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 Article of Interest - Cerebral Palsy

A new tool to assess birth defect
Canadian researchers have developed motor-development charts to help parents better gauge the outlook for a baby born with cerebral palsy.
by Adam Marcus, HealthScout News Service, October 1, 2002
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Doctors now have a new tool to assess cerebral palsy, a crippling birth defect that afflicts hundreds of thousands of people in North America.

The condition -- really an umbrella term for a brain injury that typically occurs before birth -- causes a wide range of mental and motor defects with an equally broad spectrum of severity. As a result, it's difficult for doctors and physical therapists to provide effective counselling to parents of children with cerebral palsy.

Now, however, Canadian researchers have developed new motor-development charts for babies with the condition. These should give parents a better sense of their child's outlook, at least concerning the muscular aspects of their ailment such as walking.

When they hear that their child has cerebral palsy, parents almost invariably ask two questions, says lead author Dr. Peter L. Rosenbaum, a pediatrician at McMaster University in Hamilton: "How bad is it?" and "Will she walk?"

In earlier research, Dr. Rosenbaum and his colleagues had developed guidelines to help answer the first question, using a system similar to cancer typing. Before those guidelines were developed, he says, doctors and parents alike had to contend with "meaningless" words such as "moderate," "mild" and "severe."

Dr. Rosenbaum's group, whose findings are reported in the current issue of The Journal of the American Medical Association, based its charts on data from 657 children with cerebral palsy, ages 1 to 13, who were followed for as long as four years.

The new charts, which offer five different tracks depending on a child's early motor-skills development, let doctors be more specific in predicting future levels of development -- for example, in gauging which children may someday walk and which will need wheelchairs.

"Because the curves describe motor function by level," Dr. Rosenbaum says, "we can have a reasonable guess of the child's pattern of mobility. If it's 1 or 2, you can be pretty sure they're going to walk, but for a child who's a 4, we would probably be recommending early in therapy that they should get some wheels."

Experts caution, however, that the charts aren't ironclad. A child heading down one path may do better or worse than expected.

Dr. Murray Goldstein, medical director of the United Cerebral Palsy Research Foundation, says that the charts will also help scientists developing therapies for CP. Many treatments are widely used without solid evidence that they work, he says, and having a baseline trajectory of motor development can help researchers compare the effect of an intervention with what would otherwise happen naturally.

Treatment planning will also benefit from the new curves, according to Dr. Stephen L. Kinsman, director of pediatric neurology at the University of Maryland School of Medicine in Baltimore, because it will enable researchers to more accurately assess potential participants in studies of experimental drugs designed to help patients with better prognoses.

Yet Dr. Kinsman is wary of making too much of the new tool, especially because some children won't follow the precise path of the curve they're on and because the charts only describe one aspect of CP.

"Let's be careful how we use this," he says.

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