This summer, researchers at Burke Neurological Institute in White Plains and Teachers College of Columbia University shared the results of a landmark study for therapeutic treatment of cerebral palsy.
Kathleen Friel, lab director at Burke Neurological Institute, and Andrew Gordon, professor of movement science and neuroscience and education at Teachers College, led the research and found that two intensive therapeutic techniques ”” hand-arm bimanual intensive training and constraint-induced movement therapy ”” are viable in treating children with unilateral cerebral palsy to help them learn to move, play and learn new skills.
“The research showed us that the motor system exhibits an extraordinary capacity to adapt,” Friel said. “We were pleased to finally acquire hard data showing that intensive hand therapies improve a child”™s ability to move, play, learn and progress, no matter which type of brain connectivity pattern they had.”
The study was the largest randomized clinical study yet to focus on this topic. Gordon and Friel have both been studying it for several years. Gordon was the first to show that constraint therapy and bimanual therapy are effective for children with cerebral palsy, since he began to study it over a decade ago. Friel has studied animal models of cerebral palsy, testing how methods of therapy affect the brain and spinal cord and the relationship between motor activity and neurorehabilitation.
A key facet of this most recent study, researchers said, is that it delivered data that will help identify which patients will benefit most from these types of therapy, by utilizing methods to predict success.
“One major challenge of either therapy is that it requires high intensity of training ”” 6 hours a day for 3 weeks,” Friel said. “This is a lot of time to ask of families and if it is a clinical therapy, it would cost a lot of money. This drove us and other labs, to look for any clues that would tell us, before starting the therapy, if the therapy would be effective for an individual child, since some kids improve more than others
“This was the goal of our study, to see if some kids improved more than others based on how their brain was organized. We found that indeed, some kids improve more than others, but the child”™s brain organization was not a factor that can determine which kids will improve most. Kids had the capacity to improve regardless of how their brain is organized.”
According to Friel, these types of intensive therapy are already used in many places worldwide. The role of Friel”™s and Gordon”™s respective labs and collaborative research is to continue to search for factors that can identify children and patients that will have the greatest capacity for improvement.
The study also demonstrated that the treatments are effective regardless of how the brain is wired, which can vary among children with cerebral palsy.
“Early studies suggested that some children were less likely to benefit from intensive rehabilitation, depending on how their brains had reorganized,” Gordon said. “This new study proves that assumption wrong.”
The research could also have implications for other types of neurological conditions and injuries.
“There is reason to think this would also be an effective strategy to improve hand function in kids and adults with brain injuries of a variety of causes,” Friel said. “Other labs have shown that these types of training strategies can help people with different types of brain injuries.”
When tested again six months after the trial, the children involved retained the skills.
Friel, who herself was born with cerebral palsy, said that she understands the difficulties children with the condition face, which informs her research greatly.
“I am one of very few lab directors who has CP,” she said. “I know of a few others, that”™s it. I know firsthand how difficult it has been throughout my life to optimize my physical function. My family and I were disappointed by the limited effectiveness of existing therapies ”” I would put in hours and hours of work each week, for years and get modest benefits.”
