NIH cerebral palsy strategic plan – our comments

The National Institutes of Health recently released the “Strategic Plan for Cerebral Palsy Research” which outlines challenges and priorities to guide future research to improve the lives of people with cerebral palsy.

Our diverse research group enjoyed reading and discussing this plan, which will likely influence our future research goals and support. We’ve shared our group’s comments, organized and prepared by Dr. Heather Feldner, below:

“Our research group appreciated the committee’s focus on creating a centralized data source for CP, attention to the needs and perspectives of adults with CP, their childhood experiences, and their transition from pediatric to adult healthcare providers, and the call for greater caregiver support services and patient-reported outcomes. However, we also had concerns. First, the terminology is inconsistent and often inappropriate. “Cure”, “damage”, and the implication that people with CP cannot be “healthy” is not empowering language in supporting the lives, unique contributions, and perspectives of people with CP as diverse and valued individuals in our society. Further, while advocates of people with CP were included in this stakeholder group, there is a concerning lack of people who actually have a diagnosis of CP, when these should be the primary stakeholders setting a research agenda about their own lives and needs. Finally, given the uncertainty of government funding agencies like the NIH under the current administration’s budget proposal, and the speed of science of translating research from bench to bedside, it appears that too little priority has been placed on interventions or programs that could have an influence right now for the people living with CP in the US dealing with self-identified participation issues such as access to employment and education, as well as impairment-related needs such as pain management, access to technology, and functional mobility.

We are excited that NIH is engaged to set a national research agenda for cerebral palsy and we look forward to continuing to serve this community.

Logo of NINDS/NICHD Plan for cerebral palsy research

J Wu, BR Shuman, BW Brunton, KM Steele, JD Olson, RPN Rao (2016) “Multistep model for predicting upper-limb 3D isometric force application from pre-movement electrocorticographic features.” IEEE Engineering Medicine & Biology

Example of ECoG recording during upper-extremity force production.

Peer-reviewed paper at IEEE Engineering in Medicine & Biology Annual Conference:

Can we estimate upper-extremity force production from electrocorticographic recordings?

Example of ECoG recording during upper-extremity force production.Abstract: Neural correlates of movement planning onset and direction may be present in human electrocorticography in the signal dynamics of both motor and non-motor cortical regions. We use a three-stage model of jPCA reduced-rank hidden Markov model (jPCA-RR-HMM), regularized shrunken-centroid discriminant analysis (RDA), and LASSO regression to extract direction-sensitive planning information and movement onset in an upper-limb 3D isometric force task in a human subject. This mode achieves a relatively high true positive force-onset prediction rate of 60% within 250ms, and an above-chance 36% accuracy (17% chance) in predicting one of six planned 3D directions of isometric force using pre-movement signals. We also find direction-distinguishing information up to 400ms before force onset in the pre-movement signals, captured by electrodes placed over the limb-ipsilateral dorsal premotor regions. This approach can contribute to more accurate decoding of higher-level movement goals, at earlier timescales, and inform sensor placement. Our results also contribute to further understanding of the spatiotemporal features of human motor planning.

Work by Dr. Steele and Ben Shuman featured in The Daily news post

The team found that of the 473 children who had undergone surgery in their current study, those with higher Walk-DMC scores prior to surgery had better treatment outcomes, even after factoring in age and prior treatment.

The Daily, of the University of Washington, posted an article about Dr. Steele and Ben Shuman’s recent work on predicting cerebral palsy treatment outcomes based on motor modules, or muscle synergies. This work is in partnership with Michael Schwartz at Gillette Children’s Specialty Healthcare.  An excerpt from the article is below. To read the article in full, click here.

Ben Shuman, a PhD student in the Steele Lab, smiles while working with electromyography equipment (EMG). Photo credit: Liam Brozik

 

EE Bulter, KM Steele, L Torburn, JG Gamble, J Rose (2016) “Clinical motion analyses over eight consecutive years in a child with crouch gait: a case report.” Journal of Medical Case Reports

Sagittal-plane images of child from 6-13 years of age.

Journal article in the Journal of Medical Case Reports:

A case study of crouch gait over 8-years in a child with no surgical interventions.

Sagittal-plane images of child from 6-13 years of age.

Background: This case report provides a unique look at the progression of crouch gait in a child with cerebral palsy over an 8-year time period, through annual physical examinations, three-dimensional gait analyses, and evaluation of postural balance. Our patient received regular botulinum toxin-A injections, casting, and physical therapy but no surgical interventions.

Case presentation: A white American boy with spastic diplegic cerebral palsy was evaluated annually by clinical motion analyses, including physical examination, joint kinematics, electromyography, energy expenditure, and standing postural balance tests, from 6 to 13 years of age. These analyses revealed that the biomechanical factors contributing to our patient’s crouch gait were weak plantar flexors, short and spastic hamstrings, moderately short hip flexors, and external rotation of the tibiae. Despite annual recommendations for surgical lengthening of the hamstrings, the family opted for non-surgical treatment through botulinum toxin-A injections, casting, and exercise. Our patient’s crouch gait improved between ages 6 and 9, then worsened at age 10, concurrent with his greatest body mass index, increased plantar flexor weakness, increased standing postural sway, slowest normalized walking speed, and greatest walking energy expenditure. Although our patient’s maximum knee extension in stance improved by 14 degrees at 13 years of age compared to 6 years of age, peak knee flexion in swing declined, his ankles became more dorsiflexed, his hips became more internally rotated, and his tibiae became more externally rotated. From 6 to 9 years of age, our patient’s minimum stance-phase knee flexion varied in an inverse relationship with his body mass index; from 10 to 13 years of age, changes in his minimum stance-phase knee flexion paralleled changes in his body mass index.

Conclusions: The motor deficits of weakness, spasticity, shortened muscle-tendon lengths, and impaired selective motor control were highlighted by our patient’s clinical motion analyses. Overall, our patient’s crouch gait improved mildly with aggressive non-operative management and a supportive family dedicated to regular home exercise. The annual clinical motion analyses identified changes in motor deficits that were associated with changes in the child’s walking pattern, suggesting that these analyses can serve to track the progression of children with spastic cerebral palsy.

Engineering Discovery Days

Our lab had a great time sharing our research at the College of Engineering Discovery Days. Our booth was entitled, “The Ultimate Machine” because we think of the human body as a complex system with our brain as a controller/computer and our muscles as our motors. Elementary and middle school students used their neural pathway, from brain to muscle, to control a robot gripper by either relaxing or activating their muscle.  A student activates his muscle to hold a golf ball with a robot gripper Our lab director, Kat Steele, explains why ankle foot orthoses are used and what we are doing to optimize the device. Another student tries her luck at holding a golf ball with a robot hand. The record hold time was 170 seconds. A group of students cheer on their peer as he activates his muscle to hold a golf ball with a robot gripper Elementary and middle school aged students try on 3D printed prosthetic devices