Fears that Mid Staffs patient care scandal may be repeated

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The Francis report into patient care and an abnormal death rate at Mid Staffs NHS hospital trust called for more transparency from doctors when mistakes affecting patient care are made.

However recent allegations against the Care Quality Commission over MorecambeBay and Cumbria maternity death rates have raised concern that another scandal like Mid Staffs could arise.

In 2008, the Healthcare Commission launched an inquiry into “excessive” death rates among patients arriving as emergencies at the Mid Staffs hospital – and a subsequent report criticised health bosses at the trust for presiding over a regime of “appalling” conditions in which patients were so thirsty they drank water from flower vases.

Junior doctors were also left to make important critical care decisions – and nurses were allowed to use vital life saving equipment without sufficient training.

New Labour Health Secretary Andy Burnham announced a public inquiry following publication of the report and in 2010 it fell to the new Coalition government to launch the inquiry.

Robert Francis QC was appointed to sift through more than one million documents and listen to the evidence of more than 160 witnesses before the Francis report into his findings was published earlier this year.

The main witness was Mid Staffs former chief executive Sir David Nicholson, who had headed up the trust during the period of 2005-2008, when the abnormal death rate and failings in care had been detected at the Staffordshire hospital.

Giving evidence to the inquiry Sir David claimed, however, that the conditions at the Mid Staffs trust did not represent a systemic failure in NHS care, as it was the only hospital to have been flagged up with failing care. Counsel for the inquiry termed his assertion “naïve” and “dangerous”.

The Francis report also called for criminal charges to be brought against doctors or anyone who manipulates data to hide abnormal death rates or failings in patient care at hospitals.

The report also criticised the Royal College of Nursing for its failure to support “whistleblowers” among nursing staff who had tried to highlight failures in patient care at their own health trusts.

Despite recommendations in 2010 that Mid Staffs be de-authorised – and a Francis report recommendation that a new culture of compassion be made paramount in the recruitment, education and training of nursing staff – many families who lost loved ones in terrible circumstances at Mid Staffs continue to question how this could have happened and whether it might occur again.

Some of the families received an average compensation payout of £11,000 from the NHS – but many NHS managers involved went on to hold senior management positions in the NHS, including Sir David Nicholson – now CEO of the NHS, but who is due to step down from his NHS post by March 2014.

The investigations into mother and baby deaths at Cumbria and Morecambe Bay NHS Trust continues to raise fresh concerns over patient care in the NHS and abnormal deaths rates which may be linked to this.

More information on the Stafford Hospital Scandal.

Main causes of brain injuries to children

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newbornthumbChildren can be born with conditions which have caused brain injury during gestation – or brain injury sadly can sometimes occur during delivery.

Acquired traumatic brain injury (TBI) is also a common result for both children and adults who are involved in accidents in which they suffer a head trauma on impact – this might be in a sports accident or a road traffic accident (RTA).

It can be very difficult to pinpoint the causes of congenital brain injuries in children, some of which might have resulted from adverse events during pregnancy or might be genetic.

One of the most common causes of brain injury at birth is oxygen deprivation (asphyxia) and this can occur if birth is delayed or the umbilical cord become wrapped round the baby’s neck.

Some of the main causes of brain injuries to children include:

Birth defects leading to brain injury

  • Asphyxia (lack of oxygen in the womb or during delivery)
  • Genetic defects (an inherited condition passed down the family)
  • Infections (mother suffers infection passed through the umbilical cord eg rubella)
  • Neural tube defects (the neural tube connecting the spine and brain does not develop properly resulting in conditions like spina bifida)
  • Stroke in utero (baby suffers brain haemorrhage while in the womb)
  • Tumour
  • Trauma (eg physical assault or impact).

Babies who do suffer an adverse event in the womb – or whose mothers may be ill or involved in an accident – will not always be born with brain injury; but some adverse events such as oxygen deprivation in the womb or during birth, or a neural tube defect, will make this more likely.

Serious conditions which affect the foetus may result in miscarriage or stillbirth. The neural tube defect anencephaly means that the brain does not develop at all and stillborn babies are sometimes found to have suffered this defect in the womb.

