses, a group of viruses including the herpes virus, which can all cross the placenta and infect the fetus. Exposure to viral infection was common in all newborn babies, especially in preterm babies, implying that infection before birth may also be linked to preterm delivery. Herpes group B viruses were found more often in babies who were later diagnosed with cerebral palsy than in control babies. In fact, the risk of cerebral palsy was nearly doubled with exposure to herpes group B viruses. "This is the first study to positively link viral exposure during pregnancy with cerebral palsy," Dr Gibson said. "However, only a few of the fetuses that were exposed developed CP, and this suggests that some are more genetically susceptible. We are investigating this." Further studies also are investigating the possible causes of the link. Cerebral palsy is a permanent and often serious brain disorder which causes abnormal control of body movement or posture. Its causes are largely unknown and currently it cannot be prevented. The US-based Dana Alliance is a non-profit alliance of more than 260 leading neuroscientists committed to raising public awareness about the progress and promise of brain research.

Source: http://www.spiritindia.com/health-care-news-articles-9980.html

Deakin University is taking the global lead in improving the quality of life of children with cerebral palsy.

Dr Elise Davis and Professor Elizabeth Waters from Deakin's School of Health and Social Development have developed a world-first questionnaire aimed at determining if treatments for children with cerebral palsy improve their overall wellbeing, not just their mobility.

"Until now, there have been no questionnaires which evaluate how treatments impact on the lives of children with cerebral palsy. Evaluation has tended to be based only on measures of physical ability," Dr Davis said.

The questionnaire will help doctors assess whether treatments for cerebral palsy, such as the use of Botox and surgery, actually improve quality of life.

"Treatment can impact on a child's life in a number of ways," Dr Davis said.

"At the moment, we can only measure whether a treatment has increased a child's functioning. With our new questionnaire, we can also see whether treatment impacts on how a child feels about their life."

For the past four years Dr Davis has been working with clinicians from the Royal Children's Hospital and elsewhere around the world to better understand what impacts on the children's lives.

"We interviewed children and parents and asked them what they thought the children needed to have a good quality of life," Dr Davis said.

"While good physical health was important, other aspects of life were equally as important such as good relationships with family and friends, being involved in activities, being surrounded by a healthy family, being happy with themselves, getting on well at school, having access to the services they needed and being accepted by their community."

Dr Davis said that an interesting aspect of the work looked at the difference in the way children and adults consider what constitutes quality of life.

"Children see life differently to their parents," she said.

Dr Davis said that the children tended to report a higher quality of life than the parents.

"This has been shown in other research and might be explained by the fact that children have adjusted to their situation, or in fact, are not aware of what they could be perceived as missing out on.

"Furthermore, it is very difficult for anyone to assume what another person's quality of life is like. For children, because of age or cognitive ability, sometimes we have to rely on parent proxy reports."

The international significance of the questionnaire became apparent after Dr Davis presented it at the American Academy of Cerebral Palsy and Development Medicine Conference in Boston recently.

"We were really pleased that we got requests from all over the world for the questionnaire," Dr Davis said.

Dr Elise Davis is available for interview and can be contacted on (03) 924 46131 or 0422 108 133. Dr Davis can also put journalists in touch with a family willing to be interviewed.

Source: http://www.eurekalert.org/pub_releases/2006-11/ra-cwc111406.php

BACKGROUND: Cerebral palsy is an umbrella-like term used to describe a group of chronic disorders that affect a person's movement early in his or her life. These disorders are caused by damage to motor areas in the brain that control movement and posture. Early signs of cerebral palsy usually appear before 3 years of age. Cerebral palsy may be congenital or acquired after birth. There is no standard therapy that works for all patients. Drugs can be used to control seizures and muscle spasms; special braces can compensate for muscle imbalance. Surgery and mechanical aids are other treatments, and although there is no cure for CP, medical advancements have allowed patients to lead near-normal lives.

UNDERWATER TREADMILL: Don Morgan, Ph.D., an exercise physiologist at Middle Tennessee State University in Murfreesboro, has begun a study testing an underwater treadmill on kids with CP as part of physical therapy. Underwater treadmills were first used on horses and have since been used for rehabilitating athletes, but this is the first time they've been tested on those with movement disorders. Kids with CP fatigue easily when the walk or run, and Dr. Morgan is aiming to see whether walking on the treadmill will improve walking ability and endurance.

BENEFITS: Advantages of walking on a treadmill underwater -- instead of on land -- are that there is resistance from the water that improves leg strength, but the water is also supportive, so there's less joint stress. Warm water is also comfortable on the muscles. Dr. Morgan says this "combines strength and locomotion and does so in an endurance context." He says parents have reported changes in their kids like having more balance while walking, not falling as much, and having more energy to walk.

THE STUDY: As part of his trial, CP patients undergo three weeks of pre-testing, 10 weeks of testing on the treadmill, and then a few weeks of post-testing. In the beginning, kids start off walking in waist-level water, and the water level is gradually lowered over the course of the study, as well as increases in walking speed and duration. There is also a screen for kids to watch videos or DVDs while they walk.

FUTURE: Dr. Morgan says his study focuses on kids with CP who are independently mobile -- that is, they don't need walkers or wheelchairs. The underwater treadmill could potentially be studied in kids who aren't independently mobile and could see even greater benefits. The treadmill could also be tested in other kids and adults with other diseases that affect mobility -- like multiple sclerosis, muscular dystrophy and juvenile arthritis.

STORIES: Swimming, splashing, sliding ... most kids love the water, and 11-year-old Sarah Grace is no different.

But all the water works is actually physical therapy. Sarah Grace was born more than four months premature and weighed just over one pound. She was the smallest baby to ever survive at her hospital.

"She literally was a miracle. Half inch shorter than a Barbie doll," said Sara' Grace's mom, Teresa Harris...

...And Sara Grace has been beating the odds ever since. She was diagnosed with cerebral palsy at age 2 and is now part of a study on how an underwater treadmill -- first used on horses -- can help her build up leg strength and walk better.

"It's a challenge. It'd be a challenge for anybody," Don Morgan, Ph.D., an exercise physiologist at Middle Tennessee State University in Murfreesboro, explained. "They're demonstrating to themselves and to their families that, 'Hey, look at what I've been able to do. I've gotten stronger. I've gotten fitter,' and it's a wonderful thing to be proud of."

Dr. Morgan says the water resistance helps build leg muscles but doesn't strain the joints. Kids in the study have improved heart function and have more energy to walk. Dr. Morgan says next it could be tested in kids with CP who use walkers and wheelchairs and in other conditions that affect walking.

After using the underwater treadmill, Sarah Grace noticed a difference during a class trip to New York City.

Teresa said, "When we went down a flight of steps to use the restroom, and when we came back up she was taking them just like me. I couldn't believe it. 'Baby, look what you're doing!'"

Sarah Grace dreams of someday becoming a nurse or teacher. "I'm more of like an energetic person," she said. "I will help people when they need help." And for a girl who couldn't even walk -- and can now climb stairs -- anything's possible.

