Jan 01, 2008
Most children with CP are now surviving into adulthood and they face unique physical and medical problems related to their underlying condition. Indeed, aging adults with CP experience an early decline in function which is multi-factorial and poorly documented. This is complicated by the fact that as teenagers with CP transition into adulthood, they experience a precipitous loss of educational and state provided medical services. Society needs to address these issues from a standpoint of best care, continuity of care, and prevention of early loss in function as the adult with CP is a growing population due to improved survival of low birth weight infants and concomitant increasing longevity.
Epidemiology of Cerebral Palsy: Cerebral palsy (CP) is a non-progressive neurodevelopmental condition initiated early in life that persists into adulthood. Though the exact number of children and adults living with CP in the US is unknown, the population is increasing due to improvements in the survival of low birthweight infants (Colver, Pharoah, Vincer, Odding, Uldall). 87 to 93% of children born with CP now survive into adulthood (Hutton, Evans, Nielson) and a reasonable estimate is that 700,000 children and adults up to age 50 are living with CP in the US.
Complications of Aging with CP: Adults with CP experience musculoskeletal problems and loss of function that non-disabled adults do not experience until much later (IOM). A study indicated that 75% of individuals with CP stopped walking by age 25 due to fatigue and walking inefficiency (Murphy). Another study on young adults with CP found clinical evidence of arthritis in 27 % of subjects vs. 4% in the general population (Cathels). These challenges result in chronic immobility, harming bone health. Elevated fracture rates in adults with CP are not well documented, however, documentation in children with CP (Munns), men surviving spinal cord injury (Bauman, 2001A) and stroke survivors (Sahin, Sato) does exist. Immobilization not only elevates fracture risk but also the risk for metabolic syndrome (Zderic).
Long term outcomes in the adult of current clinical practice in children with CP: The long-term impact of interventions used to treat children with CP has not been well studied. Spasticity, the most often treated condition, is managed with physical therapy, chemodenervation using botulinum toxin A or phenol, continuous intrathecal baclofen, neurosurgical procedures, such as selective dorsal rhizotomy and placement of Baclofen pumps, and orthopedic surgeries such as tendon transfers and osteotomies (Paul), but there is little scientific evidence supporting effectiveness of these treatments, particularly over the long term.
Cutting Edge Technologies in Neurorehabilitation: There is considerable evidence that the adult human brain is capable of significant recovery (plasticity) with the appropriate frequency and timing of treatments. Cutting edge therapies have shown promise in adult patients after stroke or spinal cord injury and in children with CP. Task specific training has shown to improve walking ability (Schindl, Maltais, McNevin). Neuromuscular electrical stimulation has shown improvements in muscle strength (Stackhouse ). Virtual reality therapy has improved upper and lower limb function when used in conjunction with neurorehabilitation modalities (Henderson, Stewart, Crosbie, Bryanton). Vibration therapy has been shown to decrease spasticity (Ahlborg, 2006) allow postponement of surgical interventions (Semler), and reduce the age related deterioration of body composition in animal models (Rubin).
There is an urgent need for more scientific research into the magnitude of the secondary musculoskeletal and neuromuscular complications in the adult with cerebral palsy. Clinicians who treat children with cerebral palsy may need to re-evaluate treatment choices with long-term health outcomes in mind. From what we have learned about plasticity in the adult stroke population, it may be possible that the adult with CP may gain new motor skills from the appropriate task specific rehabilitative techniques, or at the least, prevent/mitigate the secondary complications.
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