Anencephaly occurs when the neural tube leading from the spine does not seal at the end where the brain should grow – and therefore the “instruction” for the skull which protects the brain and the brain itself to grow is not transmitted, leaving just the brain stem at the end of the spinal column.

Few babies will survive this brain defect, but one baby in the US, Nicholas Coke, has survived past his first birthday. Anencephaly usually affects girls more than boys and often stillborn baby girls are found to have suffered anencephaly during a post-mortem.

Brain injury can also occur postnatal – especially if a baby needs medical treatment after delivery and complications arise. Many babies survive heart surgery well, but conditions such as stroke can flood the brain with blood and cause severe brain injury.

Medical negligence in which babies are left without an oxygen supply for a period is another commonly reported cause of brain injury in children – this is still very rare, but because of the catastrophic brain injuries which oxygen deprivation (asphyxia) can cause, claims for compensation in such cases can end in the NHS or private clinics having to pay out millions of pounds via their insurers.

Accidents are the most common cause of brain injury in children – and once babies begin to crawl, parents need to be extra-watchful, as blows to head can occur and not even leave a mark, although concussion and underlying brain injury such as a blood clot might have resulted.

Concussion is classed as mild, moderate and severe and usually involves symptoms of

  • confusion
  • dizziness
  • headache
  • loss of memory
  • problems with speech or remembering vocabulary or details
  • sight and hearing disturbances
  • vomiting.

Even mild concussion needs to be reported to a doctor and monitored for a week or so after the injury, as concussion can sometimes develop into more serious brain injury if a small blood clot has formed or a second concussion occurs if a patient falls or hits their head again.

A scan can detect blood clots, so your GP may recommend that you take your child to the nearest A&E after a blow to the head.

If your child exhibits symptoms of vomiting, losing consciousness, and has blood or clear liquid in their ears or nose, then medical help should be sought immediately.

Incidents which may result in head/brain injury in children include:

  • Falls from height –  windows or balconies
  • Leisure centre accidents –  swings, climbing frames
  • Riding accidents – on holiday or at home
  • Road traffic accidents – cars, motorcycles, quad bikes, scooters, bicycles
  • School playground accidents –  fights, trips, slips and falls
  • Sports accidents –  blow to the head from balls and bats
  • Swimming accidents – drowning causes oxygen deprivation which may result in brain injury if the child survives.

Sadly some children suffer brain damage if they are allowed to drink alcohol or access drugs, take over-the-counter medications, or drink or sniff cleaning fluids or aerosols.

Parents need to be vigilant at all times with their children – and be aware that peer pressure among youngsters can make them indulge in risky behaviour which would normally be out of character.

The charity Headway offers support to families whose child has suffered acquired traumatic brain injury or a brain defect at birth.

Help resources for children with brain defects

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babysasleep3Congenital brain defects is an umbrella term for a range of brain disorders usually present at birth or diagnosed in early life. The human brain starts developing five weeks into a pregnancy (normal as opposed to assisted conception) and continues to develop until the moment of delivery.

Clinicians used to think that the human brain was fully developed at around 37/38 weeks of pregnancy. Research has shown that in the last weeks of gestation, the brain’s grey matter (the cells which store information, memories and skills) becomes denser and so children born prematurely may be at a disadvantage in terms of their development, compared with children born full-term.

If the development of the brain as the foetus grows is interrupted or affected by the poor development of other organs, the brain may not develop properly. Poor development of the skull, which protects the brain, may interfere with brain development in the foetus. Other risks might include antenatal infections, neural tube defects (the neural tube links the spine to the developing brain) which may lead to conditions such as spina bifida or in rare cases anencephaly (when no brain grows in the foetus). Anencephaly is more common in female foetuses and is sometimes diagnosed at post-mortem after a stillbirth.

Cerebral palsy is another congenital brain defect which may be caused by adverse events during gestation or delivery – or in rare cases may be genetic.

Congenital brain defects are still rare but there are now in place resources and health services which can offer care to a child affected and their family – as well as making sure that specialist educators and therapists are appointed to a team which will provide a multi-agency solution to caring for a child born with congenital brain defects.

