Intense Physiotherapies to Improve Function in Young Children With Cerebral Palsy

Cerebral palsy (CP) is a non-progressive disorder caused by an insult or injury to the brain
when the brain is most rapidly developing and which results in some motor dysfunction. Causes
for the injury to the brain are numerous and can occur prior to birth, during the birth
process, or within the first few months following birth. The motor dysfunction can involve
any or all four extremities but most often affects the legs, causing abnormal ambulation. The
level of severity depends on the extent of the injury to the brain and can be mild to severe.
In severe instances, the child is dependent on others for all his/her care.

There is no known cure for CP, but physical and occupational therapies are administered in an
attempt to improve function. The frequency of these therapies varies from once a week (the
standard of care in the Western Hemisphere) to five times a week (the standard of care in
Asia and some Eastern European countries). The current understanding of brain plasticity
offers a theoretical explanation to justify the more intense approach. Active repetitive
motor skill-directed rehabilitation utilizes the plasticity of the brain and can restore some
function. Intense active physiotherapy can stimulate non-injured but 'dormant' neurons and
prevent their 'natural' degeneration in order for them to substitute for the function of
injured neurons. It is the very young brain that is most likely to respond to this therapy.

The aim of this proposal is to evaluate the effect of administering both physical and
occupational therapy five times each week for 12 weeks and compare it with the standard of
care (SOC) approach of one time each week in children between the ages of 12 months and 36
months. This is the first randomized crossover trial to both enroll this young a population
of children with cerebral palsy as well as to evaluate this approach from both the therapists
and the parents perspectives. The number of children that this study will enroll is larger
than in most CP studies. The children will be evaluated clinically with two validated
instruments, one of which was designed specifically for children with CP and is administered
and scored by certified therapists and the other which was designed for children with
developmental disabilities and is scored by the child's care provider. A sub-set of children
will have a special type of MRI to evaluate any changes in the neurological structure of the
brain.

The Department of Pediatrics at the University of Arizona recently completed a collaborative
study with the Neurologic Department at the Beijing Children's Hospital where the intense
approach of five therapies per week is the SOC. The positive results prompted another
investigation to determine if such an approach would be feasible in the United States. A
compliance rate of 81% confirmed feasibility and the perception that parents who have a child
diagnosed with CP will do whatever they can to improve their child's motor function.