Night sky with colorful fireworks

Happy New Year! 2023 in Review

As we turn the page on 2023, we look back with much appreciation for all that our extended community is doing to accomplish our mission of improving the health and wellbeing of people with cerebral palsy (CP) and their families. Many of you have engaged in the work of improvement in care and new knowledge generation through creation of or participation in studies. We thank you all for your efforts, your willingness to share ideas and resources with your colleagues and researchers, and your unrelenting drive to make life better for people with CP.

We kicked off the year with an impactful strategic partnership with Cerebral Palsy Alliance Research Foundation (CPARF) which is the largest private funder of CP research funding in the United States and a disability technology accelerator. The CP Research Network has fundraised together with CPARF as part of their STEPtember campaign and CPARF has supported all of our existing research efforts as well directly funded three new studies – two for adults and one for children.

Our research program benefited from the guidance of our data coordinating center at the University of Pittsburgh. A big shout out goes to Dr. Stephen Wisniewski and his whole team at Pitt for their innovative perspective on study designs, advancing our data collection and reporting, and increasing the scalability of network to enable more clinicians and community members to participate in making new discoveries in cerebral palsy. We also benefited from the addition of Dr. Joyce Trost to our research team. Dr. Trost leads our registries which have grown substantially in 2023 and underpin all our work. Alongside her, our scientific director Dr. Kristie Bjornson and Quality Improvement director Dr. Amy Bailes, strengthen our research pipeline and care improvement efforts with their related expertise. Together this team has overseen the development and advancement of 31 studies and improvement efforts including 20 newly initiated THIS year!

What does all this research activity mean to you? First that the CP Research Network is serious about changing outcomes through care for people with CP of all ages. For adults, the network is very focused on pain and its impact on function. Participating centers increased the assessment of pain in adult visits from 24% to over 90% this year and have been funded by CPARF to standardize the classification of that assessed pain so that it can be treated effectively. For children, the network is improving the dystonia diagnosis and working toward network surveillance of hip dislocation which can be a painful result especially for children with CP that are less mobile. Our improvements in care are being built into the electronic medical record system to make the clinical assessment of pain, diagnosis of dystonia and surveillance of hips, part of the standard of care for patients at CP Research Network hospitals. Three new publications this year highlighted just some of the research and improvement in the network including the effort to reduce infections after baclofen pump surgeries, chronic pain in adults, and a study of practice variation in selective dorsal rhizotomy.

Our education and engagement programs have seen large increases in enrollment in MyCP – our interactive web portal for personalized information and participation in research. Our monthly MyCP webinar series has engaged hundreds of community members in live discussions and gathered more than 7,000 views on YouTube this year. Our CP Toolkit continues to be our most often downloaded educational piece helping families understand the meaning of a CP diagnosis.

Finally, our partnership with the National Center for Health, Physical Activity and Disability provided incredible health and wellness opportunities to adults with CP. While only 16 people took advantage of the fantastic MENTOR program that teaches participants about mindfulness and how to get sufficient adaptive exercise and nutrition for improving one’s health, these MENTOR participants raved about the classes and the result, so we hope to triple the number of participants in 2024!

The timeliness of MENTOR has been invaluable to me, given my life stage, CP journey, and the additional impact of my other health conditions. The program has equipped me with the necessary skills to manage these challenges, such as mindset, activity levels, and nutrition. Additionally, the one-on-one opportunities to meet with staff have helped me fine-tune my approach.
Marji – MENTOR program graduate

We have exciting plans for 2024 including much deeper involvement of the community in our research program starting with opportunities to attend our annual investigator meeting in April and participation as co-investigators on developing projects. We anticipate a lot of progress, improvement, funding and results from our myriad research projects under development. And at least two new toolkits will be launched this year!

Dr. Sarmiento smiles broadly with her brown hair pulled back, in a navy blazer and light colored swoop neck blouse.

New CP Research Network Publication on Adults with Cerebral Palsy and Chronic Pain Experience

Dr. Sarmiento smiles broadly with her brown hair pulled back, in a navy blazer and light colored swoop neck blouse.

Dr. Cristina Sarmiento is a rising young investigator in the CP Research Network with her first network publication and an Accelerator Award granted in October. She focuses on issues of transition and adults with cerebral palsy.

