A middle aged woman with spastic quadriplegia smiles with blue eyes, strawberry blond hair and a black sweater.

CP Stories: Susan Picerno

Susan Picerno, a woman in her middle age with spastic quadriplegia, has led a few different professional lives. She has thrived in all of them. But the beginning of her career entailed the hiccups that driven, ambitious people with cerebral palsy come to expect. After graduating summa cum laude with a bachelor’s degree in social work, she decided to continue onto graduate school, obtaining a master’s in social work from the prestigious University of Michigan. Despite a graduate degree from what was the best social work program in the country, Susan recalls interviewing for twenty-two different positions before receiving an offer. For one interview, Susan recalled walking in with her crutches and being met with incredulity: “The director was so flabbergasted that I was disabled that he just stared at me, speechless. He had two directors with him, and they had to conduct the interview. He didn’t say a word the entire time,” said Susan.
She finally landed a part-time role with United Cerebral Palsy in Buffalo, New York, volunteering at a nearby center for independent living at the same time. From her volunteering, she became a board member, then an employee, and eventually, Director of Services. This was in the late ‘80s, not long before the passage of the Americans with Disabilities Act of 1990. The independent living movement was still relatively new at the time, and so Susan felt like her and colleagues at other, nearby centers for independent living were part of a movement that was growing and changing in real-time.

After her time at the center for independent living, Susan transitioned back into social work management for a while, pivoting again into grant writing for a time. At age 41, she shifted again, this time moving to D.C. to dedicate herself exclusively to federal disability policy. Susan had been working on disability issues for most of her career, but tackling the problem head-on at the federal level felt both meaningful and fulfilling.

But as Susan continued to advance and take on new challenges in her professional life, she could feel her spastic quadriplegia getting the best of her. She started developing secondary health issues common for people with cerebral palsy: obesity, type II diabetes, and hypertension. “I tried to exercise but I found physical therapy to be unsupportive,” Susan said. “I was supposed to exercise at home on my own, without the ability to stretch my own muscles and no adaptive exercise equipment or support from other people with disabilities. Why do physical therapists think that this situation will result in success?”

This is to say that for people with cerebral palsy who want to develop an exercise routine, the barriers to entry can be quite high. Pair these logistical difficulties with her harrowing experiences as a child in physical therapy—she describes being worked so hard by her abusive physical therapist that her lungs collapsed multiple times—and it’s clear that developing a regimen can present not only physical difficulties, but emotional ones. “Looking back [at my time in PT], I wonder: couldn’t they have put me in elbow pads, kneepads, etc. so that I didn’t injure myself?”

Despite these early experiences, Susan realized she was at a crossroads. Knowing what needed to be done but not sure how to make it work, Susan turned to the Lakeshore Foundation’s MENTOR program, which she was introduced to through her participation in the CP Research Network. The MENTOR program, which the CP Research Network is responsible for promoting to the CP community, helps develop wellness activities that participants can practice at home. Susan had a rocky start to the program—it was hard not to be discouraged about exercise, given her past with it—but eventually, the program became less about past struggles and more about self-improvement. Likewise, the ability to connect with other CP Research Network members who’d faced similar challenges was immensely rewarding. “These folks will always be my friends,” said Susan. She has since gone on to participate in another activity organized by the MENTOR creators, called the M2M study, which was a free exercise program tailored to people with disabilities.

Exercise was once a source of anxiety and disappointment for Susan, but now it’s a central part of her life. She consistently works out through her local adaptive fitness program, DPI Adaptive Fitness, which offers both in-person and virtual programming. One of the joys of virtual programming is the ability to participate in workout sessions that are “based” anywhere: one of Susan’s favorites is through the Bay Area Outreach and Recreation Program (BORP), which is based in San Francisco. “I work out about six hours a week now, and that includes boxing class, weight training, cardio. All kinds of activities.”

