Serial Casting

We first heard about serial casting during our son's month of intensive pediatric therapy. His PT told us about children they had worked with who were able to postpone or avoid surgery for muscle tightness using this approach.

Serial Casting - quoted from St. Joseph's Children's Hospital of Tampa

"Serial casting is a noninvasive procedure that helps children and adults improve their range of motion so they can perform daily activities with less difficulty. It is a process in which a well-padded cast is used to immobilize a joint that is lacking full range of motion. The cast will be applied and removed on a weekly basis. Each cast gradually increases the range of motion in the affected joint.

Who benefits from Serial Casting?
Muscle tightness can manifest itself in many ways and for various reasons. Doctors refer patients for serial casting to help improve overall quality of life. Serial casting helps patients who have a variety of disorders including:

• Cerebral palsy
• Spina bifida
• Brain or spinal cord injury
• Congenital abnormalities
• Muscular dystrophy
• Idiopathic toe walking
• Peripheral neuropathy

Why would a physician refer for Serial Casting?

• Serial casting is a non-surgical approach aimed at reducing muscle tightness around a joint that is limiting range of motion and functional mobility.
• Serial casting assists in achieving the optimum alignment of a joint. It also helps prepare a joint for the use of further orthopedic devices such as braces, splints, etc.
• Serial casting may help decrease the chance of a deformity developing and/or progressing due to abnormal weight-bearing.
• Serial casting is a safe and effective way to increase range of motion and improve functional mobility. It may help eliminate, delay, or minimize the need for surgical intervention.

What happens during a Serial Casting session?
Muscle strength and range of motion of the affected joint will be assessed prior to application of the cast. A team of specially trained therapists will apply the cast in the joint’s optimal position and range. Instruction about care of the cast and precautions will be reviewed with the family and patient.

How long will I need to come for cast changes?
Casts will be changed on a weekly basis until a target range-of-motion goal is achieved. Predicting the number of casting sessions is difficult, as each individual responds to the casting procedure at different rates. Typically, the casting procedure is completed in 4-6 weeks.

What happens after the casting is finished?
The physician determines what may be needed in terms of orthotics (braces, splints, etc.) to help maintain the newly gained range of motion.

How does Serial Casting affect the patient and family?
A short accommodation time will be required, as the cast has added weight and the joint is now immobile. A walking cast and cast shoe allow children to walk during the period of casting. Daily routines are not altered significantly and patients can stay very active, participating in school and normal activities. The biggest challenge is keeping the cast dry. Sponge bathing is necessary to avoid getting the cast wet."

Phosphatidylcholine (PC) : PhosChol

Phosphatidylcholine (PC) is a phospholipid and a major source of choline. I found out about a PC supplement, PhosChol, from a fellow parent who has a son diagnosed with Guanidinoacetate methyltrasferase deficiency. You can read more about John at Mommy Klor. After consulting with a doctor, I started giving the supplement to our son on 05/06/09.

It's been about two weeks, and our son seems to be opening and using his hands more than before we started the choline supplement. One of his therapists comment recently that he's using his hands and keeping them open more than before. It's hard to conclusively say that it's only the choline supplement, but his hand improvements seem to correlate with the introduction of PhosChol.

Doctors at the University of Colorado are seeing if choline taken during pregnancy by mothers can prevent mental illness in children. You can read more about their work at Choline Baby.

Botox : FDA instructs manufacturers to add boxed warning about possible negative effects

Botox has been used by doctors in recent years to help manage muscle spasticity. I've heard many success stories and some warnings about using Botox to treat spasticity. I don't have any personal experience with this use of Botox and our son's physiatrist has never mentioned that he would recommend it for our son. I've included links and quotes below from a few sources, including the FDA. Hopefully this FDA warning will help parents make informed decisions about their children's treatment.

Botox helps kids with CP
"...the drug forces the stronger contracting muscles to relax, a condition that lasts for a few months. During that time, physical therapists can work with the child to develop the weaker muscles that control extension. Although it's not appropriate for all children with CP, the treatment may help some move normally."

The Latest on Botox for Cerebral Palsy
"The FDA, which has never approved botulinim toxin for this use, issued instructions to manufacturers to add a boxed warning on labels about possible negative effects."

"Will these precautions make you less likely to seek this treatment for your child? Or have you had such success with it that you're willing to take the risk?"

Follow-up to the February 8, 2008, Early Communication about an Ongoing Safety Review of Botox and Botox Cosmetic (Botulinum toxin Type A) and Myobloc (Botulinum toxin Type B)
"As the result of an ongoing safety review, FDA has notified the manufacturers of licensed botulinum toxin products of the need to strengthen warnings in product labeling, and add a boxed warning, regarding the risk of adverse events when the effects of the toxin spread beyond the site where it was injected."

"Botulinum toxin products have been approved by FDA for one or more of the following uses: temporary improvement in the appearance of glabellar lines (frown lines between the eyebrows), treatment of strabismus (crossed eyes), blepharospasm (abnormal tics and twitches of the eyelids), cervical dystonia (involuntary sustained or repetitive contraction of the neck muscles), and primary axillary hyperhidrosis (severe underarm sweating). For these uses, botulinum toxin is injected into the skin or into muscle tissue."

