New to cerebral palsy, or experienced, our education section offers updated information about the care, treatment, and facts, for both children and adults.

Dr. Amy Bailes webinar on what is a learning health network.

What is a Learning Health Network – and why should you care?

Amy Bailes, PT, PhD

Amy Bailes, PT, PhD

On Monday, June 21, at 8 pm ET, we invite you to tune in for our next MyCP Webinar, to discover why the Cerebral Palsy Research Network is working to become a learning health network and how doing so will enhance our efforts to improve health incomes.

The webinar will be presented by Amy Bailes PT PhD, leader of the CP Research Network’s quality improvement initiatives. She will outline how learning networks – that often form a registry at their core – can quickly gather and share data that rapidly improve treatment experiences for patients.

During the 40 minute webinar, Dr. Bailes, a physical therapist and researcher at Cincinnati Children’s Hospital, will also outline the CP Research Network’s efforts to become a learning health network and how that ties in to clinical initiatives we already have underway.

“Taking the most effective practices from the best CP centers across the nation and spreading those practices in a systematic fashion, will have profound impact on the health of people with CP,” says Dr. Bailes. “This is how we should be caring for all people with CP.”

Learning health networks seek to improve outcomes through a combination of research and quality improvement (QI) initiatives. While some research studies can take years to complete and can require more time to affect a change in practice, QI initiatives can drive systemic change and bring results as early as six months.

“While QI cannot answer fundamental questions about treatment effectiveness or discover new therapeutic interventions, it can be used to dramatically improve health outcomes very rapidly,” says Paul Gross, President and Chief Executive Officer of CP Research Network.

Members of the community, clinicians and researchers interested in learning more about the CP Research Network’s drive to become a learning health network can tune in to the June 21 webinar by registering on the sidebar at the top (or on the MyCP Webinar page).

The Shrader children -- triplets to the right with sister Cate on the left.

Preparing for College – Part 3

Carol Shrader, mother of four, two of whom have cerebral palsy.

In the third installment of her inspiring story, CP and triplet mom Carol Shrader shares how she watched her son Benjamin, who has spastic quadriplegia, flourish during his college years…

The night before my son Benjamin began his freshman year, I could not sleep. I worried all night long.

“I know, right?” my husband Wade consoled, observing my nervous disposition. “I have been thinking about this day for 18 years!”

Benjamin, our triplet with spastic quadriplegia, lived at home with us and his younger sister Cate for the first three years of college, but getting around campus independently was still a big deal.

He was only a week and a half into the first semester when we hit our first snag. Benjamin was heading across campus in his wheelchair with a fellow student and following her lead. When she pointed at the curb where they needed to cross the street and asked him if he could make it, he assumed it was flat. Unfortunately, his depth-perception issues prevented him from knowing for sure. It wasn’t flat. He drove right off the curb.

His professor called me, and I rushed to the campus to find my shaken son, clearly in pain and surrounded by college kids, security, and the head of the theatre department. The footplates on his wheelchair were the only thing that prevented him from landing on his face. His feet still took the brunt of the 300-pound weight of him and his wheelchair.

I have never wanted to jerk back control of a situation more – and it was clear I needed to.

Quickly rearranging my schedule, I ensured I could be on campus the rest of the school year. I assisted between classes, shuttling Benjamin between the upper campus and the lower campus where theatre classes were held. I brought him lunch. I took care of his toileting needs. I brought him back to campus for late night events and drove him wherever he needed to go, ensuring he could fulfill his college kid schedule.

At the same time, I worked to find ways to help him achieve independence. I began by phoning the ADA compliance officer and asking for the sidewalks to be revamped on campus. They needed ramps so Benjamin could navigate them safely. When the ramps were consistently blocked by mail delivery vehicles, maintenance, and even professors, I called the dean.

With problems still arising, I called the university president and, in my sweetest Mama Bear voice, told him that Benjamin could not succeed at his college if he could not ever get into the classrooms. A few weeks later, every ramp on campus had been repainted with the words “DO NOT BLOCK” in bold letters.

Meanwhile, Benjamin worked with the ADA office to secure a scribe for tests. The professors assigned a student to copy their notes for him. I was his scribe at home for each assignment. We even burned the midnight oil together, working on a 24-hour theatre assignment to write a play overnight so his team could memorize lines and perform them the next day. Poor Benjamin had to dictate to a scribe who fell asleep between lines.

