Neuroplasticity in Cerebral Palsy

From Rat to Monkey, Brains Recover

Baby Animal Brains Recover Better

Adult Human Brains Recover

Baby Human Brains Do Not Recover?

The baby orangutan and the baby human are in step at this moment in time, but the baby human brain will not reach maturity for another 20+ years. The neuroplasticity mechanisms for regrowth, repair and reorganization are well recognized in adult human brains after injury. Unfortunately, for a child with cerebral palsy or other early-acquired brain injury, the future is still what it used to be. Commonly accepted medical wisdom and the official medical and scientific organizations state that cerebral palsy cannot be cured. http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm

This attitude is surprising. A poor outcome for the child with cerebral palsy is not what you would expect from animal studies. It has been demonstrated in many species that young animals recover faster and more completely than adult animals. If cerebral palsy truly cannot be cured, then we would have to believe that baby human brains work to a different set of rules. This is illogical at best!

Human neuroplasticity is one of the most important medical discoveries of the past 50 years. It offers new hope to people with a wide variety of neurological problems and even provides hope of improved or restored brain function to the aging baby boomer. The ability of the human brain to grow new cells, to repair damaged cells, and to re- organize the function of different parts of the brain are all characteristics of a process called neuroplasticity. This process of repair and reorganization is a scientific fact, elegantly demonstrated in humans by brain scanning techniques, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scans. The old facts, the cherished beliefs of the past, must be reexamined and discarded if seen to be false.

The first “old fact” that must be dispelled is the often stated opinion that baby brain injury is permanent and irreversible. The skeptics who cling to the way things have always been will ask, “What proof is there that a child’s brain can recover from brain injury?” You will not find any claims of cure in the cerebral palsy literature. However, if you look outside the narrow focus of cerebral palsy treatment centers, there is ample evidence of both recovery from and cure of early brain damage. Roughly 30% of babies with a documented abnormality on an early brain scan have a full functional recovery. Yet, in spite of this knowledge, that is common to all the professionals in the NICU, parents are still told that there is no hope of a cure and cerebral palsy can at best be somewhat improved with therapy. Human neuroplasticity offers the real hope that all baby brains have the potential for recovery and some children can be cured.

Please note: These are two of my previous posts on the same topic. It is now nearly 3 years later and there is still not much in the way of institutional change.

Posted October 2, 2012
A New Way of Thinking About Recovery – Neuroplasticity Exists

Posted November 8, 2012
A New Way of Thinking about Cure

It is time for a call to action within all of the Cerebral Palsy Communities. If we all work together, our voices will be heard.

My personal BHAG is “Cure for Some, Improvement for All”
What do you think?
As ever, your comments and questions are welcome.

 


12 Responses to “Neuroplasticity in Cerebral Palsy”
  1. Julianna Greenhaw says:

    Dr. Pape- At what age does neuroplasticity begin to wane? My daughter is almost six years old. She is an ex 24week preemie. She had a bilateral grade 3 bleed which led to obstructive hydrocephalus. Despite early intervention and continuous OT, PT, Feeding, and Speech therapy, she continues to struggle with gross motor and fine motor skills. She has been diagnosed with triplegic CP. This has somewhat confounded her therapists as they treat her as if she was quad cp. So what I’m asking is, do you think she would benefit from trying a different tactic with therapy? Can her brain still adjust and adapt through neuroplasticity? I should add that many of issues seem to stem from a lack of stability vs. lack of strength. Any feedback you could provide would be greatly appreciated.

    • kpape says:

      Thank you Julianna for your very good question.First and most important is the reality that neuroplasticity is lifelong.It certainly does not stop at age 6years. But that said, neuroplasticity is stimulated by novelty, challenge and consequences. Doing “more of the same harder” is unlikely to produce any big changes. Please read this blog for some ideas, starting always with better trunk control for stability. http://www.karenpapemd.com/index.php/revolutionize-your-approach-to-therapy-this-summer/ I would suggest you print some of the blogs that are of interest to you and give them to your therapists. Best wishes, Karen

  2. Jess Angove says:

    hi Karen. My son, Jacob, was born at 23+6 days, later corrected to 23+ 2 days father brain scans at three days showed his brain was still completely smooth. He had bilateral grade three ivh and pvl which is slightly different to normal….he has a significant reduction in white matter as opposed to “holes in the brain”. Here in New Zealand he was born below viability. He was expected to have very severe disabilities and at first it looked like we were heading that way. We were told from the beginning that although he had brain injuries the brains of babies are very elastic…..the attitude in nz is that even with brain injuries you cannot tell what the outcomes will be. Our son had five weeks of steroids as he was so unwell. He has mild cp…he wears splints to correct muscle placement. But he runs, jumps, climbs and plays just like his peers. His vocab is well above average. He has very poor vision, and slight social and motor delays but even the Drs cannot believe what his “damaged” brain has done!