By Zev Gershon and Wayne Willoughby

When the parents of a child diagnosed with brain damage in the first year of life come to your office for help, the first question is usually whether the damage could have been prevented. If it was caused by an injury during the perinatal period (around the time of birth) and could have been avoided with a timely delivery—for example, if the health care providers had reacted to worrisome fetal heart rate tracings—your prospective clients could have a viable medical negligence claim. 

Birth-related brain damage can be caused by hypoxia and ischemia—decreased oxygen and blood flow to the infant’s brain. Defense experts often claim that this kind of brain damage—known as hypoxic ischemic encephalopathy (HIE)—is the result of unknown factors occurring during pregnancy. But the authors of a 2003 article published in the British medical journal The Lancet reported that “more than 90 percent of term infants with neonatal encephalopathy, seizures, or both, but without specific syndromes or major congenital defects, had evidence of perinatally acquired insults, and there was a very low rate of established brain injury acquired before birth.”1 In lay terms, this means that if a newborn suffers brain damage, it was probably caused by something that occurred near the time of birth.



Fetal heart rate tracings 



Generally speaking, HIE cases fall into two categories: those involving near-total asphyxia and those involving partial prolonged asphyxia during labor and delivery. Near-total asphyxia occurs suddenly after events such as a cord prolapse, uterine rupture, or acute placental abruption. Partial prolonged asphyxia occurs over a period of time and can be due to such events as a partial umbilical cord occlusion. 

Blood gas test results and radiological films can help determine whether the injury occurred around the time of birth, but fetal heart tracings are the key to identifying more precisely when the injury occurred. Brain damage due to near-total asphyxia is relatively easy to time to the labor and delivery period if tracings from the fetal heart monitor show there was a sudden deceleration of the heart rate to less than 110 beats per minute, a condition called bradycardia.2 

But even with partial prolonged asphyxia, you and your expert can look for telltale signs in the tracings that show injury was imminent—for example, when the tracing initially is reassuring and then becomes “nonreassuring” and gets progressively worse. 

In interpreting heart tracings, some experts believe that decreased variability of the fetal heart rate is paramount, while others believe that decreased (or increased) baseline and an absence of normal accelerations in the fetal heart rate following contractions are more important in determining the condition of the fetus.3 The key to timing injury based on fetal heart rate tracings is an understanding that a fetus has only a finite reserve—a limited time—to withstand a hypoxic condition. The injury occurs some period of minutes (the length of which depends on the amount of the fetus’s reserves) after the fetal heart rate deteriorates from a good tracing to a bad one or from a bad tracing to a worse one. The question is how long the fetus can withstand a hypoxic insult before succumbing to brain damage. 

It makes sense that a fetus with a perfectly normal (reassuring) heart rate tracing before a sudden deceleration or bradycardia begins will be able to hold up against a hypoxic insult longer than an infant who has a sudden deceleration after a period of nonreassuring tracings. One study concluded that an obstetrician has up to 18 minutes after an acute sudden insult to deliver a baby to prevent possible brain damage.4 A more recent study, however, found that a longer period of hypoxia may be required for brain damage to occur.5 

Expect the defense to produce medical witnesses who will say that use of fetal heart rate tracings has not led to a decrease in the rate of cerebral palsy; therefore, they are meaningless in determining when an infant suffered a brain-damaging injury. These witnesses ignore the fact that if one focuses on the incidence of cerebral palsy as a result of HIE, the rates of cerebral palsy have fallen with the use of fetal heart rate tracings.6 



Blood acid levels 



Any lawyer who handles birth asphyxia cases should be familiar withNeonatal Encephalopathy and Cerebral Palsy (NEACP), a monograph published in 2003 by the American College of Obstetricians and Gynecologists (ACOG) in conjunction with the American Academy of Pediatrics (AAP). It will become the basis of your opponent’s causation defense and should be addressed from the outset of your case investigation.7 

The NEACP asserts that four “essential” criteria must be met before birth-related asphyxia can be identified as the cause of cerebral palsy:

• 
  an umbilical cord arterial blood pH less than 7 with a “base deficit” greater than or equal to 12 mmol/L (millimoles/liter)8

• 
   


• 
  an early onset of encephalopathy


• 
  cerebral palsy of the spastic quadriplegic or dyskinetic type


• 
  exclusion of other etiologies

In the majority of HIE cases we have reviewed, the medical records reflect an early onset of encephalopathy, spastic quadriplegia, and the exclusion of other etiologies for the brain damage. As a result, our planned response to an anticipated NEACP defense usually centers on the umbilical cord blood gas analysis. 

When the laboratory report reflects that NEACP cord blood gas criteria are met, a health care provider will find it hard to defend the case on causation. If the laboratory results do not meet the criteria, the plaintiff must be prepared to explain why the jury should reject the laboratory report or reject the NEACP standard. 

Over the years, we have seen cases in which health care providers mishandled or mislabeled blood samples, resulting in unreliable blood cord gas results. In one case, the doctor drew blood from the placenta and improperly labeled it as umbilical cord blood. Direct evidence of such errors provides a ready explanation for why the NEACP criteria weren’t met. 

Even if there is no direct evidence of sampling error or lab error, there may be circumstantial evidence that the reported test results are unreliable and that an accurate reading of the cord blood gases would have met the NEACP criteria. 

For example, we have handled cases in which the fetus was in distress for a significant time before birth, but the umbilical cord blood pH at birth did not meet the NEACP criteria. Nevertheless, the initial arterial blood gases taken some period of time after birth were abnormally low even though the baby had undergone vigorous neonatal resuscitation and shown some improvement in his clinical condition. In other words, the blood gases taken 30 or 45 minutes after delivery were worse than those taken at birth—the opposite of the result one would expect when there was a significant period of distress before birth and proper resuscitation and clinical improvement after birth. 

Under these circumstances, neonatology experts opined that the reported umbilical cord blood gas results were probably wrong, and an accurate measurement would have met the NEACP criteria. These experts cite studies showing that arterial pH will fall about .04 units per minute in the presence of total asphyxia—in other words, it takes 10 minutes for a pH of 7.4 to fall to 7.9 

Even if an infant’s umbilical pH is 7 or above, he or she may still suffer HIE.10 Acidosis in the tissues due to lack of oxygen does not necessarily result in acidemia reflected by a low blood pH, especially when heart rate circulation is decreased.11 The decrease in heart rate circulation will be reflected in the fetal monitor strips. Therefore, even if the umbilical cord pH is 7 or above, if the fetal heart tracings reflect decreased heart rate circulation, you may still be able to time the injury to the labor and delivery period. 

If the umbilical cord blood pH is 7 or above but the base deficit meets the NEACP criterion—it is greater than or equal to 12 mmol/L—then a study by Michael Ross may be useful in proving causation. Ross concluded that “base excess values have a significantly greater usefulness than umbilical cord pH values” for timing HIE to labor and delivery.12 

Ross found that fetal stress (for example, repetitive, severe variable decelerations) may reduce the buffer base by about 1 mmol/L every 30 minutes; subacute fetal compromise may reduce the buffer base by 1 mmol/L every 6 to 15 minutes; and acute, severe compromise (for example, terminal bradycardia) may reduce the buffer base by as much as 1mmol/L every 2 to 3 minutes.13 

So even if the pH does not meet the NEACP criterion, a neonatologist or pediatric neurologist may be able to opine to reasonable medical certainty or probability when HIE began by applying the Ross algorithm to the reported base-deficit level and referring to an obstetrician’s opinion about the timing and nature of the fetus’s bradycardia. You can provide evidence of causation by showing that the injury is tagged to a point in time after which delivery should have occurred under the standard of care. 



