Intensive motor training after perinatal stroke to enhance walking

Perinatal (around birth) strokes are devastating especially because the children live with its effects for the rest of their lives. Most often they are diagnosed with cerebral palsy (CP), a group of non-progressive motor conditions that cause physical disability, chiefly in the various areas of body movement. The majority of children with CP have problems walking, yet current treatments are limited. Orthopedic surgeries to correct these problems have been referred to as the ‘birthday syndrome’, due to the common need to repeat them yearly or bi-yearly. Aside from the huge quality of life impact, it is estimated that the lifetime health care cost for each CP child is around $1 million.

Currently, children with CP in Alberta receive therapy for leg related function about once a month usually starting at about age two. However, based on previous scientific evidence, Drs. Jaynie Yang, Monica Gorassini and their colleagues predict that the critical period for motor pathways to the legs is from shortly after birth to the age of two years.

Therefore, the team, from Edmonton and Calgary, intend to provide intensive motor therapy to children as young as eight months of age. The essence of the research is to intervene with walking training during the critical period for the legs, in order to train the nervous system while the neural pathways are still forming. It is anticipated that the results of this study will: 1)  determine if early, intensive training of the legs improves walking more than later training or no training, and 2) determine how age at time of training affects the pathways from the brain to the spinal cord (motor), from the spinal cord to the brain (sensory), and spinal circuits (motor/sensory).

CP results in severe and lifelong consequences for the family and the child. Dr. Yang and her colleagues aim to make a difference by applying intensive training when the nervous system
is most plastic. By intervening at the ideal time, limited resources for therapy can be applied when the effects are greatest, resulting in ‘the biggest bang for the buck’. They predict this will have further economic benefits as the child ages by reducing the need for surgeries, reducing secondary complications, increasing mobility, and leading to greater participation in employment and less dependence on social supports.

Dr. Yang received external Alberta Innovates—Health Solutions (AIHS) Collaborative Research
and Innovation Opportunities (CRIO) and Canadian Institutes of Health Research (CIHR) awards in September 2012, based on preliminary data funded by WCHRI Bridge and Innovation
grants. The team has also benefited from on-going support from the WCHRI Biostatistics,
Knowledge Translation and Grant Support services.
 
Yang’s research has been funded by the generous support of the Stollery Children’s Hospital Foundation through WCHRI.