How Cerebral Palsy Works

House Stuff Works dot com. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W. Chuck Bryan over there, and we've got guest producer Noel in the house. Uh throwing a sound effect? Noel, wait to go? Yeah? Um, I'm assuming he'll do that in post right, Uh yeah? Or maybe the sound effect is silence. Okay, that's a lack of sound effect. We'll find Know. It's like when you're a little kid and you'd have just a blank canvas. You'd be like, look, I did a picture of a

snowman in a snowstorm. I never did that. Smarty smart, a little smart alec kid gets what's coming to him, you know, So, Chuck, do you remember we did a trivia night like years ago on the roof of Five Seasons Brewery in Atlanta. Yeah, I remember. Hodgman was there, Buddy Joe Randazzo, Dave Willis was on our All Star team. David just looking around like, what's going on? Who are you guys? Why do they care about you? My publicist said I should come to this. Um that was fun night.

It was. There's a dude there and he had cerebral palsy. His name was Kyle pas I remember him. You remember Kyle kps is what he goes by. And and again this is what maybe like five years ago, four years ago, maybe six six, Okay, it was a while ago. Um. Well, Kyle was like, you guys should totally do one on cerebral policy. We're like, we totally he should, and we didn't. Well, I ran into Kyle again when you, me and I were going to visit a Laurel and Braden's baby at

the hospital because he volunteers at Pimont Hospital. Yes, and I was like, you look really familiar and he's like, so do you, and I remembered we'd never done one on cerebral palsy. Even though we totally said we would. So I was like, he was like, yeah, he didn't even say anything. He just looked at me his head. Um. No, he was super cool about it. He's a cool cat. Actually he's he's he's a cool guy. Kyle Um actually does iron Man competitions with his brother who like wheels

them along and his wheelchair. They did the New York Marathon Um and one of the wheels came off of Kyle's wheelchair and yeah, like the wheel right, So his brother is like this kind of like helping move along and think holding up the axle and U some other people said, you know what, we don't need to make time, will just help with this. So like a bunch of like strangers helped get Kyle across the finish line with his brother. That would have been me. I would have

been like, why am I running with anything? Anyway, I'll just be a good guy. Uh. That is amazing. And you see that. You saw it recently in the Olympics when athletes will forego their own race to help another. Yeah, that stuff just slays me. Or if they're qualifying and like the first three or the first five across the finish line, um go on to the next race. Um, they'll slow up and like finish at the same time Jerky noses out in front, right, So yeah, yeah, it's

pretty cool to see that that kind of spirit, right yeah. Man. So anyway, Kyle Peas, it's got his own foundation. I think it's Kyle Peas dot org or Kyle Peace Foundation. Probably should looked it up, but this one's for Kyle. Yeah, and you can google that if you want to look into his foundation more. Yeah. So we're talking cerebral paul you right, Yes, And it's something that like I've always known about. I've known people with cerebral palsy like I

I it's just something you know about. But I had no idea what was going on with the condition, and as a matter of fact, I just assumed it was one specific thing. But it turns out that cerebral palsy is actually UM basically an umbrella term for a bunch of different conditions that stem from a bunch of different um origins. I guess, yeah, causes causes, that was the word I was looking for. It's not a disease, UM, and the cause is always a brain injury of some

kind that affects your movement. Yeah, but there can be all kinds of ways, and we're going to get into all that obviously. And actually you can develop cerebral palsy from a disease, but like you said, cerebral p itself is not a disease. H. If you just off the cuff, not off the cuff, but at the outset cause stats about eight Well I was I was gonna say off, you know it, just starting out with some stats instead

of finishing out but off the cuff. Something makes it sound like I'm making this up right, right, it's not true about eight thousand children a year or born with it every year. Yeah, and I got this from a Canadian sight, so you know that's good. Yeah, there's legit. Uh. They say it's the most common childhood physical disability, affecting about two point five of every one thousand live term births in twenty two out of every one thousand live

premature births, and it affects more boys than girls. Yeah. I saw premature births in particular um have a higher incidence of cerebral palsy. And I didn't know if it was the cerebral palsy caused premature birth, but then I read it a little more in depth and saw that actually premature birth is a risk factor for developing cerebral policy. Yes, exactly. Uh, but with that broadly defined, let's you want to jump

back into a little bit of history. Let's go back way back in yeah, way back to eighteen fifty three in fact, with Dr John Little Ums it's hard at work. Yeah, in the same country as Dr Little Doctor Little This guy was a good dude. He was as a kid, he was afflicted with a lot of illnesses and he basically grew up to say, like, you know what, that was no fun, and so what I'm gonna do is dedicate my life to to discovering the causes of some

of these things. Although he didn't have some reberal palsy. Um. He started working in the eighteen thirties, uh, in his first kind of UM. I guess the first way that he was actually on the really the right track was he started doing lectures on birth injuries, which will find out, as you know, birth injury can be a way that you can get cerebral palsy. So that's where he was on the right track at first. But to him, birth

injury was the only way to get cerebral palsy. And the only way that you could get cerebral palsy from a birth injury was if you were asphyxiated while you were being born, correct, which happened and happens right, So he was right, right. But it turns that the um that was too narrow of an umbrella that he came

up with. Yeah, and he did these lectures, these really influential lectures that he later published called on the Nature and Treatment of the Deformities of the Human Frame, and um it wasn't called cerebral palsy at the time though, in fact, they called it Little's disease. He was like, oh, yeah, okay. A lot of the diseases originally had the doctor's name, and some of them kept those yeah, you know, like cop Cross syndrome, remember that one? Yeah, was that named

after Arnold Copcross? Did you just make that up? I made up the first name, but it was the name. And morgellons more Gelan's which way do you say it? You just confused to say you can't even remember now, Morglon sounds right, but you were saying it because you were poking fun at me. I think perhaps you don't even remember now I think I do. I'll just have to go back and listen the episode because it's documented.