Radiological studies 



Generally speaking, a child who has had a devastating hypoxic insult during labor and delivery initially will have a normal brain scan because the abnormality will not appear on the scan taken right after the injury. Also, the child will initially have a normal head circumference, but during the weeks and months following birth, the head fails to expand normally, and the child becomes microcephalic due to abnormal brain growth caused by the hypoxic insult. 

While no single brain scan can time injury to the exact minute or hour, a group of brain studies can be used to show whether the injury occurred before, during, or after birth. If the injury occurred before birth, one would expect to find advanced abnormalities on brain scans (and possibly an abnormally small head circumference at birth, depending on how long before delivery the injury occurred). Brain scans of babies who have suffered HIE near the time of birth usually reflect—at most—cerebral edema (brain swelling) to indicate an injury has occurred. 

Whether dealing with acute near-total or partial prolonged asphyxia, the defense will probably try to use an ultrasound, CT scan, or MRI of the brain taken during the child’s first day of life to undermine causation. Some defense-oriented medical witnesses rigidly claim that it takes at least 24 hours after an HIE event for any anomaly to appear on a brain study. They say that if a sonogram of the brain performed at 12 hours of life shows some brain swelling, then the brain injury must have occurred at least 24 hours before the study was taken (12 hours before birth). Such testimony can be a substantial hurdle to overcome. 

However, several studies have found that cerebral edema may appear within 24 hours after the injury occurred.14 Before using this literature, it is wise to have the defense medical witness clearly state—on the record—that cerebral edema will never show up on a brain scan within 24 hours of a birth-related brain injury. Otherwise, the defense witness will use the fallback position that that some edema may show up in less than 24 hours, just not the amount of edema shown on the brain scan in your case. 

Sometimes defense-oriented witnesses in the “no edema in 24 hours” camp will point to a “slit-like” appearance of the infant’s brain ventricles on the initial sonogram as evidence of edema (and thus an injury occurring 24 hours earlier). Although cerebral edema after an acute insult may compress the ventricles of a newborn’s brain and create the slit-like appearance, or even obliterate the ventricles altogether, one study reflects that slit-like ventricles occur in 62 percent of newborns with no cerebral edema.15 So if the only abnormal finding on the initial sonogram of the brain is slit-like ventricles, you can argue that the defense cannot use this finding to time the injury. 

The defense may also look to radiological studies for signs of periventricular leukomalacia (PVL), a condition marked by damage surrounding the brain ventricles, to support the assertion that the baby’s injuries are unrelated to HIE. PVL is usually described as an injury of prematurity, because many premature babies have the condition. Therefore, when a term baby has both HIE and PVL, defense witnesses will point to the PVL to claim that the injuries had to be unrelated to birth. 

Yet the renowned pediatric neurologist and author Joseph Volpe reports that PVL has been found in one-third to one-half of term infants who have suffered oxygen deprivation during labor and delivery.16 So the presence of PVL does not necessarily push the time of injury back from the perinatal period to the prenatal period. 



Nucleated red blood cells 



The issue of nucleated red blood cells (NRBCs) comes up in about half of the depositions we take. An NRBC is an immature red blood cell manufactured in the bone marrow. Some defense experts still try to time birth injuries based on the rise and fall of NRBCs, usually by claiming that insufficient time elapsed between labor and the newborn’s initial blood studies to account for the number of NRBCs found in the studies. Such experts can be confronted with the medical literature and even the NEACP. 

The NEACP reports that the data on the question of NRBCs is conflicting and that “The clinical utility of these measurements to determine the timing of neurologic injury should be considered investigational.”17 Other authors have written that NRBCs are unrelated to brain injury.18 Moreover, there is literature reporting quick rises in NRBC count shortly after an acute stress to the fetus—for example, in less than 1 1/2 hours after the insult.19 

Be careful, though, not to equate a rise in the NRBC count with the beginning of brain damage. While it is clear that asphyxia may cause elevated counts, it is also clear that not all asphyxia leads to brain injury. 



Seizures



In the past, defense medical witnesses often timed brain damage to the occurrence of the infant’s first seizure. This defense does not come up often now, but as with other fashion trends, it might resurface. 

Volpe reports that after an acute birth-related HIE event, seizures can be expected to occur by 6 to 12 hours after birth in 50 percent to 60 percent of the cases, and by 12 to 24 hours after birth in 15 percent to 20 percent of the cases.20 We emphasize the word “by” to stress the importance of reading the medical literature carefully. 

One well-credentialed defense pediatric neurologist we know has consistently testified that after an acute HIE event, it took 6 to 12 hours for seizures to occur, claiming Volpe as the basis for his opinion. So if a baby seized at two hours of age, this neurologist would testify that the injury must have occurred at least four hours before delivery. Not only did this expert misquote Volpe, he ignored literature that specifically says birth injury cannot be timed by reference to the onset of neonatal seizures.21 

Occasionally, a defense expert cites EEG tracings (showing what appears to be a more developed and chronic pattern of brain damage than an acute process) taken after birth to support an opinion that an injury occurred long before birth. Generally, it may be true that if a certain pattern persists, it may represent a chronic injury, whereas a worsening or improving pattern may represent a more acute phenomenon.22 Yet, the studies we are aware of attempt to time injuries by EEG tracings only in premature infants23; in the term baby, these studies are of questionable relevance. 



Meconium 



The defense may produce experts who will show that the baby or the placenta was stained with meconium, the infant’s first feces while still in the womb. Meconium in the amniotic fluid is a sign that the baby was under stress during labor and birth. 

Even if it can be shown that the meconium was produced many hours before birth, this does not necessarily rule out a birth-related brain injury. Fetal stress of a degree sufficient to produce meconium usually is not sufficient to produce brain damage. Nonetheless, if you have to fight the battle of timing by meconium staining, one reference is Benirschke’s placental pathology textbook that reports that staining of the outer amnion of the placenta can occur in an hour, the deeper chorion layer of the placenta within three hours, and the infant’s fingernails in four to six hours.24 Thus, the soft skin of a baby takes between one and four hours to stain. 

The attorney who investigates a claim on behalf of a child who suffered catastrophic injury at birth due to medical negligence faces many challenges. The battle will be fought on all fronts—standard of care, causation, injury, and damages—and at great expense. This is not a challenge that every attorney should take on, but for those willing and able to study the medical literature and give their client’s cause full effort, there is no greater satisfaction than pursuing justice for a child. 



Zev T. Gershon, a physician and lawyer, and Wayne M. Willoughby are partners in Gershon, Willoughby, Getz & Smith in Owings Mills, Maryland. © 2006, Zev T. Gershon and Wayne M. Willoughby.



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Notes

• 
  Frances Cowan et al., Origin and Timing of Brain Lesions in Term Infants with Neonatal Encephalopathy, 361 LANCET 736, 740 (2003).