Susan recently retired from nearly two decades of service for the federal government, almost all of which were spent working for the U.S. Department of Labor’s Office of Disability Employment Policy. But in more ways than one, she continues to work to advance the causes of people with cerebral palsy. Advances in the fields of genetics and neurology represent possible breakthroughs for disability communities, but if used unwisely, these same technologies could greatly reduce the diverse ways in which human brains function (also known as “neurodiversity”). Thanks in part to the connections she has made through the CP Research Network, Susan has continued to organize and educate about this topic, engaging with both activists and scientists alike: “As people with cerebral palsy, we need to step forward and speak decisively for our own community,” Susan said. “And we need to educate parents, medical professionals, and the general public about our disabilities.” Likewise, she also recently started Little Tiger Productions, a platform that seeks to amplify creative work by and about people with disabilities. “There are so few stories that are written with disabled people in mind. Characters that do have disabilities often exist to make a point,” she said. Tiger Talk, a Substack newsletter dedicated to just this topic, is set to publish soon.

MyCP Webinar: What is CPChecklist?

Unni G. Narayanan, MBBS, M.Sc., FRCS(C). A headshot of a broadly smiling man with short silver hair wearing a dark suit.

Dr. Unni Narayanan has created two leading outcome measures for children with ambulatory and non ambulatory cerebral palsy — the Gait Outcomes Assessment List (GOAL) and Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD).

Dr. Unni Narayanan, a pediatric orthopedic surgeon and outcomes researcher, will share his vision for helping parents manage the health outcomes for children with severe (non-ambulatory) CP which is called CPCHECKlist©. The webinar will take place on Monday, May 16 at 8 PM ET and parents, caregivers or clinicians should register in advance to receive an invitation. Dr. Narayanan is the creator of the CPCHILD which is the leading outcome measure for health-related quality of life for children with severe CP.

Cerebral Palsy Co-morbidities and a Health Tech Evaluation Checklist (CPCHECKlist©) is a new parent-reported list of specific health items and co-morbidities, commonly experienced by children with severe cerebral palsy (CP) and CP-like conditions. In addition to reporting the presence and perceived severity of each health issue, the parent/caregiver also indicates which of these they wish to have addressed at any given clinical encounter. The CPCHECKList includes a section on the use of health-technologies. The CPCHECKlist is intended to serve as a companion health module of the CPCHILD questionnaire or as a stand-alone health/comorbidity index to guide clinical decision-making or to quantify the health status of a child with severe CP in a standardized, comprehensive way for research and clinical management.

Please join us to learn about this important new tool which will help parents manage the care of their children. Dr. Narayanan will be available for live Q&A directly following this presentation. MyCP Webinar Series registrants will receive an email with login details and a recording will be posted within 24 hours.

A cartoon depicts people running and a man rolling quickly in a wheelchair to reach 60 miles for cerebral palsy

60 Mile Challenge for CP Research

A young girl in a brown knit hat takes steps in her walker.

Join us for the 60 Mile Challenge for CP

Join us this May in rallying support for the cerebral palsy (CP) community and our research work at the CP Research Network with the 60 Mile Challenge for CP Research! This peer-to-peer fundraiser is a great way to raise awareness for CP and provide a way for your friends and family to improve the lives of people with CP by raising money for our national research efforts. You can join the challenge on Facebook and raise money there or, if your are not active on Facebook, on our 60 Mile Challenge event website. And you can clock your miles any way you see fit – Fitbit, wheelchair odometer, Strava, phone app, whatever works for you and how you move! You can create a team, do it solo or just support someone else that is doing it. Share your progress on Facebook to get support for your efforts!

 

A young woman with cerebral palsy in a hat and shorts using arm crutches leans on a tree during a hike.

You can go solo or start a team or just support someone else who is doing the 60 Mile Challenge!

The 60 Mile Challenge for CP Research is the first in a series of peer-to-peer fundraising activities that we will conduct this year. Our goal is to raise funds to support our expanding research agenda to answer critical questions in the care of children and adults with CP. The CP Research Network is the largest and most comprehensive collaboration of hospitals and community members working together to improve health outcomes for people with CP. We host the largest community and clinical registries in the US to gather robust and comprehensive data for research. We focus our research and consumer educational content on the health and wellness outcomes that people with cerebral palsy value most.

