January 22, 2008

Virginia Doctors Sanctioned for Role in Birth Injuries

by Robert D'Iorio

State medical board officials have issued formal reprimands for two obstetricians. The doctors allegedly mishandled two births that led to devastating injuries including cerebral palsy.

The doctors are protected from civil litigation by Virginia's Birth-Related Neurological Injury Compensation Act. Under which the doctors will face no monetary penalty, no civil trial and the reprimands will not affect the doctor’s ability to practice medicine.

According to the Richmond Times-Dispatch these were the first such sanctions issued since the act was created in 1987.

January 17, 2008

Cerebral Palsy and Massage Therapy

by Robert D'Iorio

This is a video demonstrating the benefits of massage therapy for individuals with cerebral palsy.

January 16, 2008

Cerebral Palsy and Massage Therapy

by Robert D'Iorio

The following is a continuation of yesterday’s post of a child undergoing massage therapy for cerebral palsy.

January 15, 2008

Cerebral Palsy and Massage Therapy

by Robert D'Iorio

The following is a clip of a child undergoing massage therapy for his Cerebral Palsy. At 14 months Max could not sit and his arms and legs were very stiff. For the past five months Max and his parents Nina and Bert have been working with Peter Walker to increase his flexibility and develop a more typical pattern of development. Over the Past five months Max has demonstrated much improvement. Keep up the great work.

January 12, 2008

Cerebral Palsy and Stem Cell Therapy

by Robert D'Iorio

* The Institute of Cellular Medicine (ICM) only uses stem cells from adults, umbilical cord blood and placentas NOT fetal or embryonic stem cells, as Legal and ethical issues may arise when fetal or embryonic stem cells are involved.

Cord blood stem cell therapy is in the early stages. Umbilical cord stem cells have been used world-wide since 1988. They have typically been used to restore the immune system of patients undergoing myeloablative chemotherapy.

In the brain, neuronal progenitor cells (present in umbilical cord blood) have been shown to differentiate into new tissue circuitry that is needed for a variety of specialized neural functions. Effective neural function, of any type, depends to a great extent on the establishment of precise physical pathways and connections that allow electrical communication between individual neurons and between entire classes of neurons; stem cells derived from umbilical cord blood have been shown to repair these types of connections.

Momentum is gathering for the introduction of stem cell therapy in the treatment of cerebral palsy, not only for children, but for adults as well. In fact, on December 20th of 2005, President George W. Bush signed a bill establishing a national umbilical cord blood program in which federal funding is provided for the collection and storage of cord blood for blood cell transplants. Now parents in the U.S. have increased hope for a higher quality of lives for their children. Additionally, real hope for adults who are suffering with cerebral palsy is now also found in the extensive research that is being conducted by a long list of scientists on adult brain plasticity and "restorative neurobiology."

January 11, 2008

Cerebral Palsy and Umbilical Cord Blood Stem Cells

by Robert D'Iorio

Launched by Cord Blood Registry®, the Newborn Possibilities program offers free storage of newborn stem cells to expectant parents of babies with an increased risk of neurological impairment.

Strong preclinical data suggests a newborn's own cord blood stem cells can provide therapeutic benefit in treating brain damage. Cerebral palsy is the most common childhood cause of neurological and physical disability, diagnosed in 8,000 newborns each year, or 1.4 - 2.7% of live births. To date, newborn stem cells have been used in more than 6,000 transplants worldwide

For more information, expectant parents should call 1-888-CORD-BLOOD or visit http://newbornpossibilities.com

January 10, 2008

Brachial Plexus or Erb’s Palsy and the Long-Term Results of Surgery

by Robert D'Iorio

The results of a long-term study focusing on the outcome of infants that suffered a brachial plexus injury (bpi) or erbs palsy at birth were published in the January 2007 issue of The Journal of Bone and Joint Surgery.

The study followed up on children that underwent surgery for a bpi (mean of 13.3 years after surgery). The researchers studied 1706 children with brachial plexus injuries sustained at birth that required medical intervention between 1971 and 1997. Of these patients, 124 (7.3%) underwent surgery on the brachial plexus at a mean age of 2.8 months (range, 0.4 to 13.2 months). The most commonly performed surgical procedure was direct neurorrhaphy after neuroma resection.

