Friday, October 30, 2020

A Boy With Cerebral Palsy Changed A Doctor’S Thinking About The Brain

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I first saw Daniel with cerebral palsy as a premature infant when I was a neonatology fellow at the Hospital for Sick Children in Toronto. Daniel was born at 26 weeks. In the first week of his life, he developed a major bleed into the right side of his brain, damaging the areas that would normally control the left side of his body.A 26-week infant is tiny. Daniel at birth weighed 750 grams, about a pound and a half. When I started in neonatology in the 1970s, he would have had, at best, about a 50-50 chance of surviving. Daniel survived, but the common wisdom at the time was that the damage to his brain was permanent and would lead to disability.

To my surprise, the disabilities that developed in Daniel as he grew from infancy to childhood, as measured on a standardized scale of function, were not too bad. As I expected, he limped on the left side, landing on the front half of his foot, not his heel. His left arm hung at his side and did not swing normally when he walked. His right side was unaffected and his speech and cognition were normal. I diagnosed him with a left-sided hemiplegia, a type of cerebral palsy that affects the motor functions just on one side of the body. Hemiplegia is found in roughly 40 per cent of all children with cerebral palsy, and, like Daniel, 99 per cent of these children are able to walk.

I didn’t believe her. Daniel being able to play competitive soccer was outside my understanding of hemiplegia. I assumed, as many doctors would have, that an overly optimistic mother was seeing a degree of recovery that just wasn’t there. Still, I arranged for her to come in with Daniel so I could see for myself. Then I asked him to run.And, to my astonishment, he ran like a normal little boy, with an easy, balanced stride and reciprocal arm movements. He performed tight pivot turns, at speed, on both legs. Even the left leg, which had a limp when he walked, performed perfectly when he was running.For a moment I was speechless. (Anyone who knows me knows this rarely happens.) Then I said, “You can’t do that!” And I meant it. I could not, for the life of me, figure out what was going on.

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