Category Archives: Treatments and Research

The BRIGHT Cerebral Palsy Repository

The BRIGHT Cerebral Palsy Cure Project (www.CPCure.com) has established the “CP Repository, a large-scale collection of data from our members with Cerebral Palsy, TBI, and other related brain injuries. We make this data available to researchers studying CP and other similar diseases. In addition to the Repository, we also have created the world’s largest database of existing published research, we call this the “CP Meta-Study”. This data bank includes research in basic brain biology, treatment methods, therapeutic methods, engineering, and technology. The BRIGHT CP Repository and the BRIGHT CP Meta-Study aggregate the results of existing studies and live data from our membership, so that collectively they can be analyzed and help lead to new findings and breakthroughs.

The following links lead to input forms for members to contribute data to the database.  Please choose the appropriate link to begin contributing data.   If you would prefer to have your data entered by one of our staff, or if you are a medical professional looking to gain access to our database, please contact us at donations@brightfoundation.org.

Section 1.) Privacy This section must be completed first.   Once you have chosen a 5 character username, it will be used to identify all data in BRIGHT’s databases.  Therefore, please keep your username private and remember it.

CP Meta-Study Input Form BRIGHT members should use this form to input information about existing research.

GMFM Input Form BRIGHT members should use this form to input monthly results of the GMFM test.

CP Repository – Section 2.) General History

CP Repository – Section 3.) Birth History

CP Repository – Section 4.) History of Injury

CP Repository – Section 5.) Medical Diagnosis and Issues

CP Repository – Section 6.) Current Development

CP Repository – Section 7.) Therapy and Treatments

 

Cord Blood Stem Cell Treatment for Cerebral Palsy

Stem Cell treatment comes in many types.  Its been around now for several years.   When our daughter was born 11 years ago, we were just starting to hear about it.  In these last 11 years, clinics in places like China, Mexico, etc. have been offering stem cell treatments.  To our knowledge, no miracle cures have happened yet.   In fact, injecting anything into a child is dangerous business and some serious complications and even deaths have been reported.  China’s federal government has announced an official hold on stem cell treatments for cerebral palsy for fear of losing control over the many small clinics that have started to offer the treatment, however, my understanding is that the the network of Army hospitals operate independently and have continued to offer treatment.  Again, from what we have seen, there have been no miracle cures.

This brings us to the USA and two clinical trails being done on Cord Blood.  Here is a video that is quite interesting.

Cord Blood Stem Cell Treatment for Cerebral Palsy in Clinical Trial

The Medical College of Georgia and Dr. Joanne Kurtzberg at Duke University have begun FDA approved clinical trails using IV infusions of stem cells from a child’s own umbilical cord (autologous).

The Duke study is funded with a $10.2 million donation from the Robertson Foundation.

The mechanism that is at work is unclear, however Dr. Kurtzberg hypothesizes that cord blood cells can reduce inflammation in the brain, produce hormones to repair brain cells or possibly transform themselves into healthy brain cells to replace the damaged ones.

James Carroll, the head researcher for the clinical trials at MCG, has had success with treating oxygen related brain damage in animal tests. Rats with induced CP-like conditions were shown to have improved motor skills after multipotent adult progenitor stem cells were introduced.

In MCG’s trial, children 2 to 12 years old will be given IV infusions (half will receive cord blood stem cells, half placebo) and then examined three months later. At that point, the placeboed half of the patients will receive cord blood stem cells. Examinations will continue three and six months later.  The Duke study focuses on children 1 to 6 years old.

Outside of the trail, it is said Dr. Kurtzberg has already treated about 150 patients with positive results.   BRIGHT hopes to contact Dr. Kurtzberg or any of the parents who’s children have received these treatments.

Cerebral Palsy which affects 2-3 children per thousand in the US.  The Centers for Disease Control estimated in 2003 that the cost of caring for someone with CP over a lifetime is $921,000.

