Posts tagged cerebral palsy
Articles and news from the latest research reports.
Motor Control Development Continues Longer Than Previously Believed
Research opens up longer therapy window for children with neurodevelopmental disorders
The development of fine motor control – the ability to use your fingertips to manipulate objects – takes longer than previously believed, and isn’t entirely the result of brain development, according to a pair of complementary studies.
The research opens up the potential to use therapy to continue improving the motor control skills of children suffering from neurodevelopmental disorders such as cerebral palsy, a blanket term for central motor disorders that affects about 764,000 children and adults nationwide.
“These findings show that it’s not only possible, but critical to continue or begin physical therapy in adolescence,” said Francisco Valero-Cuevas, corresponding author of two studies on the matter – one appearing in the Journal of Neurophysiology and the other in the Journal of Neuroscience.
“We find we likely do not have a narrow window of opportunity in early childhood to improve manipulation skills, as previously believed, but rather developmental plasticity lasts much longer and provides opportunity throughout adolescence” he said. “This complements similarly exciting findings showing brain plasticity in adulthood and old age.”
Researchers had previously been able to detect improvements in fine motor control of the hand only until around ages 8-10. However, Valero-Cuevas – a professor of biomedical engineering and of biokinesiology and physical therapy – invented a tool that allows for more precise measurement of fine motor control.
The tool is simple – springs of varying stiffness and length set between plastic pads which Valero-Cuevas has patented. Motor skill is then determined by the individual’s ability to compress the increasingly awkward spring devices. Sudarshan Dayanidhi, during his PhD studies at USC with Valero-Cuevas, developed and applied clinically useful versions of this technology with great success.
With this new tool, and in collaboration with Åsa Hedberg and Hans Forssberg of the Astrid Lindgren Children’s Hospital in Stockholm, they tested 130 children with typical development between 4-16 years of age, and demonstrated that even the 16-year-olds were continuing to hone their fine motor skills. Their findings will appear in the Journal of Neurophysiology on Oct. 1.
To further this study, Dayanidhi and Valero-Cuevas joined forces with Assistant Professor of biokinesiology and physical therapy Jason Kutch (also of USC), to explore if this longer developmental timeline for dexterity was tied not just to brain maturation, but also to muscular development.
It has long been thought that improved dexterity involved only brain development and muscle growth – where muscles only got bigger and stronger – but did not add to dexterous skills since they are performed at low forces. The research by Dayanidhi, Kutch and Valero-Cuevas indicates otherwise.
“Combining our metrics of dexterity from Dayanidhi’s PhD work, with novel and noninvasive measures of muscle contraction time developed by Prof. Kutch, we were able to show a previously unknown strong association between gains in dexterity with improvement in low force muscle contraction time,” Valero-Cuevas said.
This second facet of the research showing how both dexterity and muscle function improve in children will appear in the Journal of Neuroscience on Sept. 18.
(Source: pressroom.usc.edu)
The parents searched the literature for treatment options
At the end of November 2008, the child suffered from cardiac arrest with severe brain damage and was subsequently in a persistent vegetative state with his body paralysed. Up to now, there has been no treatment for the cause of what is known as infantile cerebral palsy. “In their desperate situation, the parents searched the literature for alternative therapies”, Arne Jensen explains. “They contacted us and asked about the possibilities of using their son’s cord blood, frozen at his birth.”
“Threatening, if not hopeless prognosis”
Nine weeks after the brain damage, on 27 January 2009, the doctors administered the prepared blood intravenously. They studied the progress of recovery at 2, 5, 12, 24, 30, and 40 months after the insult. Usually, the chances of survival after such a severe brain damage and more than 25 minutes duration of resuscitation are six per cent. Months after the severe brain damage, the surviving children usually only exhibit minimal signs of consciousness. “The prognosis for the little patient was threatening if not hopeless”, the Bochum medics say.
Rapid recovery after cord blood therapy
After the cord blood therapy, the patient, however, recovered relatively quickly. Within two months, the spasticity decreased significantly. He was able to see, sit, smile, and to speak simple words again. Forty months after treatment, the child was able to eat independently, walk with assistance, and form four-word sentences. “Of course, on the basis of these results, we cannot clearly say what the cause of the recovery is”, Jensen says. “It is, however, very difficult to explain these remarkable effects by purely symptomatic treatment during active rehabilitation.”
In animal studies, stem cells migrate to damaged brain tissue
In animal studies, scientists have been researching the therapeutic potential of cord blood for some time. In a previous study with rats, RUB researchers revealed that cord blood cells migrate to the damaged area of the brain in large numbers within 24 hours of administration. In March 2013, in a controlled study of one hundred children, Korean doctors reported for the first time that they had successfully treated cerebral palsy with allogeneic cord blood.
Study identifies new approach to improving treatment for MS and other conditions
Working with lab mice models of multiple sclerosis (MS), UC Davis scientists have detected a novel molecular target for the design of drugs that could be safer and more effective than current FDA-approved medications against MS.
The findings of the research study, published online today in the journal EMBO Molecular Medicine could have therapeutic applications for MS as well as cerebral palsy and leukodystrophies, all disorders associated with loss of white matter, which is the brain tissue that carries information between nerve cells in the brain and the spinal cord.