The Cerebral Palsy (CP) Research Network congratulates Cristina A. Sarmiento, MD and her co-authors[*], for the publication of her CP Research Network manuscript, “Adults with cerebral palsy and chronic pain experience: A cross-sectional analysis of patient-reported outcomes from a novel North American registry”. The Disability and Health Journal released this peer reviewed article in November 2023, our first publication based of our adult study launched in MyCP in 2019. The publication describes the pain experience and its impact on function and quality of life among adults with CP who have chronic pain. It marks a tremendous milestone in furthering our understanding and sharing of adult pain research.

Approximately 70% of adults with CP report some type of pain with increasing rates of chronic pain with aging. Prior work has shown that pain has significant implications for activity and quality of life for adults with CP although the long-term effect of pain is not known. Not surprisingly, understanding chronic pain and the treatment of pain in adults with CP has been identified by individuals with CP, caregivers and providers and the National Institute of Health as a top CP research priority. The Cerebral Palsy Research Network is providing a rich opportunity to collect systematic, longitudinal data on people with CP such as the data used in this study.
The authors of this study sought to describe the pain intensity, interference, locations, changes, and helpful treatments experienced by participants as well as how quality of life and function are affected by pain. Information was collected from 2019 through 2022 through including functional changes and information about chronic pain through surveys circulated by the CP Research Network in our Community Registry which is hosted in MyCP — our personalized web portal on CPRN.org. The authors are inspired to continue to pursue learning about pain experience in adults with CP because they know that chronic pain is a significant, common condition for many adults with CP, affecting so many aspects of life – mobility and daily function, tone, sleep, mental health, quality of life, social participation, and more. However, they don’t yet have good ways to accurately identify, classify, and treat pain in adults with CP. The Community Registry allows adults with CP to tell us about their pain experiences so clinicians and researchers can better understand chronic pain in CP, with the goal of ultimately improving its management. We discussed some of these findings in a MyCP webinar.

Among participants in the Community Registry where community members report their experiences with CP, 78 % reported having chronic pain. The average age of pain onset was 28 years with low back and legs the most frequently reported areas of pain. Pain interfered most with work, walking and sleep. GMFCS level and age did not affect severity of pain reported. Individuals most frequently tried physical therapy, massage and exercise and stated that these non-pharmaceutical treatments helped to decrease the pain although for the vast majority of participants, their pain was worse than or the same as it was a year prior. Adults with CP with moderate-to-severe pain reported that their pain interfered with function and activities and had greater depression and lower satisfaction with social roles compared to those with mild pain.

Unfortunately, chronic pain in adults with CP often goes unrecognized and under-treated. Many adults with CP tend not to seek professional treatment and rather self-manage their pain, highlighting a critical gap in clinical practice. The authors recommend based on this work that all adults with CP, regardless of age or degree of physical disability get screened for pain, as they are at higher risk for chronic pain at younger ages compared to the general population. Screening and classifying pain is the goal of one of our research projects funding by our partner CP Alliance Research Foundation.
The full journal article is available for free download for the next 15 days in The Disability and Health Journal. After January 1, 2024, only subscribers to The Disability and Health Journal will have access. Dr. Cristina A. Sarmiento, MD first author of this publication, practices at the University of Colorado Anschutz, Department of Physical Medicine and Rehabilitation specializing in inpatient and consult pediatric rehabilitation medicine, transitions of care for adolescents and young adults with disabilities. The CP Research Network is particularly excited for Dr. Sarmiento, a young investigator / clinician who has been mentored by several clinicians in our network including her co-authors. She is also the recipient of an Accelerator Award to set priorities in adult CP research.

*Mary E. Gannotti, PT, PhD, Paul H. Gross, BA, Deborah E. Thorpe, PT, PhD, Edward A. Hurvitz, MD, Garey H. Noritz, MD, Susan D. Horn, PhD, Michael E. Msall, MD, Henry G. Chambers, MD, Linda E. Krach, MD

An empty winner's podium

Webinar: Priorities in Adult Cerebral Palsy Research

Professional headshots of four investigators smiling for a cerebral palsy adult study.

Drs. Sarmiento, Gannotti, Hurvitz, along with Jocelyn Cohen, will present on priorities in adult CP research.

