A historical perspective on cerebral palsy as a concept and a diagnosis

Size: px
Start display at page:

Download "A historical perspective on cerebral palsy as a concept and a diagnosis"

Transcription

1 European Journal of Neurology 2005, 12: REVIEW ARTICLE A historical perspective on cerebral palsy as a concept and a diagnosis A. Kavčič and D. B. Vodušek Division of Neurology, University Medical Centre, Ljubljana, Slovenia Keywords: cerebral palsy, Little s disease, Sigmund Freud Received 16 July 2004 Accepted 4 August 2004 Sigmund Freud was the first to write about cerebral palsy as a nosographic category, uniting various infantile motor deficits of brain origin. He did not ascribe more than a temporary value to the term (infantile) cerebral palsy, but it has become and still is an indispensable part of the nosographic system. Nevertheless, it is still easier to explain what cerebral palsy is not than to define it precisely. Introduction If a historical study of cerebral palsy (CP) is undertaken, it soon becomes apparent that not only are there several definitions, but also a variety of interpretations. The fact that CP has been known as a clinical entity for over a hundred years (Freud, 1968), and is still to some extent loosely defined (Badawi et al., 1998; Bax, 2001), is surprising and, we think, worth considering. Freud s analysis In clinical practice, the term CP was often used interchangeably with the eponym Little s disease [after the British orthopaedic surgeon who described spastic diplegia, which he considered to be due to birth complications (Little, 1862)] for many years (Freud, 1968; Russell and Kennedy, 1937; Fanconi and Wallgren, 1950). It was, however, Sigmund Freud [a promising neuropathologist from Vienna who became a prominent psychiatrist (Ferris, 1998)] who first wrote about (infantile) CP 1 as a nosographic category, uniting various infantile motor deficits of brain origin (Freud, 1968). In all previous publications on motor deficit of children, the term CP, if it had already been used, had been written either only in a plural form (Osler, 1987; Sachs and Peterson, 1890) or, if in the singular, only in specific combination with other words as a synonym for a particular motor deficit (i.e. infantile meningeal haemorrhage cerebral birth palsy, infantile hemiplegia acute cerebral infantile palsy) (Gowers, 1888). Nevertheless, in the routine clinical practice of the second half of the 19th century, (apparently) static motor deficits of Correspondence: Professor David B. Vodusˇ ek, Division of Neurology, University Medical Centre, SI-1525 Ljubljana, Slovenia (tel.: ; fax: ; 1 The German term Ôdie infantile Cerebralla hmungõ used in the original publication by Freud was translated into English as Ôinfantile cerebral paralysisõ, although Ôcerebral palsyõ was preferred at that time (Bartram, 1964; Bobath, 1969). children had to be labelled generally in the sense of a medical diagnosis, for Freud in his monograph on infantile CP wrote that the term infantile CP characterized Ô what already has been applied over a long period of time to pathological condition in which paralysis is overshadowed or replaced by muscular rigidity or spontaneous muscular twitching.õ (Freud, 1968). Freud s concept of infantile CP was broader than that formulated some decades later by other authors. He actually suggested that this term should be applied even to neurological cases in which paralysis was completely absent, as, for example, in children with mental retardation, or where disorders did not manifest themselves permanently, such as epilepsy (Freud, 1968) [what is very close to the concept of (early) brain damage formulated much later (Amiel-Tison et al., 1994)]. Freud probably decided to unite the various motor deficits of children in one nosographic category because he did not find any other alternative to bring more order to the field. This hypothesis is supported by the fact that he had begun studying motor deficits of children separately. First he researched cerebral hemiplegia in co-operation with Oskar Rie (Freud and Rie, 1891). Then, he considered the remaining motor deficits of children. He unified them into one clinical group, termed cerebral diplegias, defined as those manifesting a physical handicap of the whole body (i.e. both sides of the body). Among these, he differentiated four main types: (1) general cerebral stiffness, (2) paraplegic stiffness, (3) bilateral hemiplegia, and (4) general chorea and bilateral athetosis (Freud, 1893). Finally, he covered all these various motor deficits by one nosological entity, i.e. infantile CP (Freud, 1968). Little s view In the mid-19th century William John Little earned the reputation of substantiating the causal relationship between birth complications and disorders of mental and physical development after birth (Little, 1843). His 582 Ó 2005 EFNS

2 A historical perspective on cerebral palsy 583 views on this topic were summarized in the article entitled ÔOn the influence of abnormal parturition, difficult labours, premature birth, and asphyxia neonatorum, on the mental and physical condition of the child, especially in relation to deformitiesõ, probably the most commonly cited article on CP, which he addressed to the Obstetric Society. From the three responses published at the end of the article, it is clear that Little logically drew attention to the, at that time, unknown field of injuries to which the nervous system was liable during, and immediately after, birth (Little, 1862). In connection with birth complications, he actually described one clinical picture of non-progressive motor deficit of brain origin, namely spastic rigidity, which, at the end of the 19th century, constituted one of four main clinical forms of such motor deficits in children (Freud, 1968). All the same, no other name has become, and remains, so closely associated with CP than his. Little versus Freud Given that Little discussed one clinical form of motor deficits of children, which he never termed CP, nor linked it with other motor deficits of brain origin, his comparatively great influence on the common understanding of CP seems at first sight unwarranted. Little s clear and objective reply to the immediate response of his contemporaries showed that he did not claim a pioneering position in discovering neurological sequelae of abnormal and premature parturition. When he found no reference to this theme in the works of English medical writers, he referred to Shakespeare, who, universal as he was, did not disappoint him. In the physical character of Richard III 2, he in fact recognized a kind of deformity which, in his opinion, originated at birth (Little, 1862). Freud, however, combined all infantile motor deficits of brain origin except rapidly progressive into one nosological entity (Freud, 1968). Certainly, it can be said that Freud s decision to introduce the unifying concept was prudent, with the concept surviving for over a century. All the same, Freud, who supposed that motor deficits of children would eventually be defined more precisely (preferably aetiologically) by new insights into the human nervous system, did not ascribe more than a temporary value to the entity he introduced (Freud, 1968). 2 ÔI that am curtailed of this fair proportion, Cheated of feature by dissembling Nature, Deform d, unfinish d, sent before my time Into this breathing world, scarce half made up, And that so lamely and unfashionable That dogs bark at me as I halt by them.õ (Shakespeare, 1985; Little, 1862) From a distance of more than a hundred years, it is obvious that both Little and Freud contributed significantly to the understanding of the natural history of CP. Because Freud studied motor deficits of children approximately 3 4 decades later than Little, the question of priority is not contested. Undoubtedly, Little s aetiological approach represents one of the great milestones of studying motor deficits of children. This was recognized immediately. By contrast, the value of Freud s conceptual approach had been growing almost imperceptibly until decades later it was realized that his concept of CP was a great milestone as well. Attempts to solve the terminological confusion In the 20th century it became gradually evident that CP was a useful nosographic category, although its terminology was rather confused (Bax, 1964). In the mid- 20th century, as at the end of the 19th century, CP represented a clinical entity for some, while for others it was just a general denotation for similar clinical entities (Phelps, 1947; Perlstein, 1952). This lack of consensus became less and less tolerable, for it made scientific study difficult. The American Academy for Cerebral Palsy (later the American Academy for Cerebral Palsy and Developmental Medicine) coped with this problem in 1953 by inquiring extensively of its members about the nomenclature and classification of CP (Minear, 1956). Another initiative for re-thinking the terminology of CP in the mid-20th century was taken by two Englishmen, Ronald MacKeith and Paul Polani. Adherents soon began to gather around them, and in 1957 they formed the Little Club (Bax, 1964). Great contribution but little contemporary influence The terminological confusion that continued to afflict the field of CP for the first half of the 20th century shows that, with his concept of infantile CP, Freud did not significantly influence his contemporaries. From the viewpoint of the current understanding of CP, which is basically the same as Freud s, this is surprising. If the publications on infantile motor deficits of brain origin of the 19th century are read comparatively (Little, 1862; Vogel, 1870; Bastian, 1875; Gowers, 1888; Osler, 1987; Sachs and Peterson, 1890), it seems that Freud s work on this topic (Freud and Rie, 1891; Freud, 1893; Freud, 1968), being both analytic and descriptive, was too theoretical for his time. He based his work much more on literature review than on his own clinical experiences. If there had not been the

