A top-notch collaboration of 15 Australian and three international research organisations looks set to deliver the best progress in more than a century in diagnostics and interventions for cerebral palsy.
Every week, 11 Australian babies are born with cerebral palsy, and there is no known cure.
Cerebral palsy is not a modern disease. In fact, it’s not a disease, but a physical disorder where the parts of the body affected and the level of severity can differ for each person. Ancient Egyptian, Roman and Greek civilisations all documented the symptoms of cerebral palsy, but it wasn’t until the 1800s that a concerted first-world effort to pinpoint the physiological causes occurred. The conclusion was brain injury during birth, likely due to suffocation.
English surgeon William John Little was the first to medically document spasticity of the limbs in children but, in 1889, Canadian physician Sir William Osler revised the name ‘Little’s Disease’ and referred to the condition as cerebral palsy (CP), Latin for ‘brain paralysis’. Controversially, Sigmund Freud then proposed that CP was not only a birth-related injury, but one that could occur in utero. He was correct – more than two-thirds of congenital brain injury causing CP are now thought to occur in the third trimester of pregnancy, although the causes are largely a mystery.
But two positive aspects of CP are known: the brain injury is non-degenerative, and early intervention can improve the long-term outcomes of children.
Professor Catherine Elliott, Chair of Allied Health at Curtin, is a researcher in the area of neurological impairment. For many years she worked as an occupational therapist, focusing on interventions for babies and children with cerebral palsy. Now, her work is contributing to an international step-change in the diagnosis and treatment of CP.
Elliot is one of 10 Chief Investigators on the Australasian Cerebral Palsy Clinical Trials Network, a five-year national Centre of Research Excellence project. The centre is headed by the Professor Ros Boyd, a neuroscience researcher at the University of Queensland (UQ) and Haydn Williams Fellow at Curtin. In addition to several Australian research partners, the collaboration includes the University of Pisa, Italy, and the University of Auckland, New Zealand.
Two of the project’s key aims are to develop tools for earlier detection of CP, and fast-track children to clinical trials of new ‘neuroprotectants’.
So, just how early can CP be detected? and why is earlier detection desirable?
“Timely intervention can deliver better lifelong health outcomes for those born with CP, but these have often been delayed due to the lack of early diagnosis,” Elliott explains.
“Neuroplasticity is the key. If we diagnose early, we can apply interventions that exploit the young brain’s immense plasticity.”
Currently, clinical practice diagnoses cerebral palsy at about 20 months of age. However, the project has produced a new diagnostic tool, called the General Movements Assessment, which can be conducted on babies only 12 weeks old – and, according to the data, is 98 per cent accurate.
Neuroplasticity is a very exciting research area for doctors and allied health professionals. It wasn’t too long ago the scientific community was convinced that damage to the brain and neural pathways was permanent. We now know that targeted stimulation will prompt the human brain to re-route its wiring – from bypassing a single damaged neuron to reorganising an entire cortex – and regain lost functions.
Next-generation technologies are another promising research angle for the centre, and diagnostic innovations are on the way.
Using MRI scans, Professor Stephen Rose, a physicist at the CSIRO and UQ, has detected biomarkers of CP in the foetal brain, which provides the potential for a diagnosis during pregnancy.
And far from the clinical setting, a ‘diagnostic app’ is another innovation, where parents in remote locations can send video images of their baby, whose movements are assessed using pattern recognition technologies.
“Being consumer-driven research, this aspect of the project has excellent promise to ensure knowledge transfer into clinical practice,” Elliott says.
“And there’s the potential for this project’s outcomes to inform interventions and rehabilitation in autism and stroke, for example.”
The project will also trial several novel neuroprotectants – medications that may protect neural function and reduce gross and fine motor impairment. The hope is that by the time the research centre disbands in 2020, one or two neuroprotectants will be implemented and the rate of CP will be in marked decline.
Elliott believes the project’s application of neuroimaging and machine-based learning tools could put Australia at the fore of clinical innovations in neuroscience.
“In the near future we could see babies and young people with CP have relatively normal fine motor and cognitive development. And there’s potential for this project’s outcomes to inform interventions and rehabilitation in autism and stroke, for example.”
To start with, she’d like to see the General Movements Assessment embedded into clinical practice, not only in Australia, but worldwide.
“Our aim is for all children to have timely, evidence-based treatment to reduce the impact of the disability, to have a ‘better life’ culminating in full inclusion.”