• 
  F. GARY CUNNINGHAM ET AL., WILLIAMS OBSTETRICS 335 (21st ed. 2001).


• 
  See Jeffrey P. Phelan & Joo Oh Kim, Fetal Heart Rate Observations in the Brain-Damaged Infant, 24 SEMINARS IN PERINATOLOGY 221 (2000). Dr. Barry Schifrin, a popular defense expert, believes he can distinguish on a fetal heart rate tracing the difference between a hypoxemic but uninjured fetus and an injured but nonhypoxic fetus. See Barry S. Schifrin, The CTG and the Timing and Mechanism of Fetal Neurological Injuries, 18 BEST PRACTICE & RES. CLINICAL OBSTETRICS & GYNECOLOGY 437 (2004).


• 
  Anna S. Leung et al., Uterine Rupture After Previous Cesarean Delivery: Maternal and Fetal Consequences, 169 AM. J. OBSTETRICS & GYNECOLOGY 945 (1993).


• 
  That later study looked at 54,867 births between 1990 and 1995. Among those births, there were 11 uterine ruptures. Five of those 11 births involved bradycardias lasting more than 18 minutes and up to 37 minutes. One child was lost to follow-up, but none of the others sustained permanent neurological damage. Cydney Afriat Menihan, Uterine Rupture in Women Attempting a Vaginal Birth Following Prior Cesarean Birth, 18 J. PERINATOLOGY 440, 441-42 (1998).


• 
  See Julie Smith et al., The Continuing Fall in Incidence of Hypoxic-Ischemic Encephalopathy in Term Infants, 107 BRIT. J. OBSTETRICS & GYNAECOLOGY 461 (2000).


• 
  Other authors have discussed at length the shortcomings of the NEACP; therefore, this article confronts the NEACP only on the issue of umbilical cord blood gas. See generally Dov Apfel, Keep Junk Science Out of Cerebral Palsy Cases, TRIAL, May 2004, at 46.


• 
  A “base deficit” occurs when bicarbonate (HCO3) concentration decreases to below normal. HCO3 levels decrease as the body uses bicarbonate to buffer organic acid in an attempt to maintain a normal pH level. CUNNINGHAM ET AL., supra note 2, at 390-91.


• 
  See, e.g., Ronald E. Myers, Two Patterns of Perinatal Brain Damage and Their Conditions of Occurrence, 112 AM. J. OBSTETRICS & GYNECOLOGY 246 (1972).


• 
  See, e.g., Robert C. Goodlin, Do Concepts of Causes and Prevention of Cerebral Palsy Require Revision?, 172 AM. J. OBSTETRICS & GYNECOLOGY 1830 (1995); T. Murphy Goodwin, Clinical Implications of Perinatal Depression, 26 OBSTETRICS & GYNECOLOGY CLINICS N. AM. 711 (1999).


• 
  See Marcus C. Hermansen, The Acidosis Paradox: Asphyxial Brain Injury Without Coincident Acidemia, 45 DEVELOPMENTAL MED. & CHILD NEUROLOGY 353 (2003); Jeffrey P. Phelan et al., Birth Asphyxia & Cerebral Palsy, 32 CLINICS PERINATOLOGY 61, 64 (2005); Schifrin, supra note 3.


• 
  Michael G. Ross & Rageev Gala, Use of Umbilical Artery Base Excess: Algorithm for the Timing of Hypoxic Injury, 187 AM. J. OBSTETRICS & GYNECOLOGY 1 (2002).


• 
  Id. at 8.


• 
  See PAUL GOVAERT & LINDA S. DE VRIES, AN ATLAS OF NEONATAL BRAIN SONOGRAPHY 241 (1997) (cerebral edema can occur “in the first hours of life”); PEDIATRIC NEURORADIOLOGY 251 (William S. Ball Jr. ed., 1997) (cerebral edema can occur “as early as the first day”); Alastair MacLennan, A Template for Defining a Causal Relation Between Acute Intrapartum Events and Cerebral Palsy: International Consensus Statement, 319 BRIT. MED. J. 1054, 1058 (1999) (cerebral edema can occur “within 6-12 hours”); N.K. Anand et al., Neurosonographic Abnormalities in Neonates with Hypoxic Ischemic Encephalopathy, 31 INDIAN PEDIATRICS 767, 769, 772 (1994) (cerebral edema can be found on “day one of life”); A. James Barkovich, MR and CT Evaluation of Profound Neonatal and Infantile Asphyxia, 13 AM. J. NEURORADIOLOGY 959 (1992) (cerebral edema can be found “less than 24 hours after injury”).


• 
  Marilyn J. Siegel et al., Hypoxic-Ischemic Encephalopathy in Term Infants: Diagnosis and Prognosis Evaluated by Ultrasound, 152 RADIOLOGY 395 (1984).


• 
  JOSEPH J. VOLPE, NEUROLOGY OF THE NEWBORN 349, 353 (4th ed. 2001). See also Goodlin, supra note 10, at 1836.


• 
  AM. C. OBSTETRICIANS & GYNECOLOGISTS & AM. ACAD. PEDIATRICS, NEONATAL ENCEPHALOPATHY AND CEREBRAL PALSY: DEFINING THE PATHOGENESIS AND PATHOPHYSIOLOGY 59 (2003).


• 
  See, e.g., Shannon E.G. Hamrick et al., Nucleated Red Blood Cell Counts: Not Associated with Brain Injury or Outcome, 29 PEDIATRIC NEUROLOGY 278 (2003).


• 
  See, e.g., Kurt Benirschke, Placenta Pathology Questions to the Perinatologist, 14 J. PERINATOLOGY 371, 374 (1994).


• 
  VOLPE, supra note 16, at 333-34.


• 
  See, e.g., Myoung Ock Ahn et al., Does the Onset of Neonatal Seizures Correlate with the Timing of Fetal Neurological Injury?, 37 CLINICAL PEDIATRICS 673 (1998).


• 
  DAVID K. STEVENSON & PHILIP SUNSHINE, FETAL AND NEONATAL BRAIN INJURY 181 (1989).


• 
  See, e.g., Kazuyoshi Watanabe et al., Neonatal EEG: A Powerful Tool in the Assessment of Brain Damage in Preterm Infants, 21 BRAIN & DEVELOPMENT 361 (1999).


• 
  KURT BENIRSCHKE & PHILIP KAUFMANN, PATHOLOGY OF THE HUMAN PLACENTA 295 (3d ed.1995).

A medical breakthrough is underway at the Nebraska Medical Center as researchers try to help children with cerebral palsy and other motor delays live a normal life.

The goal of the study is to help these children by learning a basic movement.

At 18 months, Robin Ventura couldn't crawl, eat by himself or even play without someone holding him up. Cerebral palsy slowed his ability to sit.

"A typically developing baby could do it, no problem," said physical therapist Reggie Harbourne.

Harbourne says the act of sitting is the foundation for nearly every motor and cognitive development.

Harbourne takes Ventura through a series of revolutionary physical therapy routines she believes will help teach him how to sit.

Sam Hardy recently completed three months of Harbourne's program.