3 584 A. Kavčič and D. B. Vodusˇ ek precise descriptions of infantile motor deficits of Jacques Mathieu Delpech, William John Little, William Osler, William Richard Gowers and many others, Freud would not be able to develop his insightful concept of CP. He finished his extensive work in this field with his monograph on infantile CP (Freud, 1968), and then became renowned for psychoanalysis. It overshadowed practically all his other works (Ferris, 1998), perhaps contributing to the lack of influence of his excellent work on CP. In retrospect, this contributed to the persistence of terminological confusion. Causal relationship between birth asphyxia and cerebral palsy In over 20 years of orthopaedic practice, Little came to the conclusion Ôthat the proportion of entire recoveries from the effects of asphyxia neonatorum is smaller than has hitherto been supposed.õ He based his opinion on approximately 200 well-documented personal cases of spasticity with birth complications in their history (Little, 1862). Because he did not use any statistical methods, but only a descriptive comparison with the general opinion of that time, we cannot know how frequent such motor deficit of children were in the mid-19th century. Freud considered the relationship between birth asphyxia and infantile motor deficit of brain origin critically because of the fact that the development of children with birth asphyxia could be completely normal (Freud, 1893). Little, who was an orthopaedic physician, did not see such cases in his practice, or at least not frequently. But Freud with his analytical approach could not fail to notice these cases. He allowed the possibility that spasticity could be a result solely of intrauterine factors or combined with birth complications (Freud, 1968). Freud s analysis of birth asphyxia as a cause of CP elicited no lively discussion among his contemporaries, although it was noticeably different to Little s views. As the usage of the term CP gradually increased, Little s conclusion on the causal relationship between asphyxia (and other complications) during birth and spasticity was even generalized to all clinical types of CP (Scott, 1976). Since the mid-20th century, when CP has also been studied epidemiologically, it has been shown again and again that relatively few cases can be explained on the basis of birth asphyxia (Scott, 1976; Paneth, 1986; Nelson and Leviton, 1991), although besides spastic diplegia, as spastic rigidity was termed at that time, CP also comprised other forms of non-progressive brain motor deficits (i.e. other spastic, ataxic and dyskinetic disorders) (Hagberg et al., 1975; Mutch et al., 1992). The question, as to whether CP is, to a large extent, the result of birth complications, seemed thus practically solved. Then, studies appeared that demonstrated that birth asphyxia could not be regarded as a rare cause of CP among term infants (Hagberg et al., 2001; Moster et al., 2001), leading to the renaissance of a hypothesis thought obsolete. Cerebral palsy in the 21st century The efforts of the American Academy for Cerebral Palsy and the Little Club notwithstanding, the discussion on terminology and classification of CP continued (Bax, 1964; Mutch et al., 1992). In epidemiological studies, the Swedish classification of CP (Hagberg, 1989) became by far the commonest classification used. This has not changed yet, although recently the usage of the European classification has been slowly increasing (Surveillance of Cerebral Palsy in Europe, 2000). This happened without there being evidence that the Swedish classification is the most appropriate, and without any particular efforts to establish a consensus. In defining CP, pragmatism has not yet prevailed. Several different definitions are still used, although the compatibility of epidemiological studies is strongly dependent on the uniformity of the methodology used. If several definitions of CP are read one after another, significant differences between them are perhaps not noticed (Table 1). If a study of CP is planned, however, the definition (no matter which has been chosen) has to be defined precisely, if a study is to be firmly based. It is not possible to avoid the ambivalence of the issue of brain maturation (at what age the brain ceases to be immature). In the definitions of CP, formulations such as: Ôin the period of early brain growthõ or Ôin the early stages of its (i.e. brain) developmentõ can still be found. It is also not possible to avoid the question as to whether aetiologically and/or pathologically well-determined motor deficit beginning early in life although not being hereditary, as for instance kernicterus because of Rh incompatibility, or schizencephaly, are justifiably termed CP. The upper age limit of the onset of motor deficit being recognized as CP is (exactly) defined in only a few definitions of CP (Wilson, 1916; Vining et al., 1976). None of these has been used widely, although chronological specification of the early stages of development (the immature brain) would make the definition of CP clearer. It does not seem a logical decision, but per se it was wise, for, instead of defining an authoritative agreement on what exactly CP is, it enabled the gradual evolution of the concept, which more easily lent itself to the inclusion of new discoveries about the human

4 A historical perspective on cerebral palsy 585 Table 1 Some characteristic/frequently used definitions of CP ÔInfantile cerebral palsy would thus be defined as the general concept of all cerebral diseases in infancy caused by a direct effect of accidental etiology, occurring either in the fetal period or after birth, and affecting one or more neuron systems.õ (Freud, 1968) Infantile cerebral palsy Ôis a paralysis of cerebral origin occurring in the first six years of life. It is always a hemiplegia, and the cases which affect both sides of the body will be found to be no exception to this rule, but are simultaneous lesions upon the hemispheres.õ (Wilson, 1916) ÔCerebral palsy may be defined as a condition characterized by paralysis, paresis, incoordination, dyskinesia, or any aberration of motor function that is due to involvement of the motor control centres of the brain.õ (Perlstein, 1952) ÔCerebral palsy is a descriptive term applied to a group of motor disorders of young children, in whom full function of one or more limbs is prevented by paresis, involuntary movement, or incoordination.õ (Balf and Ingram, 1955) ÔCerebral palsy is a persistent but not unchanging disorder of movement and posture, appearing in the early years of life and due to a nonprogressive disorder of the brain, the result of interference during its development.õ (The Little Club, 1958 (Bax, 1964)) ÔThe term cerebral palsy does not designate a disease in any usual medical sense. It is, however, a useful administrative term which covers individuals who are handicapped by motor disorders which are due to nonprogressive abnormalities of the brain.õ (Crothers and Paine, 1988) The term cerebral palsy Ômay be defined as one component of a group of childhood neurologic disorders which reflect cerebral dysfunction rather than damage per se and which may result from cerebral maldevelopment, infection, injury, or anoxia before or during birth or in the early years of life.õ (Denhoff and Robinault, 1960) Cerebral palsy is Ôa disorder of movement and posture due to a defect or lesion of the immature brain.õ (Bax, 1964) ÔCerebral palsy is a group of disorders characterised by reduced ability to make voluntary use of the muscles, caused by a non-progressive and nonhereditary brain disorder arising before or at delivery or during the first years of life.õ (Christensen and Melchior, 1967) ÔCerebral palsy is the result of a lesion or maldevelopment of the brain, non-progressive in character and existing from earliest childhood. The motor deficit finds expression in abnormal patterns of posture and movement, in association with an abnormal postural tone.õ (Bobath, 1969) ÔCerebral palsy is defined as a nonprogressive disorder of motion and posture due to brain insult or injury occurring in the period of early brain growth (generally under 3 years of age).õ (The Kennedy Institute (Vining et al., 1976)) ÔCerebral palsy is a descriptive term for a collection of nonprogressive neuromotor disorders of central origin that become manifest early in life and are not the result of a recognized cerebral malformation.õ (Paneth, 1986) Cerebral palsy is Ôan umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of its development.õ (Mutch et al., 1992) nervous system function than a rigid definition without a firm biological base could. Because of complex and dynamic processes, taking place simultaneously and successively, depending on heredity and environment, the ontogenetic development of the human brain can be chronologically divided in several different ways, each defendable (Connolly and Forssberg, 1997; Kandel et al., 2000). Knowledge of the human nervous system is continuously growing; therefore it would be unlikely to expect that the concept of CP will not continue to evolve. Nadia Badawi et al. from Australia suggested that the concept of CP as a separate entity was becoming outdated because of the better understanding of the pathology underlying infantile motor impairment syndromes. But on the other hand they stated that the term CP was well recognized and still useful for service provision and management and hence it should not be abandoned. To improve interobserver agreement about the application of the term CP in epidemiological studies, they provided an extensive list of various developmental syndromes or infantile diseases with motor impairment and put forward which of these syndromes (diseases) to cover by the term CP and which not (Badawi et al., 1998). They took traditional use into account and so they in fact widened the CP category into other nosographic spectra for several cases had been included in CP registers only because knowledge had been insufficient to recognize them as separate entities. The foregoing proposal of Australian experts published in 1998 has not elicited an intensive debate yet. Given that it did not bring into question the concept of CP but its internal structure, it seems that CP will remain a part of our nosographic system, at least in the near future. How to redefine cerebral palsy? To delineate CP firmly and clearly, a consensus is required. The history of the term CP (certainly not short) shows that there has not been a complete or long-lasting consensus about details of CP as yet. We believe that it will always be difficult to achieve, for (unchangeable) biological dimensions of CP are less significant than (changeable) nosographic, therapeutic or social ditto.

