Clinical Research

 

“Developing a Communication System for Children with Cerebral Palsy”

Principal Investigator: Mary Jo Hidecker

Institution: Michigan State University

East Lansing, Michigan

While classifications of gross motor function and hand function have been created and validated for individuals with cerebral palsy, no analogous functional communication classification is available for use in CP practice and research. The lack of a quick, reliable, valid communication classification tool limits the comparison of descriptive CP epidemiological studies as well as the interpretation and generalizability of CP treatment studies.

The purpose of this study is to develop and validate a Communication Function Classification System for Children with Cerebral palsy. This tool will be used in combination with existing tools that assess motor function and manual ability to better capture a comprehensive view of the daily lives and functional abilities of individuals with CP.

“Establishment of a Minimal Clinically Important Difference for three different measures of Function in Children with Cerebral Palsy’

Hausman Awardee: Jilda Vargus-Adams

Institution: Cincinnati Children’s Hospital Medical Center

Cincinnati, Ohio

The purpose of this research is to determine the minimal clinical important difference (MCID) for three common measures of functional outcomes for children with cerebral palsy. Establishment of an MCID permits the delineation of change in functional ability that is clinically important and not just statistically significant. This will facilitate the standardization, conduct, interpretation, and efficiency of future clinical trials and meta-analyses as well as be useful in routine clinical practice and the determination of fruitful pursuits for new interventions and therapies.

“ Prediction of cerebral palsy by MRI following antenatal hypoxia-ischemia: role of mitochondria and free radicals”

Principal Investigator: Alexander Drobyshevsky

Institution: Evanston Hospital

Evanston, IL

One of the greatest obstacles in developing interventions for fetal hypoxia-ischemia (HI) is the inability to diagnose the onset and severity or brain injury in the womb. Free radicals have been implicated as a key mechanism of brain injury after a hypoxic-ischemic event causing reperfusion injury from a cascade of subsequent reactions. It has been speculated but never proven that the bigger the free radical burst, the bigger the reperfusion injury in the brain.

Ongoing reperfusion injury can now be assessed by using non-invasive and dynamic measurements of MRI. The apparent diffusion coefficient (ADC) from diffusion weighted imaging (DWI) has been shown to be very sensitive to HI mediated changes. This study is evaluating whether ADC change in reoxygenation-reperfusion is associated with concomitant excess free radical production, mitochondrial dysfunction and consequent cell death and apoptosis. An important corollary is whether ADC changes can predict the subsequent brain injury including later-onset motor deficits. Thus, the objective of this study is to establish the validity of ADC as an in vivo biomarker for free radical injury and to use ADC as a surrogate tool to investigate brain injury in vulnerable regions during neurodevelopment.

“ Robot Assisted Therapy in Children with Hemiplegic Cerebral Palsy”

Principal Investigator: JoElle Mast

Institution: Blythedale Children’s Hospital

Valhalla, NY

This study is evaluating the effectiveness of the MIT-Manus robot in improving upper extremity mobility and functionality in children aged 4 to 18 years diagnosed with hemiplegic cerebral palsy.

“Robotic Gait Training in Children with Cerebral Palsy”

Principal Investigator: Paolo Bonato

Spaulding Rehabilitation Hospital

Boston, MA

Innovations in clinical robotics technology, together with new understanding of the neurological recovery process in chronic stroke have led to new task-specific, robot-assisted neurological rehabilitation therapies for the upper limbs, lower limbs and hands. Task oriented rehabilitative modalities include robot-assisted body weight -supported treadmill training (BWSTT) for the lower limbs and robots such as the MIT-Manus for upper limb rehabilitation. These devices enable individuals with neurological injury to follow principles of motor learning and acquire new skills. Several studies have shown the potential of BWSTT to improve walking ability in patients after stroke, spinal cord injuries and in children with cerebral palsy.

This study is investigating the effectiveness of a robot-assisted BWSTT in improving locomotor function, coordination of movement and decrease in duration of muscle co-contraction in 30 children aged 4 to 12 with cerebral palsy.