The triplet’s freshman year continued to be a long year of learning for all of us. Mason was doing well, living a relatively independent life on campus at his college. Claire, my triplet without cerebral palsy, had moved onto campus about half an hour from our home. Throughout her four years, she called, texted, and sent video messages. Sometimes she would share a funny story about life on campus; sometimes, she just needed her mom and emotional support.

When April arrived, I noticed a shift in Benjamin. During a course selection meeting with his advisor, he took an assertive new tone.

“I need to arrange my schedule so that I am at the upper campus for three days a week and the theatre campus for two days a week or vice versa,” he said. “I need for my mom to be able to leave me on campus.”

By the time Benjamin began his sophomore year, he had a personal care team trained to assist him. Having a personal care attendant meant he could be independent of me and could organize his study time, extra-curricular activities, and classes the way he wanted. By his senior year, Benjamin felt confident to move into a newly built dorm with accessible units. It was an enormous step.

Initially, Benjamin didn’t love staying in the dorm, but he grew to enjoy his independence. It was empowering for him to be in charge of his schedule, meals, and life. The accessible dorm and the ultimate willingness of the college administration gave him this opportunity. He had a great college experience participating in theatrical productions as both an actor and a dramaturg and was elected to homecoming court twice in four years.

Benjamin Shrader in his second round of being elected to the Homecoming chord.

Benjamin Shrader at a college graduation celebration.

Benjamin graduated Magna Cum Laude with a major in dramatic writing and a minor in political science. When he presented his final script as a read-through performance for his senior project, every single one of his team of PCAs was in the audience because they were so invested in him.

His brother Mason was recently accepted to his second Master’s program in Anthropology, focusing on Bio Archaeology at Texas Tech. Claire is currently in her second semester of Occupational Therapy School at Thomas Jefferson University in Philadelphia.

Claire enjoyed a semester studying abroad in Argentina and founded sibling workshops for the brothers and sisters of differently-abled children worldwide. When she got an internship with an autism foundation, she discovered they had nothing for siblings, so she created a program. She went on to graduate Magna Cum Laude with a major in Spanish, a minor in English, and all her pre-occupational therapy courses.

When I reflect on the triplets’ journey, I would like to call the educators who didn’t want to invest in their potential. I want them to know that those little preschoolers they thought would place an undue burden on their teachers graduated with honors – lots and lots of honors.

I would like to tell them that when Benjamin rolled across the stage with his diploma, the faculty were the first to stand in what turned into a standing ovation throughout the graduation hall. Those faculty did not stand because Benjamin had been a burden on their teaching. They stood because he worked hard in their classes, he engaged on a day-to-day basis, he encouraged his fellow students, and set the bar high for their performance.

I would like to show them photos of Mason digging in the ancient acropolis in Majorca and receiving his hood for his thesis. I want them to read his undergraduate thesis on disability in the ancient world. I want them to know that his honors project won the Phi Beta Kappa award for best honors project at his school. They missed the chance to list this amazing Summa Cum Laude graduate and all of his accolades among their alumni.

The Shrader children -- triplets to the right with sister Cate on the left.

The Shrader children — triplets to the right with sister Cate on the left.

They also don’t get to brag about our soon-to-be Occupational Therapist Claire who is already changing the world for young people with CP and their families.

College looked different for each of my three. But they each found the school that matched their needs, the path that worked for their personal dreams, and made it not just a possibility but a reality.

College IS possible for young people with CP. They can make their mark and change the world. They can recolor the way society views students with CP. They can affect change. They CAN succeed.

Mason Shrader on an archeological dig in Spain

Preparing for College – Part 2

Carol Shrader, mother of four, two of whom have cerebral palsy.

[In the second installment of her moving three-part story, triplet and CP mom Carol Shrader describes her son Mason’s experience of finding independence as he left home for college for the very first time.]

When you’re a mama bear who has raised four children with very different needs, it’s instinctive to be a helicopter parent. But as I stood on the sidelines watching a college administrator empower my son Mason, I knew the time had come to take a backseat.

“Mason, I’ve heard what your mom thinks you need,” he remarked. “What support do YOU think you need to be successful?”