5 586 A. Kavčič and D. B. Vodusˇ ek Table 2 An example of the diagnostic criteria for cerebral palsy (CP) Possible CP Mandatory inclusion criteria: disorder of movement and posture manifesting as spastic diplegia, spastic hemiplegia, spastic tetraplegia, ataxia, dystonia, choreo-athetosis - alone or in any combination; onset early in life; no evidence of progression. Mandatory exclusion criteria: active disease that could explain the foregoing features; chromosomal disorders. Supportive features: other signs of brain dysfunction that could be caused by the same pathological process as the foregoing disorders of movement and posture (epilepsy, learning disorders, disorders of speech, vision or hearing); born after multiple pregnancy; vanishing twin syndrome; intrauterine growth retardation; major antenatal placental abruption; preterm birth; acute intrapartum hypoxia; reduced fetal heart rate variability from the onset of labour; extensive chorioamnionitis; congenital coagulation disorders; autoimmune disease of the mother; no child with the same/ similar clinical picture in a family. Probable CP Mandatory inclusion criteria: disorder of movement and posture as in possible CP; onset early in life; no evidence of progression or other disease that could explain the foregoing features at school age. Definite CP Mandatory inclusion criteria: disorder of movement and posture as in probable CP, plus still no evidence of progression unrelated to aging or other disease that could explain the foregoing features at age 18 or older. In neurology, there has been a tendency in the last decades to delineate ambiguously defined disorders by diagnostic criteria. Such an approach works well in both clinical practice and scientific studies. We propose that agreement about the diagnostic criteria for CP (an example of them incomplete as is incomplete our knowledge of CP is presented in Table 2) would prove fruitful. Conclusion The concept of CP arose as a temporary solution in an era, which is separated from the present by amazing progress in neural science. CP has, nevertheless, become an indispensable part of the nosographic system. Perhaps the umbrella term CP has continued to be used in spite of new discoveries of the human nervous system function because, as it is not firmly defined, it did not obstruct scientific progress; at the same time, however, it can fill the appointed nosographic emptiness. Whatever the explanation of this phenomenon might be, CP remains a handy term for scientific description and medical diagnosis, although it is still easier to explain what CP is not than to define it precisely. Acknowledgements AK was supported by the Ministry of Education, Science and Sport, grant no References Amiel-Tison C, Cabrol D, Shnider S (1994). Brain damage: birth asphyxia, birth trauma and fetal compromise. In: Amiel-Tison C, Stewart A, eds. The Newborn Infant. One Brain for Life. Les Editions INSERM, Paris, France, pp Badawi N, Watson L, Petterson B et al. (1998). What constitutes cerebral palsy? Dev Med Child Neurol 40: Balf CL, Ingram TTS (1955). Problems in the classification of cerebral palsy in childhood. Br Med J July 16: Bartram JB (1964). Cerebral palsy. In: Nelson WE, ed. Textbook of Pediatrics, 8th edn. W.B. Saunders Company, Philadelphia, PA, USA, pp Bastian CH (1875). On Paralysis from Brain Disease in its Common Forms. Macmillan and Co., London, UK. Bax MCO (1964). Terminology and classification of cerebral palsy. Dev Med Child Neurol 6: Bax M (2001). What s in a name? Dev Med Child Neurol 43:75. Bobath K (1969). The Motor Deficit in Patients with Cerebral Palsy. Spastics International Medical Publications in Association with William Heinemann Medical Books Ltd, Lavenham, Suffolk (Clinics in Developmental Medicine no. 23). Christensen E, Melchior JC (1967). Cerebral Palsy. A Clinical and Neuropathological Study. Spastics Society Medical Education and Information Unit in Association with William Heinemann Medical Books Ltd, London, UK (Clinics in Developmental Medicine no. 25). Connolly KJ, Forssberg H (eds) (1997) Neurophysiology and Neuropsychology of Motor Development. Mac Keith Press, London, UK (Clinics in Developmental Medicine no. 143/ 144). Crothers B, Paine RS (1988). The Natural History of Cerebral Palsy. Blackwell Scientific Publications Ltd, Oxford, UK (Classics in Developmental Medicine no. 2), (Original work published in 1959). Denhoff E, Robinault IP (1960). Cerebral Palsy and Related Disorders. A Developmental Approach to Dysfunction. McGraw-Hill Book Company, Inc., New York, NY, USA. Fanconi G, Wallgren A (eds) (1950) Lehrbuch der Pa diatrie. Benno Schwabe & Co. Verlag, Basel, Switzerland, pp Ferris P (1998). Dr Freud: A Life. Pimlico, London, UK. Freud S (1893). Zur Kenntniss der cerebralen Diplegien des Kindesalters. Franz Deuticke, Leipzig und Wien. Freud S (1968). Infantile Cerebral Paralysis. University of Miami Press, Coral Gables, FL, USA (Original work published in 1897). Freud S, Rie O (1891). Klinische Studie u ber die halbseitige Cerebralla hmung der Kinder. Moriz Perles, Wien. Gowers WR (1888). A Manual of Diseases of the Nervous System, Vol. 2. J. & A. Churchill, London, UK, pp