"It's just so great, because he is so much more independent when he learned to sit and obvious, he's crawling and pulling himself up now," said Paige Hardy, Sam's mother. "We just really feel without that he would not be where he is today."

Ventura's parents are hoping their son will have similar results.

Harbourne is still in the beginning stages of her study, but she hopes the progress they make now will make a difference for children in the years to come.

Click here or call 559-6415 for more information.

Everything was going fine for heavily pregnant Christi Wall. But then her baby stopped kicking.

The baby wasn't getting enough oxygen and was at risk of brain damage, said Wall of Pinnacle. Doctors at Forsyth Medical Center delivered her daughter Anna by emergency Caesarean section and treated Anna's asphyxia by lowering her body temperature.

This helped protect Anna from possible brain damage from the asphyxia, doctors said.

Hospitals are using more radical therapies such as hypothermia treatment to treat babies, doctors said. Other new treatments proving successful include the use of robotic devices and more microsurgery equipment.

The hypothermia therapy, developed for children late last year, "is really the first effective treatment" for children with asphyxia, or a lack of oxygen, said Robert Dillard, the director of the Neonatal Intensive Care Unit at Forsyth Medical Center. "It's really a major step for this group of babies," he said. Dillard is also a professor of neonatology at Wake Forest.

Asphyxia in newborns occurs when the body receives too little oxygen before birth. It can damage the brain, heart, blood vessels and kidneys. It can be caused by inadequate oxygen in the mother's blood or poor oxygen circulation to the placenta.

Forsyth Medical Center, Brenner's Children's Hospital, part of Wake Forest University Baptist Medical Center, and Duke University School of Medicine are the only three state medical centers using the therapy, physicians said. Forsyth Medical Center has so far treated two children using the hypothermia therapy, Dillard said.

Forsyth Medical Center and Wake Forest collaborate on neonatology services.

Using hypothermia is a significant departure from how physicians were treating asphyxia, said Michael O'Shea, the chief of the medical center's neonatology division. The medical center had been treating the condition partly by warming babies with a radiator.

Cooling the body reduces swelling of the brain, Dillard said. The procedure was reported in the New England Journal of Medicine late last year and adopted in the hospital shortly after.

The device, the Blanketrol II Hyper-Hypothermia System, is made by Cincinnati Sub-Zero Products Inc., in Ohio. It involves wrapping a baby in a cooling blanket and lowering its body temperature to about 92 degrees.

"It's certainly very exciting and likely to prevent some of the cases of cerebral palsy that could occur" in children with asphyxia, O'Shea said.

Christi Wall's daughter, born Dec. 26, initially had no heartbeat, she said. "I didn't hear her cry," Wall said. "I knew something wasn't right. I knew if I heard her cry, she would be OK."

The hospital's staff revived Anna, but feared that the lack of oxygen to her brain would cause serious complications. She was put inside the Blanketrol II for 72 hours.

After praying in the hospital "we kept a pretty positive attitude and kept believing for the best and day by day we kept getting good news," said Cliff Wall, Christi's husband.

Fifteen days after her birth, Anna was allowed to leave the hospital, Christi Wall said. Anna must still undergo regular checkups, but seems to be doing fine, she said.

The therapy is just one of the new ways doctors hope to treat very small children. They predict that advancing medical technology will allow them to perform better surgeries on babies, particularly noninvasive surgeries. Also, more equipment and medical circuitry is being miniaturized for use in children, O'Shea said. "Each generation of neonatalogists believe we have gone as far as we can go, and then something happens to change the technology," Dillard said.

"Right now, we're saying 'we've gone as far as we can go.'"

Avon- The printer is out of paper, and Tim Caskey is about to catch hell.

"You're out of paper, old man!" Harvey Graham snarls in mock anger. "Tim's getting old. He can't remember things anymore."

Caskey chuckles and shakes his head. He's used to the abuse.

In fact, he kind of likes it.

The good-natured banter is all part of Caskey's 4-year-old Computer Skills Development Program at Our Lady of the Wayside, a nonprofit agency that provides services to more than 180 people with developmental disabilities such as cerebral palsy and mental retardation.

The program teaches mentally disabled adults basic skills, including writing and sending e-mail and navigating the Internet. Touch-screen technology, jumbo mouses and extra-big keyboards help even the most severely disabled claim a small piece of the information superhighway.

More than two dozen adults from across Northeast Ohio travel to Avon on Tuesday or Thursday nights or Saturday afternoons to work on their typing skills, make holiday decorations for their group homes, correspond with friends and family or visit their favorite celebrity Web site.

The class represents a crack through which they can temporarily escape their disabilities and see the light of the outside world.

"We have a waiting list," says Caskey, a special-education teacher by day at Cleveland's Audubon School and the sole instructor of the computer-skills program since its inception. "It's important to them that their housemates know that they're in this class. It's got a certain cachet to it."

No one can recall a program exactly like Caskey's class - in Ohio or anywhere else. 

"We're not aware of anything like it," says Terry Davis, president and chief executive of Our Lady of the Wayside. "It's unique, and we've been very pleased with the results."

Truth is, the uniqueness of the program is also a sort of disadvantage. Foundations and other potential funding sources don't know how to categorize the class.

Is it an adult special-needs program? A technology program? An education program?

"It's unusual, and that's what's made it difficult to find foundation help," Caskey says.

But with donations from the Stocker and Nordson Corp. foundations, the program has maintained and slowly grown. There are now 28 students.

The genesis of the program is as unusual as the class itself. Five years ago, Caskey was moonlighting at a Micro Center computer store, teaching a free beginners class that the retailer offered to its customers.

A man in the class looked as if he would rather be anywhere else in the world. Caskey figured the guy's wife forced him to attend.

"The guy was just bored to tears," Caskey recalls. "I thought, 'Man, I'm losing this guy.' "

But Caskey hadn't lost the guy, who turned out to be Dick Griffin, then a member of Our Lady of the Wayside's board of directors. Griffin envisioned a similar kind of class for the agency's clients, and he asked Caskey to come to his office the next week and talk.

Six months later, Caskey launched the program as a six-week pilot. It was an immediate success and has continued ever since. 

On this winter evening, Craig Breeden quietly composes an e-mail. Ron Dobrinski and Patty Culley huddle at another computer, engrossed in a spirited game of "Spin and Win." The cantankerous Graham is searching the Internet for information about commercial motor coaches, one of his many interests.

He has chosen the country and western tunes that fill the classroom this night.

"It's a balancing act," Caskey says later. "You try to keep everyone engaged."

Skill levels vary dramatically. For some, printing out a snowman or wreath for a wall decoration is a major accomplishment. For others, there are few boundaries.

One student, for instance, has apparently memorized a Web site that features home listings. Ask him what a three-bedroom, two-bath, 2,220-square-foot home on West 227th Street goes for, and he will give you a remarkably accurate quote - depending on whether it has air conditioning and a finished basement.

"You get a whole new appreciation of how this little computer works," says Caskey, pointing to his head.

What the class means in the lives of his students - and their families - has startled Caskey from time to time. Several years ago, a student named Reed died. At his funeral, Caskey was approached by Reed's younger sister, a Denver school teacher. She hugged him.