He may not have made my list of favorite people right then but, as Mason replied with his thoughts, I recognized he was encouraging my son to take charge and have a voice in his own support structure. He was also empowering me to hand over the controls. I could tell by Mason’s face that he was happy. I knew this was the place for him.

Mason was born with spastic diplegic CP, and while he is physically more independent than his brother Benjamin, who has spastic quadriplegia, he has a longer list of medical issues.

When my triplets’ college years arrived, our first hurdle was to find the proper support for our sons to sit for their SATs. I spent hours finding a test site that provided the accessible space we needed for the boys and would allow for scribes to help them write their answers. I filled out multiple forms to ensure the scribes would be permitted and assembled the required medical documentation.

With all the approvals in place, the first test date approached. But even with the best-laid plans, there were obstacles we could not anticipate. My trio was as prepared as I could help them be. They were ready. Then the school called the day before the exam. The scribes had decided they didn’t want to work that Saturday, and the school could not replace them. They would “try” to hire someone for the next test date. Claire took it that day, but Benjamin and Mason had to reschedule. They ended up taking the SAT twice and gained good scores. The relief would carry us through the college application process and all that it entailed.

Our college wish list consisted of schools with excellent access, a manageable student population, and programs of interest. We visited campuses all over the country. We toured schools in Philadelphia, Minneapolis, Chicago, and their more expansive geographic areas, and checked out small liberal arts colleges in California, Mississippi, and Arizona.

We saw great colleges with insufficient access and colleges with excellent access but seemingly a million students. In the end, all three of my triplets chose small liberal arts colleges that offered them an intimate learning environment.

Once Mason had secured his favorite college choice, I helped him put everything we thought he needed in place to live independently. While his campus was only 15 miles from our home, we had made a cross-country move just a few weeks before college started. We had to find Mason doctors to manage his cerebral palsy and his related high blood pressure caused by problems with one of his kidneys, as well as his ulcerative colitis. I had equipped him to talk to doctors himself, but I had failed to teach him to talk to pharmacists. We would have more than one tense mother and son discussion about refilling meds BEFORE they ran out. Equipping him to call in his prescription refills in time and pick them up before he missed a dose was a skill I had overlooked as I prepped him for college. The truth is you can’t predict everything, and you will always be problem-solving on the go.

Mason navigated campus with an electric scooter and his power sticks. Like most moms sending her first born to college, I worried a lot and followed all the campus social media, hoping to get a glimpse of him without nagging him to send me photos.

I was nervous about the electric scooter he took to navigate campus. What if it had negative connotations for him? There was no need to worry. It didn’t. When he joined a fraternity, the president made a point of climbing on the back of Mason’s scooter with the official flag. “We’re going in last!” the president enthused. Staff and students together nicknamed that scooter and were disappointed when rain the weekend of graduation prevented “Bocephus” from attending the swiftly organized indoor ceremony.

Mason threw himself into campus life, serving his fellow students as a resident assistant in the dorms. He was elected student body senator.

When Mason called home his needs varied from emotional to physical, to help with an essential decision like which bow tie matched which shirt. My personal favorite phone call was when he needed me to stop by campus to button the little tiny buttons on his dress shirt.

Mason’s college was not perfect from an accessibility standpoint – the sidewalks were in a deteriorated state, and navigating them in the scooter could be hazardous. The beautiful old buildings had elevators that broke down and didn’t work almost as often as they worked, but the administrators were committed to Mason and his needs.

Mason Shrader on an archeological dig in SpainThe professors recognized his abilities far exceeded his limitations and worked to maximize his opportunities. He thrived, even studying abroad on archaeological digs in the Yucatan of Mexico and off the coast of Barcelona, Spain. Mason worked hard and he had chosen a school with the heart necessary for his success.

He graduated Summa Cum Laude in four years with a major in Classics (Greek and Latin), a major in Anthropology, and a minor in Archaeology. His picture hangs on the wall of the student center as one of just four students in his graduating class chosen for the Hall of Fame. Mason earned this accolade because he took the heart his school poured into him and gave it back with dedication.

Today, Mason is finishing up a Master’s in Classics at Texas Tech University. Before the pandemic, he was living alone, on campus a thousand miles from home.