The target, a protein referred to as mitochondrial translocator protein (TSPO), had been previously identified but not linked to MS, an autoimmune disease that strips the protective fatty coating off nerve fibers of the brain and spinal cord. The mitrochronical TSPO is located on the outer surface of mitochondria, cellular structures that supply energy to the cells. Damage to the fatty coating, or myelin, slows the transmission of the nerve signals that enable body movement as well as sensory and cognitive functioning.
The scientists identified mitochondrial TSPO as a potential therapeutic target when mice that had symptoms of MS improved after being treated with the anti-anxiety drug etifoxine, which interacts with mitochondrial TSPO. When etifoxine, a drug clinically available in Europe, was administered to the MS mice before they had clinical signs of disease, the severity of the disease was reduced when compared to the untreated lab animals. When treated at the peak of disease severity, the animals’ MS symptoms improved.
“Etifoxine has a novel protective effect against the loss of the sheath that insulates the nerve fibers that transmit the signals from brain cells,” said Wenbin Deng, principal investigator of the study and associate professor of biochemistry and molecular medicine at UC Davis.
“Our discovery of etifoxine’s effects on an MS animal model suggests that mitochondrial TSPO represents a potential therapeutic target for MS drug development,” said Deng.
“Drugs designed to more precisely bind to mitochondrial TSPO may help repair the myelin sheath of MS patients and thereby even help restore the transmission of signals in the central nervous system that enable normal motor, sensory and cognitive functions,” he said.
Deng added that better treatments for MS and other demyelinating diseases are needed, especially since current FDA-approved therapies do not repair the damage of immune attacks on the myelin sheath.
The UC Davis research team hopes to further investigate the therapeutic applications of mitochondrial TSPO in drug development for MS and other autoimmune diseases. To identify more efficacious and safer drug candidates, they plan to pursue research grants that will enable them to test a variety of pharmacological compounds that bind to mitochondrial TSPO and other molecular targets in experimental models of MS and other myelin diseases.
(Source: ucdmc.ucdavis.edu)
CI Therapy Produces Increase in Grey Matter in Brains of Children with Cerebral Palsy
Researchers at the University of Alabama at Birmingham (UAB) report that children with cerebral palsy who underwent Constraint Induced Movement therapy (CI therapy) saw a significant increase in grey matter volume in areas of the brain associated with movement. The findings, published online April 22, 2013 in Pediatrics, are the first to show that structural remodeling of the brain occurs during rehabilitation in a pediatric population.
“It is well understood that CI therapy produces a re-wiring of the brain, leading to functional improvement in motor skills in children and adults who have experienced a brain injury,” said Edward Taub, Ph.D., the developer of CI therapy and a study co-author. “This study reinforces the idea that CI therapy also remodels the brain, producing a real, physical change in the brain.”
Grey matter is a component of the central nervous system, consisting primarily of neuronal cell bodies, glial cells and dendrites. The study examined ten children with cerebral palsy, between the ages of 2 and 7, who underwent a three week course of CI therapy. Changes in grey matter were assessed with a technique called voxel-based morphometry (VBM), performed on images acquired through magnetic resonance imaging.
“We saw increases in grey matter volume in the sensorimotor cortices on both sides of the brain and in the hippocampus,” said Chelsey Sterling, M.A., a graduate student in medical psychology and first author of the study. “These increases were accompanied by large improvements in spontaneous arm use in the home environment. Notably, increases in grey matter correlated with improvement in motor activity.”
Sterling says the significant correlation between increases in grey matter volume and magnitude of motor improvement raises the possibility of a causal relationship.
The researchers suggest the observed increase in grey matter could be due to one or more different processes, including an increase in synaptic density, the creation of new neurons or glial cells or the establishment of new blood vessels within the brain.
“An increase in grey matter is indicative that the brain is capable of supporting increased motor activity and function,” said Gitendra Uswatte, Ph.D., a study co-author. “Along with the improvements observed in the dexterity and everyday use of the arm that was the target of rehabilitation, this is a strong indication that a child with cerebral palsy can have substantial gains in motor function when provided with the correct stimulation.”
VBM analysis was performed three weeks prior to therapy, at the beginning of therapy and at the end of the three week therapy period. The authors say that no significant grey matter change was seen during the three weeks before treatment.
The children underwent intensive motor training for three hours each weekday for a three week period in which the child’s less-affected arm was continuously restrained in a long arm cast. Each child’s caregiver received a transfer package, which included steps to induce continuation of use of the more-affected arm at home. The MRI scans were performed at Children’s of Alabama.
Taub, a university professor in the Department of Psychology, developed the family of techniques called CI therapy. The therapy has been shown to be effective in improving the rehabilitation of movement after stroke and other neurological injuries in both children and adults.
“The motor improvement and changes in grey matter following CI therapy observed in this study are similar to those observed previously in adults,” said Taub. “It is further evidence that the brain has a remarkable capacity to heal itself when presented with an efficacious rehabilitation intervention such as CI therapy.”