Neurology Today Conference Reporter: CNS Annual Meeting

Monday, October 9, 2017

An Evidence-based Therapy for Cerebral Palsy That Few Neurologists Know About

BY JAMIE TALAN

KANSAS CITY, MO—Constraint-induced movement therapy (CIMT) — a therapy that has been found to strengthen weakened arms after stroke — can help children with cerebral palsy (CP) gain functions, as well, but few of the pediatric neurologists surveyed in the US were aware of its potential benefits.

These findings, presented here at the Child Neurology Society annual meeting last week, underscore the need for improved training, access, and dissemination of research on evidence-based therapies for CP, the research team that conducted the survey told the Neurology Today Conference Reporter.

"Many physicians who treat children with cerebral palsy are not aware of the research into treatments that could help their patients gain strength and function in their arm," said the lead author Sharon L. Ramey, PhD, professor of psychology, psychiatry, neuroscience and human development at Virginia Tech Carilion School of Medicine and Research Institute.

Dr. Ramey has been studying the benefits of CIMT and bimanual therapies for infants and children with CP.

Working with Margaret Nelson, a medical student at Virginia Tech Carilion School of Medicine, Dr. Ramey sent a 26-point online questionnaire to hundreds of pediatric neurologists to assess their knowledge of evidence-based therapies for CP.

The investigators found that only 21 percent of the approximately 70 respondents knew that CIMT and bimanual therapies were effective treatments for children with CP older than two years old. More than two-thirds of the respondents (70 percent) said that the field would benefit from an online research library to learn more about evidence-based treatments. And an equal number of physicians said that the field needs more training in identifying patients who would benefit from these therapies. Almost 60 percent of physicians who have heard of these therapies said that they don't prescribe them because there are not enough trained therapists in their area to deliver the training.

CIMT requires the use of a lightweight cast (from the shoulder to the fingertips) on the good arm so that the child can strengthen the weakened arm and begin to find success in carrying out tasks. The intensive therapy is done three hours a day for five days a week over a month.

"CP can result from many medical problems but a major cause is prenatal stroke," Dr. Ramey said. "Many people think that infants born with CP or that have a neonatal stroke will have permanent damage and won't improve much, if at all. That is just not the case. They have tremendous neuroplasticity that allows them to improve a lot, especially at an early age."

CIMT therapy is specialized and very different from the more general occupational or physical therapy that a pediatric neurologist might prescribe, she added. "We now know that people can overcome or minimize their disability with this training."

Commenting on the study, Warren Lo, MD, clinical professor of pediatrics and neurology at Ohio State University and Nationwide Children's Hospital in Columbus, said: "There is a notion that people with an injury to the brain learn how to use their good side and stop using their bad side. We now know we can coach children to use the bad side, and they get better at doing that."

Dr. Lo, who was not involved with this study, is now collaborating on other studies with the Virginia Tech researchers. "I am a believer in the value of this. It is tricky to get it accomplished, though. It takes a lot of skilled training and time. We need to figure out how much is necessary for a child to benefit."

LINK UP FOR RELATED INFORMATION:

DeLuca SC, Trucks MR, Wallace DA, Ramey SL​. Practice-based evidence from a clinical cohort that received pediatric constraint-induced movement therapy. J Pediatr Rehabil Med 2017;10(1): 37-46.

Rostami HR, Malamiri RA. Effect of treatment environment on modified constraint-induced movement therapy results in children with spastic hemiplegic cerebral palsy: A randomized controlled trial. Disabil Rehabil 2012;34(1):40-44.