Whatever the problem, Mason has taken it in his stride. Despite living independently, fine motor skills are challenging, but we work out the solutions.

When he started to look like a hairy mountain man with unkempt hair, beard, and nails, we organized a reconnaissance day sending him on Uber rides around the city to find somewhere he could get his hair and beard cut plus a manicure and pedicure. Now Mason knows exactly which strip mall can serve all those needs and heads there every six weeks.

Mason has CP which has thrown some curveballs his way over the course of his life. But when he lectures, cerebral palsy is the last thing on his students’ minds. Recently, I had the opportunity to speak alongside Mason to a class of students working on their masters in special education. We were in fact, lecturing about CP and the impact these students would have as teachers. But when Mason started speaking about his archaeological research, the entire discussion shifted and the previously quiet class began raising their hands to ask questions. Even they, who were there specifically to discuss CP, had completely forgotten that Mason is affected by this challenge.

I can’t help beaming with pride.

(For more information on preparing for college, visit this resource developed by Carol Shrader from her experiences.)

Benjamin, Mason, and Claire, Triplets born to Carol and Wade Shrader in 1997

Preparing for college — a three part series

Carol Shrader, mother of four, two of whom have cerebral palsy.

[With this year’s college search and acceptance period having come to a close, we thought it would be a good idea to plant the seeds for future planning if you have a teenager with cerebral palsy. There is no one better to do this than Carol Shrader, mother of four, two of whom have CP and have recently graduated from college. So this week we return to our educational Tuesday programming with a three part series written by guest blogger Carol Shrader.]

With two out of three of her triplets diagnosed with cerebral palsy, Carol Shrader discovered that setting her children up with an excellent education would take resolve and advocacy. Today, in the first installment of her heartwarming story, she reveals how she fought to get educators to take a positive approach to her triplets’ formative school years…

As the mother of triplets, I was a bit too busy to worry much about my children’s formal education — at least not until it was time for them to begin school.

The Shrader triplets all together in a baby swing.

The Shrader triplets all together in a baby swing.

From the moment Benjamin, Mason, and Claire were born almost three months prematurely on April 19, 1997, my days overflowed with all manner of baby things. Worrying about the future was not on my to-do list.

All three of my babies began their extraordinary lives in the NICU. For the first few weeks I spent hours at the hospital watching as doctors monitored our tiny trio’s progress. Dad was a medical student and came as soon as classes were over to see their progress, and take his turn holding babies.

One by one, we were able to bring them home. Mason was the last one to leave the NICU. We put our little 4lb boy down between Claire and Benjamin in one bed and he immediately laughed out loud and grabbed hold of both of them. It was the sweetest moment.

Like most new mothers, those early days were filled with the mundane and the miraculous but we had a routine. I fed the first baby to wake up hungry – always Mason – and then Benjamin, and then would wake our little sleeping beauty, Claire, to eat. There were dozens of diapers to be changed, endless baths, clothes to coordinate. Once all three were napping, I might have a minute to shower and dress before starting the mothering marathon all over again (might being the key word). But no matter how exhausted, or unkempt I felt, simply walking into their nursery to see three little heads pop up to smile at me was enough to warm my heart and make me smile too.

Although initially, Claire presented some healthcare concerns in the NICU, she was ultimately cleared of any concerns. She became the ruler against which we judged the milestones Benjamin and Mason seemed to be missing. Ultimately, both boys would be diagnosed with cerebral palsy.

Right from the NICU, the triplets were participants in a study on premature babies and were followed closely by physical therapists.

Early on Benjamin was off the chart for motor skills. At four months – four weeks past his due date – he was holding himself up. When a visiting physical therapist announced that his impressive progress could be due to spasticity from CP, I almost quit the study. Her words felt negative and were frankly terrifying.

However, she was right. Soon, Benjamin was clearly not meeting milestones. When Claire and Mason began to roll over, Benjamin could not. Then as Claire progressed to sitting up, Mason started to lag. He couldn’t sit without my help.

As their first birthday approached, our pediatrician recommended we see a developmental pediatrician. And it was this doctor who delivered the diagnosis with a jarring lack of empathy. He’d barely entered the room when he announced, “Of course your boys have CP; what did you think I was going to say today?”