"He would e-mail his sister, and she'd e-mail him back," Caskey says. "She told me she found out more about her brother through those e-mails than she had ever known before."

Unfortunately, the woman had lost her brother's e-mails. But Caskey was able to retrieve the files, print them and send them to her.

He received a gracious thank-you note in return.

^^^^^^^^^^^^^^^^^^^^^^^^^ "It's gratifying," Caskey says. "They are exceptional people. I've learned far more from them than I could ever teach these guys."

Source: http://www.cleveland.com/news/plaindealer/index.ssf?/base/lorain/113610792979670.xml&coll=2&thispage=1

A new Australian study has found that exposure to certain viral infections shortly before and after birth, the perinatal period, is associated with cerebral palsy.

The findings support the theory that infections during this period can trigger brain damage and the development of cerebral palsy.

The study at the Adelaide Women's and Children's Hospital in Australia involved 443 children with cerebral palsy and 883 control babies.

All babies were born to white mothers between 1986 and 1999.

Within a few days of birth blood samples taken were used to test for the presence of a group of viruses including herpes viruses, known as neurotropic viruses, which can cross the placenta and infect the fetus.

Apparently exposure to viral infection was common in all newborn babies, especially in preterm babies, implying that infection before birth may also be linked to preterm delivery.

The team found that Herpes group B viruses were found more often in babies who were later diagnosed with cerebral palsy than in control babies.

The risk of cerebral palsy was in fact almost double with exposure to herpes group B viruses.

The authors say that despite some limitations, the study shows that perinatal exposure to neurotropic viruses is associated with preterm delivery and cerebral palsy.

They are apparently planning further studies in order to investigate the possible causes of this link.

The study is published online by the British Medical Journal.

Source: http://pregnancyandbaby.com/read/articles/5915.htm

Adult stem cell therapy quickly and significantly improves recovery of motor function in an animal model for the ischemic brain injury that occurs in about 10 percent of babies with cerebral palsy, researchers report.

Their findings are being presented during the 34th annual meeting of the Child Neurology Society Sept. 28-Oct. 1 in Los Angeles.

"We found that when these cells, provided by Athersys, Inc., were injected directly into the brain, it significantly improves the outcome in the animals," says Dr. James E. Carroll, chief of the MCG Section of Pediatric Neurology and the study's principal investigator.

Athersys, Inc., a Cleveland-based biopharmaceutical company pursuing cell therapy programs in cardiovascular disease, stroke, cancer and other diseases, funded the research in which about 200,000 cells were injected directly into the brain injury site.

The adult stem cells, called multipotent progenitor cells because of their ability to make different types of tissue, were taken from the bone marrow of rats and expanded by Athersys for dosing in the injury model, Dr. Carroll says.

Seven days after injury, stem cells were injected directly into the brains of 22 animal models through a tiny hole in the skull. As with human transplant recipients, the animals were placed on immunosuppressive therapy to avoid rejection, although Athersys' experience in multiple animal models for human disease has shown donor-recipient matches and immunosuppression are not required.

Behavioral tests seven days after transplant showed a trend toward recovery and significant recovery by day 14. About 1 percent to 2 percent of the transplanted cells actually survived, apparently replacing some cells destroyed by the original injury, while others helped injured cells recover.

"Recovery might be even more important in baby brains than forming new cells," Dr. Cesario V. Borlongan, neuroscientist at MCG and the Veterans Affairs Medical Center in Augusta, says of newborn brains that recover more readily than adult brains. Dr. Borlongan, a co-author on the abstract, is exploring stem cell therapy's potential for aiding stroke recovery, including the use of clinical-grade human adult cells provided by Athersys in a stroke animal model. About 80 percent of strokes are caused by clots that cause ischemic brain injury similar to that of cerebral palsy.

The MCG researchers have evidence that the healing benefit of stem cells comes from nourishing factors they secrete. The cells seem attracted by chemokines, growth factors that rally to an injury site, Dr. Carroll says. Next steps include looking at longer-term recovery and at whether surviving stem cells actually function as brain cells, networking with other cells by forming points of communication called synapses.

Perhaps most importantly, they also will look at whether stem cells produce similar results when they are given intravenously rather than injected directly into the injury site, Dr. Carroll says. "If the ideal way of doing it scientifically doesn't work, why move on from here?" he says. "Now that we know it does work, we are going to look at different methods of injection to try and find the one that is the easiest. We think the chemokines, at least in part, attract the cells, so we hope it will work even when given through the bloodstream."

He notes that the therapy likely will need to be done soon after injury. Whether this therapy could help the some 500,000 people in the United States living with cerebral palsy still must be explored, he says.

He and Dr. Borlongan note much work needs doing before their findings might move to clinical trials. But they are optimistic that the availability of clinical-grade cells would expedite such a move.

"We hope this will eventually be something that can be used in the neonatal intensive care unit in babies with severe asphyxial brain injuries," Dr. Carroll says of cerebral palsy patients. He and other pediatric neurologists and neonatologists already have begun to discuss such possibilities.

"These results suggest another promising avenue for stem cell therapy, this time to help newborn babies recover from a potentially devastating injury of birth for which there currently is no treatment," says Dr. Gil Van Bokkelen, chairman and chief executive officer of Athersys.

Ischemic brain injury accounts for about 10 percent of cerebral palsy, broadly defined as brain injury that occurs before or during birth, and about 80 percent of strokes. For every 1,000 babies born, one or two have cerebral palsy, with consequences ranging from undetectable to major physical and mental impairment. Currently there is no treatment to repair or reduce the damage of cerebral palsy; tPA was approved in 1996 by the U.S. Food and Drug Administration as the first stroke treatment to reduce the damage of ischemic injuries.

Co-authors on the study include Dr. David Hess, chair of the MCG Department of Neurology; Dr. Lin Xu, research scientist; Drs. Noriyuki Matsaukawa, Guolong Yu, Takao Yasuhara and Koichi Hara, postdoctoral fellows; and Athersys scientists Robert Mays, Jim Kovach and Robert Deans.

Source: http://www.brightsurf.com/news/headlines/view.article.php?ArticleID=21194

Objective. The purpose of this study was to evaluate the relationship between cerebral palsy (CP) diagnoses as measured by the topographic distribution of the tone abnormality with level of function on the Gross Motor Function Classification System (GMFCS) and developmental performance on the Bayley Scales of Infant Development II (BSID-II). It was hypothesized that (1) the greater the number of limbs involved, the higher the GMFCS and the lower the BSID-II Motor Scores and (2) there would be a spectrum of function and skill achievement on the GMFCS and BSID-II Motor Scores for children in each of the CP categories.

Methods. A multicenter, longitudinal cohort study was conducted of 1860 extremely low birth weight (ELBW) infants who were born between August 1, 1995 and February 1, 1998, and evaluated at 18 to 22 months' corrected age. Children were categorized into impairment groups on the basis of the typography of neurologic findings: spastic quadriplegia, triplegia, diplegia, hemiplegia, monoplegia, hypotonic and/or athetotic CP, other abnormal neurologic findings, and normal. The neurologic category then was compared with GMFCS level and BSID-II Motor Scores.

