Therapies for Cerebral Palsy: 2008

Wednesday, December 31, 2008

The Feldenkrais Method (ABM) for Cerebral Palsy

The Feldenkrais method relies on the nervous system’s ability to change and learn through a unique combination of physical therapy, psychology, and martial arts. Through “teaching” the nervous system, the Feldenkrais method claims to redirect a body’s nervous growth.

The combination therapy consists of developing movement, biomechanics, psychological treatments, and even martial arts. The Feldenkrais method for cerebral palsy can organize these elements of the person into learning how to better control one’s movements and to train the nervous system in acting in different ways. The method can help by using very simple techniques that aid in spastic muscle function and its development. Many patients in cerebral palsy have spasticity, or stiffness, in their muscles. The Feldenkrais technique can be used to help spasticity and aid in walking, sitting, or pain relief from the tension in the muscle.

As the senses interact with motor functions, a development takes place that falls into an effective pattern for future improvements. Using the Feldenkrais method for cerebral palsy, an affected person can work toward controlling and manipulating their own bodies. This control is essential in maintaining balance during walking or standing.

The therapy is often very slight, gentle, and non-invasive. This kind of therapy can be effective because it is so gentle and guiding.

More on ABM (Anat Baniel Method): Cutting-edge Treatment for Cerebral Palsy, Brain Damaged Infants and the Brain Injured Child
More on the Feldenkrais Method: Who Benefits from the Feldenkrais Method?

Monday, December 29, 2008

Holistic Therapies for Cerebral Palsy Patients

I found the following post on answerbag.com. We've consulted with a dietition and have looked into acupuncture and biofeedback (see post on ABR) for our son. At any rate, I found it to be an interesting list of holistic therapies for CP.

Step 1:
Try consulting a nutritionist, who can show you how to monitor what your child eats. Diet plays a big part in how severe cerebral palsy symptoms are. Foods that contain additives and preservatives can exacerbate your child's condition. You may also need to get your child checked for any food allergies, so you can avoid serving things that might be toxic. Go for a healthy diet that consists of fresh fruits and vegetables, legumes, nuts, whole grains and unprocessed foods.

Step 2:
Investigate acupuncture. Find a licensed, certified practitioner and see if a few sessions achieve any results. The object is to insert thin steel needles into certain areas of the body that stimulate the part of the brain that is damaged and ease other physical problems a cerebral palsy patient may have. This is not painful at all.

Step 3:
Biofeedback has been used to help with cerebral palsy symptoms. This treatment involves having electrodes attached to the skin, with the purpose of reading the body's biological signals, which are then intensified. This results in a feedback which can assist the brain and increase movement.

Step 4:
Body work may help. This may involve any number of holistic therapies, such as reflexology, rolfing and massage therapy. These can help relaxation, improve the circulation of the blood, aid in diminishing muscle spasms, and ease pain in those who have cerebral palsy

Step 5:
Consider trying the Alexander Technique. It helps improve balance, helps the cerebral palsy patient with developing more coordination and increases range of movement. This may be accomplished in several sessions that take place over a designated period of time. The biggest challenge may be in locating someone who teaches this particular method of healing.

Intensive Pediatric Therapy and HBOT for Children with Cerebral Palsy

Our immediate goal is to provide our son with intensive physical, occupational, and speech therapy coupled with another 40 sessions of HBOT in the spring of 2009.

Nestor Serrano and his daughter Amelia are featured in the clip below. Amelia was diagnosed with Cerebral Palsy early in her life and the Serranos have provided similar therapy for their daughter. You can read more about her story here.

Tuesday, December 9, 2008

Cord blood: A weapon against cerebral palsy?

This may have been an option for our son if we had saved his cord blood...

I emailed the doctor involved in this research, Dr. Joanne Kurtzberg at Duke University. She is keeping my email on file and will let me know if they start any studies that might help our son.

http://articles.latimes.com/2008/apr/07/health/he-cpalsy7

What to Buy for Baby: A growing number of ingenious gift givers have discovered a special kind of present for new babies and their families...

Sunday, November 30, 2008

Article on Osteopathy

I found this short article and thought it was relevant and a good overview of osteopathy. An excerpt of the article is below.