Link
 This is further justification for the use of music as a tool for treatment within the Snowdrop programme,both generally and using such tools as ‘The Listening Programme’ of which Snowdrop is a provider. With thanks to MNT
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Researchers have long debated whether or not language and music depend on common processes in the mind. Now, researchers at Georgetown University Medical Center have found evidence that the processing of music and language do indeed depend on some of the same brain systems.Their findings, which are currently available on-line and will be published later this year in the journal NeuroImage, are the first to suggest that two different aspects of both music and language depend on the same two memory systems in the brain. One brain system, based in the temporal lobes, helps humans memorize information in both language and music — for example, words and meanings in language and familiar melodies in music. The other system, based in the frontal lobes, helps us unconsciously learn and use the rules that underlie both language and music, such as the rules of syntax in sentences, and the rules of harmony in music.

“Up until now, researchers had found that the processing of rules relies on an overlapping set of frontal lobe structures in music and language. However, in addition to rules, both language and music crucially require the memorization of arbitrary information such as words and melodies,” says the study’s principal investigator, Michael Ullman, Ph.D., professor of neuroscience, psychology, neurology and linguistics.

“This study not only confirms that one set of brain structures underlies rules in both language and music, but also suggests, for the first time, that a different brain system underlies memorized information in both domains,” Ullman says. “So language and music both depend on two different brain systems, each for the same type of thing — rules in one case, and arbitrary information in the other.”

Robbin Miranda, Ph.D., currently a post-doctoral researcher in the Department of Neuroscience, carried out this research with Ullman for her graduate dissertation at Georgetown. They enrolled 64 adults. They used a technique called Event-Related Potentials, in which they measured the brain’s electrical activity using electrodes placed on the scalp.

The subjects listened to 180 snippets of melodies. Half of the melodies were segments from tunes that most participants would know, such as “Three Blind Mice” and “Twinkle, Twinkle Little Star.” The other half included novel tunes composed by Miranda. Three versions of each well-known and novel melody were created: melodies containing an in-key deviant note (which could only be detected if the melody was familiar, and therefore memorized); melodies that contained an out-of-key deviant note (which violated rules of harmony); and the original (control) melodies.

For listeners familiar with a melody, an in-key deviant note violated the listener’s memory of the melody — the song sounded musically “correct” and didn’t violate any rules of music, but it was different than what the listener had previously memorized. In contrast, in-key “deviant” notes in novel melodies did not violate memory (or rules) because the listeners did not know the tune.

Out-of-key deviant notes constituted violations of musical rules in both well-known and novel melodies. Additionally, out-of-key deviant notes violated memory in well-known melodies.

Miranda and Ullman examined the brain waves of the participants who listened to melodies in the different conditions, and found that violations of rules and memory in music corresponded to the two patterns of brain waves seen in previous studies of rule and memory violations in language. That is, in-key violations of familiar (but not novel) melodies led to a brain-wave pattern similar to one called an “N400” that has previously been found with violations of words (such as, “I’ll have my coffee with milk and concrete”). Out-of-key violations of both familiar and novel melodies led to a brain-wave pattern over frontal lobe electrodes similar to patterns previously found for violations of rules in both language and music. Finally, out-of-key violations of familiar melodies also led to an N400-like pattern of brain activity, as expected because these are violations of memory as well as rules.

“This tells us that these two aspects of music, that is rules and memorized melodies, depend on two different brain systems — brain systems that also underlie rules and memorized information in language,” Ullman says. “The findings open up exciting new ways of thinking about and investigating the relationship between language and music, two fundamental human capacities.”

For more information: http://networkedblogs.com/yv0WS

Self-Motivation Key to Neural Regeneration

Some extremely important work is being done by Grégoire Courtine, a neuroscientist at the Swiss Federal Institute of Technology Lausanne.

His group has achieved the very important milestone of being able to rehabilitate a rat to walk again after causing hind leg paralysis by near complete severing of the spine.

This type of injury is common in Spinal Cord Injury and results in very weak signals being transmitted with not enough bandwidth to create any meaningful motor movement.

Next Dr. Courtine inject drugs that mimic the normal chemical signals from the brain into the damaged spinal cord.   They also insert two electrodes and stimulate across the injury site.

Animals left lying idle during recovery showed improved nerve growth, but did not regain function.

Animals put on a treadmill with assisted leg movements showed some improvement, but nothing that would be considered a breakthrough.

However, when a third element was added, a goal of food, then the rats not only responded, but they learned to walk again.  Some animals even regained the ability to run and climb.