    • kpape says:

      Thank you for your comment Jess.I love hearing about “Outliers” and the pockets of positivity that do exist. From the emails I receive, Australia and New Zealand seem to have a more positive attitude to rehabilitation than I see in many areas of North America. I am just in the editing process of a book on my experiences with baby brain neuroplasticity that will be published in the Spring of 2016.Hopefully it will reduce the knowledge gap and move the field in a more positive direction. One of my favourite coaching quotes is, “If you set your standards low enough, it is easy to be satisfied with your performance”. Outliers like your son should help set all our standards higher. Thanks agin for sharing your story. Karen

  3. Debbie ui chinneide says:

    My son is living proof of neuroplasticty. He suffered hie.after a.difficult birth and from the scans we were told to expect four limb involvement. Physio diagnosed spastic quad at 5 months. Neurologist confirmed at 18 months. We use a German therapy das poernbacher involving tummy time and seating exercises and we handle in such a way not to increase tone. His poor trunk control has resolved itself and he can now sit up he is now just over three. He can’t walk but can shuffle on his.knees and he can crawl. He has no abnormal movements. He.has spastic tone in all limbs but onlya little shortening in his legs. He has never used standers walkers or afos. We have a battle starting with our care provider who wants us to follow a bobatg method and have recently diagnosed him with dyskinetic choreoathetoid. I think this is because of the three years of therapy we have been doing does not make him appear like a spastic quad child should.

    • Greet says:

      Debbie if you get a good Bobath therapist you are most likely to get the best out of your son as this therapist will help you and your son reach his maximum potential. Bobath is not just the one method, the Bobath centre provides training worldwide teaching a vast array of different evidence based techniques to help families optimise quality of movement in your child. Most therapists I work with including myself work that way. The trick is to get a therapist you trust who has enough experience to search with you for the best method that works for your son and your family. Good luck!

  4. I am so very glad to read your posts Every minute people accomplish the “impossible”. I honor your persistence and devotion. We can raise the bar and find ways to jump, step, or climb over it with the loving courage to avoid negativity and complacency.. Mary Jane DeWolf-Smith,RN,PHN,LMFT www/mjdswellness.com

  5. Ethan B. Ellis says:

    Dr. Pape,
    I was born 81 years ago (11/25/33) and diagnosed a year later with mild quadriplegic athetosis. My dad took me to PT at Columbia Presbyterian every 2 weeks and repeated the exercises he recorded there with me 6 days a week.

    I have no way of evaluating their impact but when I was 60, I began a regimen of Tragering (developed by Dr. Milton Trager) and other alternative therapies which markedly improved my gait and hand function. Unfortunately, severe cervical spinal cord degeneration required extensive surgery that interrupted that work, which I have just resumed with mixed but promising results – mixed because of the limitations resulting from the damage to my spine.

    My exceptional parents supported me in whatever I attempted and I was high school student council president, got a graduate degree and, after initially being turned down for several jobs, went on to serve in the NJ Senior Executive Service for 25 years, was the first president of the National Assn. of Protection and Advocacy Systems and retired at 77.

    Something that may be of particular interest to you was my startling success on the pool table. Dad bought me one when I was 13 and I spent an hour or more on it for 35 years. At my peak, I made over 50 balls without a missing a shot and had similar success hustling drinks in a bar on the Lower East Side where I work in the anti-poverty program in the 1960s. While those results were atypical of my other physical skills,I could only attain them on tables I played on consistently. In unfamiliar surroundings, my performance was unremarkable.

    This all seems to relate to your thoughts about neuroplasticity but I’m not sure how. Do you have any ideas?

    • kpape says:

      Thank you for sharing your interesting story Ethan. I think your life is Neuroplasticity in action…consistent, purposeful practice is what is required to reach your own personal best.You are an inspiration to us all.

  6. Suzanne Eason says:

    Thank you so much for this article, as a therapist who works with the most complex cases of individuals with cerebral palsy, I have always been an advocate of Neuroplasticity. I focus on wheelchairs and seating systems and strive to build in mechanisms to enhance movement and sensory experiences so each individual achieves the most they can be. I have just bought your book and look forward to reading it!

    Thanks so much, here’s to changing the future…

    Suzanne

  7. Ingrid Hahn says:

    Hi Dr. Pape;

    I was born with cerebral palsy. My doctors had no idea I was a twin. My twin sister does not have cerebral palsy. My mother realized that I was learning at the same rate as my twin sister. I learned to walk around 2 or 3 years old. At learned to ride a tricycle at age 10. I have a slight limb. I had corrected surgery to extend the arm, open the thumb, raised the wrist and the foot. I had a MRI at age 53 and I have a hole on my brain. The neurologist told me that my brain has adjusted and made connections. I went to regular school and college. I drive a car, outgrew epileptic seizures by age 15. I have done extensive physical and occupational therapy which I do of and on. I continue to learn about new ways to help myself. Thanks you a new way of helping people.