Glasgow conference for professionals, September 2006
On 11 September 2006 HemiHelp held a professional conference in Glasgow – our first event North of the Border! What is encouraging about our conferences around the country is that we are not only reaching more of the people who treat our children, but we are also discovering new knowledge and expertise wherever we go. Fifteen years ago Professor Robert Goodman was able to call hemiplegia a ‘Cinderella condition’; that is certainly not the case today, and our line-up of speakers in Glasgow was an example of how many excellent people are working either to discover more about the condition, or to improve the treatment offered.
Allison Morrison (a senior physiotherapist) and Michele Wells (a senior OT), come into the second category. For the last four years they have been running a clinic in the Glasgow area which specialises in prescribing and fitting children with lycra garments – everything from socks (which can be worn inside AFOs) and gauntlets to full body suits. In that time they have treated over 200 children and the expertise they have built up allows them to select the best option for any child from all manufacturers’ ranges. They also support colleagues who want to develop similar clinics in other parts of Scotland.
Increasing the effectiveness of botulinum toxin
Dr Steffen Berweck, a Consultant Paediatric Neurologist from Munich, dropped in on our conference on his way to a rather grander one on the other side of the Atlantic. He is a specialist in the use of botulinum toxin in the treatment of motor disorders, including hemiplegia, and gave us a highly graphic presentation of his methods (the video clips had some of us listening with closed eyes)! Dr Berweck has pioneered the use of ultrasound to guide the injections to the most effective place in the muscle(s) being treated, often distributing the toxin in a number of points for maximum effectiveness. Generally botulinum is used mostly to improve leg function, but the team in Munich have been using it to decrease spasticity in upper limbs as well. In most cases this is to give better arm/hand positioning, which, for example, makes dressing and personal care easier, but children with less severe hemiplegia can also gain improved function in their affected hand. Steffan Berweck believes that the earlier botulinum treatment is used, the better, and that its use in early childhood can reduce the need for surgical intervention later on – the only problem, in Germany as well as everywhere else, being its high cost.
Can hemiplegia have a genetic cause?
We also heard about advances in knowledge of the causes and effects of hemiplegia. These talks can often just confirm my worst anxieties as a parent, but at the same time it is heartening to hear about research that will benefit children in the future. Dr Peter Corry, who heads the Child Development Centre in Bradford, has carried out a study which could alter our understanding of why hemiplegia happens. Researchers in the past have not tended to regard genetic factors as a significant cause of cerebral palsy (CP) of all types, although we at HemiHelp do know of families where more than one member has the condition (our late Chair, Phil Kent, for example, had hemiplegia, and so does his daughter). Dr Corry’s experience in Bradford, however, has thrown up some interesting statistics. His Child Development Centre’s catchment area includes a large Pakistani community where it is common for close relatives to marry one another. This increases the incidence of certain disabilities known to be genetic in origin – congenital deafness, for example, is much more common in this community than in the general population, as are many quite rare conditions. This community has been the subject of a number of studies which have identified individual chromosomes responsible for one condition or another. Dr Corry to his surprise realised that the incidence of CP among this community was also abnormally high – at almost six per thousand, more than twice as high as usual. Moreover, of the Pakistani children with CP, including hemiplegia, quite a few had close relatives with the same kind of CP. He looked at other possible factors, such as maternal health or poor maternity care, but these did not seem to be significant. On the other hand, data from communities in other countries, where marriage among close relatives is the norm, confirmed his findings. He has concluded that genetic factors are much more common in causing CP than has been generally accepted, and that evidence for this is likely to grow. Download the Dr Corry's presentation: Genetic issues in cerebral palsy (pdf format)