This is an extraordinary result that has not been seen before.   The success appears to have been achieved by three factors.

  • Improved chemical environment for neural signaling using drugs and electric stim.
  • The use of assisted motor training that used a robotic harness to remove balance and weight issues and allowed the animal to focus on forward movement.
  • The final and most important factor seems to be the introduction of a goal and positive achievement of that goal.  In this case, running after some food and finally after 30 minute work-outs achieving that goal multiple times.

Examples the concept of “success” based motor learning is seen over and over.  One example would be the reliance on the “good arm” of stroke patients and consequently the loss of motor learning in the “bad arm”.

The work of Dr. Courtine could prove to be a breakthrough for Spinal Cord Injury patients and a confirms the thesis of BRIGHT that “success” based motor learning is likely a key therapeutic approach for children with Cerebral Palsy as well.

Anat Baniel and other crys for hope for CP

Here is an article that deserves a read.  We have personal experience with Anat Baniel because she treated our daughter about 10 years ago.  Our experience says that $3,000 per week can probably be spent better elsewhere, however, for a very mild case of CP, any type of movement therapy can help. However, any type of physio therapy is just too little, too late for a child’s brain injury.  Hence “The Idea for a Cure”

If you have money to burn, I would give you a list of therapies, and include Anat on that list.   We spent our whole life savings on treatments in the first five years.  Did they help?  We have no way to tell, because we don’t know what Alissa would be with-out them, but she is still non-verbal, not walking on her own, still needs a g-tube for supplemental nutrition, etc.   If Anat reads this, my guess is that she would defend herself behind a cloak of me being too negative, but that is Anat’s defense mechanism… not mine.

Mom hopes book will lend A helping hand

Sales will help pay for her son’s treatment for cerebral palsy

By Randi Bjornstad

The Register-Guard

Published: (Monday, Jun 11, 2012 10:38AM) Midnight, June 11


Story photo and/or graphicJessie Kirk Photography

Shasta Kearns Moore and her husband, Matt Millard, sit with their sons, Malachi (left) and Jaden James. Malachi has cerebral palsy, and his treatment is expensive. His mom has written a children’s book and hopes sales will help pay for the medical expenses.

Story photoJessie Kirk Photography

Shasta Kearns Moore helps her son Malachi stand up. Malachi, who will turn 2 this month, has cerebral palsy.


Loving parents will do just about anything for their children’s health and welfare, and Shasta Kearns Moore and her husband, Matt Millard, are no exception.

The young couple have identical twin boys — Malachi and Jaden James, aka JJ — who will turn 2 years old on June 26.

Within weeks of their birth, Malachi, the older by five minutes, was diagnosed with cerebral palsy. Although quick-witted and verbal like his brother, the little boy cannot sit or stand unaided.

So far, Malachi has benefited substantially from the Anat Baniel Method of treatment, which uses gentle movement to help very young children with brain injuries — such as the strokes that lead to cerebral palsy — create new brain-body neural pathways while their nervous systems still are pliable.

The therapy is labor intensive and expensive. And like many health treatments that are not yet considered mainstream, ABM is not covered by insurance.

So Kearns Moore — who graduated from South Eugene High School in 2001, earned a degree in journalism at the University of Oregon five years later and then worked at newspapers in Tillamook and Portland — decided to combine her writing and parenting skills in a children’s board book. It’s called “Dark & Light: A Love Story for Babies … (and those who read to them).” Kearns Moore hopes it will help raise enough money to continue Malachi’s treatment.

“We have used up all of our savings and have had to use credit cards, but we are determined to get this therapy that we think is best for him until we can’t,” Kearns Moore said. “I’m hoping that people will love this book and will want to buy it and maybe even pledge a little more to help Malachi.”

Kearns Moore has set a deadline of June 27 to raise $5,000, the minimum cost of printing 500 board books that can stand up to the handling and teething of their young readers.

As sometimes happens these days, a self-published book that does well may be picked up by a major publisher. If that happens with “Dark & Light,” Kearns Moore will be delighted.

“The book will always be dedicated to Malachi and his needs,” she said. “But if it brought in enough money, we could start a foundation to help other babies with cerebral palsy get this special therapy.”