Uh seven is when the term was actually coined by Sir William Ostler, who wrote Cerebral Policies of the Children. It was a book and he used a lot of Little's work UM or built upon Little's work and finally gave it you know, that lasting name. Yeah, but he was the only one that was very famous Austrian. Yeah, doctor Freud, Yeah, Freud got it right. Freud had some theories that UM, that cerebral palsy could be developed or it could be the result of something that happened during

UM before birth in the mood. Yeah, during development, that's what I was looking for. UM. And everyone's like, Freud, go back to your cigars and your mother fixation and all that. Just leave this to us, including Little. Like they got a little contentious at times. Yeah, a lot of contentious for two doctors, that is. Yeah, UM and uh Freud said, do you take the cigar and you

stick it where the sun don't shine? Maybe so. Uh So it turns out Freud was right the UM, but everyone just kind of ignored him until like the first study that really looked at cerebral palsy and the development of cerebral palsy from a birth injury, an injury that occurred during birth. So would that be perinatal. Isn't that during birth? Neo natal's right after birth, perinatals during right, So a perinatal injury developing cerebral palsy. Everyone thought it

was a of the cause. It's turns out it's like ten percent or less, something like five to of births or of cases of cerebral palsy come from being injured while you're you're being born. And there's all sorts of ways you can be injured. Some can happen naturally, like if you come out breached, UM, if you get stuck in the birth canal too long, if the doctor is a little too heavy handed with the four steps, which

is like a horrific thing that can happen. UM. You can also have a prolapsed umbilical cord where it comes out before the baby. UM. You can have the umbilical cord wrap around your neck, and any one of these things can cut off the blood supply to your brain or the oxygens supply to your brain, which are effectively one and the same and either way, your little tiny brain is like, oh, well, this region's going down because I was just as fixiated for a little while. Yeah.

So his work was later, you know, verified, um after his death. When did Freud die? Uh? Yeah, it was that'd be pretty cool c Freud and a member's only jacket. Yeah. I could see him really living it up in the Disco area, so he would have been at Studio fifty four. Yeah. Yeah, and like yeah, uh. A couple of other folks who have made a name for themselves by doing a lot

of great work. Leonard and Isabel Goldenson. Their daughter had cerebral palsy and uh she uh they basically dedicated their life to it for that reason, to learn more about it, and um, sadly she passed away at the age of twenty nine. And they founded co founded the United uh Cerebral Palsy Association in ninety and they are a really big organization now s this year the fifth largest health

agency in the United States. Uh. And then in the jeez, I don't remember the year, but there were some very famous books written by a woman named Marie uh Khalilia. So how we're going to say it. I would have said, Kilalia, but Killala if you want to go Hawaiian, gotcha? Uh. They she wrote a book, a couple of very famous books on the bestseller list, one called Karen and one called With Love from Karen that really captured the attention of uh, the United States at large. And they were

about her daughter's struggle with cerebral palsy. Yeah, and um, she Karen is still alive today. Oh yeah, She's in her seventies and is very private and I think works as as a secretary at a monastery or something that is extremely private, something like that you want to you want to keep to yourself. I'd have to put up with any chitch at work. That is where you can

get a job probably, so um secluded existence. Right, So the those I guess you'd call him civilians, non doctors, UM helped to really kind of expand public awareness of cerebral policy. Is the impression I have, right, Yeah, and those books especially, Um, should we take a break. Let's take a break, man, all right, We'll take a break and we'll get into some of the causes right after this.

All right, before we broke, you said we were talking about Freud and his um while we were talking about childbirth injuries being actually accounting for a fairly small amount. But they used to think because of Dr John Little, that it was like that was the cause of ceret

uh secent at the time. Freud was right, yeah. And you would think also that doctors, especially um pediatric doctors, the ones who are doing the deliveries, would be like, yeah, yeah, Freud's right, it's definitely not birth injury, like the obstitrician right. They'd like, it's something else that's happening during pregny. It's not us. But they didn't. They took it. You never know, well,

at the very least it didn't. It didn't happen. And if you look up, if you look up cerebral palsy caused by doctor error, like the first eight pages of Google are nothing but articles on law firm sites, like every single one. Some of them seem like pretty like well researched articles, well written, but all of them are law firm sites. So like and and by the way, give us a call. Well it's funny later we'll talk

about this later. But with uh stem cell therapy, I looked into that some more because it's hard to get accurate information on that, because the first five pages of Google are all about companies that offer trying to get money to do stem cell therapy. You kind of had to wade through that to get to actual facts. So I just I have so many questions that well, we'll

get to that later on. Um. And then the remaining what do we say is during pregnancy, five, during child birth injury wise, and then the remaining cases, as we'll see are after birth up to the age of two or three. Well, we'll get to the reasons why. So during pregnancy, there's a lot of stuff that can happen, but typically, um, you're you. You are either the baby comes down with a disease or an injury, or um, the mother has a disease that affects the baby's development. Right. Yeah,