6 A historical perspective on cerebral palsy 587 Hagberg B (1989). Nosology and classification of cerebral palsy. Giornale di Neuropsichiatria dell Eta Evolutiva 4(Suppl.): Hagberg B, Hagberg G, Olow I (1975). The Changing Panorama of Cerebral Palsy in Sweden I. Analysis of the General Changes. Acta Paediatr Scand 64: Hagberg B, Hagberg G, Beckung E, Uvebrant P (2001). Changing panorama of cerebral palsy in Sweden. VIII. Prevalence and origin in the birth year period Acta Paediatr 90: Kandel ER, Schwartz JH, Jessell TM (2000). Principles of Neural Science, 4th edn. Prentice-Hall International, Inc., London, UK, pp Little WJ (1843). Course of Lectures on the Deformities of the Human Frame. Lancet 1: Little WJ (1862). On the influence of abnormal parturition, difficult labours, premature birth, and asphyxia neonatorum, on the mental and physical condition of the child, especially in relation to deformities. Trans Obstet Soc Lond 3: Minear WL (1956). A classification of cerebral palsy. Pediatrics 5: Moster D, Lie RT, Irgens LM, Bjekedal T, Markestad T (2001). The association of Apgar score with subsequent death and cerebral palsy: a population-based study in term infants. J Pediatr 138: Mutch L, Alberman E, Hagberg B, Kodama K, Velickovic Perat M (1992). Cerebral palsy epidemiology: where are we now and where are we going? Dev Med Child Neurol 34: Nelson KB, Leviton A (1991). How much of neonatal encephalopathy is due to birth asphyxia? Am J Dis Child 145: Osler W (1987). The Cerebral Palsies of Children. Blackwell Scientific Publications Ltd, Oxford, UK (Classics in Developmental Medicine no. 1), (Original work published in 1889). Paneth N (1986). Birth and the origins of cerebral palsy. N Engl J Med 315: Perlstein MA (1952). Infantile cerebral palsy. Classification and clinical correlations. JAMA 149: Phelps WM (1947). The Cerebral Palsies. In: Nelson WE, ed. Mitchell-Nelson Textbook of Pediatrics, 4th edn. W.B. Saunders Company, Philadelphia, PA, USA, pp Russell CL, Kennedy F (eds) (1937) A Textbook of Medicine, 4th edn. W.B. Saunders Company, Philadelphia, PA, USA, pp Sachs B, Peterson F (1890). A study of cerebral palsies of early life, based upon an analysis of one hundred and forty cases. J Nerv Ment Dis 17: Scott H (1976). Outcome of very severe birth asphyxia. Arch Dis Child 51: Shakespeare W (1985). Life and death of King Richard III. In: The Complete Work of William Shakespeare, 24th edn. Hamlyn, London, UK, pp. 562 (Original work published in 1597). Surveillance of Cerebral Palsy in Europe (2000). Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol 42: Vining EPG, Accardo PJ, Rubenstein JE, Farrell SE, Roizen NJ (1976). Cerebral Palsy. A Pediatric Developmentalist s Overview. Am J Dis Child 130: Vogel A (1870). A Practical Treatise on the Diseases of Children. D. Appleton and Company, New York, NY, USA, pp Wilson JE (1916). Diseases of the Nervous System, 2nd edn. Boericke & Tafel, New York, NY, USA, pp

Cerebral Palsy An Expensive Enigma

Cerebral Palsy An Expensive Enigma Cerebral Palsy An Expensive Enigma Rhona Mahony National Maternity Hospital A group of permanent disorders of the development of movement and posture, causing activity limitation that are not attributed

More information

Cerebral palsy, neonatal death and stillbirth rates Victoria, 1973-1999

Cerebral palsy, neonatal death and stillbirth rates Victoria, 1973-1999 Cerebral Palsy: Aetiology, Associated Problems and Management Lecture for FRACP candidates July 2010 Definitions and prevalence Risk factors and aetiology Associated problems Management options Cerebral

More information

Trends in birth prevalence of cerebral palsy

Trends in birth prevalence of cerebral palsy Archives of Disease in Childhood, 1987, 6, 379-384 Trends in birth prevalence of cerebral palsy P 0 D PHAROAH, T COOKE, I ROSENBLOOM, AND R W I COOKE Departments of Community Health and Child Health, University

More information

Children with cerebral palsy in Europe: figures and disability

Children with cerebral palsy in Europe: figures and disability Children with cerebral palsy in Europe: figures and disability on behalf of SCPE Collaborative Group Coordinator: Christine Cans, Grenoble Javier de la Cruz, Hosp Univ 12 de Octubre, Madrid Surveillance

More information

Cerebral Palsy: Intervention Methods for Young Children. Emma Zercher. San Francisco State University

Cerebral Palsy: Intervention Methods for Young Children. Emma Zercher. San Francisco State University RUNNING HEAD: Cerebral Palsy & Intervention Methods Cerebral Palsy & Intervention Methods, 1 Cerebral Palsy: Intervention Methods for Young Children Emma Zercher San Francisco State University May 21,

More information

Cerebral Palsy. www.teachinngei.org p. 1

Cerebral Palsy. www.teachinngei.org p. 1 Cerebral Palsy What is cerebral palsy? Cerebral palsy (CP) is a motor disability caused by a static, non-progressive lesion (encephalopathy) in the brain that occurs in early childhood, usually before

More information

1. What is Cerebral Palsy?

1. What is Cerebral Palsy? 1. What is Cerebral Palsy? Introduction Cerebral palsy refers to a group of disorders that affect movement. It is a permanent, but not unchanging, physical disability caused by an injury to the developing

More information

A Study on Patients with Cerebral Palsy

A Study on Patients with Cerebral Palsy A Study on Patients with Cerebral Palsy MSZ Khan', M Moyeenuzzaman2, MQ Islam' Bangladesh Med. Res. Counc. Bull. 2006; 32(2): 38-42 Summary A prospective study was carried-out in the department of Physical

More information

Correlation between ICIDH handicap code and Gross Motor Function Classification System in children with cerebral palsy

Correlation between ICIDH handicap code and Gross Motor Function Classification System in children with cerebral palsy Correlation between ICIDH handicap code and Gross Motor Function Classification System in children with cerebral palsy Eva Beckung* PT PhD; Gudrun Hagberg BA BM PhD, Department of Pediatrics, Göteborg

More information

Developmental delay and Cerebral palsy. Present the differential diagnosis of developmental delay.

Developmental delay and Cerebral palsy. Present the differential diagnosis of developmental delay. Developmental delay and Cerebral palsy objectives 1. developmental delay Define developmental delay Etiologies of developmental delay Present the differential diagnosis of developmental delay. 2. cerebral

More information

Gross and fine motor function and accompanying impairments in cerebral palsy

Gross and fine motor function and accompanying impairments in cerebral palsy Gross and fine motor function and accompanying impairments in cerebral palsy K Himmelmann* MD; E Beckung PT PhD; G Hagberg BA BM PhD; P Uvebrant MD PhD, Department of Paediatrics, The Queen Silvia Children

More information

9th International Congress on Cerebral Palsy

9th International Congress on Cerebral Palsy Medimond - Monduzzi Editore International Proceedings Division 9th International Congress on Cerebral Palsy Mental and Physical Activity are Imperative Bled, Slovenia, 15-18 May 2013 Editor Milivoj Velickovic

More information

Review. Proposed definition and classification of cerebral palsy, April 2005

Review. Proposed definition and classification of cerebral palsy, April 2005 Proposed definition and classification of cerebral palsy, April 2005 Review INTRODUCTION Executive Committee for the Definition of Cerebral Palsy Martin Bax DM FRCP, Co-chairman, Emeritus Reader in Child

More information

Prevalence and disabilities in 4 to 8 year olds with

Prevalence and disabilities in 4 to 8 year olds with Archives of Disease in Childhood, 85,, -5 Prevalence and disabilities in to 8 year olds with cerebral palsy P EVANS, M ELLIOT,* E ALBERMAN, AND S EVANS Department of ical Epidemiology, London Hospital

More information

The Definition and Classification of Cerebral Palsy Contents

The Definition and Classification of Cerebral Palsy Contents The Definition and Classification of Cerebral Palsy Contents Foreword Peter Baxter 2 Historical Perspective Christopher Morris 3 Definition and Classification Document Peter Rosenbaum, Nigel Paneth, Alan

More information

Life expectancy of children with cerebral palsy

Life expectancy of children with cerebral palsy Life expectancy of children with cerebral palsy J L Hutton, K Hemming and UKCP collaboration What is UKCP? Information about the physical effects of cerebral palsy on the everyday lives of children and

More information

Epidemiology 521. Epidemiology of Maternal and Child Health Problems. Winter / Spring, 2010

Epidemiology 521. Epidemiology of Maternal and Child Health Problems. Winter / Spring, 2010 Extended MPH Degree Program School of Public Health Department of Epidemiology University of Washington Epidemiology 521 Epidemiology of Maternal and Child Health Problems Winter / Spring, 2010 Instructor:

More information

Cerebral palsy can be classified according to the type of abnormal muscle tone or movement, and the distribution of these motor impairments.

