Comprehensive Review of Research Informs Patient Care For Acquired CNS Injuries

July 10, 2009
Kennedy Krieger Institute Contributes to Special Issue on Central Nervous System Rehabilitation

Baltimore, MD - Kennedy Krieger Institute experts have contributed to the journal Developmental Disabilities Research Reviews for a special issue entitled "Acquired Central Nervous System Injuries." Published in the current issue is a comprehensive review of the literature surrounding the rehabilitation of children with acquired central nervous system (CNS) injuries. The articles provide clinicians with a thorough overview of recent findings and trends in this constantly evolving field in order to help inform clinical approaches.

Drs. James Christensen and Frank Pidcock of the Kennedy Krieger Institute served as guest editors of the issue, which brings together the expertise of twenty Kennedy Krieger researchers and clinicians to author nine different articles. While the issue covers a number of topics from cognitive and behavioral issues to the reintegration of children into their day-to-day lives, the editors highlight three key areas: neuroplasticity, neuroimaging, and intensive rehabilitation methods for motor impairment.

Neuroplasticity

The first article by Dr. Michael V. Johnston describes recent data detailing the plasticity of the brain, meaning the ability of the brain to reorganize itself following injury. The brain had long been thought to be a static organ until recent developments in research showing cellular processes that allow for plasticity. The article reviews recent research detailing the mechanisms involved in neuroplasticity and what this means for rehabilitation following a CNS injury. According to Dr. Johnston, the activation of neural tissues through the right kind of therapeutic technique is a big contributor to recovery. Appropriate therapy, such as constraint induced movement therapy, can better allow for synaptic activity and the reorganization of cortical maps, allowing the brain to remodel itself.

Neuroimaging

Neuroimaging has a far-reaching impact on acquired CNS injuries, both in terms of diagnosis and prognosis. Drs. Stacy J. Suskauer and Thierry A.G.M. Huisman explore recent advancements in neuroimaging that allow for the prediction of outcomes in pediatric brain injury. These advanced techniques include Diffusion Weighted and Diffusion Tensor Imaging, Susceptibility Weighted Imaging, and H-Magnetic Resonance Spectroscopy. The authors then discuss how these tools are starting to be used by clinicians in order to better tailor rehabilitative methods based on any expected difficulties in the future.

Intensive Therapy for Motor Impairment

Two additional articles look at intensive therapy techniques used with pediatric motor impairment that are both intense in nature and are said to be revolutionizing the treatment of CNS injuries. The first article by Dr. Kathleen Brady and occupational therapist Teressa Garcia gives a thorough review of the literature surrounding constraint induced movement therapy (CIMT). CIMT forces the patient to use the affected limb by restraining the unaffected one during intensive therapy sessions. Repetitive exercises ultimately cause the brain to grow new neural pathways that help patients regain the use of the limb.

The authors then discuss the varying ways the technique is being used with pediatric patients, emphasizing the need to compare two different treatment models: weekly sessions interspersed with home programs, or a 2 to 4 week inpatient program followed by a home program.

In a separate article, Drs. Cristina Sadowsky and John McDonald review the application of activity based restorative therapies (ABRT) in spinal cord injury. ABRT is based on the concept that the nervous system requires an optimal level of patterned activity in order to maintain plasticity and encourage spontaneous regeneration after injury. Drs. Sadowsky and McDonald discuss the benefit of physical exercise, highlighting functional electrically stimulated (FES) ergometry. The role of exercise enhanced with FES ergometry is then compared with therapist assisted overland gait training, noting the importance of further contrasting the relative effectiveness, practicality and cost for each method.

About the Kennedy Krieger Institute

Internationally recognized for improving the lives of children and adolescents with disorders and injuries of the brain and spinal cord, the Kennedy Krieger Institute in Baltimore, MD serves more than 13,000 individuals each year through inpatient and outpatient clinics, home and community services and school-based programs. Kennedy Krieger provides a wide range of services for children with developmental concerns mild to severe, and is home to a team of investigators who are contributing to the understanding of how disorders develop while pioneering new interventions and earlier diagnosis. For more information on Kennedy Krieger Institute, visit www.kennedykrieger.org.

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