Please join us this May for the 60 Mile Challenge for CP Research!

Headshot of Dr. Adam Ostendorf for his webinar on cerebral palsy and epilepsy

Update on Epilepsy and Cerebral Palsy

A headshot of Adam Ostendorf, M.D. A smiling man with short brown hair wearing a black suit and red tie.

Dr. Adam Ostendorf will present the CP Research Network findings about people with CP and epilepsy.

Our April MyCP webinar, next Tuesday, April 19, at 8 pm ET, will provide an overview of our initial findings about people with epilepsy and cerebral palsy (CP). The webinar will feature Adam Ostendorf, MD, a pediatric neurologist from Nationwide Children’s Hospital, who is the principal investigator of our epilepsy research within the network. Dr. Ostendorf has used the CPRN Registry and validated outcome measures, to learn more about the quality of life for people with CP and epilepsy.

Dr. Ostendorf was funded by the Pediatric Epilepsy Research Foundation in 2018 to add epilepsy specific support into the CPRN Registry. Since that time, Nationwide and other centers with the CP Research Network, have been gathering data about the experience of children with epilepsy and CP and examining differences in treatment and outcomes for kids with epilepsy and CP versus those without CP. Dr. Ostendorf will share his findings and how these can lead to important research to improve outcomes for children with epilepsy and CP. His findings have ramifications for children and adults alike.

If you are interested in joining the webinar, you can register on our MyCP Webinar Series page. People who have registered for our whole series will receive a link to the webinar in email a few days prior. If you cannot attend live, we will post the webinar on our YouTube channel where subscribers will receive a notification that it is posted.

Dr. Aravamuthan, a doctor specializing in cerebral palsy, with dark hair back over her white lab coast smiling.

New Publication on Cerebral Palsy

Bhooma Aravamuthan, M.D., DPhil. A smiling woman with long dark hair is wearing black rimmed glasses and a white lab coat.

Dr. Aravamuthan has championed physicians sharing an etiologic diagnosis with a diagnosis of cerebral palsy.

The Cerebral Palsy (CP) Research Network congratulates investigator Bhooma Aravamuthan, MD, DPhil and her co-authors for the publication of her CP Research Network study entitled “Diagnostic preferences include discussion of etiology for adults with cerebral palsy and their caregivers.” The publication, released in the journal Developmental Medicine and Child Neurology in January 2022, describes the results of her survey of community members about the importance of understanding their possible etiologies (origins) of CP. The results of the study indicate that most community members with a diagnostic preference would want to know both their CP diagnosis and any information about their potential etiologic diagnoses.

Dr. Aravamuthan has been a strong advocate for shifting the practice of clinicians that make a CP diagnosis to include information that is important to families for numerous reasons. This article concludes that physicians should change practice to include all information about etiologic diagnoses with their CP diagnosis. This may include, in some situations, stating that the etiologies of a person’s CP are not known.

“Based on survey work we have done with clinicians, many tend to provide either a diagnosis of CP, or a diagnosis describing the etiology of CP, but not both,” said Dr. Aravamuthan, a pediatric movement disorders neurologist as Washington University in St. Louis. “But this study shows that families value the services and the sense of community of having both diagnoses when available.”

The red cover of Developmental Medicine and Children Neurology journal

The full journal article is available to subscribers to DMCN. MyCP members can click on the journal cover to go to the page to view the pre-approved version of the article.

We have made the article in its pre-approved state available to members of the MyCP community. As with many academic publications, this article is not available for free for the general public but the journal allows for authors to post pre-approved versions. MyCP members can find the article in our CPRN Private Archive. Interested community members can join MyCP for free to access this article and other services such as personalized resource recommendations and free adaptive fitness programs.