Because children with brain defects may have a range of different symptoms – from problems with movement to epilepsy and hearing or sight problems – a team is usually put together by local healthcare providers and social services, as well as charities and other support agencies so that a complete care package is designed for each individual child and their family.

Families may have to pay for some services, however – especially if a child has special needs which may not fall within the remit of the local authority. For example, a family may feel that a certain type of therapy would be best for their child, but this is not provided by the local healthcare or social services. Some families go to court to win funding for their child in these cases.

A whole range of agencies and charities can help families with access to care for a child born with congenital brain defects and some of these include:

Support and advice for children with congenital brain defects or acquired TBI

One of the leading charities which offers advice and information to parents of children born with congenital brain defects is Headway.

Some of the other principal charities dealing with brain injuries in children include:

CBIT (Child Brain Injury Trust)
BIRT (Brain Injury Rehabilitation Trust)
Disability Living Foundation
Epilepsy Action
Speakability
The Children’s Trust
Trust-Ed
UK Acquired Brain Injury Forum

The charity Scope also provides information and advice to families whose children are born with cerebral palsy and other disabilities. The Scope website has information about the latest therapies available for those with brain injury.

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The support group BASIC (Brain and Spinal Injury Centre, based in Manchester) offers a national helpline (0870 750 0000) and works with the Department of Health to advise on best practice in the treatment of brain injured patients in the UK. BASIC has been at the forefront of many developments in treatments for those with congenital brain defects and acquired traumatic brain injury (TBI).

The US website Kids’ Health also offers useful information about children with congenital brain defects such as cerebral palsy.

For mothers-to-be who want to know how to stay healthy before and during pregnancy, as well as information about babies with brain defects, the UK website Women’s Health can advise on a wide range of issues, including gestational diabetes and the foetus, congenital infection defects and structural and metabolic defects which may affect the development of the brain during gestation.

Other support groups which can help with specific needs such as mobility issues, rehabilitation or independent living include:

Independent Living Funds
Mobilise
Momentum
Motability
Royal Association for Disability and Rehabilitation.

The care available to children born with brain defects may vary between local UK health authorities and education authorities – and in this case it may be that parents will need to consult children’s lawyers about issues like home adaptation and obtaining an SEN Statement to ensure their child receives the help they need with their education.

A full list of charities and support groups which can assist with children born  with brain defects or with acquired traumatic brain injury  is available at BrainInjuryExperts.co.uk.

Toys for babies with brain damage

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babytoyWhen a baby is born with brain injury, it is important that they receive as much external stimulation as possible to help them develop their motor and sensory functions. Brain injury at birth can not only mean problems with moving, but also speaking, hearing and being able to see.

Often one of the first indications that something may be wrong with a seemingly healthy baby is a failure to react to auditory or visual stimuli, such as music, loud noises, lights or mobile toys which hang above their cot.

Babies all develop at their own rate – and babies are born with their own tastes and a sense of what they like and do not like, so if a baby fails to react to a certain stimulus it does not necessarily mean that there is something wrong.

However, at three months, six months, nine months and 12 months a progression in development should take place, from trying to sit up and reach for toys or react to their surrounding by laughing or even crying – to trying to stand, walk and talk. Babies who are left in cots and not given attention when young may falter in their development and remain silent and immobile. But a baby whose parents take the time to play with them, talk to them and provide them with stimuli such as toys and interaction with other children should begin to develop speech, walking and social skills within the first 12-18 months.

A baby’s surroundings are extremely important to them, regardless of whether they have a brain injury or not. Babies at first can do very little fro themselves and therefore textures can be very important to them – even the interior lining of the carry cot can be fascinating if they can feel a slightly rough texture or a pattern when they touch it with their fingertips.

This is why children’s toys are often literally all bells and whistles, as well as being bright colours and different fabrics and materials.

For babies unable to speak, see, hear or walk – or even move properly in their environment – toys are not only vital to add to their everyday experiences, but also to help them develop to the very best of their abilities and learn about their surroundings – which in the future they will need to do to stay safe and negotiate their home environment.

Many therapies for patients with acquired traumatic brain injury (TBI) involve repetition and almost game-like therapies which reprogram the brain to learn the skills and movements which might have been lost after the brain injury. Some adult patients may feel that carrying out therapies which appear to be a return to their early years is frustrating – but repetition is how the human brain takes in and stores information, memories and new skills.