it could be a condition and infection and disease. We've talked about toxoplasmosis. Yeah, why you shouldn't change out the cat litter if you're pregnant, right. Uh, toxoplasmosis can lead to your baby being born with three bow policy. Uh and uh. Rubella used to be a big problem and a huge cause of um cerebral palsy until they developed the vaccine for it, that's right? What is it? Musle momps rubella MMR. Wasn't there a good band like that called m m R? No, you would know. I think

there was. As a matter of fact, I know there was. I'm just not that familiar with His eyes darted at you as if to say, did he just say my name? Uh? He still hasn't acknowledged us. That's all right? Um? What else? Epilepsy? Um,

diabetes and epilepsy. If your mother has that, they have higher chance, higher risk of having a baby with the CP right, and all of these things have um a couple of different effects like or there's different different effects that these diseases or injuries can have on the baby's development.

For for starters, when you are building your tiny little brain in the womb, it starts out as you start out, is just a single cell, right, that starts dividing fertilized cell that starts going haywire, but not haywire, haywire in a very structured manner. Okay, Um, Well, eventually it gets to the neural tube. And the neural tube is this little uh roly poly cluster of cells that on one end develops into the brain. And then the other end

develops into the spinal cord. And then as it's developing, the cells divide more and more and they actually become specialized, and they migrate to the root, to these different areas of the brain and make up different parts of the brain,

different reasons of the brain. Right if at any point any of that gets messed up, where there's like a problem with the migration or some of the cells don't develop correctly, they there seems to be a pattern that they can follow where parts of the brain that direct movement in the muscles have they they tend to cluster in a um in a in a way that that gets affected with another place more than other ways. And that's and they don't know when policy, No, they don't,

which is a pretty big mystery. You'd think would be like just a random roll of the dice, what you know, what was affected by these different conditions and diseases and injuries. But it does seem to kind of fall on the spectrum toward um the conditions that make up cerebral palsy. It's really interesting, it is, it's it's odd and and

again they have no idea why. Hopefully they will one day well, I wonder if it you know, there would just be a different condition if it was in a different area to bring though, you know, you know that mean, does that make any sense? Yeah, no, it does. But and then maybe there are conditions out there there we just aren't aware of, but everybody else knows about that. It is like, oh, if you're if you're um, your neurons don't migrate in this way, you have this condition.

If they don't migrate in this way, you have cerebral palsy. I see what you're saying. Uh, So there are some pre that see specific conditions that can cause cp UM once called uh preclampsia, and that's when you it's a disorder that causes high blood pressure and the mother that's going to affect the blood flow to the umbilical cord. And again all this goes it all goes back to the same problem, which is the baby are developing fetus

not getting enough blood and oxygen. Yeah, or the neurons didn't migrate to the right way there was either a problem with development or the developed cells were starved of oxygen. And then apparently when that happens, they form holes in the brain holes fill with water. And then get covered over and they become cysts. Yeah that's allegion, man. Yeah, so sad. We talked about our h factor and compatibility in our blood podcasts, which is one of our good ones. Yeah,

the blood one. Yeah, oh yeah, I love that one. But um, if that happens when the mother's blood type is uh not compatible with the with the babies, uh, that can result in jaundice. Jaundice can lead if it's severe enough and they don't get the good treatment, that can lead to a certain kind of brain damage that we're called uh cause CP, it's called cronic terrorists. I'm gonna go with a silent C on that one. I'm gonna make it a hard see cronic. I know we

we sometimes look these things up. I don't want to, no, I'm just saying, uh, I've tried to get better about looking at pronunciations. Um. And we've had offers from people in the medical field. Ye like give me an email, I'll let you know. But it's become part of our show. No disrespect intended. Uh. And we already talked about birth injury, which is one of the in the five percent range. Yeah, five five to ten percent, right, Yeah, what I say. I mean, you're in there part about fifty of all

kids was born with ribal palsy were born prematurely. Right, there's that premature birth being a risk factor for cerebral policy. Yeah, exactly, it's so. Yeah, it's not the other way around, right, But the article on the site makes it. It seems like it's it is the other way around the way

the sentence is structured. Yeah, I agree. Um, but you can, like we mentioned, um and and it's all very sad, but you can have a great birth, completely healthy baby, and then you can get cerebral palsy due to an injury at the age of like two, or if you almost drowned, or if you choke on something that that oxygen is interrupted, you can acquire I guess it's a quire. Yeah, it would that would be a choir uh CP, you know,

as late as three years old. And the reason why it doesn't you can't acquire cerebral palsy at age twenty or something like that because your brain's developed by that. Yeah. I think your brain is fully developed by three to five years after you're born, so you wouldn't. You would just have I guess a certain level of brain damage,

it wouldn't qualify as cerebral palsy. And the reason why it wouldn't qualify cerebral policies because cerebral palsy describes the symptoms basically of a specific type of brain damage that occurs during the brain's development, and again it affects the muscles in their movement and control of it. Yeah. The other couple of ways, um that you can get it through injury after birth or meningitis. And then the satising on earth shaking baby syndrome, which we need to do

a whole episode on that. That's a very controversial, UM thing. Controversial how there's there's a lot of people out there say it's not a real thing, that people are being put in prison for something based on junk science. Interesting, Yeah, there's a um some somebody, some group of people made a documentary about it, and they offered to send us a link to it to watch it privately. What I mean, obviously they're not saying shaking her baby is fine. They're

just saying it doesn't lead to brain damage. No. I think they're saying like there isn't a there isn't so, yeah, there isn't such a thing. As this shaking baby syndrome. I don't know what the documentarians are saying because I haven't seen the documentary, but I have read other articles about it. Um Man, I wish I could remember the name of it. I'll tweet it or something like that.

