MANAGING OVERALL HEALTH IN PATIENTS WITH CEREBRAL PALSY

For patients with cerebral palsy, managing overall health and well-being can be a day-to-day challenge.

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Mark Peterson, PhD, MS, FACSM

The pediatric neurodevelopmental disorder caused by damage to the brain, generally before or around the time of birth, results in a wide range of physical and developmental problems, such as altered muscle tone, loss of control of movements, decreased strength and balance, and problems with walking or sitting, in addition to a wide range of medical and cognitive difficulties, such as swallowing, seizures and orthopaedic abnormalities. As a father of a child with cerebral palsy, Mark Peterson, PhD, MS, FACSM, assistant professor of physical medicine and rehabilitation, has dedicated his career to improving the scientific evidence and clinical care of individuals with cerebral palsy.

Peterson is among a small group of international researchers working to increase awareness of long-term health concerns in the growing population.

Traditionally, he explains, research in patients with cerebral palsy has been focused on pediatrics patients, but these individuals can and do live long lives, and there hasn’t been as much research on how the disorder affects them once they reach adulthood.

Peterson and colleague, Edward Hurvitz, MD, professor and chair of physical medicine and rehabilitation, published two recent papers highlighting new aspects of managing overall health in patients with cerebral palsy.

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Edward Hurvitz, MD

In a study published December 2015 in JAMA (JAMA 2015;314:2303-2305), the two researchers and their colleagues measured the prevalence of eight lifestyle-related chronic health conditions in both adults with cerebral palsy and those without. They determined adults with cerebral palsy were between two and five times more likely to have secondary chronic health conditions, such as diabetes and high blood pressure, than adults without cerebral palsy.

The findings raised questions about how to prevent or reduce the conditions among the high-risk population.

“Because cerebral palsy results in accelerated loss of mobility with age, individuals tend to experience more fatigue and have greater muscle and joint pain over time. We found physical inactivity and immobility were strongly associated with these chronic health conditions,” Peterson says. “Therefore, we need to strongly consider how these health complications could further impact this population, and how we can prevent or reduce these conditions among individuals with cerebral palsy through their lifespan.”

Peterson and colleagues have been working to address physical inactivity and immobility in patients with cerebral palsy. In fact, they recently published the first paper (Dev Med Child Neurol 2016;58:798-808) to describe cerebral palsy-specific exercises and physical activity recommendations.

“Before this paper, exercise in this population was founded on what we would think of as physical therapy in children,” Peterson says. “Some types of exercises or physical activities were thought to potentially exacerbate symptoms in patients with cerebral palsy, but that’s all but been disproved at this point.”

The paper is a framework for fellow clinicians to use as a reference point for recommending exercises and physical activity for patients with cerebral palsy.

Peterson adds that many adults with cerebral palsy do not meet exercise guidelines and spend significant amounts of time being sedentary. That sedentary behavior puts individuals—not only those with cerebral palsy—at risk for metabolic and cardiovascular diseases.

“The first step towards being healthy is simply reducing excess sedentary behavior,” he says.

In the future, Peterson hopes to expand the boundaries of research for patients with cerebral palsy beyond the University of Michigan.

 

“We’re trying hard to move towards having an international consortium of experts who can collect data, increase sample sizes and write papers together, in an effort to improve the state of research and infrastructure for individuals with cerebral palsy,” he says.

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