Presidential speaker discusses optimizing long term function in patients with cerebral palsy

  • O&P Business News, June 2012
Diane L. Damiano, PhD, PT
Diane L. Damiano

BANFF, Canada — Diane L. Damiano, PhD, PT, chief of functional and applied biomechanics, National Institute of Health, gave her presidential presentation on orthotic management philosophies in ambulatory children with cerebral palsy at this year’s Association of Children’s Prosthetic-Orthotic Clinics meeting here. Damiano touched on a wide range of topics including the ambulatory prognosis for adults with CP. She cited a 2001 study that suggested that nearly 50% of patients with cerebral palsy who were walking at 18-years old, have stopped walking by adulthood.

“We know that children with CP are one of the most sedentary of all physical disabilities,” Damiano told the audience here. “If you don’t maintain a certain level of activity, they become weaker and it becomes increasingly harder to move over time.”

Damiano wanted to know to what extent muscle deterioration is preventable or reversible among children with the disease. She looked at how the care environment treats muscles.

“We are not trying to weaken muscles, but when you do muscle tendon lengthening, we can weaken muscles,” she said, “It is amazing that one of our more effective treatments, Botox, is really paralyzing the muscle in children who are already weak.”

Damiano also presented data from her recently completed clinical trial that uses the WalkAide foot drop stimulator on patients with cerebral palsy with foot drop. The clinical trial featured 21 children aged 5-17 year who were independent ambulators. Damiano compared the use of the WalkAide with shoes versus shoes alone. She also looked at the barefoot gait before and after the intervention period.

“We were excited because the data showed that electrical stimulation can grow muscle in CP patients,” she said, “Kids can tolerate it and it can have an effect.”

For more information:

  • Damiano DL. Back to the future: Do today’s orthotics optimize long term function in cerebral palsy? Presented at the Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting. April 11-14. Banff, Canada.

Perspective

  • My biggest question is how do you know which child to put this [WalkAide] on? We have such a range of severities with cerebral palsy patients. I think that is our greatest challenge for treatment. Where do we say go and where do we say stop?

    In terms of justification for payment, I am sure the study will give credence to the use of this device and that will help. I think it is one of the biggest challenges we face as a profession — how do we prove it to a third-party payer?
    • Janet Marchall, , CPO, LPO
    • President, Association of Children’s Prosthetic-Orthotic Clinics and pediatric specialist,
      Shriners Hospitals for Children, Tampa Bay, Fla.

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