Results. A total of 282 (15.2%) of the 1860 children evaluated had CP. Children with more limbs involved had more abnormal GMFCS levels and lower BSID-II scores, reflecting more severe functional limitations. However, for each CP diagnostic category, there was a spectrum of gross motor functional levels and BSID-II scores. Although more than 1 (26.6%) in 4 of the children with CP had moderate to severe gross motor functional impairment, 1 (27.6%) in 4 had motor functional skills that allowed for ambulation.

Conclusions. Given the range of gross motor skill outcomes for specific types of CP, the GMFCS is a better indicator of gross motor functional impairment than the traditional categorization of CP that specifies the number of limbs with neurologic impairment. The neurodevelopmental assessment of young children is optimized by combining a standard neurologic examination with measures of gross and fine motor function (GMFCS and Bayley Psychomotor Developmental Index). Additional studies to examine longer term functional motor and adaptive-functional developmental skills are required to devise strategies that delineate therapies to optimize functional performance.

Souce: http://pediatrics.aappublications.org/cgi/content/abstract/116/1/123

Studies Currently Seeking Patients: http://clinicaltrials.gov/search/term=Cerebral%20Palsy

Courtney Fuller looks as if she could either be undergoing some medieval torture or training to become an astronaut. Actually, elements of both scenarios apply as the 9-year-old girl stands inside a metal cage, her body encased in a corset-like suit that's tethered to the bars by elastic cords.

The Lakeland girl, who was born with cerebral palsy, is in the midst of an intensive, four-hour therapy session that can seem torturous as it challenges the innate weaknesses of her body's muscles. The therapy resembles astronaut training in that Courtney's body is given a new conception of balance -- as if she were being introduced to a different level of gravity.

"It helps me to put my feet flat," Courtney says. "I can walk a lot better."

American society tends to regard disorders like cerebral palsy only in terms of the need for a cure. But for Courtney and others born with cerebral palsy and a wide range of other disorders, living with an ailment is not an either/or situation, with a complete cure or hopeless resignation as the only alternatives. The three-week session of intensive therapy Courtney recently completed at Pediatric Therapy Services, a Lakeland clinic, shows the possibility of improvement through a combination of innovative therapy techniques and strenuous effort. Courtney hopes the therapy will help her advance from the wheelchair and walker she now uses to crutches.

Such a change could allow Courtney to handle "transfers," such as getting out of bed or into the tub -- that now require help from her grandmother, Lynn Williams. (Williams has had custody of Courtney since the girl was born prematurely, weighing 2 pounds, 9 ounces.)

Cerebral palsy is a category of mostly congenital disorders that impair movement and bodily control. Like many people with cerebral palsy, Courtney has difficulty with balance and fine motor skills that the rest of us take for granted.

Courtney has received physical therapy weekly since she was 1. The recent three-week session gave therapists a chance to use a TheraSuit, a $2,500 outfit that helps simulate the balancing system of a healthy muscle system, according to the clinic's co-owner, Denise Kilburn.

Kilburn says scientists in Poland designed the suit based on studies of Russian cosmonauts, who used similar suits to offset the damaging effects of weightlessness on their bones.

"(Patients) are unable to experience the normal give-and-take of the muscle moving against and through the force of gravity," Kilburn says, "so if you can't do that you don't understand how your foot should push into the floor to make yourself stand up."

The canvas suit consists of vest, shorts and knee sleeves, all of which can be connected by an intricate web of red elastic bands. On a recent morning, therapist and clinic co-owner Kathy Shufflebarger straps the suit over Courtney's turquoise pants and white T-shirt, patiently attaching dozens of bands to the suit's plastic hooks.

Shufflebarger connects bands from the knee sleeves to a pair of black tennis shoes fitted with their own plastic hooks, specially designed accessories to the suit. She pulls a pink cap over Courtney's light-brown hair and connects the headgear to the vest with a few more bands.

The therapist explains that the suit helps teach Courtney's muscles to work more efficiently while correcting bad habits caused by muscle weakness, particularly on the right side of her body.

The suit compresses a patient's body in a way that can be disorienting, and Shufflebarger says Courtney reacted angrily her first few days in the suit before getting used to the sensation.

Shufflebarger guides Courtney through some crunches, holding her left arm down as the girl curls upward with her right side. Courtney next does a set of pushups on a bench as Shufflebarger holds her elbows in place and then straddles the bench in an attempt to strengthen and loosen the adductor muscles in her legs and reduce her tendency to "scissor" as she walks.

After a while Shufflebarger hooks Courtney to "the spider" -- aptly named for the eight orange stretch cords the therapist attaches to the suit and then to bars of the metal cage. The cords hold the girl in an upright position.

Courtney says the spider is her favorite part of therapy.

Why? "Because I can jump."

Another therapist tosses a yellow ball at Courtney, who bats it back with both hands. The therapist rolls the ball, forcing Courtney to bend and pick it up, then lift it over her head and throw it back. With help from Shufflebarger, Courtney bounces from left to right, pushing off the sides of the cage, and rocks forward and back, braced by the stretch cords. Her face relaxes into a gleeful smile.

Shufflebarger puts Courtney back to work by making her practice rising from her knees, an action that is difficult for her. After a few attempts, Courtney asks, "Can I quit this?"

The therapist relents, removing the suit and hooking Courtney to the spider cords with just a wide belt around her waist. Courtney does a few little hops, and Shufflebarger lifts her into a Superman flying position as the girl giggles in delight. The therapist then grants Courtney's request to put her stuffed bear, Elizabeth, in the harness, and the girl yanks at the cords to make the bear dance in midair.

Such moments help offset the sometimes grueling nature of the therapy. Williams says the fourhour sessions leave her granddaughter physically spent.

"Some days I'll take her home from here and give her lunch and her nap, and she'll lie down and sleep for four hours," Williams says.

After completing the threeweek session with the TheraSuit, Courtney will continue her standard regimen of physical therapy three times a week at the clinic. The third-grader at Medulla Elementary strives to be increasingly able to do the same things as her classmates.

"They wanted to put her in a special P.E. class, and she didn't want any part of that," her grandmother adds. "She cried and cried."

But crying is not a common activity for Courtney, who smiles frequently even during the stress of her therapy sessions. Williams describes her granddaughter as "a happy child," and the girl's hazel eyes flash as she talks of an upcoming trip to Vero Beach and her plans to ride a horse owned by one of the therapists.

Williams says the therapy has changed Courtney's body alignment -- and more.

"A while ago she was eating a snack and she was sitting in a position we didn't want her to sit in," Williams says. "I asked her to sit in a different position, and she said, `Yes, the new Courtney has to sit a different way.' "

Natural chemicals that assist healing may one day help transplanted adult stem cells integrate into an injured brain, helping children with cerebral palsy recover lost function, according to researchers at the Medical College of Georgia.

“We know that we can get stem cells into the brain and they will turn into brain cells but we really don’t know how well they work,” says Dr. James E. Carroll, chief of the MCG Section of Pediatric Neurology. “The cells probably do form synapses,” he says of connections brain cells make so they can communicate. “But the question is: Will all this integrate into improved function?”

Dr. Carroll is principal investigator on a new grant from the American Heart Association and an existing grant from the National Institutes of Health that are using an animal model of cerebral palsy to identify the most effective way to transplant stem cells and possibly answer that question.