Next month’s MyCP webinar will focus on a new study that we are conducting to establish priorities in research about adults with cerebral palsy (CP). The webinar will be held on Wednesday, December 6 at 8 pm ET. It will be led by CP Research Network principal investigator Cristina Sarmiento, MD. Dr. Sarmiento and her colleagues Jocelyn Cohen, JD, Mary Gannotti, PT, PhD, and Ed Hurvitz, MD, will present their plans for a study that was funded by our new Accelerator Award program made possible by our partner Cerebral Palsy Alliance Research Foundation.

In 2017, the CP Research Network was funded by the Patient-Centered Outcomes Research Institute to engage the community in creating a patient-centered research agenda. The program included a series of educational webinars followed by a collaborative idea generation process. This led to the creation and ranking of the most important questions to study in CP. A group of 45 people split between community members and physician researchers, gathered in Chicago in June 2017 to finalize the agenda. That agenda referred to as Research CP, was published in 2018 and has been a key driver of research conducted within the network. Many of the top-ranking themes were about adults, aging, functional decline, pain, and exercise to maintain functional abilities. This new study will again engage the community but in a different format that leverages focus groups to dive deeper into the research questions that underlie the themes that have been identified and prioritize them for clinical study.

This upcoming webinar will provide an overview of the planned study and discuss how members of the community can engage in the process. We will leave a significant amount of time for questions and answers with the entire study team. If you are interested in joining us, you must register in advance (though MyCP Webinar subscribers will automatically be sent the link to join the webinar). The webinar will also be recorded and posted to our YouTube channel within 24 hours.

Award: Study of Pain in Adults with Cerebral Palsy

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Cerebral Palsy Research Network leaders Drs Bailes and Gannotti will lead a study of adult pain classification funded by CPARF.

The Cerebral Palsy Research Network has been awarded funds for a three-year study in the classification of pain for adults with cerebral palsy (CP). This study was the subject of October’s MyCP webinar. Classification of pain in adults is fundamental to identifying proper treatments and improving outcomes. Congratulations to co-principal investigators Amy Bailes, PT, PhD and Mary Gannotti, PT, PhD who will lead the team which includes the rest of the members of the Adult Care Quality Improvement.

The CP Research Network applied to Cerebral Palsy Alliance Research Foundation (CPARF) for this award earlier this year. CPARF’s research funding was a very competitive cycle this year and we are honored to receive this funding to advance our essential study of pain in adults with CP. We expect that this work will have a very broad impact on adult care by beginning to address pain, one of the most important issues identified through our Research CP program — our community created research agenda.

The study team comprises clinician investigators from Columbia University, Nationwide Children’s Hospital which has an adult outpatient clinic, University of Michigan, and the University of Colorado. This team has already demonstrated that it can improve the care of adults across multiple centers with its Adult Care QI initiative. This effort led to a substantial increase in the assessment of pain across participating CP Research Network centers from 24% of the time to over 90% percent of visits. Now the group is planning the next important step in the systematic treatment of pain – classifying it accurately as a critical step to effective treatment. The study will begin with a Delphi process to identify the best tools to classify pain during a clinical visit. The appropriate classification of an individual’s pain will enable clinicians to choose the most appropriate treatments.

We look forward to the successful execution of this grant and transforming how pain is treated in adults. People interested in the background for the study can watch October’s MyCP webinar with the study team. Adults wanting to participate in our research should either join MyCP to regularly contribute your lived experience to our research or take our initial adult study of wellbeing and pain.

A banner about nutrition in cerebral palsy features a colorful bowl of vegetables and legumes.

Growing Up Well with Cerebral Palsy: Improving Nutrition, Health, and Wellbeing

A balding man with dark rimmed glasses smiles broadly in a white lab coat with a colorful striped tie.

Dr. Richard Stevenson, a developmental pediatrician at UVA, will present on the role of nutrition in health of children with cerebral palsy.

The Cerebral Palsy Research Network is excited to announce its November MyCP webinar entitled “Growing Up Well with Cerebral Palsy: Improving Nutrition, Health, and Wellbeing” with Dr. Richard Stevenson, Developmental Pediatrician and Division Head – Neurodevelopmental and Behavioral Pediatrics at the University of Virginia Health. The webinar will take place on Tuesday, November 14, at 8 pm ET. Dr. Stevenson has been leading efforts in the network to investigate the role of nutrition in overall growth and health for children with cerebral palsy (CP).