Packing up to leave, I reeled with feelings of hurt, anger, and something else. It was the overwhelming conviction that this doctor had no idea how amazing my boys were going to be. I reeled with the knowledge that I would fight for them with everything I had, for as long as necessary.

Benjamin was diagnosed with spastic quadriplegia affecting all four of his limbs. He uses a power wheelchair. Mason was diagnosed with spastic diplegia. He uses forearm crutches – or what we call “power sticks” – to ambulate. While physically more independent than his brother, he has a longer list of medical issues.

When the triplets were babies, my husband Wade was in the first year of his orthopedic surgical training. His hours were insane, and his sleep schedule was worse than mine. His free time was limited and his worry over the multitude of hurdles and unknowns for our boys dominated that time. And perhaps because he was in his 128th year of higher education (not really, but it felt that way) their college years were what seemed to be of most concern. We vowed to give them every opportunity in life.

Dr. Wade Shrader with his triplets at Disneyland in 2002.

Dr. Wade Shrader with his triplets at Disney in 2002.

By the time we approached the triplets’ fifth birthday, I had begun to do the work to start their education. I took my three on a tour of an acclaimed private school in our then hometown of Rochester, Minnesota. As we sat across the desk from the headmaster, I asked him if he could accommodate my boys. Most of my friends’ children attended, and I was anxious to hear if this could be the place for us.

“Mrs. Shrader, this is what we can do,” he began. “We’ll enroll your children on a three-month probationary period. If in three months it proves too hard on my teachers, we will have to ask you to find somewhere else for them to attend school.”

I was not quite five years into this Mama Bear role, but my conviction was growing. Looking him in the eye, I cleared my throat.

“Really?” I remarked. “And you think starting kindergarten, the beginning of their formal education, on PROBATION is the best way to set them up for success? I cannot even imagine the stress that would place on them and us as a family. No thank you.”

I left irritated but not heartbroken. I had heard of a choice school in town that also had high academic acclaim. I made an appointment with the principal there.

This time, after I had spoken warmly about my amazing children, the principal began to explain the school admittance policy – a blind-lottery basis. For triplets, if one name was drawn, all three would be accepted. I liked those odds, until she expressed concern about how hard her teachers would have to work to accommodate my differently-abled children. In a frustrating déjà vu moment, I heard how her teachers might need to be protected from my babies. It stung. I walked out knowing that even though the odds were in our favor – we had THREE entries in the lottery after all – my children would NOT be selected in this draw. I was right.

Determined that we would find a place where my wonderful children would all be wanted and able to thrive, I took my dynamic trio to our local public school for a visit.

We were met by a warm and smiling principal who took us on an enthusiastic tour, talking about the teachers and different activities. She didn’t treat my sons like they were anything but future students. I knew this school was the one. We didn’t need special treatment; we just needed to be welcomed.

The Shrader Triplets head off to pre-school two with their walkers but all three with matching backpacks.

The Shrader Triplets head off to pre-school two with their walkers but all three with matching backpacks.

Dropping my children off on their first day was emotional. Thankfully they were super excited, and I trusted they would be OK. Kindergarten and first grade would not be without challenges, but we never felt our presence was a burden or that having our triplets in class was an undue weight for the teaching staff.

As the years passed, we relocated with Wade’s job, spending stints in Dallas, TX, and Phoenix, AZ.

By fifth grade, things were getting harder. I knew Benjamin was bright, but despite having great teachers, some could not work out how to balance his sharp mind with the physical limitations of his body, and I spent a lot of time at the school. His six-grade school was overcrowded with 35 students pushing their desks around his wheelchair after he drove into the room. I worried about accessibility and what would happen in an emergency.

The triplets were joined by a younger sister in 2006.I took a leap of faith in the middle of that school year and decided to homeschool the triplets and their younger sister Cate. We got into our own little groove, studying during the hours that worked for us and taking fun field trips and outings.

Then, before we knew it, the triplets were 15. The moment my husband had been contemplating in his mind for many years had come. It was time to navigate college choices and campuses.

As we began selecting choices, the memories, emotions, and feelings of abject rejection during those first kindergarten visits resurfaced in my mind. I knew from that experience all those years prior we needed colleges with heart.

College would look different for each of my trio, but I am pleased to report they all found their independence, navigated hurdles, and flourished.