The researchers found that approximately one-third of the patients, including all nine with a clavicular nonunion from the surgical approach, experienced pain in the affected limb. Additionally, all except for four patients used the hand of the unaffected arm as the dominant hand. Shoulder function was moderate, with a mean Mallet score of 3.0. Both elbow and hand function were good, with a mean score on the Gilbert elbow scale of 3 and a mean Raimondi hand score of 4. Incongruence of the glenohumeral joint was noted in sixteen (16%) of the ninety-nine patients in whom it was assessed, and incongruence of the radiohumeral joint was noted in twenty-one (21%). The extent of the brachial plexus injury was found to be strongly associated with the final shoulder, elbow, and hand function in a multivariate analysis.

Furthermore, a significant number of the patients continued to need help performing activities of daily living and had pain in the affected arm, with the pain due to a clavicular nonunion in one-fourth of the patients.

As a side note, I want to say that although this study appears to be harsh, erb’s palsy can present in wide spectrum of severity. That being said, these results seemed to me, to be preformed on the more severe cases of erb’s palsy. Finally, the most determinant prognostic factor predicting the outcome of children affected by a bpi appears to be the extent of the primary injury.

January 9, 2008

Brachial Plexus Palsy and Shoulder Dystocia

by Robert D'Iorio

This is a medical animation of a vaginal delivery with the occurrence of shoulder dystocia which may lead to Erb’s palsy.

When shoulder dystocia is encountered the doctor should perform several procedures (such as the McRoberts Maneuver, Woods Maneuver etc.) to dislodge the shoulder. This will avoid or mitigate damage to the brachial plexus (an arrangement of nerve fibers running from the spine (C5-T1), through the neck, the axilla, and into the arm).

January 8, 2008

Cerebral Palsy, Erb's Palsy and America's Best Children's Hospitals

by Robert D'Iorio

When a child gets diagnosed with cerebral palsy or erb’s palsy the question of where to go for the best treatment soon follows. Below is a list of the top pediatric hospitals compiled by U.S. News & World Report.

America's Best Children's Hospitals, 2007 Edition
Published by U.S.News & World Report

1. Children's Hospital of Philadelphia
2. Children's Hospital Boston
3. Johns Hopkins Hospital, Baltimore
4. Children's Hospital, Denver
5. Rainbow Babies and Children's Hospital, Cleveland
6. Texas Children's Hospital, Houston
7. Cincinnati Children's Hospital Medical Center
8. New York-Presbyterian Univ. Hosp. of Columbia and Cornell
9. Children's Hospital and Regional Medical Center, Seattle
10. Lucile Packard Children's Hospital, Palo Alto, Calif.
11. Children's National Medical Center, Washington, D.C.
12. Columbus Children's Hospital
13. Children's Hospital of Pittsburgh of UPMC
14. Children's Healthcare of Atlanta
15. St. Louis Children's Hospital
16. UCSF Children's Hospital, San Francisco
17. Childrens Hospital Los Angeles
18. Primary Children's Medical Center, Salt Lake City, Utah
19. Duke University Medical Center, Durham, N.C.
20. St. Jude Children's Research Hospital, Memphis
21. Mattel Children's Hospital at UCLA, Los Angeles
22. University of Michigan C.S. Mott Children's Hospital, Ann Arbor
23. Vanderbilt University Medical Center, Nashville
24. Long Island Jewish Medical Center, New Hyde Park, N.Y.
25. Children's Memorial Hospital, Chicago
26. Miami Children's Hospital
27. Children's Hospitals and Clinics of Minnesota, Minneapolis
28. Children's Medical Center Dallas
29. Mayo Clinic, Rochester, Minn.
30. Children's Hospital of Wisconsin, Milwaukee

January 6, 2008

Cerebral Palsy and Stem Cell Therapy

by Robert D'Iorio

Tiantan Puhua Neurosurgical Hospital, one of the world's leading treatment centers for Parkinson's disease and strokes, recently announced a breakthrough in the treatment of Cerebral Palsy (CP) by introducing neural stem cells through a non-evasive procedure to 19-year-old Gabor Bocskai from Hungary.

The treatment works by introducing stem cells into the patient's spinal cord fluid (via Lumbar Puncture) which are then circulated directly to the brain. The success of this procedure makes Mr. Bocskai the first teenage European CP patient to see rapid improvement through stem cell therapy. Unedited videos taken before and after Mr. Bocskai's injections demonstrate the profound improvement in this 19-year olds battle to walk, write, focus his eyes, concentrate, and overcome the many other detrimental effects resulting from the CP he acquired at birth.

After the eight-week stem cell therapy program, Mr. Bocskai's experinced noticeable physical improvements including improved vision, increased eye focus and better concentration on one subject. He also reported more legible writing, enhanced muscle tone, the ability to sit up unsupported, improved speech and a new capability to walk and swim in an unassisted manner.