She got the idea for the book one day last fall when she was lying down to rest while the twins were napping.

“I was thinking about their favorite books, which are simple images with no text,” she said. “I began to think how I could create a book of my own with the same concept but with words that would have a deeper meaning that both children and adults could appreciate. I came up with the concept of ‘dark’ and ‘light’ and how they relate to each other in a variety of ways.”

Since she posted her book offer on Kickstarter.com, an online clearinghouse where people with creative projects can gain community financial support in exchange for a “reward” — such as a copy of Kearns Moore’s “Dark & Light” or her earlier grown-up novella, “A Twist of Fate” — well over 100 people have made donations approaching $4,000. The way Kickstarter works, if the goal isn’t reached, nobody pays.

If Kearns Moore reaches her goal and can order the first printing, the books will be shipped to their new owners in early August.

When she was first pregnant, her husband continually teased her that she was carrying twins, Kearns Moore recalled. “Every time I had serious morning sickness, he would say, ‘That’s because it’s for two babies.’ But when the midwives first listened for a heartbeat, they could only hear one.”

At five months, she had an ultrasound, “and the image immediately showed a baby, and there was a little circle by its feet. We said, ‘What is that circle?’ and the technician said, ‘That’s another baby.’ I was in shock. After all that teasing, Matt was right.”

After her exam was completed, “about 16 medical professionals came in and said the babies probably wouldn’t survive because I had a too-short cervix,” Kearns Moore said. She went home and began what became 10 weeks of bed rest. The day before she had carried the babies for 28 weeks, contractions started, leading to a two-week stay in the hospital until the babies were born — without Caesarean section — just before the 30-week mark in the normal 40-week gestation.

At first everything seemed fine, but a week later a scan showed a small spot of blood on Malachi’s brain. The next week, the ventricles of his heart appeared swollen, and at the next check-up, doctors diagnosed cerebral palsy.

“I didn’t know anything about CP at the beginning, but I started doing a lot of research,” Kearns Moore said. She also started a blog, to share her own essays, pictures and poems about living with twins, one with and one without cerebral palsy, and share information about the Anat Baniel Method.

“It’s really a compelling way of looking at brain injuries in children,” Kearns Moore said, although the therapy applies to people of all ages with brain-related conditions such as stroke, Parkinson’s disease and multiple sclerosis. “The traditional methodology with kids with CP focuses on strengthening muscles, but ABM is the opposite — it’s brain-focused. It’s very slow and very gentle and works on the relationship between what the brain can do and what the body can do and supports the child’s ability to learn.”

Kearns Moore and her husband have taken Malachi to San Rafael, Calif., the headquarters of the Anat Baniel Method, for a weeklong intensive therapy, which costs $3,000. “When we’re there, we do two classes a day, each for an hour, with the therapists, who use some yogalike therapy and other movements,” she said. “It’s hard to see what’s going on, because it’s all happening in the brain. But after the first lesson, I couldn’t believe the change in Malachi — his muscles were so much looser, his ability to move was completely different.”

Continuing therapy, which costs about $700 per month, is available in Portland, where there are at least two certified Anat Baniel Method practitioners.

“I don’t know where Malachi is on the CP spectrum, but from what I’ve seen with this therapy, I’m optimistic — I think the results from this therapy are a research study waiting to happen,” Kearns Moore said. “Malachi’s fine motor skills are getting better all the time, and he speaks about as well as JJ. It’s the gross motor skills that lag. But we’re just thankful that he is verbal and such a joy to be around.”

http://www.registerguard.com/web/livinghealthfitness/28193566-41/malachi-kearns-moore-book-cerebral.html.csp

Nanoparticles help deliver drug to targeted brain cells for Acute Cerebral Palsy Treatment

There are two phases to brain injury.  The first is the phase that lasts for the first few days.  During this time, there is what is called a biochemical cascade which actually causes more healthy brain cells to die.  The second phase lasts for the rest of our lives.   So treatment also follows the two phases.  If you can treat early enough (hours after the injury) then there is a chance to prevent the further damage caused by the cascade.  Brain Cooling is one approach.  Another is anti-inflammatory drugs.  If you can’t treat in the first few hours, then treatment is focused around how to deal with the dead brain cells.  I personally believe that plasticity is the best approach to deal with dead brain cells (i.e. retraining other parts of the brain to take over for the dead parts.)