But there there's this um really great long form article about this couple I think in Dallas who's baby like injured himself and the dad just the E M. T. S came in and thought that the house the scene looked kind of weird and didn't like the way the dad was acting, and all of a sudden, the guys in prison now for years because he was convicted of right. I thought you were saying that people contend to contend that shaking your baby like that can't lead to uh,

these kinds of injuries and brain damage. I think some people do. I think some people are saying, like, like, weird, shaking baby syndrome is not an actual thing. Interesting. Yeah, well that's what I'm saying. We need to do a whole episode. I have to look in at that. My gut reaction is it's child abuse. Affecting the baby's head not have an impact if it's severe enough. I think yes, you could shake your baby until it gets until your baby has a concussion or has some sort of brain

damage or injury. Right. I think what what the critics of shaking baby syndrome are saying is that the current understanding, the current scientific understanding, where if you see this, this and this and a baby, especially a child who's just died under mysterious circumstances, it was the parent who shook it touch and so send the parent to jail. And they're saying, no, that's junk science. You can't send people to jail based on the criteria that we're currently using

and sending people to jail with. Not Yeah, shake a baby as hard as you can, you'll never give it a concussion or kill it like That's that's not what they're saying now. They're saying, like the science, the scientific understand people being wrongly convicted when there was no abuse going on. Right that, So there's a witch hunt and it's based on junk science. Man, we gotta do one now.

I mean, we definitely just teased it enough. Theing. Uh so here's a we we have this little sidebar in the article that I had to look into a little more about magnesium sulfate UH. In the New England Journal of Medicine in two thousand and eight, they did UM. They published an article about a study about if you have a high risk of preterm delivery and you know this and you're given magnesium sulfate, the mother is UH. It cut the rate of CP and half UM and

I looked up in studies. Basically what I came down to is this is and this was from that same Canadian website. It said that if you do know, there are two things to treatments to minimize it in newborns UM and one is magnesium sulfate if you know ahead of time that you're at risk and you like, get on it, it's amazing. And then therapeutic hypothermia, which we've

thought about before. Yeah, that's stuffs magic minimize the damage due to lack of oxygen or blood supply, which well that one makes sense, Yeah, because it's it's UM like they they will freeze you or bring you pretty close to freezing to keep you from going from suffering brain damage because it lowers your metabolism, so you need less oxygen. And if your oxygen deprived and they lower or your metabolism it's interesting. Yeah, that is that was a great episode.

Two that was therapeutic hypothermia. So the magnesium sulfate does check out. That's really astounding. But again it has to be given with the you know, well in advance. So is it like a course of treatments or is it like, here, take the shot of magnesium sulfate and you'll be fine for the rest of the pregnancy. You know, I'm not sure. My inclination from reading it was that it was a course of treatments, like you're on it during the pregnancy. But I might be wrong, but I think that's I

think that's a deal. You want to take a break, Yeah, and then we'll talk a little bit about what's going on with the muscles, all right, Chuck, So we talk muscles. Let's talk muscles. So we talked about all the ways you can get cerebral palsy acquired or develop it. I guess get works right, sure, um. But the actual way that cerebral palsy is categorized is by the types of symptoms you have, and they're generally um carved into three

types of cerebral palsy. They're spastic, there is um a taxic right, Yeah, and then um, the third type is ethnoid dyskinetic and spastic is by far the largest group of cerebral palsy. Should we talk about SPECIs space spasticity? Nice? The tooth is coming? Are you psyched? I am psyched? Ready for my s is to be a little more contained, you know what I'm saying? Uh, Spasticity is the word. Uh, And you send off that you sent over this little addendum.

I think it really kind of helps understand how it all works. Uh. Spasticity is basically the the tension in your muscle, and you always have this going on. Otherwise we would just be laying down the floor at all times. Like you might not feel like your muscles are tens or doing anything, but your muscles are tensed if you're sitting upright and you're or you're walking around or you're

doing anything. Yeah, there's there's like a real um conversation going on between your spinal cord and the muscles themselves, the nerve fibers and the muscles themselves saying, hey, we're getting a little too contracted here. Why don't you send us a little hit of relaxation. And so your muscles are just constantly alternating to keep you sitting upright, to let you talk, to do anything you use your muscles for. There's this interplay between tension and relaxation of the muscles

and all that's called tone. Yeah. And the really interesting thing is that when you're the actual message for increasing that tone comes from the muscle. Yeah. I was fascinated by that. To the message to decrease, it comes from the brain, which is weird. Yeah, because the muscles saying, hey, tell me to to to tighten. Yeah. Well it's like just do yourself. Pal Is there no brain involved there at all? I'm always having to hold your hand. Here is said, it goes directly from the muscle to the

spinal cord. Yeah, it's crazy. I would think the brain would be involved. I think the brain gives the spinal cord a lot of leeway and stuff like that, like you take you got this right, you got you got this, you know what you're doing. But like, uh, like I said that, the brain is what tells the muscle to relax. And when you have the damaged in cerebral palicy, when you have the damage to the brain, it's not sitting