What is Osteopathy?
"Former U.S. presidents and important political figures FDR, Eisenhower, and JFK all relied on osteopathic services for their health needs among many other famous figures then and now, and even though breaking the cycle of relying on doctors to heal us instead of listening to our bodies takes time, at least we are not solely looking to leeches for help. To find a DO in your area, look to The Cranial Academy to help your body heal itself through mental and physical osteopathic techniques."

Sunday, November 23, 2008

ACQUIRE Therapy (Pediatric Constraint Induced Therapy)

ACQUIRE Therapy is a new therapy to assist children with neuromotor disorders. It is based on Constraint Induced (CI) Therapy, also called Taub Therapy after its founder.

ACQUIRE is an acronym for:

Acquisition of new motor skills through
Continuous practice and shaping to produce
Quality movement of the
Upper extremity through
Intensive therapy and
Reinforcement in
Everyday patterns and places

The following is taken directly from the UAB Pediatric Neuromotor Research Clinic web site:

"ACQUIRE Therapy begins by casting the child's less-affected arm. A full-length, lightweight fiberglass cast is applied from the upper arm to the tips of the fingers. Then the cast is uninvolved so it can be removed by the staff once a week to check for skin integrity, clean the arm, and offer the child a few minutes of movement. The cast is then immediately placed back on the arm. The reason for applying the cast is to restrain the use of the less-affected arm allowing concentrated facilitation of the more-affected arm.

ACQUIRE Therapy begins the day after casting and includes play-based and functional activities to encourage your child to use the more affected arm. An ACQUIREc trained therapist will establish a close working relationship with your child in his/her typical environment. The therapist will provide intensive treatment for 6 hours a day for 21 days (some weekend days are included) over a 26-day period. The procedures are designed to elicit, facilitate, and refine voluntary control of the upper extremity. We will engage your child in many fun games and activities, with both familiar and new objects. We especially seek to have your child ACQUIRE useful movements and motor skills, and also to develop new confidence and independence in a variety of everyday situations."

Read more about ACQUIRE Therapy by downloding the ACQUIRE Therapy Brochure.

Friday, November 14, 2008

News Story about Hyperbarics

NBC 15 in Madison, WI published a story yesterday about a family doing hyperbarics at the same clinic we treated our son, the Wisconsin Interactive Hyperbaric Center.

http://www.nbc15.com/home/headlines/34422984.html

Tuesday, November 4, 2008

Article Conclusion: Children Should be Allowed Access to HBOT

The Journal of American Physicians and Surgeons published a great article in Volume 12 Number 4 - Winter 2007 reviewing and comparing the currently accepted therapies with HBOT in the treatment of cerebral palsy. I really appreciated the conclusion of the article, which is quoted below.

============
"Hyperbaric Oxygenation Therapy in the Treatment of Cerebral Palsy: A Review and Comparison to Currently Accepted Therapies"
Carole Sénéchal, Ph.D.; Serge Larivée, Ph.D.; Engelbert Richard; Pierre Marois, M.D.
Download article in PDF format

Conclusions
"Previous studies of HBOT in CP have shown noteworthy favorable results, but to produce conclusive evidence, additional, more systematic trials are needed.

Much is at stake. Improvement in the function, independence, and comfort of persons with a severely disabling neurologic conditioncould lead to significant improvements in health and quality of life as well as to significant cost savings in the long term. While other treatment modalities are paid for by government programs, parents must bear the cost of HBOT as the controversies continue.

In the meantime, given the very low risk of adverse effects and the promising results, children should be allowed access to HBOT."

The Institutes for the Achievement of Human Potential

According to their website, The Institutes for the Achievement of Human Potential is a nonprofit educational organization that serves children by introducing parents to the field of early child development. They offer courses for parents at their campus.

I read "What to Do About Your Brain-injured Child", written by Glen Doman who founded "The Institutes" in 1955. I found some of the concepts in the book useful, such as patterning. The program they typically recommend is very time and energy intensive, which isn't for everyone.

http://en.wikipedia.org/wiki/The_Institutes_for_the_Achievement_of_Human_Potential

Olympic Cool-Cap System

The Olympic Cool-Cap System is the only FDA approved device for the treatment of hypoxic-ischemic encephalopathy (HIE) in term infants. It works by utilizing a unique cooling cap to provide selective brain cooling while maintaining core temperature at safe levels through the use of a radiant warmer.