In fact, proir to the treatment, Mr. Bocskai was not able to walk independently, using a wheelchair for transportation. Within four months of the initial treatment, he stated that he was able to walk with the help of a walker and no other support, with increased maneuverability in his legs and torso.

This is a very promising treatment and one of many on the verge of being offered to the public.

January 5, 2008

Cerebral Palsy and TheraSuit Therapy

by Robert D'Iorio

The following is a video demonstrating the use of TheraSuit therapy on children with Cerebral Palsy.

TheraSuit serves as an exoskeleton supporting patients with neuromuscular disorders such as cerebral palsy. Patients wear it while undergoing an intensive exercise program conducted by specially trained physical therapists.

January 4, 2008

Cerebral Palsy Ability Center

by Robert D'Iorio

The Cerebral Palsy Ability Center (CPAC) is an organization that offers Conductive Education (CE) a complex, integrated program of developmental learning (including physical, social, emotional, and academic) for children with motor disorders caused by damage to the central nervous system such as cerebral palsy available to children in the greater Washington, DC metro area. They offer classes year-round for toddlers, kindergartners, and school-age children. Scholarships are available based on a determination of need.

This is an excellent program, to learn more please contact The Cerebral Palsy Ability Center.

January 3, 2008

Cerebral Palsy and Hyperbaric oxygen therapy

by Robert D'Iorio

Hyperbaric oxygen therapy (HBOT) is a medical treatment that uses oxygen to speed and enhance the body's natural ability to heal. High dose oxygen therapy is AMA, FDA and Medicare approved. During therapy, the patient breathes 100% oxygen under increased atmospheric pressure. Sessions typically last an hour or two.

Normally, oxygen is almost exclusively carried by red blood cells. During HBOT, there is a substantial increase in the amount of oxygen carried in all body fluids including plasma, cerebrospinal fluid, lymph, and intracellular fluids. This allows increased oxygen levels even in areas with poor or compromised blood supply as well as in areas of tissue damage.

In most children with cerebral palsy the damaged areas of the brain do not exist in sharp contrast to regions of completely normal function. In these children, there exists a population of neurons that while alive, are not functioning at optimum capacity. It is these “idling neurons” that respond to hyperbaric oxygen therapy (HBOT).

Increasing tissue oxygen levels produces several important long term therapeutic benefits including enhanced growth of new blood vessels, increased ability of white blood cells to destroy bacteria and remove toxins, increase growth of fibroblasts (cells involved in wound healing), and enhanced metabolic activity of previously marginally functioning cells including brain neurons.

Currently, research is taking place in Montreal Canada to study the results of HBOT. Dr. Pierre Marois of McGill University has recently studied 25 children with cerebral palsy, aged 4 to 7 years, who have been treated with 20 hyperbaric oxygen therapy treatments. According to Dr. Marois

“…the results are really incredible! Twenty-three of the 25 children have great results. Twenty-three have amelioration with their spasticity and may have amelioration with speech and cognitive function”.

Further, their published results reveal

“the clinical observations do list numerous functional changes, definite improvements, a large amount in the level of arousal/response to communication. From statistical analysis of the objective estimations we confirm these changes, more particularly on the level of motor functioning like walking and the quality of sitting position, similarly on the level of spasticity. These results are surprising considering the small number of treatments (20), and of extreme importance because it’s the first study documenting objectively the prospects of beneficial effects of HBO in the treatment of children suffering from cerebral palsy.” Marois, P., The Pilot Project on Treatment in Hyperbaric Oxygen Therapy

These results seem extremely promising and in the future I expect to see further studies as well as HBOT being used more commonly to treat cerebral palsy.

January 2, 2008

Cerebral Palsy and Hyperbaric Oxygen Therapy (HBOT)

by Robert D'Iorio

This news clip shows a child with cerebral palsy undergoing Hyperbaric Oxygen Therapy (HBOT)

January 1, 2008

Cerebral Palsy and Intense Therapy at Euro Peds

by Robert D'Iorio

This Video depicts children and young adults with cerebral palsy receiving physical therapy at the Euro-Pēds clinic.

Contact Information:

North Oakland Medical Centers
461 W. Huron St., Suite 406
Pontiac, MI 48341

Phone: (248) 857-6776
Toll Free: 1(888) 875-NOMC(6662)
Fax: (248) 857-7102
Email: europeds@nomc.org

Medical Director: Colleen Noble, M.D., FAAP
Director: Michelle Saunders, MSPT