"In pediatric postmarketing adverse event case reports, botulinum toxin products were mostly used to treat muscle spasticity in cerebral palsy, a use that has not been approved by the FDA. The reported cases of spread of botulinum toxin effect beyond the site of injection were described as botulism, or involved symptoms including difficulty breathing, difficulty swallowing, muscular weakness, drooping eyelids, constipation, aspiration pneumonia, speech disorder, facial drooping, double vision, or respiratory depression. Serious case reports described hospitalizations involving ventilatory support and reports of death."

"...healthcare professionals who use botulinum toxin products should understand that these adverse events have been reported as early as several hours and as late as several weeks after treatment."

Allergan to Resolve Botox Safety Labels
"Most deaths and serious problems were seen in children treated for cerebral palsy-associated limb spasticity, the FDA said."

Blues for Botox? 'Black box' warning, slumping economy, competitors may impact dominance
"Typically reserved for medications associated with serious or life-threatening risks, the "black box" warning is one of the strongest safety actions the agency takes. The FDA noted that problems with botulinum toxin had occurred mainly in patients receiving overdoses for unapproved therapeutic treatments, such as use in limb spasticity in children with cerebral palsy."

Olive Oil

We've been giving our son organic olive oil since he was around one year old, initially to provide him with some healthy calories since he was mainly eating, and continues to mainly eat organic baby food and some pureed table food. Much of the following information is taken from the book Brain-Building Nutrition.

Olive oil is high in the Omega-9 fatty acid oleic acid and rich in antioxidants and phytonutrients. Organic cold-pressed virgin or extra virgin olive oil is preferred. It has also been shown to elevate HDL "good" cholesterol, which might have an important affect on preserving brain function. In terms of overall health value, olive oil is one of the most important.

Fatty acid content:
Omega-6 = 8 percent
Omega-9 = 82 percent

Brain-Building Nutrition: How Dietary Fats and Oils Affect Mental, Physical, and Emotional Intelligence

I just finished reading a book by Michael A Schmidt, PhD on the importance of dietary fats and oils and our intelligence. I thought it was a good read covering the different fats and oils that we consume and how they affect our brain.

The book includes a small section on cerebral palsy. The author writes: "Looking carefully at the fatty acid status of any child with cerebral palsy seems to be an important step in fostering recovery. Supplementation with fatty acids may allow slow restoration of some functions and may lead to an improved quality of life."

Without giving away too much of the book, here are some strategies for healing with fats and oils:

1. Determine the Ideal Omega-3
2. Balance Omega-6 and Omega-3
3. Keep Your Carbohydrates Balanced
4. Eliminate Trans Fatty Acids
5. Eat Brightly Colored Fruits and Vegetables
6. Remember Important Brain Minerals
7. Use Spices That Help to Balance the Messengers and Protect the Brain
8. Include Mitochondrial Nutrients
9. Enrich with the Sulfur-Bearing Nutrients
10. Get Adequate Methyl Donors
11. Get Enough Sleep
12. Exercise

I highly recommend reading this book to better understand the nutritional importance and brain benefits of the right balance of fats and oils.

Brain-Building Nutrition: How Dietary Fats and Oils Affect Mental, Physical, and Emotional Intelligence

Vitamin D

Vitamin D is an important fat-soluble vitamin that promotes bone mineralization, enhances the immune system, and works as a neurohormone to stimulate proper brain development.

Our son has food allergies and we had his vitamin D levels tested the last time he had a blood draw to test for food allergies. Be sure to get a 25(OH)D vitamin D test before starting any oral supplementation. Our sons vitamin D levels were low and we've increased his oral supplementation accordingly. We'll be getting a repeat 25(OH)D test soon and and may supplement less since it's now spring and he'll be getting more vitamin D from sun exposure.

• Vitamin D
• Test Values and Treatment for Vitamin D Deficiency
• The Link Between Autism and Low Levels of Vitamin D
• Vitamin D Council

Deep Pressure and Proprioceptive Technique (DPPT) or the Walbarger Brushing Technique and Joint Compression

Our son doesn't like us to touch his right hand and always makes a "yucky" face with the first bite of every meal. We continue to expose his hands to different textures, which will hopefully help desensitize his hands. He seems to have decreased proprioception in his hands and feet, as well as some tactile sensitivity.

If you're anything like me, you're probably thinking "What is proprioception?". Well, proprioception means "one's own" perception. It is the awareness or sense of one's own limbs in space. I found this information from http://www.wisegeek.com/what-is-proprioception.htm interesting "Without proprioception, we'd need to consciously watch our feet to make sure that we stay upright while walking." Our son does tend to watch his feet while walking.

One technique that may help with these issues is Deep Pressure and Proprioceptive Technique (DPPT) or the Walbarger Brushing Technique and Joint Compression.

** This should only be done with supervision from an Occupational or Physical Therapist. **

The brushing technique was developed by Dr. Patricia Wilbarger. Dr. Wilbarger, is an occupational therapist and clinical psychologist who has been working with sensory processing theories for over 30 years.