the right message. Then you have an overworked uh not overworked, but the muscle is is doing the message sending only because the muscles um, neurons or sensory fibers are fine. So they're getting their message across loud and clear. But the other message that's part of that interplay, that conversation

to relax, is not coming through. So in um, in spastic cerebral palsy, you have muscles that are basically constantly rigid, and it may or may not be accompanied with by tremors right um, and the the outcome, the result of a constantly tensed to muscle um is is ultimately a deformity, like the the limb might shrink, UM, the bone itself can become twisted. Uh, there's a lot of things that can happen from just I mean just flex your forearm for for thirty seconds, like imagine that all the time,

like un relenting lee. That's what spastic cerebral palsy is. So it's it's not like a child who was born with spastic cerebral palsy comes out with limbs that are um that are malformed or deformed. Um. The that that actually is the result of years, even just a few years of that constantly contracted muscle. Well, yeah, but we should point out though it's not a degenerative disease, it doesn't get worse over time, No, it doesn't. But the

these because it happens as your body is developing. If your muscles developed like that, um like the the that will that will get worse until it develops into I think a certain equilibrium about of people get the spastic kind. And there are three uh sub groups within that. One is quadra uh sorry, quadra plegia. And that's when all four limbs or effect did. You might have seizures and tremors. Uh, you might not be able to talk, You might not be able to walk right, might be wheelchair bound. And

that's the most severe. Uh yeah, because again like I'm using a bunch of different muscles right now to talk and uh swallow, eat, bring food to my mouth, Uh, do anything anything you need to use your your muscles for if you are a quadriplegic cerebral palsy, So for you are you it's all up for grabs. Yeah you you there there. You might not you might be able

to do very little, that's true. Uh. Himoplegia, which is one side of the body, and as we've talked about the brain, it's usually affects the opposite side from where the injury is. You might have to have braces on your legs. Um, your limbs might grow at different rates, but you probably can walk. Um. And then the final subgroup of the spastic kind of uh daplegia, and that's the lower part of the body only. Um, you might be a toe walker if you've ever heard of that.

That doesn't necessarily mean if you're a tell walker that U f c P because there are other causes of toe walking. Oh really, yeah, that's unusual. Yeah. I had a friend actually whose daughter was a toe walker, and um, I don't know that I've ever seen that. Like, in researching this, I was trying to bring it to mine. I don't think I've ever seen anybody to walking. Yeah, she's exactly what it sounds like. Yeah, walking on your tippy toes. But it's it's no good for balance, Like, um,

it's not just like oh that's a that's charming. Yeah, I mean it actually affects their their balance like big time. Because I can imagine um and and like there you know, she's constantly moot in motion basically like she could never just stand still because you know, get on your tippy toes. That's what it would be like. And um, she eventually had a surgery. Um, hers wasn't CP and she had I guess something elongated to allow her attendant or something.

I'm not exactly her, but then you know, it fixed it and she could like stand still for the first time in her life. So like her ten was too short, which made which brought her up on her tips. So I don't remember exactly, but I think that's the way he described it. But um, scissoring too is another thing. If your your legs cross. Um, Yeah, like when you when you pick a baby up and they cross their legs immediately, that could be an early sign number two

DISCONNECTICU at thetoid and those aren't. You can call it either one. I think right, this is a banner moment. We just agreed on pronunciation. Pronunciation. Everybody do a shot. Uh. This can result in involuntary movements that are usually slower, usually in the arms, and they're repetitive, so it looks like a tick almost but the right let me suck

your blood. Um. The big difference with this one, though, is that your tone is usually um, decreased, You're you're not contract well, it can be either they can be rigid or or they describe it and here is loosen floppy. Okay, so let me ask you this then, chuck, is that loosen floppy and then rigid in the same patient Like it's going from alternating from one to the other or to somebody could have loosen floppy tone or rigid tone and they could both still have athtoid dyskinetic. Uh, this

is a good question. I don't know. I mean, if you read the literal sentence, sometimes are muscles are STIFFI rigid, other times they're loosen floppy. Makes it sound like one person can have these. It can come and go. Maybe, Uh, who knows. Yeah, I guess we'll never know. Someone let us know. You'd think we would know. Uh, you may actually have difficulty walking, talking, eating, basic motor skills might be affected if you have this kind And then finally,

a taxi a taxic CP. It's the least common five um. And this is like when you have trouble with your fine motor skills, like you might not be able to write well or you know, you might have trouble walking. Uh, you can walk, but you might have trouble with your balance. M hm. And uh. This one has another interesting side

effect called an intention tremor. And that's when it's it's very specific to like you have an intention like I want to go pick up that cup of coffee, Like your hand might be fine and not have a tremor, but when you go to do something with it specifically, it will start a tremor, right, which has to be really frustrated. Oh yeah, I can't imagine, but it makes sense if if if a taxi um affects the fine motor skill, I mean it takes increasingly more UM fast

twitch muscles too. When you finally do go to grasp and pick something up, then it does just move your arm toward it, you know. And you can have a mix of these as well. And these are not this isn't like you as spastic as the worst, and atotoid is the second worst, and then a taxic is the lightest. You can have UM, mild or severe versions in each of these. It just describes what what the symptoms are, what areas are affected, and how they're affected. Yeah, and

I get the feeling. It all comes down to the severity of that initial brain injury. It does. I read somewhere that cerebral palsy. There's no two cerebral palsy cases alike, because the region of the brain that's affected is a factor when it's affected in the development of the brain. And then how how how the whether it was safe from a disease that the mother had or an injury that occurred a couple of years after birth. Um, So every person with cerebral palsy is a special little snowflake.

