AACPDM Focuses on New Research

By Miki Fairley

Rebounding with enthusiasm and resilience from last year's canceled meeting due to the events of September 11, the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) drew 764 participants to the 2002 Annual Meeting September 11-14 in New Orleans, Louisiana.

James A. Blackman, MD, (left) incoming president, accepts the gavel from outgoing President Michael D. Sussman, MD. An exciting highlight was the Mac Keith Basic Science Lecture presented by John W. McDonald III, MD, PhD, assistant professor of Neurology and Neurological Surgery at Washington University School of Medicine, and director of the Barnes-Jewish Hospital Spinal Cord Injury Program, St. Louis, Missouri.

Shortly before the meeting, it was announced that a famous patient of McDonald's, "Superman" star Christopher Reeve, had astonished the medical community by recovering function nearly six years after his injury in a fall from a horse. Reeve's case marks the first documentation of someone improving two ASIA grades more than two years after injury. On a scale developed by the American Spinal Injury Association (ASIA), Reeves progressed from C2 ASIA Ano sensory or motor function below his shouldersto C3 ASIA C. He has now regained sensation and some movement in the majority of his body. Reeves is a long way from full recovery; however his progress has greatly enhanced his quality of life both physically and emotionally.

Although the reasons for Reeve's surprising progress are not fully understood, Washington University's Activity-Based Recovery Program may be a key. Based on the hypothesis that continued patterned movement may help damaged spinal nerves to "re-learn" how to send signals and even sprout new connections around the injury site, the program uses specially designed rehabilitation therapies to help spinal cord injury (SCI) patients improve overall health, strengthen bones and muscles, and possibly regain ability to feel and move. For more information on the program and Christopher Reeve's progress, visit http://spine.wustl.edu . McDonald also discussed stem cell research and how it may help SCI patients.

John W. McDonald III, MD Another highlight was the session "Surgical Options in Cerebral Palsy: Point/Counter-Point." The speakers discussed and debated orthopedic surgery, selective dorsal rhizotomy (SDR), and intrathecal baclofen (ITB). It was noted that "The paradigm of treating the CP child is changing before our eyes." As pointed out in the session, the rehabilitation field needs to facilitate multicenter research collaboration, maintain evidence-based reviews, and develop standards of care.

During another session, a speaker said that, although ITB has produced positive results, it can involve acute, life-threatening withdrawal symptoms and progression of scoliosis significantly beyond natural history expectations, even after skeletal maturity.

The two Presidential Guest Speakers delved deeply into the mysteries of the brain. A. James Barkovich, MD, head of Pediatric Neuroradiology, University of California San Francisco, described the newest developments in neuroimaging. "Modern neuroimaging makes many contributions to diagnoses of the substrate of cerebral palsy and helps us to understand the underlying mechanisms of injury," he noted, adding, "This better understanding allows more accurate&early therapy."

Eric B. Keverne, MD, professor, Behavioural Neuroscience and director, Animal Behaviour, University of Cambridge, UK, discussed genomic imprinting, brain evolution, and behavior.

A new family of therapeutic techniques successfully used to improve the rehabilitation of stroke patients and other adults with neurological injuries has recently been successfully applied to children with cerebral palsy. Discussing constraint-induced therapy (CI) were Edward Taub, MD, a behavioral neuroscientist at the University of Alabama, and Stephanie DeLuca, research associate and coordinator of the Pediatric (CI) Therapy Project. The intense therapy program involves restraining the stronger arm while a therapist helps the child develop use of the more-affected arm and hand. For more information, visit www.circ.uab.edu/cit.htm

The meeting provided a truly international forum for networking and exchanging ideas. Besides participants from the US and Canada, about 90 rehabilitation professionals came from 25 other countries. Eighty-one representatives from 42 companies staffed exhibits displaying the latest in rehabilitation-related products and services.

CD-ROMs of the meeting are available for sale; visit www.aacpdm.org for a sample and order form.

Next year's meeting is scheduled for September 10-13 in Montreal, Quebec, Canada.

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