Scoring Goals with CP Soccer’s Shea Hammond

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters. And this is The Brain & Life Podcast.
Well, I definitely like celebrations, every day, every week or every month has some sort of special focus or occasion. In fact, today's Wednesday, hump day, I like to celebrate it. And it's also our taping day, Daniel, for our podcast.

Dr. Correa:
No, I mean I like, yes, the monthly different occasions and celebrations, but really I'm always looking for a celebration and an occasion to cook something different, some of my favorite foods, get a group of friends together and I'm often bringing some little indulgent chocolate dessert treat to whatever that get-together or party is. And I like your idea, Wednesday seems like a perfect reason to celebrate, why not?

Dr. Peters:
Absolutely.

Dr. Correa:
Yeah, maybe tonight I'll try making a new curry dish or some other change in pace and maybe, of course, finish the night with a little bit of a chocolate treat. What about you?

Dr. Peters:
I like the idea of chocolate. That sounds really good. I like the idea of curry, but it's so beautiful here. I am going to start up our grill tonight.

Dr. Correa:
Oh, you're taunting us with warm weather.

Dr. Peters:
Yes, it's 70 degrees. It's awesome. But Daniel, did you know that there's a special focus for the month of March? Did you know that March is Cerebral Palsy Awareness Month?

Dr. Correa:
I was recently reminded when I saw a news release from the United Cerebral Palsy Research Council where they were sharing that they're expanding advocacy and research initiatives to help make change possible for cerebral palsy. I'm glad to see there are more people advocating for research in this and other pediatric conditions. And it makes me think of, when you bring back the fact that it's Cerebral Palsy Awareness month, it makes me remember some of the past episodes and stories from RJ Mitte, Gavin McHugh, Josh Blue, and Paula Carozzo that we've featured on the podcast, each of them really is a very unique and amazing example that every person and their story and journey, whether it's with cerebral palsy or another neurologic condition is truly unique.

Dr. Peters:
I got to chat with Shea Hammond. He is a Olympic soccer player who has cerebral palsy and he talked with us about his passion for playing soccer and how he founded the initiative CP Soccer. And it's an international initiative for people with CP to play soccer and to compete. He is very inspiring and talks about how he got active at an early age, and I know he will be so inspiring to our listeners because he talks about how he was doing physical therapy at the tender age of five and how he had so much fun with that and that put him on the road to really get out there and to keep on moving and it makes me want to get out there and move, perhaps even play soccer

Dr. Correa:
Movement in any way is great. I'm not sure I'll be back on the soccer field in a while, but I do love running.

Dr. Peters:
Brain & Life audience, I'm so excited today to bring our guest, Shea Hammond. He's a Paralympic soccer player and founder of the initiative, CP Soccer. Shea has cerebral palsy, but his disability has not slowed him down in any way. He's very active on Instagram and that's how I learned about him, so @shea_Hammond. He is joining us on the Brain & Life podcast today. So thank you so much, Shea. Welcome to the podcast.

Shea Hammond:
Thank you Dr. Peters, just very happy to be here. Thank you for having me. Looking forward to it.

Dr. Peters:
Absolutely. So I gave a brief introduction, but I know you've got loads going on. Can you tell us a little more about what's going on with you and where you're joining us from?

Shea Hammond:
Absolutely. So I am joining you from my apartment in Clemson, South Carolina, where I am currently a graduate student. I am getting my master's in communication. I received my bachelor's in communication from Clemson University this past spring where I graduated. It feels weird, but I wanted to stay and continue on and-

Dr. Peters:
Congratulations, that's awesome.

Shea Hammond:
Yeah, thank you. I've been a part of the Clemson Paralympic soccer team here now, this is now my fifth year, which is crazy to say, but I wasn't quite ready for the real world yet, and I wanted to keep learning more about the world of communication and stay at Clemson for just another two years.

Dr. Peters:
Well, that's great. I'm in North Carolina technically, so... I have so many wonderful patients that come from Clemson, so shout out to you guys and shout out to your team. Now, I played soccer as a small tyke, but tell us why is soccer such a great sport?

Shea Hammond:
So there's two reasons. One, it's just, it's the world's game. It's a beautiful game. I play soccer because of my dad and my dad's from England where soccer is 10 times bigger. What I've learned in South Carolina and really the South in general is that college football rules the world, while over in England, obviously soccer rules the world and honestly through most of the world soccer rules. But that's just one reason. And then the second reason I would say, and this is primarily for people with cerebral palsy, is it's just so good to get active and it's such a great way to get active, engage the whole body, run a lot. I know most people don't like running a lot, but it's a fun way to run a lot and get great exercise and I just love it. I love it. I could go on and on and on about how much I love soccer.