This series will continue on June 8th. You can read Carol’s guide to preparing for college in our Transitioning to Adulthood section.

New CPRN Website

A Labor of Love: Our New Website

Marquis Graduating Walking off stage with a big smile using his walker

The new CP Research Network website on a mobile device

The Cerebral Palsy Research Network will launch its new website – combining all four of its web properties – this Monday, May 24! Our extended community will benefit from this single rich repository of information, resources, research and collaborative tools. In order to learn how to maximize the benefits of our new site, it will be the subject of our next MyCP Webinar on May 26 at 8 pm ET.

Founders Paul Gross and Michele Shusterman will provide background information on the creation of merged site, talk about the design principles and walk attendees through the new user experience, including plans for future enhancements to MyCP.

In January we announced the merger of CP NOW, including its toolkit, wellbeing resources and CP Daily Living blog, with CPRN and its MyCP community engagement site. Carefully sorting how to organize our four web properties was a key step to bringing together CP NOW and the CP Research Network. The new website, found at https://cprn.org, focuses on the four cornerstones of our mission:

  • Engaging the community in research and sharing their lived experiences;
  • Research and implementation of evidence-based health care for cerebral palsy;
  • Educating community members of all ages with content reviewed by experts in CP care;
  • Wellbeing programs for optimizing life-long health.

During this webinar we will demonstrate how to get the most value out of the network and MyCP, including how you can contribute to improving outcomes for people with CP.

Please join us! You can register here: https://cprn.org/mycp-webinar-series/

New Website Sneak Peak

Here’s a sneak peek at our new website!

Thanks to our merger with CP NOW and new research studies already off the ground, it’s been an exciting year so far for the CP Research Network. So, what’s next? Our new website!   

 Since our January merger, our team has been busy integrating four websites into one to create a new online home – cprn.org – a place where we will bring together our community, research efforts, education, and wellbeing programs.   

Here’s a sneak peek of what’s to come!   

To make things easier to navigate, our one platform, CPRN.org, will feature the four cornerstones of the combined organization:  

1) Community  
Join a committed group of community members on the MyCP platform at CPRN.org. All are welcome, including adults with CP, parents, and caregivers, clinicians, researchers, and advocates shaping impactful research to improve the lives of people with CP.  

2) Research  
The Cerebral Palsy Research pages of our soon-to-be-released site will fill you in on our active studies and highlight opportunities to participate in ongoing research to improve healthcare outcomes for people with CP.  

3) Education  
Please take advantage of our educational resources and programs to help navigate CP from diagnosis to therapies, treatments, and interventions to maintaining mental and physical health and transitioning to life as an adult with CP. You’ll find many toolkits, guides, and resources all ready to download on our education webpages.   

4) Health and wellbeing  
Log on for programs to maintain and improve physical health and wellbeing. We are working with our trusted partners to implement regular opportunities for community members to participate in healthy activities in their communities.  

Excited? We are too! We’ll reveal our launch date soon, but for now, please keep swinging by cpdailyliving.com, cpnowfoundation.org, cprn.org, and mycp.org for everything you need to know about the CP community.    

Adults with CP require ongoing neurologic care

Neurologic Care for Adults with CP

Bhooma Aravamuthan, MD, DPhil
Bhooma Aravamuthan, MD, DPhil

Most people living with cerebral palsy today are adults, yet there is a disconnect about how childhood neurological care should transition into adulthood. Today, Dr. Bhooma Aravamuthan, MD, DPhil, shares her efforts to bridge that gap…

As a pediatric neurologist, the bulk of my practice is caring for children with cerebral palsy, yet I did not receive training in the unique needs and concerns of adults with the condition.

As my patients make the often-difficult transition away from pediatric care to adult care, what medical symptoms and red flags do I tell them to watch out for? How can I help them advocate for their medical needs? How do I convince my adult neurologist colleagues that CP is not just something that happens to kids? These kids become adults, and they still need us. 

Last year, I was elected as Vice-Chair of the American Academy of Neurology (AAN) Adults with Intellectual and Developmental Disabilities Section. My election was bolstered after I sounded the alarm that neurologists who care for adults should increase their focus on patients with CP. I am not alone in my passion for this topic, and there is a growing consensus that we need more expertise. 