Cerebral palsy can be classified according to the type of abnormal muscle tone or movement, and the distribution of these motor impairments. The Face of Cerebral Palsy Segment I Discovering Patterns What is Cerebral Palsy? Cerebral palsy (CP) is an umbrella term for a group of non-progressive but often changing motor impairment syndromes, which

More information

The Child With Cerebral Palsy

The Child With Cerebral Palsy The Child With Cerebral Palsy Lisa Thornton, MD Medical Director, KidsRehab LaRabida Children's Hospital Schwab Rehabilitation Hospital University of Chicago Pritzker School of Medicine Cerebral Palsy

More information

Statement for the Record. Mr. Chairman and Members of the Committee:

Statement for the Record. Mr. Chairman and Members of the Committee: The Need For National Cerebral Palsy Surveillance - Testimony before the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies - Committee on Appropriations Dr. Janice

More information

Cerebral palsy in Victoria: Motor types, topography and gross motor function

Cerebral palsy in Victoria: Motor types, topography and gross motor function J. Paediatr. Child Health (2005) 41, 479 483 Cerebral palsy in Victoria: Motor types, topography and gross motor function Jason Howard, 1 Brendan Soo, 1,4 H Kerr Graham, 1,4,5 Roslyn N Boyd, 1,2,4 Sue

More information

Cerebral Palsy. 1 - Introduction. An informative Booklet for families in the Children and Teens program

Cerebral Palsy. 1 - Introduction. An informative Booklet for families in the Children and Teens program Cerebral Palsy 1 - Introduction An informative Booklet for families in the Children and Teens program Centre de réadaptation Estrie, 2008 Preface Dear parents, It is with great pleasure that we present

More information

CLINICAL OUTCOME SCORES FOR THE FAMILY HOPE CENTER FOR 13.0 YEARS, COMPARED TO NATIONAL SAMPLE OF OUTPATIENT REHABILITATION FOR SIMILAR DIAGNOSES

CLINICAL OUTCOME SCORES FOR THE FAMILY HOPE CENTER FOR 13.0 YEARS, COMPARED TO NATIONAL SAMPLE OF OUTPATIENT REHABILITATION FOR SIMILAR DIAGNOSES CLINICAL OUTCOME SCORES FOR THE FAMILY HOPE CENTER FOR 13.0 YEARS, COMPARED TO NATIONAL SAMPLE OF OUTPATIENT REHABILITATION FOR SIMILAR DIAGNOSES This document references data from a Report compiled and

More information

CEREBRAL PALSY CLASSIFICATION BY SEVERITY LEVEL

CEREBRAL PALSY CLASSIFICATION BY SEVERITY LEVEL Patient Name: Today s Date: CAUSE OF CEREBRAL PALSY Hypoxic-Ischemic Encephalopathy (HIE) or Intrapartum Asphyxia - Brain injury Lack of oxygen to the brain or asphyxia. Intracranial Hemorrhage (IVH) Brain

More information

Cerebral palsy in children in north-eastern Poland

Cerebral palsy in children in north-eastern Poland ORIGINAL ARTICLE Journal of Pediatric Neurology 2004; 2(2): 79-84 www.jpneurology.org Cerebral palsy in children in north-eastern Poland Wojciech Kułak, Wojciech Sobaniec Department of Pediatric Neurology,

More information

Cerebral Palsy: Classification and Epidemiology

Cerebral Palsy: Classification and Epidemiology Cerebral Palsy: Classification and Epidemiology Amy Thornhill Pakula, MD a, Kim Van Naarden Braun, PhD, CDC b, Marshalyn Yeargin-Allsopp, MD, CDC b, * KEYWORDS Epidemiology Cerebral palsy Prevalence Risk

More information

Mædica - a Journal of Clinical Medicine

Mædica - a Journal of Clinical Medicine Mædica - a Journal of Clinical Medicine ORIGINAL PAPERS Clinical Correlations in Cerebral Palsy Ioana MINCIU, MD Paediatric Neurology Clinic, Al Obregia Hospital, Carol Davila University of Medicine and

More information

CEREBRAL PALSY WHAT IS THIS CONDITION

CEREBRAL PALSY WHAT IS THIS CONDITION CEREBRAL PALSY WHAT IS THIS CONDITION We do not know the cause of most cases of cerebral palsy. That is, we are unable to determine what caused cerebral palsy in most children who have congenital CP. We

More information

Cerebral Palsy. 1995-2014, The Patient Education Institute, Inc. www.x-plain.com nr200105 Last reviewed: 06/17/2014 1

Cerebral Palsy. 1995-2014, The Patient Education Institute, Inc. www.x-plain.com nr200105 Last reviewed: 06/17/2014 1 Cerebral Palsy Introduction Cerebral palsy, or CP, can cause serious neurological symptoms in children. Thousands of children are diagnosed with cerebral palsy every year. This reference summary explains

More information

Classification of Cerebral Palsy and Major Causes Physiologic Topographic Etiologic Function. trauma, infection)

Classification of Cerebral Palsy and Major Causes Physiologic Topographic Etiologic Function. trauma, infection) Cerebral palsy (CP) It is a diagnostic term used to describe a group of motor syndromes. a static encephalopathy, a term previously used, is now inaccurate because of the recognition that the neurologic

More information

Cerebral palsy (CP) was defined before the specific

Cerebral palsy (CP) was defined before the specific Perinatal Factors Associated With Cerebral Palsy in Children Born in Sweden Kristina Thorngren-Jerneck, MD, PhD, and Andreas Herbst, MD, PhD OBJECTIVE: To identify perinatal factors associated with cerebral

More information

DOI: 10.1542/peds.110.6.1220

DOI: 10.1542/peds.110.6.1220 Trends in the Prevalence of Cerebral Palsy in a Population-Based Study Sarah Winter, Andrew Autry, Coleen Boyle and Marshalyn Yeargin-Allsopp Pediatrics 2002;110;1220-1225 DOI: 10.1542/peds.110.6.1220

More information

Cerebral Palsy. In order to function, the brain needs a continuous supply of oxygen.

Cerebral Palsy. In order to function, the brain needs a continuous supply of oxygen. Cerebral Palsy Introduction Cerebral palsy, or CP, can cause serious neurological symptoms in children. Up to 5000 children in the United States are diagnosed with cerebral palsy every year. This reference

More information

In This Issue... From the Coordinator by Amy Goldman... 2. Early AAC Intervention: Some International Perspectives by Mary Jo Cooley Hidecker...