Dr. Peters:
What kind of shoes do you have to wear, do you wear cleats, soccer shoes? I'm a novice, tell me a little bit more.

Shea Hammond:
Well, when you're playing you wear cleats because you play on turf, you play on grass, you play on any sort of surface like that. But there's also indoor soccer where you use indoor shoes. They have flat bottoms. I don't play that because hardwood floors are... When you have cerebral palsy and you fall a lot, hardwood floors you want to try to avoid sometimes. But when I play outside, I'm wearing cleats.

Dr. Peters:
So you did play in the Parapan games, so tell us about that.

Shea Hammond:
Yeah, so the Parapan games, which I have the banner for behind me, I know this is an audio recording, and you can see behind me, the banners behind me of the tournaments that I've played in. So our federation is the IFCPF, the International Federation of Cerebral Palsy Football, and they are our governing body or our FIFA, and they host their own World Cups. They host their own Copa Americas. Now the Parapan American games are still under the Paralympics and the IPC. Now that last games was in 2023. That was in Chile, Santiago, Chile where we earned a bronze medal, which was probably my favorite trip that I've been on with the team so far. It was spectacular, to say the least. But yeah, no, behind me are all the international trips that I've been on. I'm missing a few, because I didn't get a banner for every single one, but I've been on quite a few.

Dr. Peters:
So what's your next trip?

Shea Hammond:
Our next trip will be our Copa America. We just got back from our World Cup, which was in this past November where unfortunately we finished seventh overall, which is still very remarkable. I mean seventh in the world is nothing to be ashamed of, but for our standards, we obviously want to go for gold and we want to go for a medal podium in the world. But our next trip is this year in 2025, where we will be competing in the Copa America against other teams from North and South America, just like the Parapan American Games only that happens every four years.

Dr. Peters:
And how many teams are there?

Shea Hammond:
In the world? That's a good question. I don't know off the top of my head, but if you were to take most of the soccer playing countries that are commonly known in the world, then they typically have a team. So some of the best teams in the world include England, Brazil, Argentina, Ukraine, the Netherlands are great, and other teams like that.

Dr. Peters:
You know what I love about the sport, you make it even more accessible. It's accessible to begin with because it's so international and then you include people that are differently challenged that have cerebral palsy and now it's even more inclusive. And so I just, kudos to you. And I mentioned cerebral palsy, can you just tell us a little bit more about what that is?

Shea Hammond:
Yeah, so Cerebral palsy is a physical disability caused by the brain's inability to send signals to various parts of the body. Now I'll speak more on my cerebral palsy. Mine came from a stroke I suffered in utero on the right side of my brain, so the entire left side of my body is affected. Thankfully for me it's mostly muscular effects, so it's my left arm, my left leg, and all those muscles and the fine motor skills. And really it just makes doing things on your affected side or in some cases both sides, just more difficult. You have to think harder, you have to try harder, you have to practice more, you have to go to physical therapy and there's just a long list of other treatments and ways to help correct it or challenge it or beat it in some ways. But there is no 100% cure for cerebral palsy. It is only what work you do to better your situation depending on your severity.

Dr. Peters:
Now, you're definitely in training because you're an athlete and you're a top athlete, do you still do physical therapy too or do you sort of... Tell me how you integrate that?

Shea Hammond:
Yeah, that's a great question about doing physical therapy now, thankfully that I'm older and I grew up in a PT office, I like to say I was the youngest one there by a long time. Well, I grew up there because I was six, seven, eight years old in the PT office doing my physical therapy while all the other people, the high school athletes getting rehab or the people just tending to their injuries, whatever it was and here I was as six-year-old kid trying to learn about cerebral palsy as well as what would help it. Thankfully I retained a lot of that information.

Dr. Peters:
That is amazing.

Shea Hammond:
Yeah. I retained a lot of that information. I retained a lot of the information I gained in physical therapy, and now I'm able to do it on my own for the most part. So when I do my stretches, I do my movements, I do whatever it is I need to do on a daily basis, whether it's my duck walks, my monster walks, or whatever else it is on a daily basis on my own time. I don't have to go to a physical therapy office anymore, thankfully. But that's because I went and was so on it. Well, thankfully my parents were so on it with me when I was so young.