That's true. Um. In terms of diagnosis, when you're a baby, doctors will look at things like weak muscles or very tight muscles. When your baby crawls, if one leg kind of drags behind, that could be an early sign. Talked about the scissoring already in the in the toe walking, or any kind of really bad posture, difficulty balancing, um, which is can be tricky because you know, babies don't have great balance to begin with, so you know, diagnosing

it is uh. Eventually they're gonna get you in a in a brain scan if they really think that, you know, your symptoms might be leading down that road, right, and there's like a there's a fine line to walk as a parent between freaking out over nothing or unnecessarily and getting it early because basically every course of treatment for dealing with cerebral palsy and managing it because again it's it's incurable that literally the damage is done, but you

can treat and manage the symptoms. The earlier you catch it that the better the outcome you can possibly have from that treatment. Things like UM, working on muscle muscle muscle development, UM massages are really big. Yeah, teaching a little kid yoga and even like if you can, if you can um uh diagnose cerebral palsy as an infant, you'll want to start like working out, pumping those legs. Just UM, we're just really working on the muscle development

has a big impact on the child's life later on. Uh. Some of the things UM with the other kinds of the uh attoid diskinetic CP, which like I said, could result in trouble breathing and speaking and eating, they're gonna be doing a lot of therapy with a speech language pathologists UM, different modes of communication, occupational therapy. UH, so they can learn how to feed themselves. UM. And again the two are alike. So it's really going to depend

on the severity. That's what kind of therapies are gonna need. Right. And one other thing too about catching this early chuck is that the brain again is still developing, which means it's highly plastic, so you can actually find novel ways to do stuff without using say your arm for your leg. Like there was a very famous guy named Christy Brown.

Oh is that my left foot? Yeah? Yeah, yeah. He had severe cerebral palsy and his left foot would follow the commands from his brain, so he didn't he created art with his left foot. Man, what a movie that was. I never saw it. It's pretty good. Yeah, he's an Irish poet and artists, I believe. I think it just any Daniel day Lewis movie, it's just a must. He's one of those. He's like the brando like you, you just have to see it. Sure, you know, what are you about to say? What do you think of my

left fock? Dentil They Louise as Lincoln. He's so good though, it's just ridiculous. That was That was the line that clinched the oscar that year. What do you think of my left foot? You know, he's the one that goes so far and deep into the method that like, you know, I think when he was on what movie was it where he basically worked as a like a nineteen century carpenter. Don't know he like jumped Was he in the Crucible? No? I think it has Gary Oldman, Well, they might have

both been in there. No, he's in the Scarlet Letter one of the know it sounds like Dan day Lewis. He basically jumped in with the set carpenters, and I was like, I'm gonna help build these sets with my old school Like great, Yeah, that's great, Mr day Lewis, we'd love to have you. Yeah, now bring in the real one. Right after builds it, he just falls over as he's walking away. Job well done. What accent would you like me to try? Now? Uh? Drugs, Yes, they

use drugs sometimes. Muscle relaxers can help with the spasticity. Benzo diazepines like valium. Yeah, I thinks annex is one of those. The problem is is you're giving those two two or three year old Yeah, and they're on like volume all the time. There's there's undesirable side effects of it, but they do work. Apparently. Botox is like killing it. Yeah, and it's a it's FDA approved now is an off label use. So um botox is it's the botulin toxin, right,

but it paralyzes muscles. So if you and if you inject botox into a spastic muscle, UM, it relaxes it and it lasts apparently for months UM for treatments, and it might not just be like okay, everything's all all good, but it's gonna definitely reduce the effects of the spasticity UM enough that it's a it's a pretty good treatment UM. And they apparently are not finding many harmful side effects at all with it. That's great. Yeah, we should do

one on botox, Okay, I know with it. We had a listener right in and say, I started keeping count how many times you said that? And I'm up to like seventy or eighty and if we could remember him? And I was like, well, what's the list? He said, Oh, I'm not writing them down. I've just been making notches on my cave wall. And I was like, well, what good are you? We need a list we can't keep. He might start writing, well, I keep the list of

my own blood. I can't write the titles some children you might have a pump permanently, well maybe not permanently, but a pump implanted in your abdomen permanently once you get old enough to deliver a constant stream of a drug called backloaf in. It's an anti spasmodic. Apparently it works really well, really, but you can overdose from it, which is not good. So what does that mean, Like the pump better work? Right? Yeah, it's automatic. Wow, that's scary.

