Understanding Cerebral Palsy with Dr. Jennifer Miller

Jennifer Earle Miller, M.D., is a physiatrist, or physical medicine and rehabilitation doctor, at Shriners Children's New England. She has expertise in the treatment of patients with cerebral palsy, a condition that appears in infancy or early childhood and permanently affects body movement and muscle coordination. Dr. Miller explains what cerebral palsy is, dispels common misconceptions and describes why working with this patient population is so rewarding.

What is cerebral palsy?

Cerebral palsy (CP) is a condition that affects a child's brain before birth, at birth, or in the month after birth, and it can present in many different ways. One characteristic is that it affects the way a child moves. It affects their muscles but not necessarily their intelligence. There is a very broad spectrum. So, if you've met one person with CP, you've met one person with CP.

How do you help families understand what cerebral palsy may look like for their child?

One important characteristic of CP is that whatever type of injury to the brain took place doesn't change or worsen over time. However, the way it presents itself in an individual child's life will change because children grow and change. I spend a lot of time during appointments helping families with expectation management about what their current reality looks like and how things might look as their child grows or develops new abilities.

What are some common misconceptions people may have about CP?

I think a common misconception is that automatically it means someone's intelligence is different. I think you need to evaluate that separately and with nuance, because someone could require a lot of physical assistance from caregivers and still have normal intelligence. Or someone who presents with a very mild CP and is walking and very mobile might have a concurrent behavioral or developmental diagnosis affecting their learning abilities. So those two entities do not go hand in hand and need to be thoughtfully assessed.

What are some things you wish people knew about CP?

I think at the most basic level, I wish more people knew what CP is. Often, I am starting absolutely from scratch, even with families who know their child had something happen either during their birth or after birth. They have never been given the terminology of CP to relate to that experience. Or there is some fear around what CP means because of preconceived ideas they have of someone who might be very significantly affected, and there is a huge spectrum of what falls under CP. So, the term in and of itself shouldn't be scary. The idea that we have a static condition, a condition that is not going to worsen, not going to progress, but that we're going to adapt to over the long game, is hopeful and a good starting place for beginning to strategize around care.

What are some things people may not realize about individuals who have CP?

Often, people don't realize how much people with CP are capable of, especially when given the right tools and the right support. I think challenging someone to push their body to their own limits and enjoy activities that are meaningful to them is an important part of their care.

What are some of the amazing things you have seen your patients accomplish?

What immediately comes to mind are some of the athletic endeavors of some of my patients. I had one patient with hemiplegic cerebral palsy, meaning that half of his body is affected by a stroke that he had before he was born. Nonetheless, he was a track star and would tell me, "Dr. Miller, it doesn't look pretty, but it works," and would move his body much faster than many of his teammates. I have also had patients who have figured out, despite limitations of their body, how to climb the Adirondack Mountains, how to participate in competitive shooting events, even though their arm was hemiplegic, so only one of their two arms could help hold and stabilize the equipment from their wheelchair. But it is very fun to see them be creative in the way they engage, especially in sport and recreation.

I have also been amazed by some of my patients' academic pursuits. I have kids with cerebral palsy I cared for throughout their childhood off at college studying to be a doctor, an aerospace engineer, a cyber security specialist and more.

What makes working with children with CP so rewarding?

I just love the tone of my visits with patients with CP because at the end of the day, there is always a hopefulness. There is always the idea that in the future, we will either try something new or come up with something else, or even though we are addressing a chronic medical condition, something that they are always going to have, there is an endless opportunity to reframe and think about it differently.

What would you like people to know when they meet someone with CP?

When you meet someone with CP, you are meeting someone who is resilient and brave, someone who is creative, and someone who might have more barriers in their day-to-day life, but at the end of the day, probably wants many of the same things that you want. Greet them openly, learn more about them, and respect the individuality of each patient with CP, understanding that they're having a very unique experience all their own.