In This Issue... From the Coordinator by Amy Goldman... 2. Early AAC Intervention: Some International Perspectives by Mary Jo Cooley Hidecker... Unless otherwise noted, the publisher, which is the American Speech-Language-Hearing Association (ASHA), holds the copyright on all materials published in Perspectives on Augmentative and Alternative Communication,

More information

Long-term survival of children with cerebral palsy in Okinawa, Japan

Long-term survival of children with cerebral palsy in Okinawa, Japan DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY ORIGINAL ARTICLE Long-term survival of children with cerebral palsy in Okinawa, Japan MAYUMI TOUYAMA 1 JUN TOUYAMA 1 YASUO OCHIAI 2 SATOSHI TOYOKAWA 3 YASUKI KOBAYASHI

More information

THE TERM Bermuda triangle has entered

THE TERM Bermuda triangle has entered The Bermuda Triangle of Neonatal Neurology: Cerebral Palsy, Neonatal Encephalopathy, and Intrapartum Asphyxia Michael I. Shevell, MD, CM, FRCPC The terms cerebral palsy, neonatal encephalopathy, and intrapartum

More information

People First Language. Style Guide. A reference for media professionals and the public

People First Language. Style Guide. A reference for media professionals and the public People First Language Style Guide A reference for media professionals and the public What is People First Language? People First Language (also referred to as Person First ) is an accurate way of referring

More information

Autism and Intellectual Disabilities

Autism and Intellectual Disabilities Autism and Intellectual Disabilities (DSM IV & V) Accessibility Politecnico di Milano Autism (I) A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B)

More information

CEREBRAL PALSY AND MENTAL RETARDATION DEFINITION

CEREBRAL PALSY AND MENTAL RETARDATION DEFINITION CEREBRAL PALSY AND MENTAL RETARDATION DEFINITION It is a disorder of posture movement and tone due to a static encephalopathy acquired during brain growth in fetal life infancy or early childhood. Though

More information

Changing Perspectives in Cerebral Palsy. Dr Owen Hensey

Changing Perspectives in Cerebral Palsy. Dr Owen Hensey Changing Perspectives in Cerebral Palsy Dr Owen Hensey Definition Cerebral Palsy A persistent, but not unchanging, disorder of movement and posture due to a non-progressive lesion in the immature brain

More information

What percentage of term cerebral palsy cases have a normal head MRI? Cerebral Palsy: Definition. No financial conflicts of interest to report

What percentage of term cerebral palsy cases have a normal head MRI? Cerebral Palsy: Definition. No financial conflicts of interest to report Cerebral Palsy: Risk Factors and Etiology No financial conflicts of interest to report William M. Gilbert, MD Regional Medical Director, Women s Services Sutter Health, Sac-Sierra Region What percentage

More information

A thesis presented to the National University of Ireland, Galway in fulfilment of the requirements for the degree of Doctor of Philosophy (Ph.D.

A thesis presented to the National University of Ireland, Galway in fulfilment of the requirements for the degree of Doctor of Philosophy (Ph.D. Title: Cerebral palsy in the West of Ireland and the application of the international criteria for the identification of acute intrapartum hypoxia: a cohort study. A thesis presented to the National University

More information

WHAT IS CEREBRAL PALSY?

WHAT IS CEREBRAL PALSY? WHAT IS CEREBRAL PALSY? Cerebral Palsy is a dysfunction in movement resulting from injury to or poor development of the brain prior to birth or in early childhood. Generally speaking, any injury or disease

More information

Copyright and use of this thesis

Copyright and use of this thesis Copyright and use of this thesis This thesis must be used in accordance with the provisions of the Copyright Act 1968. Reproduction of material protected by copyright may be an infringement of copyright

More information

65G-4.014 Eligibility for Agency Services Definitions. (1) Autism means any condition which is part of the autism spectrum disorder and which meets

65G-4.014 Eligibility for Agency Services Definitions. (1) Autism means any condition which is part of the autism spectrum disorder and which meets 65G-4.014 Eligibility for Agency Services Definitions. (1) Autism means any condition which is part of the autism spectrum disorder and which meets the requirements of Florida Statute 393.063, which are

More information

Prevalence and characteristics of children with cerebral palsy in Europe

Prevalence and characteristics of children with cerebral palsy in Europe Prevalence and characteristics of children with cerebral palsy in Europe Surveillance of Cerebral Palsy in Europe (SCPE) (For participating centres see Appendix I) Correspondence to Ann Johnson, National

More information

www.cpinstitute.com.au https://secure.cpregister-aus.com.au

www.cpinstitute.com.au https://secure.cpregister-aus.com.au Australian Cerebral Palsy Register Report 2009 Birth Years 1993-2003 www.cpinstitute.com.au https://secure.cpregister-aus.com.au AUTHORS The Australian Cerebral Palsy Register Group consists of representatives

More information

REQUIREMENTS FOR REGIONAL CENTER ELIGIBILITY HAVE CHANGED

REQUIREMENTS FOR REGIONAL CENTER ELIGIBILITY HAVE CHANGED REQUIREMENTS FOR REGIONAL CENTER ELIGIBILITY HAVE CHANGED As a result of a Trailer Bill AB 1762, which amended The Lanterman Developmental Disabilities Act, regional centers across the state are required

More information

By Dr. Mindy Aisen CEO and Director United Cerebral Palsy Research and Educational Foundation www.ucpresearch.org CEREBRAL PALSY RESEARCH

By Dr. Mindy Aisen CEO and Director United Cerebral Palsy Research and Educational Foundation www.ucpresearch.org CEREBRAL PALSY RESEARCH By Dr. Mindy Aisen CEO and Director United Cerebral Palsy Research and Educational Foundation www.ucpresearch.org CEREBRAL PALSY RESEARCH Main Sources of Federal Funding for Cerebral Palsy and Disability

More information

A8b. Resuscitation of a Term Infant with Meconium Staining. Session Summary. Session Objectives. References

A8b. Resuscitation of a Term Infant with Meconium Staining. Session Summary. Session Objectives. References A8b Resuscitation of a Term Infant with Meconium Staining Karen Wright, PhD, NNP-BC Assistant Professor and Coordinator, Neonatal Nurse Practitioner Program Dept. of Women, Children, and Family Nursing,

More information

Guide to Pregnancy and Birth Injury Claims

Guide to Pregnancy and Birth Injury Claims Being pregnant, especially for the first time can be a very daunting experience where you often have to put all of your faith in your midwife or doctor. The majority of pregnancies and births occur without

More information

New Estimates of the Economic Benefits of Newborn Screening for Congenital Hypothyroidism in the US

New Estimates of the Economic Benefits of Newborn Screening for Congenital Hypothyroidism in the US The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination

More information

Frequency of joined disabilities of children with cerebral palsy in Tuzla canton

Frequency of joined disabilities of children with cerebral palsy in Tuzla canton Journal of Health Sciences RESEARCH ARTICLE Open Access Frequency of joined disabilities of children with cerebral palsy in Tuzla canton Mirela Babajiæ 1 *, Emira Švraka 2, Dijana Avdiæ 2 1 Centre for

More information

September 2009. 2. Describe briefly the various approaches used in occupational therapy for children with cerebral palsy.

September 2009. 2. Describe briefly the various approaches used in occupational therapy for children with cerebral palsy. September 2009 [KV 804 F] Sub. Code: 9108 M.O.T. DEGREE EXAMINATION (Revised Regulations) Part II Branch III Time : Three hours Paper II CLINICAL SPECIALITY -II Answer All questions Draw suitable diagrams

More information

12/15/2008. Image from: http://www.emedicine.com/neuro/topic533.htm

12/15/2008. Image from: http://www.emedicine.com/neuro/topic533.htm A non-progressive disorder Caused by brain injury pre (70-80%), peri, or post natally Injure occurs before CNS reaches maturity Patients often have great potential masked by their condition Image from:

More information

What is cerebral palsy?