For babies, any toy can be a new experience – and usually with tiny babies the first action is to place the toy or object in their mouth, as this is the primary sensory area for a tiny baby.

Babies also have very sensitive hearing and eyesight, so bright lights, loud noises – and even extremes of temperature – should be avoided, as the body’s temperature regulator in a baby is not as developed as a child or adult human body.

It is also important to remember that babies with brain injury may not react in the same way as other babies, who will cry, whimper, shake their fists or laugh in response to stimuli which scare them or which they perceive as fun.

babystuffedtoysTherapists treating a baby or small child with brain injury will devise a treatment plan involving toys which stimulate the areas of the brain which may not be as reactive as they should be – and will also advise families on the best toys for a brain injured child.

Children with deaf-blind disabilities would, for example, benefit from sensory experiences such as lights which they may be able to perceive if they have some basic sight which detects shapes or light; or tactile sensations they can enjoy, from the feel of a soft toy with different textures to a breeze blowing gently on their face or hand.

Children also love playing with their brothers and sisters, as well as their parents and other family members, so the act of playing with a child suffering from brain injury can help them assimilate new information and learn new skills, as well as enjoying their playtime and toys.

Here are some of the leading online suppliers of toys for children with special needs:

  • The US website Fat Brain Toys is full of ideas for toys suitable for children with special needs – including autism, brain injury, dyslexia and blindness.
  • Sometimes toys for children with special needs can be more expensive, but Kaleidoscope Toys offers toys for children with brain injury at much reduced prices.
  • The website All4KidsUK also offers specially adapted toys for children with brain injury or special needs – and is a one-stop shop for advice on holidays for children with special needs, as well as services and products.
  • The Sensory Toy Warehouse offers toys from around £1.50 which are designed to offer special needs and brain injured children a wide range of sensory experiences, from tactile toys to light and sound effects and toys to chew, squeeze and stroke.
  • Other online toy shops offering toys for special needs and brain injured children are ToyShopUK and Special Needs Kids.

Research into children’s brain injuries gets $1.6M boost

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Donation comes amid heightened awareness of sports-related concussions

Research into better ways to treat concussions and other brain injuries among kids is being boosted by a $1.6-million donation

Thanks to the generous gift from the Ronald and Irene Ward Foundation, new labs for pediatric brain injury research have been developed at the University of Calgary-Alberta Health Services’ Alberta Children’s Hospital Research Institute for Child and Maternal Health.

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Understanding child brain injury symptoms

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babydummyMost children have scrapes and knocks during childhood and school activities –  and recognising the symptoms of conditions like concussion  can help parents make the right decision about whether to see a GP or take your child to A&E.

Some children are also born with brain injury or sadly suffer brain injury at birth – and understanding what is happening in the brain can help parents, family and friends communicate with a brain-injured child and recognise what their needs may be.

Brain injury ranges from mild concussion to catastrophic brain injury, either from a mismanaged birth, adverse event during gestation or delivery – or as the result of an accident or event after birth (acquired traumatic brain injury or acquired TBI).

The degrees of concussion can also range from mild to moderate or severe – and although concussion may seem like a temporary condition, if an underlying symptom such as a blood clot develops after a blow to the head or fall, then concussion can mean the patient’s condition deteriorates rapidly.

The symptoms of brain injury generally are:

  • Abnormal gait and problems walking
  • Abnormal movements in limbs
  • Facial paralysis or facial palsy (as in Bell’s palsy)
  • Hearing and sight impairment, including deaf blind conditions
  • Lack of speech or impaired speech
  • Learning difficulties.
  • Physical disability
  • Trembling, shaking and palsy (as in cerebral palsy)
  • Slow development in babies and children.

If brain injury occurs following a blow to the head or an adverse event such as oxygen deprivation during a swimming accident or even surgery, the symptoms of brain injury may be:

  • Blackouts
  • Blood or clear liquid in nose or ears
  • Headache and pain
  • Lack of consciousness
  • Listlessness
  • Memory loss
  • Problems standing or walking
  • Paralysis
  • Palsy and trembling limbs or lack of control over limbs
  • Shouting and/or swearing irrationally
  • Speech difficulties, including loss of vocabulary or jumbled speech
  • Writhing or stiff limbs
  • Vomiting.