With this latest grant, Dr. Carroll, who also treats patients with cerebral palsy, wants to determine whether transplanted stem cells work best when the cells are injected directly into the brain along with these natural chemicals, called chemokines.

Chemokines are growth factors that attract white blood cells and are quickly summoned to the site of an injury, such as a brain injury that occurs in cerebral palsy. More recently, researchers have found that chemokines also seem to attract stem cells to an injury site. However, at least in an animal model of cerebral palsy, the healing chemicals are present for only a few days after injury, Dr. Carroll has shown.

“Chemokines are produced normally, naturally and briefly after a brain injury of some type as part of the healing process,” Dr. Carroll says. “But probably there are not enough of them produced and they are not produced long enough to do what we want to do. So we are working on ways to get additional factor into the brain to promote the integration of new cells long after the injury has occurred.”

When he began his studies several years ago, Dr. Carroll was putting stem cells from donor mice into the circulation of an animal model of cerebral palsy. Preliminary work had shown that stem cells migrated to the injury site, but his studies showed too few cells were making the journey. The two-year grant from the American Heart Association, will enable to him to explore whether a direct injection into the brain can help increase the number of cells where they are needed and if the extra chemokines help them become part of a better-functioning brain.

He’ll try several direct approaches including injecting chemokines into the injury site first and stem cells second and taking the technically-easier route of injecting both at the same time. To enable this approach, Dr. Carroll will use a virus’ ability to infect a cell to get chemokines inside stem cells before they are injected.

Although stem cells are immature cells coveted for their potential to become many different types of cells, donated stem cells may trigger an immune response, much like a transplanted organ. So Dr. Carroll also will compare the success of transplants that include the immunosuppressive agent, cyclosporine-A, to those that don’t.

He’ll also look at the bottom line: whether the motor skills of the animal model are improved following the transplant.

Since he began his studies of stem cell transplants, parents nationwide have asked when the technique will be available to help children. “I tell them we are working hard and making progress, but it is slow and there may be clinical trials in several years,” Dr. Carroll says. Although he thinks there is potential for stem cell therapy to one day help restore function lost to the group of disorders known as cerebral palsy, many unanswered questions remain. One concern is whether these proliferating young cells might cause tumors. Also, cerebral palsy is not a single problem, but a complex disease in which virtually all brain cell types could need repair.

He noted that there is much parents and caregivers already do for children with cerebral palsy, including physical therapy along with botox injections and baclofen pumps to reduce debilitating spasticity that comes from confused communication to the muscles about whether they should relax or contract.

Cerebral palsy, which affects about 500,000 people in the United States, is defined as brain damage that occurs before or during birth. The number of people with the disorder has increased over the last 30 years as more premature babies survive. Its effects run the gamut, from barely detectable to devastating loss of motor control. The causes are diverse as well, including everything from oxygen deprivation during birth to prenatal infections.

Cerebral palsy begins before birth with damage to an infant's brain. The malfunctioning brain then sends conflicting signals to the infant's muscles. In some cases, these signals pit one muscle against another, locking the limbs in place so that living in the grip of cerebral palsy is like living in rigor mortis. In other cases, the baby can move, but its muscles refuse to obey commands. About half of the infants born with the disorder are mentally retarded.

Clearly, preventing cerebral palsy would be "very desirable indeed," asserts neurologist Karin B. Nelson of the National Institutes of Health in Bethesda, Md.

Scientists at the Centers for Disease Control and Prevention (CDC) in Atlanta have taken a step in that direction. They have shown that giving magnesium sulfate to pregnant women may greatly reduce the incidence of cerebral palsy in infants born weighing less than 3.3 pounds. These low birthweight infants are 60 to 75 times more likely to develop cerebral palsy than babies that reach a normal weight before birth--and the number of children with cerebral palsy is growing. Medical advances enable many 1-pound infants to survive the trauma of prematurity.

Magnesium sulfate is routinely given intravenously to halt preterm labor or prevent convulsions in women with pregnancy-induced hypertension. In 1987, Dutch researchers found it also prevents hemorrhaging in the brains of infants whose mothers have this form of hypertension.

Last year, Nelson and Judith K. Grether of the California Birth Defects Monitoring Program in Emeryville studied infants in four California counties to see whether giving at-risk women the drug can prevent cerebral palsy in low birthweight babies.

Of the low birthweight babies born to women who had been given magnesium sulfate, 11 percent had cerebral palsy. However, 46 percent of the premature babies of women who had not been receiving the drug had cerebral palsy. The drug might have a "protective effect," the researchers concluded. It seemed to protect infants of women who experienced preterm labor and those of women with pregnancy-induced hypertension.

More recently, Diana E. Schendel and her coworkers at CDC set out to study low birthweight infants born in Georgia between 1986 and 1988. They found that less than 1 percent of children whose mothers were given magnesium sulfate developed cerebral palsy, compared to 8 percent of babies whose mothers were not given the drug.

The researchers calculated that magnesium sulfate reduced the prevalence of cerebral palsy by about 90 percent and reduced the prevalence of mental retardation by about 70 percent, although the latter link was weaker. Their findings appear in the Dec. 11 Journal of the American Medical Association.

"One of the striking things about the CDC study is the reduction in mental retardation," says Nelson, author of an accompanying commentary.

The CDC has begun large-scale studies to test these results. Meanwhile, NIH plans to study two groups of pregnant women -- one that will be given the drug and one that will not -- to determine once and for all whether magnesium sulfate prevents cerebral palsy and mental retardation.

In the first few months after birth, an infant with brain damage may show some or all of these symptoms that can indicate cerebral palsy:

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  Lethargy – lack of alertness


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  Irritability or fussiness


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  High-pitched crying


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  Trembling of the limbs


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  Poor feeding abilities, such as sucking or swallowing


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  Low muscle tone


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  Seizures, staring, body twitching


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  Abnormal reflexes

By six months, other signs of brain damage may appear:

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  Muscle tone may change – the baby may go from floppy to stiff


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  The child will clench its fist tightly


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  Asymmetry of movement – one side favored over the other


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  Poor feeding – tongue pushing food out of the mouth

In addition, other symptoms might be noticed:

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  Developmental delay – the child is developing more slowly in skills such as rolling over, crawling or sitting up


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  Motor disability – inability to hold on to objects


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  Mental retardation: Some, although not all, children with cerebral palsy are affected by mental retardation. Generally, the more severe the retardation, the more severe the disability overall.


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  Speech problems: Speech is partly controlled by movements of muscles of the tongue, mouth, and throat. Some individuals with cerebral palsy are unable to control these muscles and thus cannot speak normally.


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  Vision problems: Three quarters of people with cerebral palsy have strabismus, which is the turning in or out of one eye. This is due to weakness of the muscles that control eye movement. These people are often nearsighted. If not corrected, strabismus can lead to more severe vision problems over time.


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   Hearing loss: Partial hearing loss is not unusual in people with cerebral palsy. The child may not respond to sounds or may have delayed speech.


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  Abnormal movements: Movements may be unusually jerky or abrupt, or slow and writhing. They may appear uncontrolled or without purpose.