What is cerebral palsy? What is cerebral palsy? This booklet will help you to have a better understanding of the physical and medical aspects of cerebral palsy. We hope it will be a source of information to anyone who wishes

More information

Cerebral Palsy: Motor Types, Gross Motor Function and Associated Disorders

Cerebral Palsy: Motor Types, Gross Motor Function and Associated Disorders Iranian Rehabilitation Journal, Vol. 11, No. 14, 2011 Original Article Cerebral Palsy: Motor Types, Gross Motor Function and Associated Disorders Farin Soleimani, MD, Pediatric Neurorehabilitation Research

More information

3030. Eligibility Criteria.

3030. Eligibility Criteria. 3030. Eligibility Criteria. 5 CA ADC 3030BARCLAYS OFFICIAL CALIFORNIA CODE OF REGULATIONS Barclays Official California Code of Regulations Currentness Title 5. Education Division 1. California Department

More information

Newborn Neurological Injury and Litigation: Medical Legal Challenges to Causation

Newborn Neurological Injury and Litigation: Medical Legal Challenges to Causation Newborn Neurological Injury and Litigation: Medical Legal Challenges to Causation Richard C. Halpern Thomson Rogers July 12, 2011 INTRODUCTION Newborn neurological injury due to trauma occurring in and

More information

SCRIPTA MEDICA (BRNO) 580 (5): 219 224, November 2007

SCRIPTA MEDICA (BRNO) 580 (5): 219 224, November 2007 SCRIPTA MEDICA (BRNO) 580 (5): 219 224, November 2007 children with cerebral palsy after 6-month PHYSIOtherapy Drlíková L. 1, HASHIM M. K. A. 2, AL FADHLIA. K. 2, ANBAIS F. H. 2, ERAJHI A. A. 2, POSPÍŠIL

More information

An overview of Intellectual Developmental Disability Functioning levels of Mental Retardation/Intellectual Disability Autism

An overview of Intellectual Developmental Disability Functioning levels of Mental Retardation/Intellectual Disability Autism An overview of Intellectual Developmental Disability Functioning levels of Mental Retardation/Intellectual Disability Autism Intellectual/Developmental Disability (IDD) - indicates an overall intellectual

More information

BIRTH ASPHYXIA The New Consensus Statement

BIRTH ASPHYXIA The New Consensus Statement P.E.L.T. 2015 BIRTH ASPHYXIA The New Consensus Statement Keith Bolton Rahima Moosa Mother & Child Hospital THE HERD IS UNDER THREAT HPCSA CIVIL COURTS CRIMINAL COURTS Background The child with cerebral

More information

Other Common Names Palsy; Little s Disease; Infantile Cerebral Paralysis; Static Encephalopathy.

Other Common Names Palsy; Little s Disease; Infantile Cerebral Paralysis; Static Encephalopathy. 1 CEREBRAL PALSY Other Common Names Palsy; Little s Disease; Infantile Cerebral Paralysis; Static Encephalopathy. Definition/Description Cerebral Palsy (CP) is an umbrella term that covers a group of non-progressive,

More information

Genetic Aspects of Mental Retardation and Developmental Disabilities

Genetic Aspects of Mental Retardation and Developmental Disabilities Prepared by: Chahira Kozma, MD Associate Professor of Pediatrics Medical Director/DCHRP Kozmac@georgetown.edu cck2@gunet.georgetown.edu Genetic Aspects of Mental Retardation and Developmental Disabilities

More information

Epilepsy 101: Getting Started

Epilepsy 101: Getting Started American Epilepsy Society 1 Epilepsy 101 for nurses has been developed by the American Epilepsy Society to prepare professional nurses to understand the general issues, concerns and needs of people with

More information

Predicting the development of communication skills by children with motor disorders

Predicting the development of communication skills by children with motor disorders Predicting the development of communication skills by children with motor disorders Dr Lindsay Pennington, Dr Mark Pearce, Professor Allan Colver, Professor Helen McConachie, Newcastle University Dr Mary

More information

Cortical Visual Impairment An introduction

Cortical Visual Impairment An introduction Cortical Visual Impairment An introduction This is a general introduction to Cortical Visual Impairment intended for families and support workers who may live with or support children and adults with learning

More information

Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers

Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers Surveillance of Cerebral Palsy in Europe (SCPE) Correspondence to Christine Cans, RHEOP, 23, Av Albert

More information

I.O. Phd International Research Program

I.O. Phd International Research Program Founders A.W.D. Gavilanes, MD, PhD (Maastricht, The Netherlands) D.S.M. Gazzolo, MD, PhD (Alessandria, Italy) F. van Bel, MD, PhD (Utrecht, The Netherlands) G.H.A. Visser, MD, PhD (Utrecht, The Netherlands)

More information

AUSTRALIA AND NEW ZEALAND FACTSHEET

AUSTRALIA AND NEW ZEALAND FACTSHEET AUSTRALIA AND NEW ZEALAND FACTSHEET What is Stillbirth? In Australia and New Zealand, stillbirth is the death of a baby before or during birth, from the 20 th week of pregnancy onwards, or 400 grams birthweight.

More information

Learning Disabilities

Learning Disabilities Factsheet: British Institute of Learning Disabilities, Birmingham Research Park, 97 Vincent Drive, Edgbaston, Birmingham, B15 2SQ Telephone: 0121 415 6960 l Fax: 0121 415 6999 enquiries@bild.org.uk l www.bild.org.uk

More information

INTRAPARTUM PATHWAYS TO NEONATAL NEUROLOGIC INJURY - A LAWYER S VIEW OF THE MEDICINE

INTRAPARTUM PATHWAYS TO NEONATAL NEUROLOGIC INJURY - A LAWYER S VIEW OF THE MEDICINE INTRAPARTUM PATHWAYS TO NEONATAL NEUROLOGIC INJURY - A LAWYER S VIEW OF THE MEDICINE By Richard C. Halpern Partner Thomson Rogers rhalpern@thomsonrogers.com 416-868-3215 November 2013 INTRODUCTION Newborn

More information

Gait Analysis Laboratory Centro de Rehabilitación Infantil Teletón Estado de México

Gait Analysis Laboratory Centro de Rehabilitación Infantil Teletón Estado de México Gait Analysis Laboratory Centro de Rehabilitación Infantil Teletón Estado de México Dr. Demetrio Villanueva Ayala Doctorado en Biomecánica, CINVESTAV Dr. Juan Carlos Pérez Moreno Especialista en Medicina

More information

CEREBRAL PALSY A MESSAGE OF HOPE FOR ILLINOIS FAMILIES

CEREBRAL PALSY A MESSAGE OF HOPE FOR ILLINOIS FAMILIES CEREBRAL PALSY A MESSAGE OF HOPE FOR ILLINOIS FAMILIES A WHITE PAPER PRESENTED BY WHAT YOU NEED TO KNOW AFTER YOUR BABY RECEIVES A DIAGNOSIS OF CEREBRAL PALSY A white paper presented by the medical malpractice

More information

2.1 Who first described NMO?

2.1 Who first described NMO? History & Discovery 54 2 History & Discovery 2.1 Who first described NMO? 2.2 What is the difference between NMO and Multiple Sclerosis? 2.3 How common is NMO? 2.4 Who is affected by NMO? 2.1 Who first

More information

Fetal Acid Base Status and Umbilical Cord Sampling. David Acker, MD

Fetal Acid Base Status and Umbilical Cord Sampling. David Acker, MD Fetal Acid Base Status and Umbilical Cord Sampling David Acker, MD Part I: Some Background Intra-uterine Event as Causative of CP Cord ph < 7.00 and base excess of > 12 Early onset neonatal encephalopathy

More information

The Effect of Adding Homeopathic Treatment to Rehabilitation on Speech and Social Development of Children with Cerebral Palsy

The Effect of Adding Homeopathic Treatment to Rehabilitation on Speech and Social Development of Children with Cerebral Palsy Original Article Iran J Ped Vol 17. No 1, Mar 2007 The Effect of Adding Homeopathic Treatment to Rehabilitation on Speech and Social Development of Children with Cerebral Palsy Firoozeh Sajedi * 1, MD;

More information

ABSTRACT LABOR AND DELIVERY

ABSTRACT LABOR AND DELIVERY ABSTRACT POLICY Prior to fetal viability, intentionally undertaking delivery of a fetus is the equivalent of abortion and is not permissible. After fetal viability has been reached, intentionally undertaking