Brain injury which results from an accident – eg concussion – can be temporary. Other causes of brain injury include events such as strokes – when a blood clot may form and flood an area of the brain.

When an individual appears to have suffered trauma to the head, an adverse event such as stroke or heart attack, or an accident or incident in which they were deprived of oxygen, it is vital to seek medical help immediately. The hour following a stroke is known as the golden hour by medics, because patients who are treated with clot busting drugs within an hour of a stroke have been found to suffer fewer side effects, including fewer mobility issues and speech problems.

The effects of brain injury on an individual are caused by a break in communication between the white brain matter, which contains cells called neurotransmitters – and grey matter which contains cells storing information, memories and motor skills such as walking, talking, movement and coordination.

Depending on which part of the brain suffers injury, messages sent out by the neurotransmitters cannot be processed properly by the cells in the brain’s grey matter, which acts as a databank. This means that although a child or adult with brain injury knows what they want to do or say, the messages from the brain telling their body to do it do not get through.

Neuroscientists such as Professor Adrian Owen, who investigates “locked in syndrome” among brain damaged patients, have found that even a severely brain injured individual may be able to store new memories, be aware of what is happening around them – and their brains may even be able to respond to external instructions to move their bodies; but none of this mental activity is apparent to the onlooker, who may feel the patient is in a persistent vegetative state and has no awareness of their surroundings.

This can explain why patients with brain injury who do display activity and cognitive skills can become incredibly frustrated and feel isolated. Your loved one may be firing on many cylinders internally – but the messages their brain is sending out do not reach the target area of the body to enable them to speak, walk, move or even visibly react in some cases to what is going on around them.

cerebralpalsytoddlerChildren with brain injury – eg cerebral palsy – usually appear slower in their development than their peers. Catastrophic brain injury in children results in very obvious symptoms, some of which may become more apparent as doctors and therapists begin working with the child. Brain injury which is less evident may take time to diagnose and evaluate – and usually doctors will carry out MRI and CT scans to confirm the extent of brain injury in a child who may have cerebral palsy or another birth defect affecting their brain.

In the case of acquired traumatic brain injury, children’s brains can be remarkably adaptive when it comes to learning new skills – young brains are endowed with the ability to assimilate information quickly because they have neuroplasticity, a quality older brains lose as they age: it is as though new information and memories are literally imprinted on young brains.

Brain injury therapies often involve daily repetition to learn or relearn skills and information – and the brain is able to adapt after brain injury and frequently another part of the brain will slowly take over the function which has been lost in the injury.

Getting a diagnosis as soon as you suspect your child is not developing as quickly as they should can help both your child and the family adapt and make progress together in dealing with the situation.

As your child grows there will times when they feel frustrated with their own progress – but many children with brain injury lead happy and fulfilling lives and develop new skills throughout their lives, even if this take a little longer than even they themselves would like

What causes cerebral palsy in babies?

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cerebral palsy in babiesCerebral palsy is the term used to describe a range of conditions related to developmental and movement issues, which are commonly the result of brain injury at birth, or an adverse event during pregnancy, such as an infection which causes brain injury to the foetus. In rare cases, there may even be a genetic reason for a baby being born with cerebral palsy.

High profile compensation cases involving babies born with cerebral palsy often cite medical negligence at birth as the reason, and usually this involves oxygen deprivation during delivery or while the foetus is in the womb – for example, when a Caesarean section is delayed or a baby has the umbilical cord wrapped round their neck during delivery and is unable to breathe properly.

Sometimes the brain simply does not develop properly during pregnancy – and it can be very difficult for doctors to diagnose this before delivery. There is currently no diagnostic test for cerebral palsy during pregnancy. Babies can also experience brain trauma in the womb, such as a stroke – or may not develop fully for a wide range of reasons.

The first trimester of pregnancy is thought to carry the highest risk for damage to the foetus, which is why mothers-to-be are advised not to smoke, drink alcohol or take part in physically risky activities. Remaining stress free during pregnancy is now also thought to offer the foetus the best chances of normal development.