Studies have shown that if used in the first six hours of life, the system can prevent or significantly reduce the severity of neurologic injury associated with HIE.

Monday, November 3, 2008

Harnessing The Power Of The Brain

Human beings driving wheelchairs and operating computers with only their thoughts...impossible, right?

Harnessing the Power Of The Brain

"People who are completely paralyzed due to illness or trauma are getting help communicating with a new technology that connects their brains to a computer."

Saturday, November 1, 2008

Advanced BioMechanical Rehabilitation (ABR)

ABR is a unique biomechanically based hands-on rehabilitation approach created by Leonid Blyum for children and young adults with brain injury. The therapy claims to bring about predictable recovery of musculoskeletal structure and motor functions.

ABR focuses on strengthening smooth muscles to restore the mechanical structure of the musculoskeletal system. Strengthening of the smooth muscles is suppose to induce gradual growth of internal pneumatic capacity, which in a cascade effect helps to re-establish - unit-by-unit - proper skeletal and muscular structure.

We have not done this therapy for our son because we don't feel it's necessary at this time. It's something we may consider in the future.

Check out http://blyum.com/ for more information.

Monday, October 27, 2008

Hyperbaric Oxygen Therapy (HBOT)

I have contacted many subject matter experts in the field of hyperbaric medicine over the last several months and have received an overall positive response regarding the use of lower pressure (mild) HBOT to treat brain injury. I found this explanation of HBOT posted to an online support group by a medical doctor, some of which I’ve edited for clarity.

"There are two components to hyperbaric oxygen: increased ambient pressure and increased inspired oxygen concentration. The physics of hyperbaric oxygen in a nutshell is that under increased atmospheric pressure, more gas goes into substances.

This increased oxygenation, or hyperoxia, has several beneficial effects. First, the high level of oxygen in the blood allows improved oxygen delivery to tissues that are not getting enough oxygen at baseline (i.e. hypoxic tissues). Second, having times of alternating hyperoxia and hypoxia (as occurs during a series of HBO treatments) promotes the growth of new blood vessels into the hypoxic tissues, a process known as neovascularization.

In the case of a brain injury, whether from a traumatic brain injury, a stroke, a near-drowning, cerebral palsy, or any incident which causes lack of oxygen to part of the brain, there are some cells that have died.

It is thought that around the area of the dead cells or the "umbra" there is a surrounding area of damaged and dormant nerve cells--the "penumbra"--which can heal over time.

The theory--and there does seem to be considerable evidence to support it--is that when a patient is in a hyperbaric oxygen chamber and given 100% oxygen under increased atmospheric pressure, the oxygen dissolves not only into the red blood cells (as happens normally when we breathe) but also in much higher concentration into the blood plasma, the cerebral spinal fluid, the lymphatic system and all of the body's fluids, bathing all of the body's cells with increased oxygen levels.

The result is high levels of oxygen carried to the brain, bypassing the normal way the brain gets oxygen; by the circulation of the blood stream bringing oxygen rich red blood cells.

At least one study was conducted comparing the use of air, which has about 21 percent oxygen, to the use of 100 percent oxygen. The patients given room air were intended to be the "control" group, and they did as well as those with 100 percent oxygen. The conclusion, erroneously, I think, was that because there was no difference in outcome between the two groups, that hyperbaric oxygen was ineffective.

However, importantly BOTH groups improved. So the conclusion I believe is that the use of hyperbaric pressure does significantly help in healing injured tissue--in this case, the brain.

The KEY is the use of increased atmospheric pressure, so that increased oxygen dissolves into the cerebral spinal fluid to be delivered to the damaged brain tissue to speed up healing.

Dr. Harch and some of the other hyperbaric medicine physicians have found 1.5 ATA with 100 percent oxygen given either once or twice a day to be safe.

It appears--although it would be nice to have better studies--that any amount of oxygen from room air to 100 percent oxygen has a beneficial effect. We know that for prolonged periods, using 100 percent oxygen can be toxic, but those are under conditions of using 100 percent oxygen over days or weeks. The short periods of time used for hyperbaric oxygen chamber treatment don't carry that risk--the exposure is much shorter.