Dr. Peters:
Well, and I'm going to give a shout-out to our physical therapists. I'm a neurologist. I refer my patients consistently, regularly to our physical therapists. And really it's about, even if you have a neurologic injury, if you can just keep moving and don't have a degradation of your physical function, it is so important. You want to not be deconditioned. And I always say I want to keep my patients frisky and moving. And so you know what? Listen, Shea did it as a six-year-old, so if he can do it as a six-year-old, we can all do it now. Right, Shea?

Shea Hammond:
Absolutely. And again, shout out to the physical therapists of the world. I know it couldn't have been easy for me being a six-year-old, being young kid in the physical therapy office, just not wanting to be there, just wanting to play games. And physical therapists do such a good job of making it enjoyable in so many different ways.
I'll never forget my first physical therapists and PT aides, Kevin Duffis, and this man named Brandon, unfortunately, I don't remember his last name, but he made it so fun where he was able to... We stood on BOSU balls to help with balance and we jousted with foam rollers. I'm sure you know what... The foam rollers, the long foam rollers?

Dr. Peters:
Oh, yeah.

Shea Hammond:
Who would've thought of that as a fun way to practice balance with a six or ten-year-old kid and just say, "Hey, you got to stay on the BOSU ball, and if I push you off lightly with the foam roller, oh, I get a point. Oh, if you get me, you get a point." And he made a ten-minute activity out of just standing on a BOSU ball and challenging me and my balance, just more fun than anything else I could have done.

Dr. Peters:
Well, that is so cool. I love that. I love that story. Again, get out there. If he can do it at six, you can do it at 70. So you found-

Shea Hammond:
A hundred percent.

Dr. Peters:
Absolutely.

Shea Hammond:
Maybe don't stand on a BOSU ball right away.

Dr. Peters:
Yeah, yeah, yeah. Go slow. Go slow.

Shea Hammond:
Do something [inaudible 00:12:40].

Dr. Peters:
Eventually you'll get to the BOSU Ball, I feel like we'll all get there. So you founded CP Soccer, that's correct, right?

Shea Hammond:
Correct. I am one of the co-founders of CP Soccer.

Dr. Peters:
And tell us about that initiative.

Shea Hammond:
Absolutely. It's the love of my life. So I am one of the co-founders with my dad as well as another family named the Halliwell family, specifically Eli and Levi, while Erica and Malka, their kids do an incredible job as well, and they do so much work and so much amazing, amazing stuff. Eli is our chairman and he is spectacular. We founded it together and it is to give kids with cerebral palsy, stroke, TBI, the access to soccer that they normally wouldn't have.
When children approach the age 8, 9, 10, 11, no matter what, sports get more competitive. It's a known fact around the sports world. And they get almost too competitive where people that just want to play and just want to be involved get weeded out so quickly and that is oftentimes kids with disabilities, kids with impairments, kids with whatever it might be.
And I was no different. I was cut from my town travel team, I was told I wouldn't be good enough, I wouldn't be retained. And thankfully my dad created a team, created a club in New Jersey for me to play on. And then years later, Eli saw that, saw that story came to us, because his son, Levi, who has cerebral palsy as well, was experiencing the same thing and said, "Why don't we create our own team?" And thus we created CP Soccer, which now we're nationwide with over 15 locations across the country providing amazing training to kids with CP, stroke, TBI. We also have our annual summer camp. We compete in competitions overseas and we participate in U.S. Soccer's Adapt and Thrive Invitational, which is a great initiative by U.S. Soccer where they invite all of the disability soccer teams together to train for one week.

Dr. Peters:
That is so cool. So how long has this been going on? What year did you start this?

Shea Hammond:
So CB Soccer, we founded CP Soccer in 2017. It was going into the fall of 2017. We started in my home state of New Jersey, and we invited kids from the Tri-State area, put it out there, physician's offices, hospitals, "Hey, if you have CP, if you are age 6 to 18 and want to come play soccer and you have CP, come try out, come play with us." And we drew kids from Connecticut, we drew kids from New York, from all over Jersey, from Pennsylvania, and we realized we needed to grow. And a year later we expanded to Maryland and our amazing people in Maryland run an amazing location there because they didn't want to drive four hours every week to New Jersey, and that makes total sense. And we expanded to Houston and Chicago and Cincinnati and Raleigh and all over, and it's just truly evolved into something just so, so incredible. And we're only just getting started.

Dr. Peters:
So how can future soccer players find CP Soccer?