Cerebral Palsy Photo Contest Winning pictures

Cerebral Palsy Awareness Day 2022

Today, March 25, is the federally recognized Cerebral Palsy (CP) Awareness Day! We are excited to announce the winners for our inaugural CP Awareness Month photo contest. In February, we began accepting submissions in five categories: creativity, diversity, participation & inclusion, perseverance, and physical activity. Each of the following submissions were selected by leading these categories in votes out of 13,383 counted:

A young girl with cerebral palsy smiles while holding the bottom of her dress above an incoming ocean tide.

Creativity Winner: Michelle Toy: Live every day like Mighty Mara!

A young boy with cerebral palsy uses his gait trainer with determination and glee

Diversity winner: Reena De Asis: Determined to thrive as he reaches out to you and lights up the room. The flames on this joyous toddler’s gait trainer are a reminder that he’s a CP warrior on fire!

A proud young woman with CP, seated in a wheelchair and wearing a blue-and-gold graduation cap and gown, receives her diploma.

Participation & Inclusion winner: Jersey Morrison: Jersey’s Graduation in 2021

A man in a wheelchair with cerebral palsy sits between hospital administrators receiving his fundraising check for $10,000.

Perseverance winner: Gary Lynn: “I have not ever let Cerebral Palsy stop me or define who I am!”

A young boy with hemiplegic cerebral palsy jumps for joy as he heads for a puddle of rain water

Physical Activity Winner: Sarah Board: Jumping for joy despite my hemiplegia!

Congratulations to each of these photographers and subjects for their selection and their prize of $100.

In addition to these winners, the staff and volunteers of the CP Research Network voted for best overall photograph in terms of what represented the CP Research Network’s values, the categories and our focus on wellbeing. The winner is:

An adaptive basketball coach in a wheelchair lifts a boy with cerebral palsy overhead in his own chair to dunk a basketball

Best Overall winner: Dawn McKeag: Slam dunk!

Congratulations to Dawn McKeag for the photo of her son Fin and the coaches their local Y for adaptive basketball and the $500 prize!

In addition to this winner, our team wanted to recognize two pictures for honorable mention:

The Shrader triplets, two of whom have cerebral palsy, at graduation

Best photo honorable mention: Carol Shrader: Triplet selfie at Benjamin’s graduation from Belhaven University!

A young man with cerebral palsy in a wheelchair focuses intensely as he aims down his drawn arrow preparing to release it

Honorable Mention: Wesley Magee-Saxton: My 22 year old son, who has CP,  has been perfecting his archery technique with a bow that his dad modified for him. He spent hours practicing and can now almost always hit the target.

Thank you to EVERYONE who participated – submissions, shares and votes. We hope that by sharing pictures and our awareness banners we helped you create awareness for CP and celebrate our vibrant community! Our board will continue to match donations this month 2:1! Wear your green proudly today!

A bar chart shows the age bands and totals for people with cerebral palsy in our national registry.

Cerebral Palsy Registry Update

Headshot of Garey Noritz, M.D. Go to Gary Noritz’s profile

Dr. Noritz, a developmental pediatrician and internal medicine physician, will provide an overview of the current CPRN cerebral palsy registry.

Next Tuesday, March 29, at 8 pm ET, Garey Noritz, MD, the principal investigator of the Cerebral Palsy Research Network’s cerebral palsy registry, will present the latest findings from our registry for our next MyCP webinar. He is a developmental pediatrician and an internal medicine physician at Nationwide Children’s Hospital who treats children and adults with CP. The presentation is open to the public and characterizes the patient population – children through adults – that are captured in our national registry. Attendees will learn how the CP Research Network registry collects data and how that data is used to accelerate research. He will also share what we have learned about the more than 5,200 patients enrolled in the registry.

The Cerebral Palsy Research Network was founded out of a need identified by the National Institutes of Health (NIH) to establish a national registry for cerebral palsy (CP). Unlike countries with socialized medicine such as Australia or Sweden, surveillance of CP at a national level in the United States is exceedingly difficult and prohibitively expensive. The CP Research Network chose to build a “clinical” registry rather than a surveillance registry with the main difference being a focus on children and adults who were treated for CP rather than only whether they were born with CP. A clinical registry is an essential tool for planning research for CP, providing preliminary data to increase research funding success, and improving the treatments and outcomes for people with the condition.