Probably shouldn't connected. Let it be connectible the Bluetooth or anything hackable too, I would agree with that. And then surgeries you talked earlier about your bones becoming twisted. They can untwist them surgically. Yeah, they will, um, I guess, probably cut them in two and then just twist them around so that they're aligned in a in a straight line. Again. Yeah, if you think about it, like the fact that that

works is astounding. Yeah, that's a pretty primitive operation if you think about it, like, can you really think about the nuts and bolts of it. It's, well, the bone twisted this way, so we're gonna cut it in two and then reset it so that it's back to the way it's supposed to be. It sounds like something of Barber would have thought exactly, That's exactly what I was thinking of Barber. Surgeon. Have you heard about the head transplant that's happening. Oh no, yeah, dude. Is it Rosie Greer? No,

I'm not even sure what that means. Uh, the thing with two heads? It was Ray Milan and Rosie Greer. I think the Man with Two Heads, the Steve Martin movie Man with Two Brains. This is this is the thing with two heads Ray Milan, and I think it's and it might not be Rosy Grey, could be Jim Brown. Is it a movie, Oh dude, Yeah, it's like a Saturday shocker. No, this is a but real surgery. I need. I mean, it's happening very soon if it hasn't already. And I read about it on one of our UK flights.

There's a surgeon that is I think he's Italian. That is, he's found a body donor, which is a body on life support with no chance of coming off life support, and he is taking the head off of the man who needs help putting it on this body. Supposedly there are he is roundly being called a quack and a lot of circles. But the doctor said, yeah, those same people are calling me quack, are also calling me up and saying like, how are you doing this? Like tell me, like,

is it possible? They'll I'll be licking my boots when this is over. Maybe. I mean it's I couldn't believe what I was reading. When I was reading this, Um, they freeze, I think, the body and the head, and there's like an hour that they have to get this thing reattached and the blood flowing and the nerves connected. And to make it worse, they play the Jeopardy theme

exactly that. Uh So this guy, I can't remember what affliction he has, but it's um, it's well, no, it's something sort of like this in it he has no uh but I think it's degenerative where he has no control over his own body. Oh is it a l S. Leuke Garrick's disease. Don't think it's a l S. I wonder. And the guy was volunteering, saying, you know, I might very well die, but he's like, somebody's got to go first. Man,

I'm willing to. Yeah. The number of like nerves and blood vessels and everything that you would have to connect the spinal column to the brain, Like, how would you even do that? I don't know, man, I mean it does. It seemed like botox crazy science when I was reading it, and while means it might be. I gotta check that out. Yeah, that's amazing. I mean we're gonna do it sooner or later. Yeah, it's just insane that it's happening now. Well, I thought

for sure in the twenties at the earliest. Yeah, he called it head transplant, but once I read it, it's feels more like a body transplant. I guess. Yeah, tomato tomato head transplant sounds awesomer. That's probably why I picked it. Um, where were we? Oh, surgeries, they're also surge reas if you have severe spasticity. UM where they actually identify nerve fibers and cut those is called selective dorsal uh rise rise toemy. Yeah, and um that's a last resort surgery though. Yeah,

it's not like that's something that would go to right away. Yeah, because I would imagine once you cut a nerve to your muscle, like you can't use that muscle anymore. But if it's been spastic your whole life, you're probably like, fine, fine, just cut it. I'm sick of it. And then the cord blood therapy, which we talked about earlier. What I found was this, currently there are no approves them self therapies for treating scruble palsy, so I think they're all

in clinical trials. Um. And it's interesting this Canadian website said if you research this uh across the website, you will come across companies that say otherwise and offer fee based treatment, which is what I found, which is super sad and the worst thing to prey on people that are willing to pay whatever on something that may or may not work. So these aren't approved. They are in trials though, and they're seeing uh if either your own

cord blood. And one of the problems is people are starting to bank their cord blood more now, but it wasn't a very common thing, so people like, oh, I don't have any chord blood, so they think that sibling cord blood could um or sibling stem cells. What do they call those, like savior babies or something like that. Yeah, something like that, but um, it's not quite there, but it could be at some point. It's fascinating. Yeah, although

it's a tough act to follow. The head transplant well, sure, you know, I have a feeling that this guy won't ever you know, he probably won't do a lot of medicinal practicing if if it doesn't go well, No, who knows, he'll go back to like merging pigs and orange and tanks. It's sort of what it sounded like. Uh, your life expectancy is normal if you have CP, um, but like you indicated, you could have worshening mobility over the years. Right.

And we should also say I think a lot of people assume that people with cerebral palsy have um intellectual disabilities. They very well may. If the brain or if the blood supply or oxygen supplies cut off to your brain. Uh, that can lead to intellectual disabilities. That's almost co morbid though, right or co occurring co occurring? Did you see somebody write that in They were like, Chuck, don't worry. There's another term for it, like occurring because it's not necessarily

because the CP, it's because of the brain injury. Right. Um, so it would be co occurring. Right. Um, So some people who have CP also have an intellectual disability. You would be very much mistaken to assume that all people who have CP have an ellect disability. And I think you could probably bet that most people who have CP, who you talk to like they have an intellectual disability, would resent that tremendously because they are typically of average

intelligence or even above average intelligence. Yeah. Imagine that's a big struggle. Yeah, especially if you have this condition called dis arthria where you can't speak because you can't control those muscles. So people just assume that, um, since you can't speak, you have an intellectual disability. Or do you remember Jerry Jewel? Jerry from Facts of Life and she was also in dead Wood too. Oh yeah, she played Jewel, who I think was like an innkeeper or tavern lady

or something like that. She didn't have intellectual disabilities, but people assumed she did because she had a certain amount of disarthria. Uh. Same with Josh Blue another comedian. By the way, Jerry started out doing stand up in the seventies. Oh no, I remember that. Um, Josh Blue one last comic standing I think. Really he's a very famous stand up comedian who has cerebral palsy. Uh what about r J. Middy? Yeah, we both wrote him down. If you look at the note,