Below is a new article announcing some exciting results of a new way to deliver drugs safely to the part of the brain that needs treatment.  This has been one of the issues with brain cooling, drug treatment, etc.  You can just treat the entire brain.  You need to target the correct cells.  These nano-particles are helping to do this.

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A team of scientists from Johns Hopkins and elsewhere have developed nano-devices that successfully cross the brain-blood barrier and deliver a drug that tames brain-damaging inflammation in rabbits with cerebral palsy.

 A report on the experiments, conducted at Wayne State University in collaboration with the Perinatology Research Branch of the National Institute of Child Health and Human Development, before the lead and senior investigators moved to Johns Hopkins, is published in the April 18 issue of Science Translational Medicine.

For the study, researchers used tiny, manmade molecules laced with N-acetyl-L-cysteine (NAC), an anti-inflammatory drug used as antidote in acetaminophen poisoning. The researchers precision-targeted brain cells gone awry to halt brain injury. In doing so they improved the animals’ neurologic function and motor skills.

The new approach holds therapeutic potential for a wide variety of neurologic disorders in humans that stem from neuro-inflammation, including Alzheimer’s disease, stroke, autism and multiple sclerosis, the investigators say.

The scientists caution that the findings are a long way from human application, but that the simplicity and versatility of the drug-delivery system make it an ideal candidate for translation into clinical use.

“In crossing the blood-brain barrier and targeting the cells responsible for inflammation and brain injury, we believe we may have opened the door to new therapies for a wide-variety of neurologic disorders that stem from an inflammatory response gone haywire,” says lead investigator Sujatha Kannan, M.D., now a pediatric critical-care specialist at Johns Hopkins Children’s Center.

Cerebral palsy (CP), estimated to occur in three out of 1,000 newborns, is a lifelong, often devastating disorder caused by infection or reduced oxygen to the brain before, during or immediately after birth. Current therapies focus on assuaging symptoms and improving quality of life, but can neither reduce nor reverse neurologic damage and loss of motor function.

Neuro-inflammatory damage occurs when two types of brain cells called microglia and astrocytes — normally deployed to protect the brain during infection and inflammation — actually damage it by going into overdrive and destroying healthy brain cells along with damaged ones.

Directly treating cells in the brain has long proven difficult because of the biological and physiological systems that have evolved to protect the brain from blood-borne infections. The quest to deliver the drug to the brain also involved developing a technique to get past the brain-blood barrier, spare healthy brain cells and deliver the anti-inflammatory drug exclusively inside the rogue cells.

To do all this, the scientists used a globular, tree-like synthetic molecule, known as a dendrimer. Its size — 2,000 times smaller than a red blood cell — renders it fit for travel across the blood-brain barrier. Moreover, the dendrimer’s tree-like structure allowed scientists to attach to it molecules of an anti-inflammatory NAC. The researchers tagged the drug-laced dendrimers with fluorescent tracers to monitor their journey to the brain and injected them into rabbits with cerebral palsy six hours after birth. Another group of newborn rabbits received an injection of NAC only.

Not only did the drug-loaded dendrimers make their way inside the brain but, once there, were rapidly swallowed by the overactive astrocytes and microglia.

“These rampant inflammatory cells, in effect, gobbled up their own poison,” Kannan says.

“The dendrimers not only successfully crossed the blood-brain barrier but, perhaps more importantly, zeroed in on the very cells responsible for neuro-inflammation, releasing the therapeutic drug directly into them,” says senior investigator Rangaramanujam Kannan, Ph.D., of the Center for Nanomedicine at the Johns Hopkins Wilmer Eye Institute.

Animals treated with dendrimer-borne NAC showed marked improvement in motor control and coordination within five days after birth, nearly reaching the motor skill of healthy rabbits. By comparison, rabbits treated with dendrimer-free NAC showed minimal, if any, improvement, even at doses 10 times higher than the dendrimer-borne version. Animals treated with the dendrimer-delivered drug also showed better muscle tone and less stiffness in the hind leg muscles, both hallmarks of CP.