MyCP webinar subscribers will automatically receive an email with the link to the webinar. If you are interested in joining this webinar or signing up for our series, register at: https://cprn.org/mycp-webinar-series/. If you cannot make the webinar, we will post a recording on our website and on our YouTube channel.

CP Stories: Alexander and Lisa Diller

A young man with cerebral palsy dressed in a scouting outfit and smiling hugs his mother in a black sweater and striped shirt.

Alexander Diller, a young man with CP from his premature birth, hugs his mother Lisa, during a scouting event.

Like so many others with cerebral palsy (CP), Alexander was born premature, at 27.5 weeks. While on an oscillating ventilator, the endotracheal tube scraped the back of his throat, triggering a bilateral pulmonary hemorrhage. In turn, the hemorrhage caused intraventricular bleeding, which resulted in hydrocephalus. It would be nine weeks before Alexander was discharged.

During his nine-week stay at the hospital, Alexander’s parents—Lisa and Tim—began their advocacy, working alongside a neonatologist to ensure that Alexander had regular skin-to-skin contact. While this practice is common today, it was rare twenty years ago. Because pediatric neurologists often prefer to wait before making the diagnosis, Alexander would be three before he was formally diagnosed with CP. But as a physical therapist with advanced neurologic training, Lisa suspected it from early on: the month Alexander arrived home, Lisa said, he “began to show signs of lower extremity spasticity and other movement patterns characteristic of spastic diplegia.”

Growing up, Alexander has faced the kind of ableist pushback that young people with CP and their parents have come to expect. As Lisa and Tim prepared him for kindergarten, they settled upon a private school that they thought was best equipped to meet his needs. The school initially expressed reservations about their ability to accommodate Alexander, but after Lisa, Tim, and Alexander’s preschool teacher, Pat, assured the school that Alexander’s needs were as simple as finding a chair that allowed his feet to touch the floor, he was accepted. Later, in high school, Alexander would compete in impromptu and extemporaneous speaking, only to be docked points for his “walking style.” Some judges even went as far as commenting that he should “fix it.”

Alexander has taken these challenges in stride: he was talkative and outgoing from an early age. He has maintained an active, fulfilling extracurricular life in high school, consistently qualifying for impromptu and extemporaneous speaking tournaments[1] at both the state and national levels despite insensitive comments from judges. But the transition into high school did present its own challenges. “We had an influx of new freshmen that I met for the first time,” Alexander said. “I also had new teachers. A lot of it was explaining my CP or answering their questions.”

There were, too, the stares and the speculation from students Alexander didn’t know personally. They wondered whether his CP implied an intellectual disability, something that folks with physical disabilities often must contend with. “Sometimes there were assumptions that because I had CP I wouldn’t be capable academically,” Alexander said. Working with a psychologist who also has CP guided Alexander through the transition. Hearing from someone who had faced similar challenges helped Alexander develop strategies to better understand his own feelings.

Adults with CP have served as valuable mentors for Alexander. During his time with Boy Scouts—he recently attained the rank of Eagle Scout with a silver palm in 2021—Alexander met Steve, a Scoutmaster who also happened to have CP. Alexander has relished the physical challenges that scouting entails. During the same summer he met Steve, Alexander successfully completed a 50-mile hike over a 12-day period with his troop at Philmont Scout Ranch in Cimmaron, New Mexico. Later that summer, he then completed a 50-mile bike ride in seven hours on the Olympic Peninsula.

Scouting aside, Alexander is also an avid Aikido enthusiast and will be testing for his first-degree blackbelt in March. Lisa and Tim made it a point to foster Alexander’s interests from an early age. Some of this was pragmatic: This passion has helped Alexander physically, particularly with his strength, balance, and coordination skills. But it has also helped him develop a strong sense of independence. “Aikido has allowed Alexander to practice with his peers and teach younger students,” said Lisa.