Shea Hammond:
So that would be through our website for sure. If you go to cpsoccer.us, that's the best way to find information on if there's a location near you, if you are interested in starting a location. Now, it does take a lot of work to start a location and keep a location running, but CP Soccer has the funds, thankfully to our amazing donors, thankful for our amazing donors for the funds to help get new locations started. Last year, I want to say we launched at least five or six new locations or restarted some locations that had stopped programming for a little bit. And this year we are hoping to add on at least three or four to five more. Obviously, the more you get, the harder it is to start more, but we don't want to slow down our growth anytime soon.

Dr. Peters:
So what do you see as the future for CP Soccer? What's the next step? Is it international? What are we looking for?

Shea Hammond:
So we have a few different goals. One metric that we use to measure what we provide is our Kid Hours Initiative, where we take the number of players that we have and the number of hours that they participate on the field, and we have our number, which we call Kid Hours. Last year we had over 5,000 kid hours across all of our programming, and it truly was incredible. It was our best year by far, and we are already on track this year to beat it, thankfully, because growing every single year. So a long-term goal of ours is to get over a hundred thousand kid hours consistently.
We want to have a team in every city in America. Now, this is a very long-term goal, probably beyond my lifetime, but we want to have a location in every city in America. We want to compete in Club World Cups and Club championships. We want to have regional tournaments and establish a CP soccer league. I mean, we just really want there to be accessibility to soccer for any child in the United States that has cerebral palsy. And thankfully this year we have a great opportunity to showcase that because the US is actually hosting the Club World Cup. Well, CP Soccer is hosting the Club World Cup in Raleigh, North Carolina over the summer. So really looking forward to that.

Dr. Peters:
That's my neck of the woods.

Shea Hammond:
Well, I don't know if you've ever heard of our Raleigh location, but our Raleigh location is one of our strongest locations. It's run up by an amazing family named the Thurston family, as well as U.S. Soccer Hall of Famer, Josh McKinney. He's the first ever player with cerebral palsy to be inducted into U.S. Soccer's Hall of Fame.

Dr. Peters:
That's awesome. And what's the date for that?

Shea Hammond:
It's all throughout the fall. If anyone listening wants to get in contact with one of our locations, all of our information is on cpsoccer.us.

Dr. Peters:
Now, I know you're very active on social media because that's how I learned about you. And I know you're on Instagram. Can you tell us a little bit more about how beyond CP Soccer, using social media, you're engaging with followers?

Shea Hammond:
Yeah, so with Instagram, what I've realized is it's just so connecting to so many different people, and I didn't truly realize how impactful it would be for me to just talk about cerebral palsy until I did it. I decided, "Hey, I'll post some videos of me talking about how cerebral palsy affects me and see what happens." And the response was great. I had tons of parents reach out to me of parents of young children saying, "Wow, you give us a perspective of what my child could look like or what my child could do." And I always try to be transparent in saying, "Listen, I am the way that I am because of what I did and because of the people that were around me."
So I'm honored that people want to be like me, but also know that it takes a lot of work, it takes a lot of physical therapy, it takes a lot of sacrifices. So I always try to be transparent in that. But it is truly incredible for me to just not only talk about soccer, but just talk about life. Talk about, "Hey, it sometimes is hard for me to tie my shoes." I'm now 22 years old and still there's days where it is 20 degrees outside and my CP hand will not be able to open for a little while because it is so cold. And my brain is just saying, "I just need to get to my car. Don't worry about the hand, I need to get to my car," and just talk about simple things like that.

Dr. Peters:
Well, I think that's great. And I learned about you because I mentioned the podcast to my own physician and she's like, "Oh, a great guess would be Shea Hammond, because my niece had an intrauterine Stroke stroke and she felt like she couldn't really get into sports. But after seeing you, she's running and wants to play soccer and is..." So I just thank you from my own physician's niece, who I don't know, but hey, it's six degrees of separation. Now you have so many followers. What have you learned from your followers?

Shea Hammond:
That's a really good question. What have I learned? I've learned, I would say less learned, but more reaffirmed and opened my eyes to just how similar having cerebral palsy can be, even though it is a snowflake disability where no two cases of cerebral palsy are exactly alike or 100% identical. But so, so many of the experiences are just carbon copies, where I'll have a message with a parent, and then right below it will be a message with a different parent from a different corner of the country, and they're saying the exact same thing, for two different kids with two different levels of cerebral palsy or impairments of cerebral palsy and it's the same conversation, it's the exact same thing. So I would say I've just really learned how important it is to see it, how important representation is, and just how similar everyone is when it comes to having cerebral palsy. Even though, like I said, it's like a snowflake where there are no two exact carbon copies, but the experiences, no matter, the severity of the impairment, are so similar.