Growth is considered an integral indicator of nutrition, health, and wellbeing in children. The regular measurement of growth and comparison to reference data is a key component of health maintenance in children across the globe. In general, if a child is growing well compared to their peers, then they are considered to be disease free, adequately nourished, and living in a safe and “good enough” environment. Children with cerebral palsy are smaller in stature compared to their peers and in proportion to the severity of their motor impairment. But this raises many questions:

  • Is this growth pattern a problem that is modifiable?
  • Is the difference in growth due to poor nutrition, due to medical co-morbidities, due to poor activity levels or other factors that can be manipulated?
  • Does this difference in growth for children with CP matter?
  • Is it associated with poor health or with differences in quality of life?

A part of the overall differences in growth in people with cerebral palsy is the manner of growth and maturation of bone and muscle, and that bone and muscle problems (e.g. spasticity, contracture and osteoporosis) contribute to chronic pain and decreased mobility over the lifespan. Could these long-term problems be mitigated through childhood management of diet and physical activity?

Dr. Stevenson will review current knowledge on growth and nutrition and the relationships among growth, health, physical activity, and wellbeing in children with cerebral palsy. He will also discuss knowledge gaps and opportunities for additional research and improvements in how we care for children with cerebral palsy with the goal of improving health and quality of life across the lifespan. Dr. Stevenson also looks forward to community input on these questions and more. To join the webinar, please register using the form below or at https://cprn.org/mycp-webinar-series/. A recording of the webinar will be posted to our YouTube channel within 24 hours of the presentation.

Growing Up Well with Cerebral Palsy
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Cerebral Visual Impairment Workshop

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Dr. Trost, Registries Director, has been invited to participate in the NEI workshop on CVI.

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

Dr. Bjornson, Scientific Director, has been invited to participate in the NEI workshop on CVI.

We wanted to share information on an upcoming workshop about Cerebral Vision Impairment (CVI). CVI impacts many people in the cerebral palsy (CP) community, and nearly 10 years ago, Michele, Shusterman, Co-Founder of the CP Research Network, blogged about it as she was fighting to sort out how to help her daughter Lilly (aka Maya) to see. The National Institutes of Health (NIH) wants to build upon the expertise and discussions that have taken place in recent years. Two of our directors have been invited to this new workshop and they will be moderating discussions.

The National Institutes of Health (NIH) is hosting a workshop on Cerebral Visual Impairment (CVI), Roadmap to Consensus and Building Awareness.

CVI emerged as a priority area in the 2021 National Eye Institute (NEI) Strategic Plan, following concerted stakeholder input from CVI patients, families, providers, teachers, and researchers. The plan outlined strategies to develop methodologies to diagnose and classify CVI in order to ultimately understand the neural basis and structural/functional relationships. It also called for forging partnerships with CVI community stakeholders and improving clinician awareness to increase timely recognition of CVI when rehabilitation is most effective. Toward these goals, NEI Director Dr. Michael F. Chiang announced in June 2022 that NEI would create a CVI patient registry. This workshop is designed to discuss technical and practical aspects of creating that registry and identifying the next scientific steps to advance the field.

In developing this workshop, NEI is excited to partner with the National Institute of Neurological Diseases and Stroke, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development to incorporate expertise from the following disciplines: pediatrics, rehabilitation, behavioral science, and neuroimaging. Of particular interest to NIH leadership is learning from the CP Research Network about the development of their registry and how these lessons could be applied to a CVI registry.

Would you like to register for this workshop?

The workshop will be November 17, 9:30 am – 5 pm ET, in Bethesda, Maryland. In-person seating is very limited. Registration will open to the public on October 23, 2023. The meeting will be videocast in real time, and also recorded for later viewing. For more information, and to register for the live videocast or to attend in-person, please visit the event page https://www.nei.nih.gov/events/cvi-workshop.

Surgeons in blue gowns and wearing loupes perform surgery.

New CP Research Network Publication on Selective Dorsal Rhizotomy (SDR)

A neurosurgeon with a full beard, glasses, brown hair and eyes grins in a white lab coast for El Paso Children's Hospital

Dr. Ziyad Makoshi, first author of this publication, completed his neurosurgical fellowship while working with CP Research Network Dr. Jeffrey Leonard at Nationwide Children’s Hospital.

