Through its intramural and extramural organizational units, the NICHD supports and conducts a broad range of research projects on cerebral palsy, some of its associated conditions, and its rehabilitation and treatment. Short descriptions of this research are included below.
Much of the NICHD’s work related to cerebral palsy is done extramurally; that is, it is supported by the NICHD but conducted at other research institutions.
Within the Division of Extramural Research, several Branches support projects relevant to cerebral palsy.
For example, researchers in the Maternal-Fetal Medicine Units (MFMU) Network, supported through the NICHD’s Pregnancy and Perinatology Branch (PPB), collaborated with researchers supported by the National Institute of Neurological Disorders and Stroke (NINDS) on a trial of antenatal exposure to magnesium sulfate for the prevention of cerebral palsy. This double-blind, randomized trial involved 2,241 women at high risk of delivering very preterm infants (less than 32 weeks of gestation). The trial concluded that magnesium sulfate did not reduce the rate of the primary outcome of moderate to severe cerebral palsy or death, perhaps because death was the predominant component of the outcome. However, the antenatal magnesium sulfate did reduce the rate of moderate to severe cerebral palsy alone by 50% (PMID: 18753646). As a result of this research, the American Congress of Obstetricians and Gynecologists supports the use of magnesium sulfate for neuroprotection of infants who will likely be born very preterm.
Other PPB-supported projects are examining ways to prevent fetal brain injury from infection, acidemia, hypoxia, excessive bilirubin and other causes. PPB research also focuses on reducing or preventing preterm birth, which is associated with cerebral palsy.
Within the Developmental Biology and Structural Variation Branch (DBSVB), under the support of the Birth Defects Working Group and several other NIH Institutes and Centers, the Birth Defects Initiative sponsors basic, translational, and clinical research related to the developmental biology and genetics of birth defects, including cerebral palsy.
The Intellectual and Developmental Disabilities Branch (IDDB) also supports projects on cerebral palsy, including studies of genetic polymorphisms associated with the condition and other neurodevelopmental disorders, inflammation-induced brain injury, characteristics of intellectual disability in certain types of cerebral palsy, and ways to detect cerebral palsy in the womb and early in the neonatal period.
The National Center for Medical Rehabilitation Research (NCMRR) supports efforts focused on therapies and rehabilitative approaches for cerebral palsy. Some of this research includes developing advanced computer simulations to restore natural walking patterns in patients with cerebral palsy. The researchers use motion capture data to analyze movement in people with and without cerebral palsy to determine the musculoskeletal origins of impairment. Pinpointing the origin of impairment can provide more accurate targets for surgery, orthotic devices, or rehabilitation. Other research involves incorporating robotics and electrical stimulation into rehabilitative devices that train patients with movement disorders to walk.
Other NCMRR-supported research is exploring ways to relieve torsion and tensed muscles in people with cerebral palsy to help improve gait and mobility, as well as methods for measuring brain damage after fetal or neonatal stroke to help improve development. Researchers are also exploring muscle and bone physiology and trajectories of function among those with and without cerebral palsy.
Some Center-supported research related to cerebral palsy is described by the researchers themselves in the NCMRR 20th Anniversary Scientific Symposium Proceedings.
Researchers in the NICHD’s Division of Intramural Research (DIR) also work on projects related to cerebral palsy. For example, researchers in the Section on Tissue Biophysics and Biomimetics in the Program on Pediatric Imaging and Tissue Sciences use multimodality magnetic resonance imaging (diffusion tensor imaging, functional magnetic resonance imaging, and quantitative relaxometry) to evaluate cerebral reorganization caused by various rehabilitation protocols in children with cerebral palsy and traumatic brain injury.
In addition, researchers in the Program in Perinatal Research and Obstetrics (PPRO) are exploring the effectiveness of nanodevices in delivering therapeutic agents across the blood-brain barrier, using a rabbit model of cerebral palsy. Inflammation of brain cells is thought to play a key role in the development of cerebral palsy, particularly in preterm infants.
- Medical rehabilitation, a key component of the NICHD mission, involves basic and clinical studies in the domains of pathophysiology, impairment, function, disability, and societal interaction and includes work on cerebral palsy and similar disorders. With NINDS and the National Institute of Biomedical Imaging and Bioengineering, NCMRR funds the Medical Rehabilitation Research Infrastructure Network, which facilitates researchers’ access to technologies and training. Specific research activities include computer simulation of human motion and promoting walking in children with cerebral palsy.
- The Eunice Kennedy Shriver Intellectual and Developmental Disabilities Research Centers (EKSIDDRCs) program supports researchers whose goals are to advance understanding of a variety of conditions and topics related to intellectual and developmental disabilities (IDDs), including cerebral palsy. Some EKSIDDRC researchers use advanced neuroimaging techniques to more precisely characterize brain injury underlying cerebral palsy in order to improve classification and treatment for children with the condition. The program is funded by the IDDB.
- The NICHD Brain and Tissue Bank for Developmental Disorders, located at the University of Maryland Medical School, is a tissue bank designed to advance IDD research. The bank currently contains more than 80,000 frozen tissue specimens, representing more than 400 disorders, including cerebral palsy.
- The MFMU Network focuses on clinical questions in maternal-fetal medicine and obstetrics, particularly with respect to the continuing problem of preterm birth. The Institute funds the MFMU Network through its PPB. The MFMU Network conducted a large, longitudinal study of magnesium sulfate, which led to use of the substance to reduce cerebral palsy among preterm infants.