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A new tool to assess
birth defect
Canadian researchers have developed motor-development charts
to help parents better gauge the outlook for a baby born with
cerebral palsy.
by Adam Marcus, HealthScout News Service, October 1,
2002
For more articles on disabilities and special ed visit
www.bridges4kids.org.
Doctors now have a new tool to assess cerebral palsy, a
crippling birth defect that afflicts hundreds of thousands of
people in North America.
The condition -- really an umbrella term for a brain injury
that typically occurs before birth -- causes a wide range of
mental and motor defects with an equally broad spectrum of
severity. As a result, it's difficult for doctors and physical
therapists to provide effective counselling to parents of
children with cerebral palsy.
Now, however, Canadian researchers have developed new
motor-development charts for babies with the condition. These
should give parents a better sense of their child's outlook,
at least concerning the muscular aspects of their ailment such
as walking.
When they hear that their child has cerebral palsy, parents
almost invariably ask two questions, says lead author Dr.
Peter L. Rosenbaum, a pediatrician at McMaster University in
Hamilton: "How bad is it?" and "Will she walk?"
In earlier research, Dr. Rosenbaum and his colleagues had
developed guidelines to help answer the first question, using
a system similar to cancer typing. Before those guidelines
were developed, he says, doctors and parents alike had to
contend with "meaningless" words such as "moderate," "mild"
and "severe."
Dr. Rosenbaum's group, whose findings are reported in the
current issue of The Journal of the American Medical
Association, based its charts on data from 657 children with
cerebral palsy, ages 1 to 13, who were followed for as long as
four years.
The new charts, which offer five different tracks depending on
a child's early motor-skills development, let doctors be more
specific in predicting future levels of development -- for
example, in gauging which children may someday walk and which
will need wheelchairs.
"Because the curves describe motor function by level," Dr.
Rosenbaum says, "we can have a reasonable guess of the child's
pattern of mobility. If it's 1 or 2, you can be pretty sure
they're going to walk, but for a child who's a 4, we would
probably be recommending early in therapy that they should get
some wheels."
Experts caution, however, that the charts aren't ironclad. A
child heading down one path may do better or worse than
expected.
Dr. Murray Goldstein, medical director of the United Cerebral
Palsy Research Foundation, says that the charts will also help
scientists developing therapies for CP. Many treatments are
widely used without solid evidence that they work, he says,
and having a baseline trajectory of motor development can help
researchers compare the effect of an intervention with what
would otherwise happen naturally.
Treatment planning will also benefit from the new curves,
according to Dr. Stephen L. Kinsman, director of pediatric
neurology at the University of Maryland School of Medicine in
Baltimore, because it will enable researchers to more
accurately assess potential participants in studies of
experimental drugs designed to help patients with better
prognoses.
Yet Dr. Kinsman is wary of making too much of the new tool,
especially because some children won't follow the precise path
of the curve they're on and because the charts only describe
one aspect of CP.
"Let's be careful how we use this," he says.
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