600 Section - A Case of Functional Deterioration in an Older Adult with CP: Challenges in Diagnosis, Treatment and Rehabilitation

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

IA

Ian Ackers, DO, PhD

Pedatric Rehabilitation Medicine Fellow
Gillette Children's Specialty Healthcare
Lansing, Michigan, United States

Co-Author(s)

DW

Duncan O. Wyeth, MA

Retired State of Michigan agency director; retired MI STATE UNIV. adjunct facultyRetired
Retired from State of Michigan and Michigan State University
Eagle Harbor, Michigan, United States
Michael T. Andary, MD, MS

Associate program director
Michigan State University
East Lansing, Michigan, United States
KR

Kenneth J. Richter, DO, DO

Clinical proffesor MSU-COM
Micigan State University COM
Lake Orion, Michigan, United States
LK

Linda E. Krach, MD

Physician/Clinical Researcher
Gillette Children's Specialty Healthcare
Minneapolis, Minnesota, United States
Edward A. hurvitz, MD (he/him/his)

Professor
Department of PM&R, Michigan Medicine
Ann Arbor, Michigan, United States

Case Diagnosis: Cervical Myelopathy in Cerebral Palsy (CP)

Case Description: A 78-year-old male with a history of spastic/dystonic cerebral palsy (GMFCS I-II) presents with a subtle decline in motor function over 6-12 months, following a fall with facial trauma. Despite maintaining an active lifestyle, he experienced increased falls, worsening balance, fatigue, and slow overall decline. MRI of the cervical spine showed moderate to severe degenerative changes, multilevel spinal canal narrowing, and cord compression, worst at C3-C4. Surgical intervention was considered to prevent further compression; however, the decision was complicated by the challenge of attributing the deterioration to cervical myelopathy, aging with CP, deconditioning, or another unknown issue. Both patient and physicians hesitated due to factors like his potential response to major surgery, 10+ weeks with a neck brace, lengthy rehabilitation, age, deconditioning, and psychosocial considerations, all in the context of CP.

Discussions: Ultimately, a C2-C6 decompression-laminotomy and fusion was performed. Rehabilitation after surgery was challenged by insurance denial for inpatient rehabilitation against medical recommendations. Consequently, the patient completed rehabilitation at a residential facility specializing in neurological rehabilitation. He eventually returned home and resumed his prior level of activity with slight improvement 18-weeks post-operation.

Conclusions: Aging individuals with CP face unique challenges due to the lifelong nature of the condition and its interaction with aging.In individuals with CP, may be unrecognized or ignored due to overlapping symptoms such as upper motor neuron abnormalities, gait disturbances, and upper limb weakness. In this case, decompressive cervical spine surgery prevented further decline and improved function. The case highlights a positive patient outcome despite challenging decisions regarding diagnosis, care, and healthcare system barriers to care. Further research into identifying cervical myelopathy before significant, irreversible functional decline is warranted.