“ Mechanisms of Impairment in Children with Dystonia Secondary to Cerebral Palsy”

Principal Investigator: Terrance Sanger

Institution: Stanford University

Stanford, CA

In children with tetraplegic or dyskinetic cerebral palsy, the primary impairment affecting the arms is usually dystonia, a disorder of the control of muscles. This study will provide the first data on muscle activation patterns during voluntary single-joint movements in dystonia due to CP. Successful results of this study will provide new potential avenues for treatment and indicate the potential benefits that can be achieved by reduction of each of the features of childhood dystonia. Early diagnosis and specific classifications of impairments can allow appropriately matched treatments to reduce or correct for abnormalities.

“The Effect of Botulinum Toxin on Neuromuscular Plasticity in the Child with Cerebral Palsy”

Principal Investigator: Richard Lauer

Institution: Shriner’s Hospitals for Children,

Philadelphia, PA

This is an observational study that will help to understand the neuromuscular plastic changes that occur in children with hemiplegic CP after an injection of botulinum toxin A to treat spasticity. The investigators are using a new method developed for the analysis of surface electromyographic signals to extract time and frequency characteristics to measure muscle activity combined with H-Reflex measurement and functional magnetic resonance imaging to measure nervous system activity. This information will be used to generate a larger study to better gauge the impact of botulinum toxin for the treatment of spasticity, and how to better direct this intervention, either alone or with existing treatments towards motor re-education.

‘Assessment of Neuroplasticity in Children with CP: A Multi-Source Detector Near Infrared Spectroscopy Imaging Study”

Principal Investigator: Mauricio Delgado

Institution: Texas Scottish Rite Hospital for Children

Dallas, TX

This study aims to use advanced multi-source detector functional near infrared spectroscopy brain imaging technology (fNRIS) for the real time evaluation of brain activity of motor movements. The investigators aim to identify the temporal and spatial characteristics of cortical activation during upper extremity movements in normal children and compare it to those activated in children with CP while performing the same movement. Functional assessments, MRI and fNRIS results will be correlated. This project intends to uncover plastic changes in sensorimotor network activity during upper extremity motor tasks that might occur as a result of CP, by measuring the dynamic oxygenation levels of hemoglobin during repetitive movements in this patient population. This information will provide insight as to the reliability and efficacy of NIRS brain imaging as a sensitive diagnostic tool for this motor disorder.

“Cortical Reorganization following Pediatric Constraint-Induced Therapy”

Principal Investigator: Marjorie Garvey

Institution: National Rehabilitation Hospital

Washington, DC

This is a clinical study designed to gain an understanding of the underlying brain reorganization that occurs in children with hemiplegic cerebral palsy after treatment with constraint induced (CI) therapy. The goal is to determine whether the presence of ipsilateral projections in the affected hemisphere of the patient is associated with worse outcomes after CI therapy. If true, then CI therapy would not be indicated for children with CP that have these projections, and might obscure the beneficial results of the therapy in clinical trials.

“The Application of Chaotically Induced Gait Perturbations to Improve Walking in Teenagers with Cerebral Palsy: A Feasibility Study in the Middle East”

Principle Investigator – Simona Bar-Haim

Institution: Assaf Harofeh Medical Center

Zerifin, Israel

The clinical study aims to determine the feasibility of incorporating the Chaotic Perturbation Technique in the treatment approach for improving gait in a group of teenaged children with diplegic cerebral palsy.

“The Relationship between Running, Lower Extremity Alignment and Participation in Important and Meaningful Physical Activities in Children with Cerebral Palsy”

Hausman Awardee – Margo Orlin

Institution:Drexel University

Philadelphia, PA

The long – term goal of the awardee is to develop and implement safe and effective therapeutic interventions to enhance the running ability of children and adolescents with cerebral palsy to support meaningful participation in life activities, play, fitness and sport activity.

“Correlates of Communication Development in Children with Cerebral Palsy”

Principle Investigator: Katherine Hustad

Institution: University of Wisconsin-Madison

Madison, WI

The goal of this work is to further the understanding of the relations among speech, language and cognition in children with CP; and to begin understand whether specific regions of brain damage lead to predicted multidimensional behavioral outcomes in the communication domain. This research will provide critical information that will have direct implications for speech and language interventions and for improving the quality of life of children with CP.

Adults with Cerebral Palsy

‘Pain management and exercise in adults with cerebral palsy’

Principal Investigator: Laura Vogtle

Institution: University of Alabama Birmingham

Birmingham, AL

This is a clinical study that will evaluate the effect of a structured exercise program on pain and cognitive impairments in adults with cerebral palsy.