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March is Cerebral Palsy Awareness Month, and who better to break down this topic than Dr. Edward Hurvitz, a Physical Medicine & Rehabilitation Physician/Physiatrist at the University of Michigan? He recently joined Hope for HIE LIVE to discuss the diagnostic journey of cerebral palsy, the multiple pathways of care available to those with CP, and the integral role a PM&R plays throughout the patient’s life experience!
Missed the live Q&A? Don’t sweat it! Like any trusty sidekick, we’ve gathered the key takeaways from the discussion so you don’t miss a beat.
When you simplify the term, cerebral means “involving the brain,” and palsy means “involving movement.” Depending on the area of the brain impacted, there are four main types of cerebral palsy, all with their own defining features of movement and motor function:
The movement types above affect a specific number of limbs, as well. This is where the following classifications come into play:
A Gross Motor Function Classification System [GMFCS] is a great way to visualize the various levels of severity. Consisting of 5 levels, it ranges from Level I, in which a child with CP can perform gross motor skills such as walking, running, or climbing without much [or any] assistance, to Level 5, in which the child has minimal mobility and uses a wheelchair in all settings.
Dr. Hurvitz says the GMFCS is just a description, and while it is good to know, it is not necessarily a disadvantage to not receive a rating on that scale. He assures that it is never too late to receive a rating, as it can improve the quality of conversations and clarity of information when speaking with your child’s medical team.
HIE is not a guaranteed precursor of cerebral palsy; in fact, only about 40% of those experiencing HIE receive an official CP diagnosis. Looking at the whole picture, HIE is just one cause of cerebral palsy out of many and makes up 10-15% of all cases. Most cerebral palsy cases are caused by other types of brain injuries, like those associated with prematurity, brain bleeds, etc.
Dr. Hurvitz made it a point to note that cerebral palsy does not always affect cognition and that most children with CP experience a lot of success in school and beyond! Building awareness and gaining access to trustworthy information is essential for refuting incorrect or hurtful stigmas of CP and improving levels of accessibility and inclusion in all settings!
While cerebral palsy differs in type and severity from one person to the next and may change over time, providers typically look out for the following early signs and symptoms:
Depending on accessibility and patterns of practice in your area, a pediatrician can refer your child to other providers for an official CP diagnosis and plan of care:
No matter the pathway of care, Dr. Hurvitz explains that most cases of cerebral palsy are diagnosed by the time a child reaches 12-24 months. While rare, diagnoses can and do occur later in life and are often associated with more mild cases or a lack of access to brain-imaging devices and evaluative tests.
Simply put, an earlier diagnosis leads to more opportunities for early interventions. While cerebral palsy does not have a cure, therapeutic options can improve the child’s motor functioning and quality of life over time! There is no standard procedure of care, but most options involve one or more of the following:
Physiatrists can treat children with CP from diagnosis through the rest of their lives! Dr. Hurvitz likes to refer to them as quarterbacks, as they can play an integral role in creating an effective care plan for each patient. This plan covers a range of services:
While there is no cure for cerebral palsy, there are many courses of treatment that providers may recommend to improve motor function and development. Medicines are one such route – some are taken orally, some are injected directly into the impacted muscle area, and others are delivered through surgically-implanted pumps that can be upgraded every few years. Of course, as with any medication, it is always wise to discuss the pros and cons of each with your child’s medical team to determine the best fit!
While therapies are often helpful, depending on the severity of the case, many patients look to orthopedic and neurosurgeons to provide treatment. In the orthopedic world, surgeons can improve mobility by lengthening muscles and tendons, while neurosurgeons can perform a procedure called selective dorsal rhizotomy, or SDR, in which they locate and cut overactivated nerves at the base of the spine to relax muscles and reduce spasticity.
There is no standard therapy or surgery that works for every person with cerebral palsy, so it is of the utmost importance to converse with the medical team about a treatment plan that is both safe and effective.
Dr. Hurvits warns against a simple google search of cerebral palsy because that may yield results flooded with inaccurate information. As a result, he recommends the following trustworthy resources to begin your quest for knowledge:
If you found this blog helpful, watch the full recording on our YouTube channel to listen to Dr. Hurvitz respond to poignant questions from our community!
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