As I investigated this issue, I turned to the Cerebral Palsy Research Network and engaged with The Adults with Cerebral Palsy Workgroup within the network.

The workgroup features clinicians across specialties (including physiatry, physical therapy, developmental pediatrics, and orthopedics) who have long worked to increase awareness of the many changing needs faced by adults with CP.

I came to them asking, “Where do I start?” Together, we established what we knew, what we thought we knew, and what we needed to learn more about regarding the neurologic care of adults with CP. Along with a talented MD-PhD student at my home institution, Washington University School of Medicine, we conducted a comprehensive systematic review of the available literature on neurologic concerns faced by adults with CP. 

The results were informative but also sobering. Adults with CP have twice the risk of stroke and eight times the risk of myelopathy (spinal cord compression and injury) than adults without CP. A third of adults with CP lose mobility as they age, and the majority suffer from increasing pain and fatigue. These are all concerns that require neurologic surveillance, which, by and large, is not occurring. We also established how much we still need to learn about the neurologic problems faced by adults with CP. As you may have guessed, there is still a lot we do not know. 

Together with my neurologist colleagues, members of the AAN section, and members of the CP Research Network workgroup, we published our findings. Our article, Adults with cerebral palsy require ongoing neurologic care: A systematic review, was printed in this month’s Annals of Neurology, one of the flagship journals in our field.

In the article, we include recommendations for clinicians, researchers, and adults with CP about the kinds of neurologic symptoms to look for and what symptoms we need to learn more about.

We believe that resources of this type are an essential step toward ensuring adult medical practitioners are more aware of the issues facing adults with CP. Our findings highlight the critical need for ongoing neurologic surveillance of adults with CP.

At the least, we hope that including specific recommendations for adults with CP will empower patients to self-advocate until we, as clinicians, can bridge the wider knowledge gap we have regarding their care. 

As word spreads of our recommendations, we have been encouraged by the positive feedback but are eagerly awaiting to see if this changes practice as well. While we are hopeful, we are not naïve. We will keep sounding the alarm until ongoing neurologic surveillance of adults with CP is the norm. 

[If you want to participate in our adult study of personal wellbeing, please join MyCP!]

About Dr Bhooma Aravamuthan

Dr. Aravamuthan is an Assistant Professor of Neurology and pediatric movement disorders specialist in the Cerebral Palsy Center at the Washington University School of Medicine in St. Louis.

Research CP Dystonia Edition

Don’t miss our 2021 MyCP Webinar Series!

Last year, more than 1,000 people logged on for our MyCP webinar series as we came together as a community to discuss cerebral palsy (CP) research. We are thrilled to announce our webinar series will return in 2021 with our first installment, Research CP: Dystonia Edition Results, scheduled for Tuesday, February 9, at 8 p.m. EST. 

Research CP embodies our efforts to engage stakeholders — community members, advocates, clinician and researchers — to set a research agenda that matters to the community.  It began in 2017 with our inaugural effort to establish the top research questions valued by the community. The result was published in Developmental Medicine and Child Neurology in 2018 and has set the research agenda for the CP Research Network.  In 2019, we launched Research CP: Dystonia Edition. We engaged more 160 people in educational webinars on the topic, community members and clinicians generated a prioritized list of unanswered questions about dystonia in CP

The Research CP: Dystonia Edition Results webinar is the summary of our findings from this initiative to set a patient-centered research agenda for dystonia in CP. It will be presented by CP Research Network Chief Executive Officer Paul Gross, Bhooma Aravamuthan, MD, DPhil, a pediatric neurologist from St. Louis Children’s Hospital in Missouri, Darcy Fehlings, MD, a developmental pediatrician from Holland Bloorview Rehabilitation Hospital in Toronto, Ontario, Canada and Michael Kruer, MD, a pediatric neurologist and neurogeneticist from Phoenix Children’s Hospital in Arizona.

To find out more, please visit our MyCP Webinar Series page and follow the instructions to sign up and secure your Zoom link to the online event. Webinars will also be recorded for later viewing.

Throughout 2021, we will bring you eleven monthly webinars featuring principal investigators from the CP Research Network, sharing concepts, development, and goals from their network research.  We will cover a broad spectrum of CP research ranging from genetics to care of adults with CP. The webinars are available for free to all CPRN community members and clinicians.