"The DPPT uses a specific pattern of stimulation delivered through a specific type of brush and gentle joint compression or “pushing” to send information to the brain in an organized fashion. Simply put, it primes the brain to receive and organize information in an effective and useful way. It is done approximately every two hours for a specified number of days and then according to the needs of the child. Consistency is a critical factor! However, the protocol can be administered in between scheduled sessions, to assisting with transitions between activities, reducing overwhelm reactions, and re- organizing the nervous system after emotional upset.

The brush used for this technique, is a soft plastic surgical brush. This brush has been found to be the most effective in stimulating nerve endings in the skin. The actual brushing is done using a very firm pressure, starting at the arms and working down to the feet, avoiding the chest and stomach. The brushing is slow and purposeful providing “proprioception” (input through muscles and joints.) It is not ‘scrubbing’, and should never be painful, or cause damage to the skin. Children may initially react with crying or other avoidance measures because it is new, and the re-organizing can be disquieting. Generally within a few sessions, it becomes pleasurable and children will often ask for it or do it themselves.

The joint compression is also done in a specific pattern; ten count repetition, using light pressure. Students can be taught to do this themselves, by using an alternative method of ‘wall’ push-ups, and jumping."

Sources: http://www.pbbkids.com/the_wilbarger_brushing_protocol.htm
http://ezinearticles.com/?Tactile-Defensiveness-The-Facts-About-the-Wilbarger-Brushing-Protocol&id=1776984

HBOT on Oprah

The hyperbaric chamber may look high-tech, but the concept is pretty simple.

When you take oxygen and pressurize it in a tube, Dr. Oz says the oxygen is forced into a person's cells. "It gets me to mobilize stem cells from my bone marrow," he says. "It gets those cells moving along so it goes out to heal areas. In some parts of the body, like the brain, where you don't always have a lot of oxygen in the tissues, it might improve memory. It might play a role in making those cells which have energy factories function more efficiently."

Oxygen therapy isn't just for people who want to live longer. It's also speeds up the healing process for wounds and helps repairs broken bones. If you're interested, Dr. Oz encourages you to seek out qualified technicians.

"They should usually be used in a hospital with folks really watching what's happening," he says. "You have to wear 100 percent cotton, because it's oxygen in there, and oxygen's combustible. If you have synthetic fabrics, those fabrics can rub and make a spark."

Source: Oprah.com :: High-Tech Ways to Extend Your Life

HBOT Effective Against Autism

Okay, this information isn't cerebral palsy specific, but I think it's worth mentioning. Both autism and cerebral palsy are based in the brain, so it's great to see a study that scientifically supports HBOT for such diagnoses.

A multicenter, randomoized, double-blind, placebo-controlled study (the strongest kind of research) was published today that shows significant improvements in autistic children after 40 hours of hyperbaric oxygen therapy. The study, A Controlled Trial of the Clinical Effects of Hyperbaric Therapy in Autistic Children, included 62 children with autism between the ages of 2 and 7 years of age who were randomly assigned to 40 hourly treatments of either hyperbaric treatment at 1.3 atmosphere (atm)and 24% oxygen or slightly pressurized room air at 1.03 atm and 21%oxygen.

To quote the study
"Children with autism who received hyperbaric treatment at 1.3 atm and 24% oxygen for 40 hourly sessions had significant improvements in overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air."

For more details, please read the study - Hyperbaric treatment for children with autism: a multicenter, randomized, doubleblind, controlled trial

News storied regarding the research study:
Hyperbaric Therapy Called Effective Against Autism
Oxygen therapy benefit in autism

Tomatis

The Tomatis method is suppose to re-educate the way a person listens. It's intensive therapy where children wear head phones and listen to music like Mozart that is filter out except for the high frequencies. Children also listen to their mothers voice after it's been modulated to replicate what the fetus hears in the womb. This is suppose to stimulate the brains desire to communicate. The method is named after Dr. Alfred Tomatis who developed the method. I found a good overview of the method here:

"In 1953, Dr. Alfred Tomatis said "The voice contains only the sounds which the ear hears." This quote basically sums up the process he created to reteach the ear to listen. The program begins with an initial assessment with a consultant to test present and potential hearing. The patient is also evaluated to ensure that auditory stimulation is the appropriate treatment. Then a program is custom made, but it follows a basic pattern. The Electronic Ear is a tape recorder where sound is filtered and frequency can be adjusted. Initially, workouts consist of sessions of listening to very high frequencies that stimulate the pre-natal sounds and reproduce the stages of development from an audial point of view. This training makes it possible to switch ear dominance, reteach the listening process. These passive exercises, which consist of listening to specific frequencies, are gradually combined with active exercises utilizing the voice to maintain the lessons learned. For language learning and transformation of words and pictures, beginning with pre-natal sounds enables a person to learn a language quicker and more efficiently. The first fifteen days usually require about two hours a day. Subsequent sessions are shorter, with up to one or two months between each session."

Some national media interviews can be viewed here.

What is the Tomatis Method?