Dr. Peters:
So I think that's really important to tell patients, that there are commonalities, but you will find your own unique space.

Shea Hammond:
Absolutely.

Dr. Peters:
And you can also have a community too, to share things. And so I just want to say thank you for sharing. I think that's really important. So I asked, what was next for CP Soccer? You're getting a graduate degree, definitely, you just finished up your bachelor's with Clemson. What's next for you, Shea? What's up?

Shea Hammond:
What's next for me is there's a snowstorm coming this weekend and I need a brace for that.

Dr. Peters:
I know I'm ready.

Shea Hammond:
But other than that, I look both near term, I look long-term. I also look what's for dinner tonight. And really what's next for me is consistently staying with the national team, staying fit enough, staying healthy enough to consistently make the national team. I'm very fortunate to have played in every game for the past two years, and I want to keep doing that and keeping my body physically healthy enough, but also being good enough as a player to play in the games and being selected for those rosters. Long-term, I really just want to help children with disabilities, children with cerebral palsy, see what's possible, see what they are capable of, because so often it just helps to see it. It helps to hear it. It helps to know that it can be done. And really, again, get my masters the next year and a half and then go from there.
I'd love to continue speaking publicly. I've spoken at numerous schools. I've spoken at a couple businesses here and there, and that's been spectacular. I love public speaking as well. I gave my first TEDx Talk a few years ago, which was crazy to think about. And really just continuing on with that and hopefully making some money from all the things that I'm so passionate about, because while being a graduate student is amazing, I still find a way to get some consistent income some time in the near future. So all of those things and plus some more.

Dr. Peters:
Well, I think your future's bright. I'm so excited you came to talk to us. I hope I get to see you in Raleigh. I think that would be awesome. Shea, you are awesome. You're such an inspiration and just keep on doing what you're doing. Check out CP Soccer, the website. You can check out Shea @Shea_Hammond on Instagram. And thank you very much.

Shea Hammond:
Thank you for having me. It's been great.

Dr. Correa:
Are there questions you have about living with and thriving with one of many neurologic conditions? We're excited to start taking your questions and feedback and sharing those responses here with you on the podcast. You can also email or record an audio message and send it to blpodcast@brainandlife.org. And of course, you can also reach Audrey and I on social media or the Brain & Life team at Brain & Life Mag, that's M-A-G.

Dr. Peters:
Hello, Brain & Life podcast audience, and thank you for joining us today. I am your cohost Dr. Katy Peters, and I'm honored to introduce our medical expert, Dr. Mauricio Delgado. Dr. Delgado is a professor of neurology at UT Southwestern Medical Center in Dallas, Texas. He specializes in neurorehabilitation of children with motor disorders with central origins like cerebral palsy. He also specializes in neurogenetic disorders such as holoprosencephaly and tuberous sclerosis complex. In 2019, he became the president of the American Academy for Cerebral Palsy and Developmental Medicine. He is the co-founder member of the Mexican Academy for Cerebral Palsy and Neurodevelopmental Disabilities. His training includes a medical degree from the University of Monterey in Monterey, Mexico training in pediatrics and neurology at the University of Ottawa and Ottawa, Canada. He is board certified in child neurology and neurophysiology by the ABPM, and he is here to tell us more about cerebral palsy. Welcome Dr. Delgado.

Dr. Delgado:
Thank you, Dr. Peters.

Dr. Peters:
So I just introduced you, I gave you a short introduction, and again, thank you for your time. Can you tell us where you're joining us from today and a little more about yourself?

Dr. Delgado:
Yes, thank you Dr. Peters. First of all, thanks for the invitation to participate in this podcast. I'm a little bit nervous, this is the second time I ever participated in a podcast. But anyway, so yes, I'm joining you from Dallas, Texas where I have lived for 40 years. After finishing my training in Canada, I moved to Dallas and I worked at a hospital called Scottish Rite for Children all my life pretty much. And when I first arrived there, I realized that we had about 2,000 patients with cerebral palsy.

Dr. Peters:
Wow.

