Bhooma Aravamuthan, MD, DPhil

"From a medical intervention perspective, there are things like steroids, antenatal steroids given to mom, magnesium given to mom in the setting of preterm delivery, and vital sign control in babies that are born in the NICU. One of our biggest interventions for reducing the risk of CP is cooling."

Cerebral palsy (CP), a group of disorders that impact an individual’s ability to move and maintain balance, is the most common motor disability in children. CP is typically diagnosed in the first or second year after birth, with some diagnoses occurring a few years later. From birth to 5 years of age, children are expected to reach movement milestones such as rolling over, sitting up, standing, and walking; however, not achieving these can be a sign of CP.

, assistant professor of pediatric neurology, Department of Neurology, Washington University in St. Louis, has been a leader within the CP community, both as a clinician and a researcher. While there is no current method of preventing CP, she believes that the focus should shift more towards social interventions and empowering patients and their families with the tools they need to live as comfortably as possible.

® recently sat down with Aravamuthan to discuss some of the general facts about CP, how it develops, and who might be at an increased risk. She also provided insight on the ways of preventing CP, or at least fully mitigating the effects of it.

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The assistant professor of pediatric neurology at Washington University in St. Louis provided an overview of cerebral palsy and ways to reduce the risk of developing the condition. [WATCH TIME: 3 minutes]

Characteristics of and Prevention Methods for Cerebral Palsy: Bhooma Aravamuthan, MD, DPhil

“Cerebral palsy is quite common, with some estimates [putting it at] at least 3 out of every 1000 live births affected by [it]. That’s a lot of kids, and there are not enough neurologists and neurodevelopmentalists to diagnose all of them.”

A recently published dataset from a survey conducted by Bhooma Aravamuthan, MD, DPhil, assistant professor of pediatric neurology, Department of Neurology at Washington University in St. Louis, and colleagues suggests that despite their desire to be involved in the process, child neurologists and neurodevelopmentalists (CNs/NDDs) are not often included in the diagnosis of cerebral palsy (CP).

Their data showed that the majority of those surveyed felt that CNs/NDDs should always be involved in CP diagnosis, but 42% reported that their patients were typically not diagnosed by these stakeholders. More intriguing for Aravamuthan was that 18% of these respondents did not receive referrals to establish the diagnosis of CP at all. In this conversation with 

, she expressed the group’s desire to expand the survey to a larger group of neurologists and neurodevelopmentalists to assess the feasibility of making a recommendation to involve them in the CP diagnosis process.

Additionally, Aravamuthan discussed some of the other initiatives that the special interest group is pursuing as they further their research into this topic. She described the current landscape of CP care and management, explained some of the ongoing challenges in that care, and offered up her insight into what to expect from the field in the coming years.

REFERENCE
Aravamuthan BR, Shevell M, Kim YM, et al. Role of child neurologists and neurodevelopmentalists in the diagnosis of cerebral palsy. 

. 2020;95(21):962-972. doi: 10.1212/WNL.0000000000011036.

The assistant professor of pediatric neurology at the Washington University in St. Louis spoke to the insights of a recent survey she and colleagues conducted.

The Variability of Cerebral Palsy Care: Bhooma Aravamuthan, MD, DPhil

“We all, as a whole, perhaps as neurologists, are very interested in diagnosis—what’s causing the problem, what is the diagnostic workup going to be? There was a heavy lean in the respondents toward our skills in diagnosing cerebral palsy.”

After developing a special interest group (SIG) to discuss the diagnosis of cerebral palsy (CP) at the 2019 Child Neurology Society annual meeting, Bhooma Aravamuthan, MD, DPhil, and colleagues conducted a survey of child neurologists and neurodevelopmentalists (CNs/NDDs) to find out more about the role that they can fill in the diagnosis of cerebral palsy (CP).

All told, the data showed that the majority of those surveyed felt that CNs/NDDs should always be involved in CP diagnosis, but 42% reported that their patients were typically not diagnosed by these stakeholders. Even more intriguing for Aravamuthan was that 18% did not receive referrals to establish the diagnosis of CP at all.

To discuss the findings of this survey into CP care further, 

spoke with Aravamuthan. The assistant professor of pediatric neurology in the Department of Neurology at Washington University in St. Louis, detailed the results, what she found to be surprising about the data, and what they imply considering they conflict with the current guidelines for the diagnosis of CP.

The assistant professor of pediatric neurology at Washington University in St. Louis spoke to the results of a recent survey she and colleagues conducted.

Reassessing CP Diagnosis to Involve Child Neurologists: Bhooma Aravamuthan, MD, DPhil

“[We were] really just [trying] to get a pulse of how everybody was feeling, and in that meeting, it was clear that one of our main goals as a SIG was to really define what the role is of child neurologists and neurodevelopmentalists in cerebral palsy care.”

At the 2019 Child Neurology Society annual meeting, Bhooma Aravamuthan, MD, DPhil, and Young-Min Kim, MD, and colleagues put together a special interest group (SIG) to discuss the diagnosis of cerebral palsy (CP). What came of that discussion was a large amount of interest in the role that child neurologists and neurodevelopmentalists (CNs/NDDs) play in that increasingly complicated process.

