International Partnership Leads to Cerebral Palsy Insights

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The most common cause of childhood disability in the world, cerebral palsy affects between 1 and 2 infants per thousand. But despite its prevalence, this neurological condition — which can cause a variety of movement issues and other challenges — tends to be understudied, especially in developing countries.

However, a new study from The Children’s Hospital of Philadelphia sheds light on CP’s impact. Based on an ongoing partnership in Botswana with the University of Pennsylvania, pediatric researchers in Children’s Hospital’s Global Health Center performed the first rigorous study of CP outcomes in Africa. In this and related studies, they summarized the scope and overall public health challenges CP presents in this low-resource setting.

“For a variety of reasons, children with cerebral palsy tend to have poorer outcomes and a higher prevalence of comorbidities in Botswana compared to those in higher-resource countries,” said study leader David Bearden, MD, a pediatric neurologist at CHOP. “Our research represents a first step toward designing better prevention and treatment of CP in settings such as Botswana.”

Dr. Bearden and his team presented their findings recently at the American Academy of Neurology annual meeting last month in Washington, D.C. The Academy selected one of the investigators’ studies for the “highlights in the field” session.

CP encompasses a variety of motor dysfunctions resulting from brain injury during the fetal period, infancy, or early childhood. Patients with this lifelong condition often have poor muscle control and speech problems.

In their study cohort of 68 children with CP at a referral center in Gaborone, Botswana, Dr. Bearden and colleagues found the most common causes of the condition were prematurity, intrapartum hypoxic events (periods of low oxygen during labor or birth), and infections during infancy. Severe motor impairments were common, with the most severe category occurring in 42 percent of the patients. In the U.S. and European studies, less than 20 percent of children with CP are in the most severe category.

The participants in the study also had high rates of comorbidities, or accompanying conditions. The most predominant was cognitive impairment, found in 83.8 percent of the children, followed by epilepsy (76.5 percent), and visual impairment (45.6 percent). These rates of epilepsy and cognitive impairment were more than double the rates reported in studies of CP in high-resource settings.

When parents and caregivers were interviewed about health beliefs, cultural values, and other barriers to care for children with CP, they expressed major concerns about lack of access to physical therapy, adaptive medical equipment, and good nutrition.

For Dr. Bearden, who has participated in the Botswana/Upenn Partnership since 2007, spending 2 to 3 months there every year, the current studies provide a foundation for further medical work, both in improving health education and devising better public health interventions.

“We need to work closely with doctors in low-resource settings to develop low-cost interventions for children with cerebral palsy,” Dr. Bearden said.

“For example, a community-based rehabilitation approach, teaching parents basic rehabilitation techniques, combined with regular check-ins by a community health worker in the family’s home, is much more likely to succeed that an approach that depends on parents regularly bringing children to the hospital for therapies,” he noted.

To learn more about cerebral palsy care at The Children’s Hospital of Philadelphia, see the Cerebal Palsy Program website. And for more information about CHOP’s global health work, see the Global Health Center.

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