TMC for Children Supports Research Study to Gauge Success of More Frequent Pediatric Therapy

TMC for Children is supporting a study to help determine whether children diagnosed with cerebral palsy show more progress with a more intense and frequent burst of therapy delivered at young ages when the brain is rapidly developing.

Cerebral palsy, which is a disorder in which damage to the central nervous system results in motor dysfunction, is one of the most common pediatric developmental disorders in the U.S.

Under the study, funded by the TMC Foundation, 20 children with mild to moderately severe levels of spastic cerebral palsy between the ages of 18 to 36 months are being seen by TMC for Children’s pediatric occupational and physical therapists for five days a week for 12 weeks. The children would typically receive just one therapeutic session a week under most insurance plans.

Dr. Burris Duncan, a professor of public health and pediatrics who is leading the study, became intrigued by the question of intensity and frequency when he went to China more than a decade ago to participate in some maternal-child health clinics in rural China. While there, he found that the hospital in which he worked advised parents of very young children with cerebral palsy to put their child in the hospital for three months. The children received daily physical and occupational therapies, as well as acupuncture, deep massage and herb baths.

That isn’t practical to replicate here, he said, since parents and insurance companies would likely balk at three months of inpatient treatment.

Another question was whether parents could commit to such an intense program if it was offered on an outpatient basis. Hence, a feasibility study was designed.

So far, 16 children have completed the therapeutic program, with four slots remaining. Staff is collecting data and performing evaluations at the start and end of the program, as well as 12 weeks later, to evaluate whether the children have retained the momentum.

Dr. Duncan said the premise of the study is rooted in the concept of “brain plasticity,” which is essentially the brain’s ability to adapt and remap. Although the brain changes throughout life, to the point that even older stroke victims can recover partial function from some injuries to the brain, the young brain is growing at an unprecedented rate. Research has demonstrated that active and repetitive movements is what fuels brain development. Theoretically, neurons in the brains of children with cerebral palsy that would otherwise fade because of lack of use, could take over some of the functions of the damaged neurons.

“The key message here is we have many neurons we aren’t using, and if we want the maximum benefit out of them, we have to stimulate them,” he explained.

In an earlier, three-year study Duncan just had published in the Archives of Physical Medicine and Rehabilitation, Dr. Duncan and his coauthors were unable to prove one way or another whether acupuncture made any difference in the outcomes, but said it was clear that at the end of the intensive 12-week treatment period, functional changes were better in the children who received the intense approach than in children who received standard once-a-week therapy regimens.

Therapists report that preliminary indications show children are faring well. “It’s very demanding on the parents to get here every day, but they are consistently amazed at the progress they see in their children,” said Charlene Fregosi, a physical therapist.

“Although we continue to evaluate the outcomes, we’ve seemingly had really good results. Kids who were not sitting can sit. Kids who were not walking are walking better now,” she said, adding parents are given some techniques to work on at home with their children.

Michael Duran, Vice President & Chief Development Officer with the TMC Foundation, said TMC for Children has long been fortunate to have donors who support pediatric therapies, but the hospital was also eager to assist in unraveling more about how the brain works. “As scientists learn more about brain plasticity, it is really driving a revolution in the ways we look at brain health,” Duran explained. “Quite aside from the complexities involved in the research, however, it really comes down to what’s best for kids.”

Dr. Duncan agreed, noting he’s long been drawn to children with the diagnosis. “The kids are just incredible individuals who will try, try and try to get the most from what they’ve been given. It is up to us to give them the wherewithal to achieve their full potential.”