Dr. Delgado:
Active patients. Not in the hospital, obviously, they were outpatients. But I came out of training without knowing too much about cerebral palsy myself, we're talking about the '80s. So neurology and pediatric neurology residents did not have that much exposure to these patients unless they had seizures or headaches or something else. So here I was with a large population of children with cerebral palsy, and I knew very little about it, but over the years, especially after we started getting new treatments to manage the spasticity like intrathecal baclofen pump and botulinum toxin injections and so on, I became more and more interested and involved in the care of these patients to manage the spasticity.
And being part of a multidisciplinary team, I started learning from orthopedic surgeons, rehab doctors, therapists, and so on, all the things I needed to learn. But the most important teachers were my patients and their family. So I owe it to them, the experience and so I'm happy to be here and share with you guys what I have learned over the years.

Dr. Peters:
I think it's so true. I'm a neuro-oncologist and I learn so much from my patients, and I love it when I learn something from them and I can share something like a tip or a trick with my other patients, and be like, "Oh, my patient did X and this is their outcome." So I think it's really fun for that. Now we all hear of cerebral palsy because it is common. It's the most common childhood motor disability, but I don't think a lot of people know exactly what it is. So can you just give us the basics of what is cerebral palsy?

Dr. Delgado:
Yeah, I will start with saying what it's not. It's not a disease. It's not a single entity. Cerebral palsy is an umbrella term that we use to refer to a group of lifelong neurological disorders that affect the person's ability to move and maintain posture. And this happens because the patient's develop a lesion or abnormality in the brain during the developmental stages. And this lesion is not progressive, it's static, so it's going to stay the same forever, but the manifestations can get worse. People with cerebral palsy may develop other problems over time, but not because the brain lesion is getting worse, but because of the nature of growth and aging and so on. So CP is not one thing, but many things. Okay, so that's the first thing I would say.
The other thing is, because it's many things, so it's kind of complicated sometimes to refer to cerebral palsy, it presents in different ways. So over the years, since it was first described 170 years ago by an orthopedic surgeon in England, we have developed different classification systems to kind of try to understand better what we're talking about because it it's like talking about a salad. So we have the tomatoes, we have the lettuce, we have the cucumbers and so on, so we have developed different classifications. And one of the first ones developed by one of the most prominent neurologists, a Canadian, Sir William Olson. He basically developed a classification that was according to what parts of the body were affected by what parts of the body were weak or had this abnormal movement. And so we came up with the idea then of having patients who have one side of the body affected that we call hemiplegia. We have people who have the whole body affected, and we call it quadriplegia and so on.
And then Sigmund Freud, who was a neurologist before he was a psychiatrist, he developed a classification that took into consideration the abnormal movement that was affecting these patients. So now we had patients who had spasticity or had chorea or had athetosis, which are involuntary abnormal movements. And so we had somebody with a spastic hemiparesis or choreoathetoid quadriparesis, so we had this other component that was helping us understand better what we were talking about. But it's not until the last part of the 20th century in McMaster University in Canada that a group came up with a functional classification, and that's the one we use today. And I think parents or patients are going to hear a lot about it, which is based on the gross motor function of the patient. So we're interested in what the patient is able to do. The spasticity is okay, the weakness or whatever, but it is, what is the patient able to do?
So this gross motor function classification system, which we call GMFCS, allows us to kind of classify patients according to their ability to move around. And that is a classification that basically came to help us communicate better and classify patients better, not because we want to label them, but we want to understand it, we want to know what we can do for them. What are the treatments that work better for these group of patients? What are the treatments that work better for these other type of patients? Because CP, as I said, is many things. So this classification system that now has basically been the basis to develop other functional classification systems for hand use, for example, which is the manual mobility classification system or for communication, we have a communication function classification system and so on now allows us to communicate much better about what we are talking about. So now we can say that we can design better studies to hopefully find better treatments for these groups of patients.

Dr. Peters:
That's ultimately what it is, what can we do to help these patients? And it's okay to be a lumper sometimes, that this is one entity, but you need to split to find the proper ways and proper treatments for those patients. Now, what are some risk factors? This affects children, are there risk factors during pregnancy or are there risk factors at the time of birth or development that predispose someone for cerebral palsy?

