Dr. Alexa Craig (Guest): Well, thanks for having me on. Cerebral palsy is a disorder of the movements of the body that’s caused by an injury to the brain. One of the most challenging parts about cerebral palsy is identifying it before a child is about 18 months to two years old because the signs can be very subtle up until that time.
Melanie: What is a parent to look for?
Dr. Craig: It’s kind of hard for a parent to pick up on cerebral palsy, but I think the easiest thing for parents to look for would be a child who’s not meeting their expected developmental milestones, things along the order of maybe the child isn’t sitting up by seven months or not walking by 12 to 15 months.
Melanie: Okay. So those milestones, we hear about those from our pediatricians, and yet parents get nervous. Are milestones pretty well set? Do they generally happen for babies around the same time?
Dr. Craig: Yeah. The milestones are pretty well established, and I think certainly, if a parent has a concern, the first person they should bring that concern to would be their pediatrician or family practice doctor. But I think there are certain children who we know are at much higher risks for cerebral palsy and those are infants that are born very prematurely. The more prematurely you’re born, the higher the risk. So, some of the projects that we’re working on here at Maine Med are really focusing on how to identify those very high-risk babies before they even leave the hospital.
Melanie: So tell us, what’s previously been done to detect cerebral palsy in infants at such a young age to maximize that early intervention which will in turn improve outcomes? What’s previously been done and now what’s changing?
Dr. Craig: Well, there’s a lot of research currently in America utilizing high technological things like magnetic resonance imaging, or what people have probably commonly heard of as MRI, and getting these images on babies and looking at the development of the brain. It’s a very effective way to study this but the problem is it’s also a very expensive technology and difficult to justify the implementation of that for every single baby that’s in the Neonatal Intensive Care Unit. What we’re doing in our study is observing the movements of the baby and it’s an almost cost-free intervention. The only thing we need to do is to pay the charges to train the people to look at the movement. And what we can tell is with certain patterns of movements, that there’s a much higher risk for cerebral palsy. And then make sure that those infants get plugged into developmental followup before they even leave the neonatal intensive care unit.
Melanie: How long do you have to watch for those changes in movements before you can make a diagnosis?
Dr. Craig: A neurologist is usually the one who makes the diagnosis, so we wouldn’t make the diagnosis in the neonatal ICU. We would say to the family this is a baby that we’re concerned about and we want to follow up closely. And then we would see them when they’re three months old, probably again when they’re six months old, and again when they’re about 12 months old, and then ongoing if they continue to need interventions. But when they leave the NICU, we have probably watched at least two or three one-to-two-minute video clips of the baby and that gives us enough information about the pattern of movement to tell us whether it’s a high-risk baby or a low-risk baby.
Melanie: It would be so scary for a parent, Dr. Craig, to hear this. What are some of the things that are going on today in cerebral palsy research and treatment? What does the treatment look like out there?
Dr. Craig: Well, as you can probably imagine, I have to present this kind of bad news all the time to parents. It is really hard and it’s terrifying for them. But what I try to emphasize to these parents is that knowing early, knowing before the child leaves the NICU, gives them a tremendous power to access that early intervention that you just mentioned because there is absolutely no substitution for that early intervention because what we can do is we can essentially rewire the brain. We can help the brain learn to use other pathways, to kind of go around the injured areas of the brain, and we can have children who have very significant brain injuries doing things you would have never suspected they would be capable of because of that rewiring that happened from those early intervention therapies. So I really try to emphasize to the parents while it’s a scary thing to learn about now when your child is so small and really before you can even see this happening in the child, what it does is it allows us to really improve the long-term outcome really substantially.Another example of that is a type of therapy that we’re now doing called constraint-induced movement therapy. And what that does is it allows a child who for reasons most commonly of stroke, they can’t use one side of their body very well, we actually retrain the body to use the side that’s not working through all of these different therapies and make it so that eventually the child has really two almost normal-functioning hands instead of just one.
Melanie: And what is life like for these children as they grow older in these developmental situations? Are they able to mainstream pretty well, especially with the early intervention?
Dr. Craig: A lot of children who have cerebral palsy have very near-normal or normal cognitive functions, so they can do math and spelling and they can learn like other children. And so what they mostly have is barriers in terms of their ability to keep up with their peers running on the playground, those sorts of things. With the early intervention, what we’re able to do is overcome some of the tone issues that they have in terms of muscles being too tight to really allow the arm and the leg to work particularly well, and that allows them to do more and keep up with their peers better.
You kind of just want to hope that it will go away and hope that the child is going to get better all by himself. What I find is that if we really focus on it early and we get all those interventions in place, we can speed up that whole process so that by the time the kid is aware that anything is different about that kid, things are not that different from that kid to their peers anymore.
Melanie: What research is going on in the world of cerebral palsy today?
Dr. Craig: There is a tremendous amount of research ranging from therapies like what we were describing with the constraint-induced movement therapy to lots and lots of different ways of imaging, like with MRI, to predict whether or not children are going to have cerebral palsy. And then there’s other types of studies going on in other countries. I’m not sure there’s that much going on here with implantation of stem cells even to see if we can regenerate some of these tracks in the brain that way. What we’re trying to do here at Maine Med is to focus on how we can do something that’s available to all babies at low cost to make sure nobody gets missed from these early intervention opportunities.
Melanie: In just the last minute, Dr. Craig, if you would, tell the listeners why they should come to Maine Medical for their pediatric neurological care.
Dr. Craig: Well, we are the only pediatric neurologist in the state, so that’s kind of easy. [Laughter] Yeah. There are four of us that take care of all the needs of pediatric neurology unless the families go to Boston. And I would like to think that at least here in our neonatal intensive care unit, we have exactly the same services here that you could get anywhere else. So there is no need to go to Boston and I think that really says a lot about what we’re providing here.
Melanie: Thank you so much. It’s great information, really fascinating. You’re listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening.