ABR is a therapy that, in brief, is based on the premise of providing beneficial stimulation to otherwise under stimulated tissues. We are currently completing a 3 year prospective cohort study developed to assess the influence of ABR therapy on the quality of life, wellbeing, and function of a child with cerebral palsy.  We had over 400 participants, mostly GMFCS types 4 and 5, in the study from the US and South America and results show, with statistical significance, the beneficial trends provided by the therapy.  The study has been fully approved and monitored by appropriate ethical committees.  All measures were taken without knowledge of preceding results and the data was processed blindly.  Our results point to improved health and wellbeing (documented via the CPCHILP© questionnaire), augmented spinal stability and improved compressional integrity of the abdomen (a known link to the functional behavior of the trunk). This is truly our large scale study that we are eager to publish.  To date we have published and presented various preliminary studies or short alternative that are referenced hereafter. 

Health and wellbeing

Regarding the patients’ health and wellbeing, measures were taken every 6 months for a period of 3 years and the control group was taken at the beginning (baseline) and after 36 months.  In figure 1 below one may appreciate the improved measures over time.  The y-axis reports the CPCHILD scores, for which the higher the score the better.  This is scored as a function of months post therapy, shown on the x-axis.  More specifically, the baseline average values for patients classified as GMFCS types 4 and 5 were different at 52.83 and 48.22 respectively (p = 0.05).  To date, GMFCS type 4 patients improved their CPCHILD scores by 5 points (8%, p<0.05) over initial measures after 36 months of home therapy.  Correspondingly, GMFCS type 5 patients improved their CPCHILD scores by 7 points (14%, p<0.05).  Perhaps most importantly results are also clinically significant.

image 2

Intra-abdominal pressure and spinal stability

Severely affected patients with cerebral palsy often lack the spinal stability to the extent of restricting their ability to sit independently. In addition, abdominal weakness is often coupled with shallow breathing and may lead to an apparent disconnection between the upper and lower body.  In CP patients, the reported abdominal weakness is evident and results in irregular abdominal bulges when positioned in a seated position.  Further, implicated therapists often report the observation of weak abdominal regions when placed under light manual pressures. It is thus ABR’s educated belief that a weakened abdominal region (with respect to the passive compression resistance regulated by membranous strength) is a factor that encourages spinal instability in these patients.  To support this notion and verify that ABR therapy improves intra-abdominal integrity and augments spinal stability, a 2 year prospective test was performed.  Further, this test was limited to GMFCS types 3, 4, and 5. 

In order to explore the aforementioned hypotheses, the intra-abdominal compression was interpreted using a SHIMPO force gauge (MF-PT100).  This calibrated force gauge has the ability to document compression force of up to 20 lbs with an accuracy of 0.2%.   Padded ERGO® accessories was used to compress the abdomen of patients with CP to a depth of 1 inch over the umbilicus (belly button).  After compression of 1 inch was achieved (measured with custom depth measuring device for abdomen compression) the required force was documented while repeated measures explored inter- and intra-observer reliability.  The quantification of spinal stability will be explored using a custom grading scale.  The patient will be positioned in a seated position while the required minimal level of support for 10 seconds of independent seating will be scored on the following scale.  In order to insure patient compliance, the CP patient will be distracted and encouraged as to achieve independent seating by their legal guardian (shoulders = 0, mid-ribs = 1, lower-ribs = 2, upper pelvic = 3, lower pelvic = 4, independent = 5).

The average initial force required for abdominal compression of 1 inch was 3.2 lbs and after 2 years was improved significantly to 4.6 lbs (p<0.05). A higher measure is analogous to a stronger core.  Furthermore, the baseline measure of spinal stability was 2.2 and improved consecutively to 3.1 after 2 years (p<0.05).  For both test 70 patients with cerebral palsy took part in the study.

 

Measures of the GMFCS classification

GMFCS classification has been adopted as the main means to classify cerebral palsy patients over the last decade.  The GMFCS system is based upon self-initiated movement thus indicative of the patient’s motor function.  Level 1 is considered to have the most function while level 5 has the least.  In the past, the general consensus was that one is not able to jump the classification, especially the more severely limited patients (GMFCS types 4 and 5).  ABR is a therapy that prides itself on being able to provide beneficial outcomes to even the more limited patients.   Thus, a study was performed to follow 70 patients for 2 years while intermittently documenting their GMFCS classification every 6 months.   The average baseline measure was a GMFCS classification of 5 suggesting the majority of the patients lied within the more limited individuals.  The average measure after 2 years was reduced (a reduction suggest improved function) in a consistent manner from 5 to 4.

