Transcription:
Pediatric Cerebral Palsy

Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world class clinical and research physicians covering everything from your child's allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Dara Jones. She's an Assistant Professor of Clinical Rehabilitation Medicine, specializing in Pediatric Rehabilitation Medicine at Weill Cornell Medicine. And she's here to highlight pediatric cerebral palsy for us today.

Dr. Jones, it's such a pleasure to have you with us. Not everybody knows exactly what it is or what it really means when they hear the term cerebral palsy. Can you tell us what that is and how it affects the brain?

Dr Dara Jones: Sure. Thanks so much for having me, Melanie. So first, just simply breaking down the words cerebral means of the brain, palsy means a lack of muscle control. And cerebral palsy is just that. It is a condition that is caused by a brain injury that occurs at or around the time of birth for any variety of reasons. And although the brain injury itself is a one-time occurrence and it's static, meaning it does not worsen or progress over time, it does have lifelong implications on the way an individual moves, how much strength they have and their muscle tone.

Melanie Cole (Host): That was an excellent definition. You're a great educator. I loved how you really cleared that up for us. So how does CP, depending on the severity obviously, affect the body? You mentioned the spasticity. Does it affect the brain, the thought process? Tell us a little bit about some of things that you've seen that it affects over the years.

Dr Dara Jones: Sure. So cerebral palsy, depending on the severity, how much brain tissue or how much the nerves are involved can have varying effects on the body. It can be anywhere from mild weakness in one limb or one hand or one leg to total body involvement where an individual may have almost no voluntary control over their body. There's also a variation in the degree of how it affects an individual's cognition. There are children who have typical abilities to learn to those who may need 24-hour caregiver support and assistance in all of their daily care. It just depends really on the initial injury. And with that, there's a variation in how it affects other systems of the body. It can affect vision, hearing. About 50% of children with cerebral palsy may have seizure disorder. And then, of course, it also affects the way the joints and bones develop as a child ages over time.

Melanie Cole (Host): Dr. Jones, what are some of the signs to look for when parents think their child might have it? When do they find out, such as not meeting their milestones? Is it something that's identified nearer to birth? Tell us about that.

Dr Dara Jones: Some of the earliest signs of cerebral palsy that can generally be detected within the first year of life, meaning from birth up until about 12 months, can include abnormal muscle tone, either high muscle tone, meaning a child is very tight or stiff or low muscle tone where a child is relatively looser or floppy, for lack of a better word. There may be a different quality of their movements, shakiness or jerkiness. And even though a child may sometimes meet milestones, there's not quite the same quality of movement that we would like to see.

Other signs can include early handedness or preferring to use one side of the body more than the other side, so an asymmetry in how they move. For the mildest cases of cerebral palsy, sometimes we don't even detect some of these changes until they're about 12 to 18 months of age. But it's important for if there's ever any question in how a child is moving and how they're developing to have them evaluated, to rule out any other conditions.

Melanie Cole (Host): Well then, Dr. Jones, why is it so important for early detection and intervention? Because there's a lot you can do nowadays, right, to improve the quality of life.

Dr Dara Jones: Absolutely. While we know there is no cure for cerebral palsy, it is permanent and a lifelong condition that we treat, there is a lot that can be done. And early detection and intervention allows us to identify any changes or abnormalities in the way a child is moving and to implement therapy services immediately. Fortunately, most states have early intervention programs available where therapists will come into the home and evaluate the child, looking at their entire developmental domain, be it gross motor, fine motor, language and speech and feeding skills and provide the services necessary, sometimes either in the home or at a local facility, in order to help maximize their developmental potential.

And for us as medical caregivers, we're able to also be a lot more vigilant and implement surveillance and screening protocols for things that we know children with the palsy may be at risk for later down the roads, such as hip displacement or scoliosis, for instance. While we can't cure it, our goal is to minimize the impact as much as possible on the individual's life in order to maximize their quality of life and ability to participate in their community.

Melanie Cole (Host): As we're talking about the therapies and I'd like to get into how rehabilitation helps children with CP, tell us a little bit about some of the more important aspects of the medical home care, because these children still have vaccinations and well visits, and there's a whole host of other things. Tell us a little bit about the multidisciplinary approach that's so important for these children and their families.

Dr Dara Jones: So from the very beginning when I see a child who either has already received a diagnosis for CP, or is at risk for cerebral palsy or who I have identified as having it, we establish a team, a multidisciplinary team to provide care for that child. Starting with having a pediatrician who is experienced in taking care of children with complex needs, who can help make sure that we're staying on top of their vaccinations, their dental health, vision screening, hearing screening, et cetera. Most children also at some point will need an evaluation with a neurologist, to either confirm the diagnosis of cerebral palsy or investigate other potential conditions. Many children may need a brain MRI or an EEG at some point. And then, in addition to a physiatrist like myself, children will oftentimes also see an orthopedic surgeon, who can provide further guidance and, management for the musculoskeletal impact of cerebral palsy.

That generally comprises the hub of the medical home for the child with CP. It can include other providers' therapist again, as we mentioned; a gastroenterologist, if a child has difficulty feeding or an ENT, et cetera. But the benefit of having early detection is that we can better identify what services a child may need from the beginning and work towards coordinating and building that team.

Melanie Cole (Host): I'd like you to speak briefly, Dr. Jones, about rehabilitation and how it helps these children have that better quality of life. Tell us about the types of care Weill Cornell Medicine provides. You could talk about bracing and splints or some of the other interventions that can really help these children integrate into the mainstream. Tell us what you offer and how you work with them.

Dr Dara Jones: We always start by establishing the goals. Because CP affects so much of how we function and how we move in day to day life, I work closely with the families and with the children, especially as they become of age and are able to contribute and speak to the things that they would like to do and things that they would like to improve. We work on identifying specific goals, that will help maximize their ability to move. And that includes, really at the foundation, having a really good team of therapists. We have here at Weill Cornell, physical therapy, occupational therapy, speech therapy, and feeding therapy, particularly for those who are younger, for infants and school-aged children who have swallowing difficulties. We also have nearby local orthotists, that I work with to help identify bracing options for the feet and for the upper extremities that may be able to improve their ability to use their hands and to walk.

I also provide tone management, which is, as I mentioned, spasticity is a very common part of cerebral palsy, or one of the most common forms of cerebral palsy. And that tone can affect the ability to move in different positions and lead to abnormal postures. And so providing a way to help relax the muscles can result in much better outcomes for these patients. And that can be anything from oral medications to stretching exercises to slightly more invasive procedures, such as injections with botulinum toxin or alcohol.

Melanie Cole (Host): As we wrap up, and this is such uneducational and informative podcast, Dr. Jones, what is something you'd tell parents of a child who was recently diagnosed with cerebral palsy? And speak to just a bit how the families are involved and how, when you're doing these therapies, you're really working with the whole family because they're all learning together.

Dr Dara Jones: The most important thing that families should know is that cerebral palsy, while it does affect a child for their life, it does not mean that they have a lesser quality of life or does not mean that they won't necessarily be able to do certain things. Our goal in rehabilitation medicine is to really help open the door to children still being able to have a fulfilling and fun life, albeit adapting it and finding ways to meet the child where they are and meeting their specific goals.

Melanie Cole (Host): So important. Thank you so much, Dr. Jones, for joining us today. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcasts, Spotify and Google Podcasts. For more health tips, go to weillcornell.org and search podcast. And don't forget to check out our Back To Health. I'm Melanie Cole. Thanks so much for listening.

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