We encourage all who have participated in this important ongoing process to attend. We hope to see you there!

Exercise and Physical Education Part 4

Exercise and physical activity in spastic diplegia – older children, adolescents, and adults – part 4

[This post is part of our Knowledge Translation/Education Tuesday series. Guest author Lily Collison, author of Spastic Diplegia–Bilateral Cerebral Palsy, continues the series. You can ask questions of the author on the MyCP Forum].

In the last post I included links to the guides Fit for Life, Fit for Sport, and exercise and physical activity tips for the younger child. This post will address exercise and physical activity tips for the older child, adolescent, and adult. I wrote them with therapists at Gillette.

  • For all types of exercise, a referral to either a PT or OT is recommended, even for just one or two sessions. There are also wonderful athletic trainers who have advanced training in working with people with physical limitations. Trainers who lack this specialized training, however, may advise overexercising, which can lead to injuries. Consider calling the fitness centers or gyms in your area to check if any of their staff have training in adapting exercise programs for people with physical challenges.
  • If you’re working with weights, consider getting expert guidance on how much weight is safe to work with and how many repetitions to perform.
  • Fast walking can achieve many of the same benefits as running and may be safer for some people.
  • You have many options when it comes to cycling, including outdoor and indoor (static) bikes. Three-wheeled bikes may be ideal for those with balance issues. You can purchase blocks (trainers) to convert an outdoor bike to an indoor bike when the weather doesn’t allow for outdoor mobility.
  • A therapist can offer guidance on the appropriate size and type of sports wheelchair to use and can check to see if you are eligible for any funding aid to purchase one.
  • A few tips for swimming:
    • Consider scheduling a few sessions with a pool PT or OT to develop an appropriate swimming program.
    • If you use a wheelchair, call around to find a pool with PVC pool chairs and a ramp.
    • A pool temperature of 88–94 degrees Fahrenheit can be very therapeutic and can help reduce pain and stiffness.
    • Nonskid pool shoes are recommended for walking from the changing room to the pool and back to avoid falls on wet pool decks.
    • Swim paddles, kickboards, flippers, etc. can be used to increase resistance for muscle strengthening.
  • You can find many excellent videos online to guide you through adaptive yoga, tai chi, and other such programs. The National Center on Health, Physical Activity and Disability (NCHPAD) has some.
  • Incorporate as much exercise as you can into the normal day (for example, cycling to school, after-school activities, or work).
  • Most school programs include at least a weekly session of physical education. Try to ensure that the program includes the child or adolescent’s needs as much as possible so that they can participate in the sport, even if this means adapting the rules, the equipment, or the mindset of the teacher or coach. Forcing the child or adolescent to sit out their school physical education period is a missed opportunity both in terms of the benefits of exercise and the camaraderie and social experience of teamwork. Research has shown that school-based exercise programs are beneficial for children and adolescents with CP.

I’m very respectful of the fact that the people who live with physical disability will have other tips. Your comments are very welcome over at MyCP.

Image of a person holding a tool

Webinar: Body Composition and Strength in Cerebral Palsy

Ed Hurvitz, MD, Chair of Physical Medicine and Rehabilitation, University of Michigan

Ed Hurvitz, MD, Chair of Physical Medicine and Rehabilitation, University of Michigan

The Cerebral Palsy Research Network (CPRN) announced that its next webinar in its MyCP webinar series would be about importance of body composition and strength in cerebral palsy (CP) on Monday, December 7, at 8 pm ET. Dr. Edward Hurvitz, Chairman of the Department of Physical Medicine and Rehabilitation at the University of Michigan will discuss his research into new measurements of strength for people with CP and role that strength plays in long term health. Dr. Hurvitz, also a member of the CPRN Executive Committee, will present for approximately 20 minutes and be available for Q&A after the presentation. Dr. Hurvitz’s research was recently funded by the Foundation for Physical Medicine & Rehabilitation Gabriella Molnar grant. This study is important because it may enable new standardized ways to measure strength in the CP population that can be easily added to routine care.

Interested participants need to register for the webinar to be sent instructions for joining. Webinars will be recorded and posted for later viewing. The MyCP Webinar series includes one presentation per month on different aspects of CPRN’s research studies. Please join us!