are J. Middy is at the top. He's at the top. If you have seen Breaking Bad and you know, uh and love Flynn or Walter White Jr. People loved him or they hated him. I thought he was great. Yeah, he was like I mean what you know, he's a handsome kid, he's a good actor, and why not put someone in there? Like I think people are like, well, why why did they? Why does he have cerebral palsy? Like, why not? Because people have it? And as soon as we normalize this by just saying I'm sure put him

in that role, why not exactly like it? It had no impact on the show. It might have. I mean maybe there was an extra vulnerability that the family felt as a protectors, But I think that humanized them even more rather than it added certainly in an extra amount of depth to their characters. Yeah. Have you heard of Abby Nicole Curran? She was missing, she represented I was She was Miss Iowa for the Miss USA two thousand

eight pageant um already mentioned Christy Brown, my left foot guy. Uh, there's a dude named Jerry Trailer who jogged across the United States on his crutches. Jogged across the US on his crutches, um and then Stephen Hopkins had cerebral palsy and he signed the Declaration of Independence and he had this awesome quote, my hand trembles, my heart does not. I love that guy. And then lastly, if you want to um, just kind of see what it's like to

live with cerebral palsy. There are a lot of um online journals Facebook pages of people who are more than happy to tell you about it. I came across one called CP Daily Living UM and it it's the written by the mom of a nine year old girl named Maya who has cerebral palsy. And like it's it's extremely uplifting and inspiring and then heart wrenching and just neat to just kind of peek in on this girl's life.

She's the new Karen. That's why those books captured America's attention, because it's it's really just about the ins and outs of your life. Yeah, this is this is exactly what it's like. UM. Yeah, it's a it's a neat blog for sure. So cerebral Palsy get off our backs, Kyle, Okay, and uh. Cerebral Palsy Awareness Month I believe is March. We're coming out in September. Were either late or we're early. We're both. Yes. If you want to know more about

cerebral palsy, go online. You can also type those words in the search bar. How stuff, we're dot com. And since I said search bar, it's time for listener mail. I'm gonna call this clearing up a couple of things about ice. Is this about ice? No, but we should go ahead an issue that. Um, there was a gaff about ice being more dense than water, the one liquid that's that's not And first of all, we want to thank Actually, let me take that back because that's probably wrong,

and we'll get listen to mail about that. First of all, we want to thank the forty two people who sent us messages and nineteen and counting what one just came in, we should have a counter d um. But if you listen to our Icebergs podcast, Josh very eloquently explains the correct thing. Oh I just forgot in depth in the Icebergs podcast. So thanks man. How did you know that you remembered it well? Now, someone said, Josh, you you did a great job explaining it correctly in the Icebergs podcast,

and yeah, it's just well goof. But like at this point a marionette of knowledge. It just lurched from one fact, well, proof that things get jumbled up. There after eight and fifty something shows. You know, I gotta go back and listen to Icebergs again. Remember that one, Just like when you go to bed and I put it on under your pillow and just curl up. A single tear rolls down my cheek and freezes. Um. All right, hey, guys, just want to see your podcast has been an absolute

revelation for me. I've avoided podcasts for the last decade somehow, but I started a new job with an hourly commute. We're the commuter's best friend, uh, and picked up you guys is my first one? Anyway, you're pretty much you were pretty full of info. I thought I posed a question that I came up with in the shower. Is it better to hear good news first or bad news?

I could see good news being better first, so bad news would be softened, but the opposite could make sense, helped take your mind off the bad news once you've heard the good news. Any thoughts, Uh, definitely, it's a personal preference bad news first. Yeah, I'm a bad news first guy too. Yeah, let's get it out of the way. I want to know the bad first and then yeah, there's a treat coming afterward. Yeah, you know, you get this sugar with the medicine. Yeah, like Mary Poppins. All right,

I agree. Um. Mostly I want to tell you, guys how much you've enriched my life, um, by not only making my commute better, but teaching me about topics that had no idea. We're so fascinating. Like so you get a lot of emails like this, but from the bottom of my heart, I want to say thank you for what you do. And that is Jacob Beasley. And there's another question. Okay, well this is a ps. What's the

difference between a fact and a factoid? I always thought a factoid in a statement of the pierced true, that isn't you guys use a lot. I'm sure you. I'm sure I'm incorrect, Jacob, You're not. We are factoid Now, factoids one of those words because language evolves as a living thing that now has officially two meanings. Norman Mailer invented the term factoid in the seventies like truthiness, yeah, sort of, but his original definition was a piece of

information becomes accepted as fact even though it's not true. Um, that sounds like Norman Mailer all over totally. But since then it is evolved, it can mean just a insignificant little fact, right, like a nugget. Yeah, it's it's evolved into what it sounds like. Finally. Yeah, so language evolves, people, it does, man, octopi, octopusses, octopods, take your take your pick, and stop being weirdos about it. Yeah, pedantry is no

fun for anyone. It's not. If you want to hang out with Chuck and Iron our social meds, you can catch up with us on Twitter at s y s K podcast. You can hang out with me at Josh Underscore UM Underscore Clark. You can hang out on face Book at Facebook dot com slash Stuff you Should Know or Facebook dot com slash Charles W. Chuck Bryant Uh. You can send us an email to Stuff podcast at how stuff Works dot com and has always joined sort a home on the web, Stuff you Should Know dot com.

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