The parents of children with CP inevitably become experts as the child ages, but Lisa’s background in physical therapy has also informed her approach to Alexander’s CP. “I feel my educational background, connections to my peers, and access to current research has enabled me to make educated and informed decisions about Alexander’s care and advocate for him when needed,” said Lisa. “It has also enabled me to teach Alexander from an early age how to advocate for himself.”

As Alexander transitions into adulthood, his independence will undoubtedly prove useful. He recently turned eighteen, starting to cross “the unsteady bridge from pediatric to adult care,” as Lisa called it, that both researchers and advocates alike realize is a critical time. As an educator and provider of adult neurological interventions herself, Lisa has made it a point to stay informed about current research so that she can help guide Alexander during the transition.

Now that Alexander is eighteen, he has started taking the CPRN registry surveys with the hope of contributing to the improvement of treatment interventions for individuals with CP. He graduates from high school in June 2022, and either D.C. or the Northeast seem like the most likely landing spots for college. He will study international relations and global health, ideally with an emphasis on East Asia (he has been learning Mandarin since he was six). “I’d like to involve myself in diplomacy and create policy that’s based on the needs of a community,” said Alexander. What he ends up doing, of course, will be up to him. But it’s abundantly clear that Alexander’s future is bright.


[1]An impromptu speech tournament requires participants to prepare a speech on an unplanned topic in just a few minutes.

Dr. Kristie Bjornson in a bright green CPRN shirt and holding an orthotic.

CP Research Network Hires Scientific Director

Kristie Bjornson, PT, PhD. A smiling woman with blond hair, wearing a black vest over maroon turtleneck in a hospital hallway.

Kristie Bjornson, PT, PhD, MS, has been hired by the CP Research Network to be the Scientific Director.

The Cerebral Palsy Research Network hired Kristie Bjornson, PT, PhD, MS to lead its scientific direction. Dr. Bjornson, featured in our CP Stories in April 2021, is a leader in the field of research for cerebral palsy. In her new role, Dr. Bjornson will lead the network’s effort to pursue public funding from granting agencies such as the National Institutes of Health, the Patient-Centered Outcomes Research Institute and the National Institute on Disability Independent Living and Rehabilitation Research. Dr. Bjornson brings multi-center clinical trial experience for various interventions for CP (i.e. surgery, injections, orthoses, and rehabilitation).

“I’m excited to merge my experience in clinical research in cerebral palsy with the power of the network,” said Dr. Bjornson. “There are so many important to questions to answer for our community and the network is a highly efficient way to conduct this research.”

In addition to her role as Scientific Director, Dr. Bjornson will continue as a site principal investigator for Seattle Children’s Hospital (SCH) where her first-hand experience with our registry will be invaluable to our future research endeavors as she has real world experience with how the registry can be used to make clinical research more effective. Under her leadership, SCH has become a significant contributor to the richness of data in the network’s cerebral palsy registry as SCH has enrolled its entire CP population. Understanding and leveraging the registry to plan new research studies is a great strength that Dr. Bjornson brings to the network.

CP Awareness Month Begins

CP Awareness Month Begins!

A young woman with cerebral palsy leans on a tree while hiking.

Come back every day to vote for YOUR favorite pictures.

Join the Cerebral Palsy (CP) Research Network in our activities to celebrate National CP Awareness month. This recognized month is a great opportunity for us to create awareness about living with CP for the general public to help fund research, support disability policies, and to promote inclusion. There is so much you can do to help the community:

  1. In February, we gathered photos for our CP Awareness photo contest. You can vote for the best picture in each of five categories on our website. We will be awarding a total of $1,000 in cash prizes to the winners on national CP Awareness Day – March 25! Go vote for your favorites – and share them on social media to get more votes.
  2. We have CP facts as Facebook banners that you can download and use to spread the word. We will be posting a CP fact every day on our Facebook and Instagram – feel free to share those!
  3. You can buy CP Research Network merchandise at our Bonfire store and wear green through the month! A portion of the proceeds is donated to our work!
  4. You can donate or start a Facebook fundraiser – our board with 2X match the donations you give or raise throughout the month of March!

Please help us in our efforts to spread awareness for cerebral palsy!