The Cerebral Palsy (CP) Research Network congratulates investigator Ziyad Makoshi, MD and his co-authors[*], for the publication of his CP Research Network manuscript entitled “A Mixed-Methods Study of Practice Variation in Selective Dorsal Rhizotomy: A Study by the Cerebral Palsy Research Network.” The publication, released online in the journal Pediatric Neurology in September 2023, investigates provider perception about SDR candidates against the characteristics of those undergoing SDR in the CP Research Network clinical registry.

Selective dorsal rhizotomy (SDR) is an established procedure for the treatment of spasticity associated with cerebral palsy (CP). There is variation in the patient characteristics, e.g., age, motor function, and co-morbidities, deemed most suitable for the surgery. With the indications (valid reasons for using the procedure) expanding, and sometimes conflicting research results, the study team aimed to investigate provider perceptions about SDR candidates through structured interviews compared with the quantitative results of characteristics of those individuals undergoing SDR in the CP Research Network registry.

The results of the study indicate that most CP Research Network registry participants who receive SDR are 8-12 years and typically function at Gross Motor Functional Classification Level (GMFCS) level II or III while a third of individuals receiving SDR are non-ambulatory (not able to walk, i.e., GMFCS Levels IV and V). When surveyed, providers across the range of clinical disciplines that refer children SDR, varied on what the youngest age for SDR should be but agreed on the most likely GMFCS level for SDR and dystonia screening methods. There was not good agreement providers on whether individuals with CP and dystonia should receive an SDR.

The decision to pursue SDR surgery should be made as a team that includes the caregiver and the individual with CP (whenever possible). With differences in the approach to determining the best candidates for SDR and the differences in technique, age and patient characteristics, discussions with families should acknowledge these variations and allow families to reach a decision based on individual concerns, caregiver and/or patient goals, and expectations of outcomes.

Both the registry and the qualitative study of SDR were inspired by our co-founder’s experience with recommendations for his son with CP. Either an extensive orthopedic intervention or an SDR were recommended for improvement of his gait in 2012. Comparative evidence was lacking and most studies of SDR had been done with strict inclusion criteria about patient characteristics. The registry and the qualitative studies were developed by CP Research Network CEO Gross as building blocks to a much larger observational study of SDR for which the network is currently seeking funding. This mixed method analysis provided important preliminary data for that grant application to the National Institute of Neurological Disorders and Stroke earlier this year. The study team expects to get a funding decision for that study in Q1 2024.

The full journal article is available for free download for the next 45 days in Pediatric Neurology. After December 16, 2023, only subscribers to Pediatric Neurology will have access.


*Jeffrey Raskin, MD, Robert Bollo, MD, Brandon Rocque, MD, Susan Zickmund, PhD, Patrick Galyean, BS, Grace Perry, BA, Samuel Browd, MD, Paul Gross, BA, Kristie Bjornson, PT, PhD and Jeffrey Leonard, MD

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Priorities in Adult Cerebral Palsy Research

Professional headshots of four investigators smiling for a cerebral palsy adult study.The Cerebral Palsy Research Network, in partnership with Cerebral Palsy Alliance Research Foundation (CPARF), has awarded its first Accelerator Award, a new internal funding program supported by CPARF to advance critical research questions more quickly. This particular award will be used to prioritize research questions about adults with cerebral palsy (CP). The study, entitled “Priority Setting for Multi-center Research Among Adults with CP” will be conducted by leading investigators focused on adult research – Cristina Sarmiento, MD, (principal investigator), Ed Hurvitz, MD and Mary Gannotti, PT, PhD (consultants) in partnership with Jocelyn Cohen, a community member co-investigator. The study team will lead a series of focus groups around the country to gather input from the community about which health concerns are most pressing to them. This study will build upon the original patient-centered research agenda created through the Research CP program.

The main objectives of this award are to develop a community prioritized set of questions to research through a multi-center clinical trial. The priority setting process will use qualitative methods (a process to find common themes in transcribed answers from focus group participants). Participating community members will be drawn from the CP Research Network’s MyCP community engagement platform and from the CPARF community. They will be involved in every stage of the research process and will have the opportunity to be co-investigators for the study that follows.