 

Cerebral palsy is recognized as being a non-progressive neurological disorder while the musculoskeletal system may undergo degeneration over time. These changes in musculoskeletal health offer a viable premise for rehabilitation therapies to work to deter, arrest, or even reverse. ABR therapy seeks to achieve this through a known method of providing positive stimulation to neglected tissue. The only feasible platform, for this approach, where sufficient stimulus could be delivered is one that employs a home or family based approach. Beneficial outcomes of this study advocate that ABR therapy, a high frequency home based method, provides an effective treatment platform for severely affected cerebral palsy patients.

Some notable ABR publication and Congress presentation:

Driscoll, M. and Blyum, L., (2010) The presence of physiological stress shielding in the degenerative cycle of musculoskeletal disorders. Journal of Bodywork and Movement Therapies, 15(3): 335-342.

Blyum, L., and Driscoll, M. (2011) Mechanical Stress transfer the fundamental physical basis of all manual therapy techniques. Journal of Bodywork and Movement Therapies, 16(4): 520.

Driscoll, M. and Blyum, L. (2009) The Influence of Altered Mechanical Properties in Hypertoned Fascia on Muscle Activational Strategies. Second International Fascia Research Congress, Amsterdam, Netherlands, Vrije Universiteit. (international)

Driscoll, M. and Blyum, L. (2009) The Presence of Physiological Stress Shielding in Load Bearing Articulation of Patients with Cerebral Palsy. 3rd Inter-nation Cerebral Palsy Conference, Sydney, Australia, Sydney Convention and Exhibition Centre. (international)

Driscoll, M. and Blyum, L. (2009) Stress Allocation in Cerebral Palsy: A Process Governed by Physiological Properties. A global status quo on Cerebral Palsy, with a view to the future, Utrecht, Netherlands, Het Vechthuis. (international)

Driscoll, M. and Blyum L. (2010) The offset of mechanical homeostasis in cerebral palsy. 8th Mediterranean Congress of Physical and Rehabilitation Medicine, Limassol, Cyprus (international)

Driscoll, M. and Blyum, L. (2011) Home based and family centered treatment of cerebral palsy. 27th
Annual Pacific Rim International Conference on Disabilities, Honolulu, Hawaii. (invited oral communication, international)

Blyum, L., and Driscoll, M. (2012), Mechanical stress transfer – the fundamental basis of all manual therapy techniques, Third International Fascia Research Congress, Vancouver, Canada. (international)

Blyum, L. and Driscoll, M. (2012) Dynamic anatomy, a new approach to functional anatomy, 1st Annual European Fascial Congress, Brussels, Belgium (invited oral communication, international)

Driscoll, M. and Blyum, L. (2012), Results of a 2 year study investigating the influence of home based therapy on cerebral palsy, 4th International Cerebral Palsy Conference, Pisa, Italy (international).

Driscoll, M., and Blyum, L., (2013), Investigation of the influence of a home based therapy on the health and well-being of cerebral palsy patients, 2nd Singapore Rehabilitation Conference, Singapore (international).

 

AACPDM Abstracts

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Description: Abstracts of the study

Preliminary Results of the Study

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Description: Preliminary results of the 2-year prospective cohort study investigating the influence of a home based therapy on the health and well-being of cerebral palsy patients.

Results of the 3 Year Prospective Cohort Study

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Description: Results of the 3-year prospective cohort study investigating the influence of a home based therapy on the health and well-being of cerebral palsy patients.

Abstract Presentation of the Study by Mark Driscoll

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Description: Mark Driscoll is the principal investigator of the two-year international multi-center prospective cohort study exploring the influence of therapeutic stimulation on the functional performance and well-being of children afflicted with CP. He was invited to present the study in a conference in Honolulu. This is the first of the many conferences he has been invited to present the study at.

An interview with Mark Driscoll

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Description: Mark Driscoll is the principal investigator of the two-year international multi-center prospective cohort study exploring the influence of therapeutic stimulation on the functional performance and well-being of children afflicted with CP. Mark sat down for an interview with The American Academy of Audiology and talked about Cerebral Palsy and how ABR has proven to positively change CP kids. This interview happened after the preliminary results of the study came out.

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