Premature births may also carry a higher risk for cerebral palsy because the brain has not had the opportunity to develop as much as a full-term foetus.

Researchers writing in the journal Psychology found that, whereas it was once commonly accepted that the brain was fully developed at 37 weeks, in the last few weeks of pregnancy certain areas of the brain’s grey matter – the cells which store information, memories and skills – become denser.

The word cerebral refers to the brain – and palsy describes the type of uncontrolled movements, tremors and stiff muscles of patients with the condition cerebral palsy.

The symptoms a baby with cerebral palsy exhibits will depends on which area of the brain has been injured during gestation or delivery.

The physical symptoms of cerebral palsy – including muscle spasms, contracted and stiff muscles, tremors, trembling and abnormal movements of muscles, including facial muscles – are the result of signals from the brain to the spinal cord not being transmitted properly. This means the patient is unable to control muscle movements – and one or more limbs may be affected, or even one side of the body.

The brain, spinal cord and heart begin to develop in the fifth week of pregnancy in a natural conception.

The brain continues to develop throughout pregnancy, so any infection or adverse event may cause trauma to the foetus from the weeks after conception onwards.

This is not to say that a mother is to blame if her child is born with cerebral palsy, however – even pre-conception factors can in some cases result in cerebral palsy.

According to the charity Scope, there are few high-risk factors which may be relevant, however, although these have not been proven conclusively

  • Child born fifth or more in a family
  • First born
  • Low birth weight or premature baby
  • Mothers over 40
  • Multiple births (including twins)
  • Younger mother or father (under 20 years).

cerebral palsy in babiesWomen are often blamed for birth defects – especially older mothers – but whereas females are born with a set number of eggs and the condition of these deteriorates over a period of time until the menopause, men constantly renew their sperm supplies on a daily basis, which makes the chances of a mutation in sperm’s DNA much higher.

The quality of sperm can be greatly affected by a man’s drinking, smoking and drug-taking habits, which again can contribute to DNA mutations in sperm.

Even sporting activities can affect the quality of sperm – especially when male reproductive organs are encased in sports clothing such as tight-fitting cycle shorts. This may affect fertility rates in men – but the fact that a man’s sperm supply is renewed on a daily basis means that the chance of a mutation in the DNA of sperm is increased.

A female’s eggs may occasionally have a genetic flaw which was present when she was born, or perhaps developed pre-pregnancy or during pregnancy as a result of exposure to chemicals or medications, as in the case of the morning sickness drug Thalidomide – or even the tranquilliser Librium, widely prescribed in the 1960s and 1970s and now known to carry a risk of birth defects in the babies of women who went on to become pregnant after taking it.

In the case of men, healthy eating and healthy lifestyles can help protect against DNA changes in sperm which may lead to birth defects in their children.

But in the case of cerebral palsy, there are so many factors which may contribute that unless there has been a recognised error in the clinical management of a pregnancy or a delivery by medical staff (eg asphyxia at birth), then it can be hard for doctors to pinpoint exactly what caused the condition in a baby.

There have been increased risk factors associated with mothers who are diabetic and may also be obese – being overweight can make delivery more difficult and increase the risk of some sort of intervention being needed, such as forceps delivery in which the baby may sustain a head/brain injury. Babies of diabetic mothers also have a tendency to be larger and have a higher birth weight, which can make delivery more difficult. Diabetes before pregnancy or which sometimes develops during pregnancy is usually well managed by clinicians, however.

In some cases, cerebral palsy may occur after birth as the result of a brain injury – for example if a child undergoes surgery and the brain is starved of oxygen during the procedure, or if the brain is attacked by a viral infection such as meningitis.

The charity Scope has more information about cerebral palsy in babies and how to recognise the signs.

Converting Skin Cells To Brain Cells Holds Promise For Multiple Sclerosis And Cerebral Palsy Treatment

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Researchers at Case Western Reserve School of Medicine have discovered a technique that directly converts skin cells to the type of brain cells destroyed in patients with multiple sclerosis, cerebral palsy and other so-called myelin disorders.

This discovery appears today in the journal Nature Biotechnology.

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