More information

ENTITLEMENT ELIGIBILITY GUIDELINES VARICOSE VEINS AND SUPERFICIAL THROMBOPHLEBITIS

ENTITLEMENT ELIGIBILITY GUIDELINES VARICOSE VEINS AND SUPERFICIAL THROMBOPHLEBITIS ENTITLEMENT ELIGIBILITY GUIDELINES VARICOSE VEINS AND SUPERFICIAL THROMBOPHLEBITIS 1. VARICOSE VEINS MPC 00727 ICD-9 454 DEFINITION Varicose Veins of the lower extremities are a dilatation, lengthening

More information

The Facts about Cerebral Palsy

The Facts about Cerebral Palsy The Role of the Obstetrician in preventing Cerebral palsy and protecting oneself from litigation. Prof R. J. PEPPERELL Professor Emeritus,University of Melbourne Previous Professor, Penang Medical College,

More information

C CS. California Children Services Alameda County

C CS. California Children Services Alameda County C CS California Children Services Alameda County The California Children Services (CCS) Program strives to assure access to medical services essential to the health and well-being of children with catastrophic

More information

a guide to understanding moebius syndrome a publication of children s craniofacial association

a guide to understanding moebius syndrome a publication of children s craniofacial association a guide to understanding moebius syndrome a publication of children s craniofacial association a guide to understanding moebius syndrome this parent s guide to Moebius syndrome is designed to answer questions

More information

Facts on. Mental Retardation NATIONAL ASSOCIATION FOR RETARDED. 2709 Avenue E East P.O. Box 6109 Arlington, Texas 76011

Facts on. Mental Retardation NATIONAL ASSOCIATION FOR RETARDED. 2709 Avenue E East P.O. Box 6109 Arlington, Texas 76011 Facts on Mental Retardation NATIONAL ASSOCIATION FOR RETARDED CHILDREN 2709 Avenue E East P.O. Box 6109 Arlington, Texas 76011 This booklet was revised and updated in August, 1973 as part of an ongoing

More information

The Taxi Program provides services only to residents of the City of Napa.

The Taxi Program provides services only to residents of the City of Napa. The NCTPA Taxi Program is a valuable taxpayer funded component of our agency s transportation services. While not intended as a primary means of transportation, this program was created to provide a lifeline

More information

Survival of individuals with cerebral palsy born in Victoria, Australia, between 1970 and 2004

Survival of individuals with cerebral palsy born in Victoria, Australia, between 1970 and 2004 DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY ORIGINAL ARTICLE Survival of individuals with cerebral palsy born in Victoria, Australia, between 1970 and 2004 SUSAN M REID 1,2 JOHN B CARLIN 1,3 DINAH S REDDIHOUGH

More information

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (APA, 2001) 10

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (APA, 2001) 10 5. Diagnosis Questions to be answered: 5.1. What are the diagnostic criteria for ADHD in children and adolescents? 5.2. How is ADHD diagnosed in children and adolescents? Who must diagnose it? 5.3. Which

More information

EFFECT OF VIBRATORY PLATFORM THERAPY ON POSTURE IN CHILDREN WITH CEREBRAL PALSY: A PILOT STUDY

EFFECT OF VIBRATORY PLATFORM THERAPY ON POSTURE IN CHILDREN WITH CEREBRAL PALSY: A PILOT STUDY EFFECT OF VIBRATORY PLATFORM THERAPY ON URE IN CHILDREN WITH CEREBRAL PALSY: A PILOT STUDY Pierina MAGNA a, Natalia JERIA a, Carlos ALVAREZ a,b, Chiara RIGOLDI c & Manuela GALLI c a Departamento de Kinesiología

More information

REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD

REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD What is Rehabilitation Medicine? Rehabilitation Medicine (RM) is the medical specialty with rehabilitation as its primary strategy. It provides services

More information

Effective SLP Interventions for Children with Cerebral Palsy

Effective SLP Interventions for Children with Cerebral Palsy Effective SLP Interventions for Children with Cerebral Palsy NDT/Traditional/Eclectic, PhD, CCC-SLP, C/NDT Contents Preface Acknowledgments Contributors ix x xi Chapter 1. The Development in Neurodevelopmental

More information

Developmental Disabilities

Developmental Disabilities RIGHTS UNDER THE LAN TERMAN ACT Developmental Disabilities Chapter 2 This chapter explains: - What developmental disabilities are, - Who is eligible for regional center services, and - How to show the

More information

Edited by P Larking ACC Date report completed 18 January 2010

Edited by P Larking ACC Date report completed 18 January 2010 Brief report Hart Walker Reviewer Adrian Purins AHTA Edited by P Larking ACC Date report completed 18 January 2010 1. Background Cerebral Palsy (CP) is a group of disorders that arise from brain damage

More information

Cerebral Palsy. Information for patients. Cerebral Palsy Treatment With Stem Cells from your own Bone Marrow / Adipose Tissue

Cerebral Palsy. Information for patients. Cerebral Palsy Treatment With Stem Cells from your own Bone Marrow / Adipose Tissue Information for patients Cerebral Palsy Treatment With Stem Cells from your own Bone Marrow / Adipose Tissue Cerebral Palsy Cerebral palsy is a neurological impairment principally causing loss or limitation

More information

Behaviour in children with cerebral palsy with and without epilepsy

Behaviour in children with cerebral palsy with and without epilepsy Behaviour in children with cerebral palsy with and without epilepsy Malin Carlsson* MD; Ingrid Olsson MD PhD; Gudrun Hagberg BM; Eva Beckung PT PhD, Department of Paediatrics, Queen Silvia Children s Hospital,

More information

Child Development. Caseworker Core Training Module VII: Child Development: Implications for Family-Centered Child Protective Services

Child Development. Caseworker Core Training Module VII: Child Development: Implications for Family-Centered Child Protective Services Child Development P R E - T R A I N I N G A S S I G N M E N T Caseworker Core Training Module VII: Child Development: Implications for Family-Centered Child Protective Services Developed by the Institute

More information

Autonomic dysfunctions in Paralympic athletes.

Autonomic dysfunctions in Paralympic athletes. Sochi 2014, Russia Rosa Khutor, March 10, 2014 Autonomic dysfunctions in Paralympic athletes. Andrei Krassioukov MD, PhD, FRCPC Professor, Dep. of Medicine, Div. Physical Medicine & Rehabilitation, Associate

More information

a guide to understanding facial palsy a publication of children s craniofacial association

a guide to understanding facial palsy a publication of children s craniofacial association a guide to understanding facial palsy a publication of children s craniofacial association a guide to understanding facial palsy this parent s guide to facial palsy is designed to answer questions that

More information

Webinar title: Know Your Options for Treating Severe Spasticity

Webinar title: Know Your Options for Treating Severe Spasticity Webinar title: Know Your Options for Treating Severe Spasticity Presented by: Dr. Gerald Bilsky, Physiatrist Medical Director of Outpatient Services and Associate Medical Director of Acquired Brain Injury

More information

Guidelines for Medical Necessity Determination for Speech and Language Therapy

Guidelines for Medical Necessity Determination for Speech and Language Therapy Guidelines for Medical Necessity Determination for Speech and Language Therapy These Guidelines for Medical Necessity Determination (Guidelines) identify the clinical information MassHealth needs to determine

More information

3-1 THE NERVOUS SYSTEM

3-1 THE NERVOUS SYSTEM C A S E S T U D Y 3 : T o d d l e r Adapted from Thomson Delmar Learning s Case Study Series: Pediatrics, by Bonita E. Broyles, RN, BSN, MA, PhD. Copyright 2006 Thomson Delmar Learning, Clifton Park, NY.

More information