Brain tissue analysis revealed that rabbits treated with dendrimer-borne NAC had notably fewer “bad” microglia — the inflammatory cells responsible for brain damage — as well as markedly lower levels of other inflammation markers. They also had better preserved myelin, the protein that sheaths nerves and is stripped or damaged in CP and other neurologic disorders. And even though CP is marked by neuron death in certain brain centers, animals who received dendrimer-borne NAC had higher number of neurons in the brain regions responsible for coordination and motor control, compared with untreated animals and those treated with NAC only.

The findings suggest that the treatment not only reduces inflammation in the cells, but may also prevent cell damage and cell death, the researchers said. The Kannans, who are married, say they plan to follow some treated animals into adulthood to ensure the improvements are not temporary.

A separate study, led by Rangaramanujam Kannan, has already demonstrated the therapeutic benefits of this approach in reversing retinal damage in rats with macular degeneration, the vision-robbing eye disorder that affects millions of older adults.

Source : Johns Hopkins Medical Institutions

http://www.biologynews.net/archives/2012/04/23/nanodevices_that_cross_bloodbrain_barrier_open_door_to_treatment_of_cerebral_palsy.html

Second Skin “Bio-Suit” for Cerebral Palsy?

Dava Newman is professor of aeronautics and astronautics and engineering systems at the Massachusetts Institute of Technology (MIT).

She has been working to develop a new type of space suit.  Currently space suits are like balloons.  They are filled with pressurized gas to provide the astronaut with both oxygen and also positive pressure to counter the vacuum of space.  The problem is that moving around inside of a pressurized bubble is not easy.

Therefore, Dr. Newman’s team at MIT is working with NASA to develop a new type of mechanical pressure suit they are calling the “Bio-Suit”.   The key advantage for astronauts will be that it will allow much greater mobility.  Much like having a second skin.

However, the “Bio-Suit” may have applications beyond space exploration.  It is also very possible that the “Bio-Suit” could form the foundation for a new type of Exoskeleton.  One that is much less bulky and intrusive then current robotic like designs.  In addition, much like the currently used Adeli Suit, the positive pressure aspect of the suit could help with sensory and stability issues.

Dr. Newman’s own team recognises these potential medial benefits and has been working with doctors at Children’s Hospital in Boston, Harvard’s Wyss Institute, Boston University, and Draper Laboratory to see if the bio-suit can help patients with anoxic brain injuries.  For example, children with cerebral palsy, and even children and adult stroke victims, who typically lose motor skills on one side of their bodies.

Currently they are using the BioSuit and it’s built-in sensors to measure movements of normal children and adults and compare those to injured patients.   As it turns out, when patients suffer a brain injury, its harder to move and often movement attempts are unsuccessful (for example spilling the cup of water, rather then drinking it).  This leads to something that Dr. Ed Taub coined as “learned non-use”.   When you don’t use movements, the brain quickly loses its programing for that movement.  Taub’s studies showed this can happen as quickly as 1 month post accident.

However, Taub’s studies also also showed that movement could be preserved or even recovered through the use of what he called Constraint-Induced Therapy.  Which was basically just forcing the patient to continue to use their movement patterns to avoid losing them.

Therefore, Dr. Newman’s team realizes the next step for the Bio-Suit would be to fit the suit with actuators.  These would turn the Bio-Suit into a powered exoskeleton and would facilitate movement therapy like Dr. Taub has found to be successful and we have written about in the post exoskeleton-suits-for-cerebral-palsy-the-idea .

Here are Dr. Newman’s words: “People with cerebral palsy expend a lot of energy moving and have stiffened muscles; our BioSuit technology and know-how could guide movement and enhance mobility to make it more efficient. And because the brains of newborns are still so plastic, enhancing the natural kicking of infants with potential motor problems from brain damage might actually reshape the motor programs and partly “heal” their brains.”

Dava J. Newman is Professor of Aeronautics and Astronautics and Engineering Systems at the Massachusetts Institute of Technology

Treadmill therapy (exoskeleton assisted) for cerebral palsy

A  study using the Lokomat robotic assisted treadmill was conducted at University of Munich, Germany. The results are very exciting because they are exactly as we would have expected based on the research of BRIGHT.