As such, they decided to conduct a survey of the group to determine the landscape of CP diagnosis and to re-assess what might be the optimal role for these stakeholders to operate from. In November 2020, the group published the findings of their survey in 

, which showed that the majority of those surveyed felt that CNs/NDDs should always be involved in CP diagnosis, but less than half experienced that their patients with CP were typically not diagnosed by CNs/NDDs, and 18% did not receive referrals to establish the diagnosis of CP in any way.

To find out more about this ongoing discussion in CP care and about the survey itself, 

spoke with Aravamuthan. The assistant professor of pediatric neurology in the Department of Neurology at the Washington of University in St. Louis discussed the findings in this interview.

. 2020;95(21):962-972. doi: 10.1212/WNL.0000000000011036

The assistant professor of pediatric neurology at the Washington University in St. Louis spoke to the roles of multiple specialists in CP diagnosis.

The Role of Child Neurologists in Diagnosing Cerebral Palsy: Bhooma Aravamuthan, MD, DPhil

“[Pediatric neurologists] are particularly well equipped to diagnose cerebral palsy and determine the cause of cerebral palsy—but caring for these people doesn’t just stop with diagnosis.”

Data which were set to be presented at the 

American Academy of Neurology (AAN) 2020 Annual Meeting

 by Bhooma Aravamuthan, MD, DPhil, assistant professor of neurology, Division of Child Neurology/Movement Disorders, University of Washington in St. Louis, and colleagues revealed that there is wide variability in cerebral palsy diagnosis among different providers. Ultimately, they identified that significant differences between diagnoses from neurologists and non-neurologists were common.

For Aravamuthan, this highlights an ongoing challenge in the care and diagnosis of these patients. She told 

 in an interview that the role of the neurologist in the diagnosis of these patients is impacted by a number of factors and improving that role may help improve the care of these patients. Although, caring for an individual with cerebral palsy requires a more connected approach that fits the ongoing move in medicine toward a more collaborative effort from multiple providers.

To find out more about what needs to be done to improve this care and what role the adult and pediatric neurologist can play in that, 

 sought Aravamuthan’s insight. She detailed the real need for a systemic, multi-specialist approach to this systemic condition, and provided the main takeaways from her and her colleagues’ work.

Aravamuthan B, Fehlings D, Kruer M. High Practice Variability in Cerebral Palsy Diagnosis: Need for clarification of the consensus definition? 

The assistant professor of neurology at the University of Washington in St. Louis discussed the need for a systemic, multi-specialist approach to cerebral palsy and provided the main takeaways from her and her colleagues’ work.

Bhooma Aravamuthan, MD, DPhil: Taking a Multi-Specialist Approach to Cerebral Palsy

“Cerebral palsy has, as a disorder—even though it’s remarkably common and is the most common cause of motor disability in childhood&mdash;fallen kind of in the middle of several different specialties, and neurologists, as of late, have not taken real ownership over a lot of these patients.”

Bhooma Aravamuthan, MD, DPhil, assistant professor of neurology, Division of Child Neurology/Movement Disorders, University of Washington in St. Louis, and colleagues conducted a survey of a number of various health care physicians who come in contact with patients who may require a diagnosis of cerebral palsy. Their aim was to assess practice variability in its diagnosis, one of the challenges in this space for the last decade.

Their data, which was set to be presented at the 

, revealed that in spite of the international consensus definition for cerebral palsy, significant differences between diagnoses from neurologists and non-neurologists were common. In their survey, the group offered 4 hypothetical, but common patient scenarios for diagnosis, and noted that in 1 of the scenarios, non-neurologists tended to cite hypotonia, normal MRI, and/or genetic diagnosis as exclusion criteria for cerebral palsy, while neurologists appeared to only cite genetics—a significant difference in respective approaches.

To find out more about what these data suggest about the factors that may contribute to these diagnosis inconsistencies, including lack of provider education and awareness, as well as the role neurologists play in the care of these patients with cerebral palsy, 

The assistant professor of neurology at the University of Washington in St. Louis detailed the &shy;&shy;factors that may contribute to these inconsistencies in cerebral palsy diagnosis and what role neurologists should play.

Bhooma Aravamuthan, MD, DPhil: Improving Neurologists' Focus on Cerebral Palsy

“There are a lot of other disorders that we’re learning about that look like cerebral palsy but aren’t and are treatable—because of that the diagnosis is getting more and more complicated.”

, data was accepted for presentation from a survey study conducted by  Bhooma Aravamuthan, MD, DPhil, assistant professor of neurology, Division of Child Neurology/Movement Disorders, University of Washington in St. Louis, and colleagues. The study aimed to assess practice variability in cerebral palsy diagnosis, which has been beset by challenges for the last decade, in part due to the wide variety of specialists who care for these patients.

All told, the study found that despite having an international consensus definition for cerebral palsy for more than a decade, there were significant differences between diagnoses from neurologists and non-neurologists. In 1 of the scenarios presented in the study, non-neurologists cited hypotonia, normal MRI, and/or genetic diagnosis as exclusion criteria for cerebral palsy, while neurologists appeared to only cite genetic diagnosis, highlighting significant differences in their respective approaches.

To find out more about this undertaking and what the data suggest about the ability for neurologists to diagnose patients with cerebral palsy, 

The assistant professor of neurology at the University of Washington in St. Louis discussed a study she and colleagues conducted which revealed significant differences between practitioners in diagnosing cerebral palsy.