Dr. Delgado:
Yep. There are many risk factors for cerebral palsy, and they can vary according to the gestational age. For example, 40 to 50% of patients with cerebral palsy have a history of premature birth. So prematurity is a risk factor. This is an important risk factor. These premature babies can develop bleeds in the brain, scars in the brain, and therefore end up with cerebral palsy. Obviously, things that happen during the pregnancy like infections in the mother, that could be viral infections like rubella or other type of viruses, diabetes in the mother, thyroid diseases in the mother, exposure to toxic agents, drugs, and obviously complicated deliveries where there is an abnormal presentation of the baby, an umbilical cord prolapse or abnormal placental position and other delivery complications. In the past, we used to think that actually most of the reasons why patients will develop cerebral palsy were related to what happened during the actual delivery, but now we know, especially after a very large study done from the '50s and '60s in almost 60,000 pregnancies that most of the causes of cerebral palsy occur before birth. So that changed the way we were thinking.
And now with the development of more sophisticated genetic testing, we are finding that about 20 to 25% of patients with cerebral palsy have genetic abnormalities that probably have something to do with the cause of cerebral palsy. So these risk factors, although by themselves they could end up causing cerebral palsy, most of the times they work together. So for example, somebody has a genetic abnormality that predisposes that person under certain circumstances to develop cerebral palsy, it's something that is probably happening more frequently than we actually know. So this interaction of risk factors play an important role. It's important to recognize them because then we may be able to do something about this. So if we know what could cause cerebral palsy, maybe we can go there to the root and hopefully prevent the patient to develop this motor disorder.

Dr. Peters:
That is fascinating because the whole idea would be to see if you could prevent something from happening before they develop a neurologic injury because essentially it's a neurologic injury that's manifested into now a motor, a phenotype, correct?

Dr. Delgado:
Exactly.

Dr. Peters:
When you first see a patient, what is usually the age that you say, "This is cerebral palsy?" When does that come about in that discussion with I guess the parents and also the child?

Dr. Delgado:
Yeah. Well, this is a very important question because it has to do with early diagnosis. And I think we need to understand that the earlier we're able to diagnose cerebral palsy, the better chance we have to use treatments that may actually have a higher impact in the outcome because of the neuroplasticity that is happening in those first stages of development.
Unfortunately, we still see the diagnosis being made between one and two years of age. We wish we could have the diagnosis before five months of age, and there are tools that have been developed to actually diagnose somebody at risk of developing cerebral palsy early. So I think the idea today is to promote these tools as much as we can, educate pediatricians, healthcare providers so they can use them so we can diagnose these patients as early as we can. But I still see patients who come to clinic when they're, to get the diagnosis of cerebral palsy when they're two, three years old.

Dr. Peters:
Wow.

Dr. Delgado:
That is too late.

Dr. Peters:
Oh, yeah.

Dr. Delgado:
That is extremely late. And sometimes it has to do with the healthcare system. It takes a while to get patients referred and all that, but I think we're improving in the early diagnosis. I think we need to do more work on education of healthcare providers to be sure that they are aware of the signs of cerebral palsy as early as possible.

Dr. Peters:
Because you would like to intervene. I mean, of course prevention, but if you do have a child that you're concerned about, if you can do some of those acute treatments. And so let's say it's sort of the correct scenario, you diagnose someone, you identify them, what really is the next step for treatment? What do you do next for that patient?

Dr. Delgado:
Yeah, well, so first let me say that the diagnosis is a clinical diagnosis. So first of all, we need to be sure we're dealing with cerebral palsy. There are things that look like CP, but they are not. And so the diagnosis needs to be well established. It's a clinical diagnosis, but we do radiological studies like MRI of the brain to be sure that we can identify the lesion and confirm the diagnosis that we're making. If the MRI of the brain is normal, then we obviously do MRI of the spinal cord because there are patients who may have a lesion in the upper cervical level of the spinal cord or spine malformation that could cause a motor disorder like quadriparesis or quadriplegia and look like CP, but it's not. So once the diagnosis is well established, we need to start obviously therapy for the child. And as I said, the earlier, the better.
And then the other thing is to start looking for things that may be preventable. We don't want to see contractures, I mean shortening of the muscles and the tendons that could limit the ability of the patient to move a joint, so we need to be sure that that's not happening. We need to be sure the joints are not being subluxated or dislocated. So we are watching that child be sure that we not have other complications that could aggravate the impairment, the motor impairment and cause more disability. And then obviously treating if there is a spasticity and the spasticity is causing or contributing to the impairment, we need to address that. If there are other movement disorders like dystonia or chorea and so on, that could be controlled with some medication, we are going to do that.
If the patient has seizures, one third of the patients with CP have seizures, so we need to be sure the seizures are under control. Nutrition is important too, so some patients may not be able to keep up with their nutritional demands because they cannot swallow well. So that will be in the more severe cases. So we may need to address that nutrition and be sure that they are fed well. Respiratory problems, so all kinds of systems can be affected and that's why it's so complex, the care of these patients. And that is why I always think it's important that the child, especially those with a more severe form of cerebral palsy, are treated by a multidisciplinary team in a specialized center where they see a lot of these patients where there are orthopedic surgeons, neurologists, rehab doctors, physical therapists, et cetera, et cetera.
So we identify goals with the family. I think that's one of the first things we need to do. So what is the goal? What are we trying to achieve under these circumstances? And the goal has to be realistic goal. It's very specific. It is going to be measurable within a certain period of time, so a smart goal. And then we are going to get the people and treatments that we need to get to achieve that goal together with the family. So we work together as a team, we identify goals, we communicate those goals, and then we move forward and we take one step at a time.

