Irascible Ink

For the past couple of weeks I’ve been indulging in some hard core geekdom and my “nerd file”, filled with research papers is getting fatter and fatter. Horrifyingly enough, it makes me yearn to go back to college for a—gasp—4th degree. Because, you know, the perfect compliment to an English BA, a creative writing masters and a library science masters is a degree in exercise physiology. Relax, Mom and Dad, I won’t be quitting my job any time soon. I suck too much at math to study anything technical. But to indulge my nerdy side, I’m resurrecting a research feature here in my own virtual fifedom. The goal is to spread the word about research relevant to this blog—CP research, exercise research, obesity research, etc., and to allow me to pontificate and gush about the geeky stuff I read. It’s my soapbox, after all.

So this week’s read was: Neural plasticity and treatment across the lifespan in motor deficits in cerebral palsy by George F. Wittenberg, MD, PhD.

I draw your attention to this article because I was incredibly stoked when I found it. I know from my own experience that my strength and muscle control has improved over the years through lots and lots of repetitive cardio and weight training.  All 13 of those years, I should mention, were after age 22—and after doing nothing physically for about 7 years. Over the years during my quest for treatments, I have also been told–on more than one occasion–that the reason treatments for adults with CP have focused largely on pain management is that adults cannot relearn how to move.

I should be clear that each time I was told this, it was not in anyway intended to be personally discouraging. In fact, each time, it was in the context of: “Wow, you’re in amazing shape. I generally wouldn’t recommend X treatment for an adult. But if you want me to do X, I would consider doing it for you, because obviously you’re capable of changing your behavior.” So really what these folks meant was, in their experience, most adults won’t relearn how to do things. But still, I was perplexed as to why treatments for CP are almost exclusively focused on children, as if by age 18 there was no hope of improvement.

Here’s what never made sense to me: When someone has a stroke, practically no matter how elderly they are, there is generally a presumption that they will recover at least some function through hard work, PT and OT (occupational therapy). This recovery is generally attributed to neural plasticity or the ability of the brain to recover or adapt through physiological processes.  Somehow once you hit a certain age with CP  there’s has been an assumption that the window on improvement is shut. I wanted to find out if there is a medical reason for this divergent treatment philosophy. I wanted to know why it’s understood that patients can regain functions after stroke or other brain injuries through intensive physical and other therapies, but this philosophy doesn’t appear to apply to adults with CP.

Now, I’m not a doctor, much less a scientist. I’ve got three humanities degrees, so my grasp of neuroscience is pretty much non-existent. I thought that  maybe there was something about the kind of brain damage resulting from CP or the fact that it’s an injury that occurs during fetal development or shortly after birth that made it fundamentally different. Maybe these differences account for the difference in treatment philosophy that I’ve witnessed? Being a big nerd, I started reading.  I gave it the old college try—i.e, I read the introduction and conclusion which are largely in English. So sue me: I skipped the neuroscience-y part in the middle when I discovered that I was only understanding 1 word out of 5.

But I think the upshot of the deal, according to Dr. Wittenberg, is that plasticity should be present in adults with CP as it is in adults with stroke. Sure, children’s brains are far more plastic than those of adults, but there’s no reason to assume that “the window for intervention cannot extend to adults with CP.” So you don’t have to take my word for it that it’s never too late to make changes and improvements. Even if like me, you took a 7-year hiatus from physical therapy and physical activity, the window is still open.