The study shows that assisted gait training improves Gross Motor Skills in a very short period of time (just three weeks of periodic training).  It also shows that results improve with more intense training.

This strengthens the case of BRIGHT that a fully autonomous exoskeleton that will allow 24×7 training would be the ideal treatment approach for Children with CP.  Children that are more severely impaired would stand the most to gain because current systems like the Lokomat are bulky and require the child to exercise in a controlled environment.  This is demotivatational and impractical and therefore, only when more sophisticated exoskeleton suits which allow the child freedom to interact in a natural setting will the child be motivated to “train” intensively and thus achieve improvement through re-routing of the brain through neuroplasticity.

Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy

Abstract

Objective

Task-specific body-weight-supported treadmill therapy improves walking performance in children with central gait impairment. The aim of the study was to investigate the effect of robotic-assisted treadmill therapy on standing and walking performance in children and adolescents with cerebral palsy and to determine parameters influencing outcome.

Methods

20 Patients (mean age 11.0±5.1, 10 males and 10 females) with cerebral palsy underwent 12 sessions of robotic-assisted treadmill therapy using the driven gait orthosis Lokomat. Outcome measures were the dimensions D (standing) and E (walking) of the Gross Motor Function Measure (GMFM).

Results

Significant improvements in dimension D by 5.9% (±5.2, p=0.001) and dimension E by 5.3% (±5.6, p<0.001) of the GMFM were achieved. Improvements in the GMFM D and E were significantly greater in the mildly affected cohort (GMFCS I and II) compared to the more severely affected cohort (GMFCS III and IV). Improvement of the dimension E but not of D correlated positively with the total distance and time walked during the trial (rs=0.748, p<0.001).

Conclusions

Children and adolescents with bilateral spastic cerebral palsy showed improvements in the functional tasks of standing and walking after a 3-week trial of robotic-assisted treadmill therapy. The severity of motor impairment affects the amount of the achieved improvement.

Keywords: Driven gait orthosis, Body-weight-supported treadmill therapy, Task-specific learning

Abbreviations: DGO, driven gait orthosis, CP, cerebral palsy, GMFM, gross motor function measure, GMFCS, gross motor function classification system, BWSTT, body-weight-supported treadmill therapy

    • Ingo Borggraefe

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany
      • Corresponding Author InformationCorresponding author. Tel.: +49 89 5160 7851; fax: +49 89 5160 7745.

      email address

,

    • Jan Simon Schaefer

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

,

    • Mirjam Klaiber

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

,

    • Edward Dabrowski

      Affiliations

      • Children’s Hospital of Michigan, Division of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Department of Pediatrics, Detroit, MI, USA

,

    • Corinne Ammann-Reiffer

      Affiliations

      • Rehabilitation Centre, Affoltern a. Albis, University Children’s Hospital Zurich, Switzerland

,

    • Beat Knecht

      Affiliations

      • Rehabilitation Centre, Affoltern a. Albis, University Children’s Hospital Zurich, Switzerland

,

    • Steffen Berweck

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

,

    • Florian Heinen

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

,

Wilmington Robotic Exoskeleton

Here is a video of the Wilmington Robotic Exoskeleton.  The WREX is an orthosis for enhancing movement of the upper extremities in people with neuromuscular disabilities

This unique assistive device aids in activities of daily living for a variety of pathologies such as muscle disease, cerebral palsy, spinal cord injury, multiple sclerosis and amyotrophic lateral sclerosis – which effect upper limbs. It also serves as a cost effective exercise/therapy device for people recovering from stroke and other debilitating injuries.

Exoskeletons – An Interview With Prof. Daniel Ferris

As we have suggested in our article Exoskeleton Suits for Cerebral Palsy – The Idea, Professor Ferris also shares the idea that soon Exoskeletons could be used to help rehabilitate those with Cerebral Palsy.

There is a very good article about the possible use of Exoskeletons for therapeutic purposes at this link http://www.exoskeleton-suit.com/FerrisInterview.html.

The link is an interview with Professor Daniel Ferris who is a world renown expert on the subject of exoskeletons.