Our December webinar will feature the investigative team for this grant. They will provide a more in-depth overview of the planned research and how community members may become involved. This will be a separate webinar from this evening’s webinar on pain classification though it will feature some of the same speakers. Subscribers to our MyCP webinar series will receive an email with the webinar instructions when it is announced in December.

A picture of a plastic model of a lumbar spine.

Webinar: Classifying Pain in Adults with Cerebral Palsy

Four images of our speakers including headshots of Drs Bailes, Gannotti, Hurvitz and NoritzThe Cerebral Palsy Research Network will host its next MyCP webinar on classifying pain in adults with cerebral palsy (CP) next Tuesday, October 24 at 8 pm ET. Gathering more detailed information about a person’s pain will help clinicians determine what treatments may help address it. Leaders in the network’s care improvement for adults, our team that does continuous improvement of outcomes in the treatment of adults with CP, will present plans for the next phase of their work to address pain which is a significant issue in the quality of life for adults. Drs Amy Bailes, Mary Gannotti, Ed Hurvitz and Garey Noritz will present the work of this multi-center implementation effort aimed at establishing the widespread assessment of pain for adults with cerebral palsy.

Why are we focused on pain in adults with CP?

Adults with CP consistently report that they are in pain that often goes unaddressed. In our most recent survey of adults with CP, 78% report that they are in pain. It is part of our vision to work towards addressing the most pressing concerns of the CP community in the most efficient manner possible and pain is at the top of our list.

The CP Research Network’s Adult Care quality improvement team greatly improved how often pain was assessed in adults over the last two years, surging from 24% to over 90% of visits at participating network sites. Now the group is planning the next important step in the systematic treatment of pain – classifying it accurately as a critical step to effective treatment. The clinician researchers will describe:

  • The importance of assessing and treating pain in an adult CP clinic
  • Our findings about pain to date from our Community Registry
  • How pain is classified and why pain classification is important
  • Our process for quality improvement in the care of pain in adults with CP

After the presentations of these topics, the speakers will engage the community
attendees for feedback on the planned work to improve outcomes in treating pain. We encourage adults with CP to attend and participate in this webinar. The webinar is free and open to the public by registering at https://cprn.org/mycp-webinar-series/ or sign up below. The webinar will be recorded and posted to our YouTube channel following the webinar.

Classifying Pain in Adults with CP
A blog banner features speakers Lisa Letzkus and Zach Vesoulis in white lab coats smiling.

Early Detection of CP Webinar

Dr. Vesoulis in a white lab coast, short wavy hair and a red tie smiles for his professional headshot.

Dr. Vesoulis will be co-leading the webinar on Early Detection of Cerebral Palsy.

Dr. Letzkus with blond hair and dark blouse covered by a white lab coat smiles for her professional headshot.

Dr. Letzkus, a nurse scientist and nurse practitioner, will co-lead the webinar on Early Detection of Cerebral Palsy.

The Cerebral Palsy Research Network plans to add early detection of cerebral palsy (CP) to its national registry to accelerate the pace of research in early intervention (EI) for children with CP. Early intervention holds the promise to improve outcomes for children with CP. CP Research Network Co-Principal Investigators Lisa Letzkus, PhD, RN, CPNP-AC and Zachary Vesoulis, MD, MSCI will present the study design to the community in a webinar next Thursday, September 21, at 8 pm ET. This free MyCP webinar is open for anyone who registers from the CP community or the clinical care community and will be recorded.

Dr. Letzkus is a nurse practitioner and nurse scientist that leads the early detection program at UVA Health in Charlottesville VA and Dr. Vesoulis is neonatologist and NIH funded researcher at Washington University in St. Louis. The two will present our planned research project, its goals and how it may impact outcomes in CP. They will both be available for questions and answers following the presentation.

The CP Research Network clinical registry has recently exceeded 8,000 patients from sites across its network and continues to grow. Patients are enrolled in the registry when they have a clinic visit or an intervention related to CP. Because the network was founded before the early detection guidelines had been created, most of those patients are enrolled at age two or later. The opportunity to begin enrolling patients as early as 12 weeks at our sites that follow the early detection guidelines would be a tremendous benefit to researchers who seek to test early interventions to improve outcomes for children with CP. And because our registry is longitudinal, we will be able to follow children as the progress through milestones and see how early diagnosis and intervention impacts the lives of children with CP. Please join us to learn about this exciting research initiative.