Dr. Peters:
What are some of your favorite places to send your parents to as far as for resources?

Dr. Delgado:
Yeah, so there are... Obviously a lot of parents Google these days, a lot of this, but I think there are institutions out there that are dedicated to provide support and an education to parents and families and patients like the United Cerebral Palsy, or Cerebral Palsy Foundation or Easterseals or the Center for Parent Information and Resources. There are multiple places. The Gillette Children's Hospital has developed a series of educational materials as well that are very informative and they're written for non-medical people so they can understand better what we're talking about. So it is important to have that referral for the parents, the family to understand what we are talking about, because many times we doctors don't have the time or we speak at a level that they don't understand. So it's important that we educate parents because they are, as I said, they're the most important members of the team.

Dr. Peters:
I agree with you. I think definitely the caregivers are so key for this. And what's really important is this podcast is going to come out during March and March is Cerebral Palsy Awareness Month. So I think this is the perfect time for people to really get educated on this. Now, what are some new exciting areas as far as research? You mentioned the genetics, which I thought was fascinating, especially from a preventative, but are there other areas that are helping our patients with cerebral palsy?

Dr. Delgado:
Yeah, so there are many areas where we are making progress. And one of them is, and I'm very excited about that, is prevention. What's happening in the nursery, what's happening in the NICU or in the delivery room? Different treatments that can be given to the mother when we know there is a risk of this child to suffer, I think it's important to recognize that as an area that it needs to continue to grow because if we can prevent it, we'll be much better than having to deal with this condition for the whole life. And so I think that research in that area is key.
The other thing is in the last decade or so, so the treatment, cell treatment or cell therapy has become also an important area of research, either with stem cells, mesenchymal cells, or the type of hematopoietic cells. The idea there is to reduce inflammation, replace damaged cells, and promote healing of damaged cells. And those treatments, what we are learning is that the earlier, the better, and there are some limitations to that. And again, they're all being used at this point under research protocols. So I will encourage parents if they are pursuing these or any other type of new treatment, that they do it under research protocols, which obviously are regulated by ethics committees and so on. And because it takes a while to get a treatment approved and to be sure it's effective and is safe.
Another area, well, with all the advancements in technology, the more we advance with computers and all that, the better type of tools we have to help patients communicate better. So improvements in augmentive and alternative communication are exploding. Robotics, robotics either to assist with therapy or to help the patients actually moving space. This is something that is also growing tremendously. And who knows where AI is going to take us.

Dr. Peters:
Exactly.

Dr. Delgado:
I mean, a lot of things can happen. I think this is an exciting time where we are really exploring different avenues of research that we never thought before that it could happen and so on. So I think the field in cerebral palsy is going through a very exciting time, and I think we're seeing that we can make the impossible possible, and I think that's important to know that because that gives us hope. And I think patients and parents with cerebral palsy need to have that hope that we are moving forward. And I know it's going to take a long time, but we are really, I think, coming up with new treatments that can help patients have a better quality of life.

Dr. Peters:
Well, Dr. Delgado, I agree with you. I like the idea of making the impossible possible, especially for our patients with cerebral palsy. I just want to thank you so much for educating us today. I will say that for your second time on a podcast, you did amazingly well and we would love to have you back in the future, and I also want to thank our listeners.

Dr. Delgado:
Thank you, Dr. Peters. It's been a pleasure. Thank you so much. Have a wonderful day.

Dr. Correa:
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Dr. Correa:
You can also find that information in our show notes, and you can follow Katy and me and the Brain & Life magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online @Neurodrcorrea.

Dr. Peters:
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