It is way past time for the US government to sponsor controlled studies using a variety of protocols, with careful assessments using SPECT scanning. It is clear to many of us that there is a very great benefit from hyperbaric oxygen in treating a variety of brain injuries and many studies as well as individual case reports which prove this is true."

Our son suffered from lack of oxygen at birth (hypoxic ischemic encephalopathy (HIE)), along with seizures shortly after birth. He has cerebral palsy, developmental delay and cortical vision impairment (CVI), as well as secondary microcephly (small head size) due to this lack of oxygen at birth.

I read The Oxygen Revolution by Paul G. Harch, M.D. and found it to be a well organized text and a good overview of the use of hyperbaric oxygen for off-label indications.

I spoke with a nurse who has been closely involved with clinical trials for many years using HBOT to treat acute traumatic brain injury. She told me in so many words that as a mother; she would be doing what we’re doing.

I also spoke with a clinical research nurse involved in an ongoing clinical trial in Ohio sponsored by the Department of Defense involving 80 some children with cerebral palsy. She informed me of many initial positive results from the study An Evaluation of Hyperbaric Treatments for Children With Cerebral Palsy. Many children see a decrease in spasticity and increased attention span.

Based on this research and the experts I spoke with we completed 40 sessions lasting 60 minutes each, twice a day (at least 4 hours apart). We observed a definite decrease in the spasticity of our son, as did his Physical and Occupational Therapists. His vision and attentiveness have also improved.

In conclusion, the use of HBOT (1.5 ATA) to treat brain injury has minimal negative side-effects and great potential for positive results. HBOT is certainly not a miracle cure, but it is a valuable therapy to ensure the most complete recovery possible.

The OxyHealth Fortius 420 Hyperbaric Chamber

Sunday, October 26, 2008

Doctor of Osteopathy (D.O.)

We met with a doctor of osteopathy (otherwise known as a D.O.). If you’re anything like me, you’ve probably never heard of an osteopath before.

So what is an osteopath? Osteopaths have the same amount of schooling as M.D.s and have the same rights in hospitals, but D.O.s specialize in a person’s skeletal structure and take more of a whole body approach. We took our son to a D.O. to hopefully help with the shape of his head.

Introduction to Osteopathy

Many D.O.s don’t practice cranial manipulation, so it’s important to find the right one. This is the second D.O. we’ve met. The first was really nice, but she called herself a “bad D.O.” because she didn’t often apply osteopathy with her patients and had no experience with cranial manipulation. She thought osteopathy would help our son and encouraged us to find a D.O., but unfortunately didn’t know anyone who could help us. Fortunately, we got a reference elsewhere for an osteopath who did have experience with children.

We feel comfortable with the D.O. we are working with. He has worked with children and one of his specialties is cranial manipulation, which is what we wanted for our son.

The doctor manipulated our son's skeleton, which was really interesting. He started with the bottom of our son’s spine and ended the session working on his head. It was hard to get our son to sit still, but he faired well.

It’s a very gentle approach and almost seemed a bit like a massage. The doctor compared the manipulation to working on a stuck drawer. If you pull on a stuck drawer hard, you won’t get anywhere and will only make the drawer worse. But, if you know the correct place to push and are gentle about it, you can easily get a drawer unstuck. We thought this was an effective analogy.

One exciting thing the doctor said was that sometimes osteopathy can help with head growth. That is so exciting! Of course, he can’t promise us anything, but I think either way, this therapy will only help him. After his manipulation, the doctor told us that our son has tightness on the top front of his skull (where his ridge is) and the back of his skull is also tight. The thought is that that tightness is pushing down and could be restricting his head growth.

It’s so interesting to me how D.O.s can be trained to feel the fascia on the skull, can move things around to facilitate growth and to help to prevent the skull from fusing prematurely, and to help make sure the cerebral spinal fluid is flowing correctly. It’s another one of those things I don’t completely understand, but I think that it makes sense. I’m just amazed that he can feel all those things. When I touch our son's head, all I feel is a head. We’ll be seeing this doc once every two weeks for awhile, so it’s looking like this busy lifestyle won’t be slowing down anytime soon.

Here are a few links I found useful.

What is Osteopathy
Cranial Osteopathy
Neurodevelopmental Problems

Therapies for Cerebral Palsy