Our Approach

Our Approach

The Kennedy Krieger Institute’s Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine is proud of its long-standing tradition of treating children with cerebral palsy and other neurodevelopmental disorders. Our treatment plans are individualized for each patient’s and family’s specific needs to maximize function and participation in home, school and community. The Phelps Center specializes in the evaluation of infants and young children with developmental delays in motor, language or behavior and in the treatment—well into adulthood—of medically complex children with cerebral palsy.

Our treatment approach draws on the depth and breadth of expertise at Kennedy Krieger Institute and Johns Hopkins—from our renowned neurodevelopmental pediatricians, pediatric neurologists and neurosurgeons to dedicated therapists and rehabilitation specialists—all focused on addressing specific patient and family concerns and providing coordinated care for each patient and family. 

Evaluation and Diagnosis:

New patients are first evaluated by a neurodevelopmental pediatrician or pediatric nurse practitioner to establish an accurate diagnosis and make initial recommendations for treatment. The diagnostic process may involve magnetic resonance imaging (MRI) of the brain and genetic testing under the direction of Kennedy Krieger’s Neurology and Neurogenetics Clinic as well as consultations with specialists from pediatric neurology, neurosurgery, genetics and ophthalmology. When appropriate, additional consultative services may be recommended.

Depending on the diagnosis, ongoing care and therapy may be provided by the Phelps Center, other programs at Kennedy Krieger, The Johns Hopkins Hospital or other medical institutions and community programs. As appropriate, parents and caregivers will be provided with information about planning for their child’s significant life transitions (i.e., from infant and toddler services to school-based services and from school-based services to adult services). Coordination with the child’s primary care physician is a critical part of the process and continues throughout the child’s life.

Treatment Approach:

Our interdisciplinary team works closely with our patients and their family members to develop a treatment plan that meets the needs of each patient.  Physical, occupational and speech-language therapists help patients establish the foundations for improved mobility and communication for enhanced independence. Referrals are made to Kennedy Krieger’s orthopedic surgery and neurosurgery teams when appropriate. Psychosocial evaluations and counseling are provided as needed. 

Medical and Rehabilitative Interventions:

  • Adapted sports and recreation
  • Neuroimaging
  • Aquatic therapy
  • Neurological care of epilepsy
  • Assistive technology
  • Neurosurgical procedures and care
  • Intrathecal baclofen pump
  • Occupational therapy
  • Bone health
  • Orthopedic care
  • Botulinum toxin (Botox)
  • Physical therapy
  • Bracing and casting
  • Recreational therapy
  • Feeding and nutrition
  • Seating evaluation
  • Hearing evaluation and treatment
  • Social work evaluation
  • Medication, especially tone management
  • Speech-language therapy

Orthopedic Surgery:

Orthopedic surgical interventions vary depending on the degree of impairment and the potential for functional improvement. Our orthopedic experts combine operative care with intensive post-operative physical and occupational therapy to maximize surgical outcomes and rehabilitation benefits. When appropriate, single-event, multilevel surgeries are recommended.
Some of the most common procedures include:

  • Tendon lengthenings and transfers
  • Spine surgery for scoliosis
  • Hand surgery
  • Hip reconstructive surgery
  • Derotational osteotomies

Neurosurgery:

Under the direction and expertise of Johns Hopkins neurosurgeon Dr. Shenandoah Robinson, we offer a variety of neurosurgical interventions to aid in the management of cerebral palsy and other neurological conditions. These neurosurgical procedures include selective dorsal rhizotomy (SDR), baclofen pump placement and—in the future—deep brain stimulation (DBS).

  • With selective dorsal rhizotomy, specific nerve fibers are eliminated to decrease spasticity. This procedure can improve your child’s ability to move.
  • Baclofen is a medication used to decrease spasticity. For a baclofen pump placement, a pump is placed under the skin in the abdominal area with a catheter leading to the spinal canal. The pump continuously delivers baclofen in small doses directly into the spinal canal to reduce spasticity and variably improve comfort and function.
  • Deep brain stimulation – This procedure has often been described as a “pacemaker for the brain.” Areas of the brain are identified that cause signals that produce unwanted movements. A neurosurgical plan is developed to treat the problem.

Research Directions:

Through research and national and international collaborations, the Phelps team is refining outcome measures and striving to develop novel therapies to improve the motor function of children with cerebral palsy. Current Phelps Center research focuses on using novel brain imaging to better understand the relationship between brain structure and clinical function. Through its partnerships with the American Academy for Cerebral Palsy and Developmental Medicine and the National Library of Medicine, the Phelps Center is developing common data elements to be used across all research projects related to cerebral palsy.

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