Mark Peterson’s research highlights the need for updated clinical care guidelines for people with cerebral palsy as they age.
Cerebral palsy is a life-long disability that increases the likelihood of serious health risks as those with the condition transition into adulthood and beyond
Cerebral palsy (CP) is the most common pediatric-onset disability in the United States, with approximately 10,000 babies diagnosed with the condition every year. Caused by malformation or trauma to the developing brain during pregnancy, childbirth, or early infancy, CP alters growth, development, and overall health. Thanks to medical advances, people with mild to moderate CP can now expect to live into adulthood with a near-normal lifespan. However, despite being a lifelong neurologic disorder, the Centers for Disease Control and Prevention continues to classify CP as a childhood motor disability.
Mark Peterson, Ph.D., M.S., professor of physical medicine and rehabilitation at Michigan Medicine, studies CP across all stages of life. With over 200 publications on muscle physiology and preventive medicine, his work explores the long-term consequences of physical disabilities on health and well-being. He actively engages with medical leaders, disability researchers, clinicians, and other CP advocates to raise awareness of the health risks and care needs unique to this population, especially as they age.
Pediatric-Onset Disability, Life-Long Implications
As a disability that arises in early childhood, CP affects movement, muscle tone, posture, balance, and, for some, the ability to communicate throughout life. These primary symptoms can result in behavioral changes that over time contribute to new, but related, health conditions that increase the risk of serious illness and death.
The physical changes caused by CP often lead people with the condition to become less physically active as they age. Pain, one of the most frequently reported symptoms of CP, makes movement especially difficult. According to research by Peterson and colleagues, this reduction in exercise may contribute to the development of additional health concerns, such as obesity, chronic sedentary behavior, fatigue, muscle loss and stiffness . Many of these secondary health problems can, in turn, make moving even more difficult or painful, disincentivizing exercise further, exacerbating the new health issue and creating a negative cycle that is difficult to break.
But the consequences of that cycle are severe. Whether as a result of the primary or secondary effects of CP, Peterson’s work shows those with the condition tend to exhibit symptoms of premature aging, such as muscle wasting and a loss of motor function. Adults with CP also tend to have higher rates of bone-related disease (55%), such as osteoporosis or osteoarthritis, compared to adults without CP (39%), contributing to an elevated risk of bone fracture.
Peterson and team also found that high rates of chronic conditions such as stroke, hypertension, and heart disease are common among adults with CP as well. In a study on cardiometabolic illness, in which the majority of participants were under 65 years old, Peterson found that 41% of people with CP or a similar disability had a cardiometabolic disease, compared to only 30% of the general population. This suggests these potentially life-threatening conditions may be manifesting earlier in life for those with a pediatric-onset disability.
Concerningly, for people with CP, the chances of developing a cardiometabolic disease also increase significantly with age. In fact, Peterson and co-authors found those with CP are more likely to die from a non-communicable disease like heart or pulmonary disease, stroke, and certain cancers than those without CP.
The challenges related to this disability can take a significant toll on mental and cognitive health as well. According to Peterson’s findings, 38% of adults with CP or a similar disability live with a psychological disorder, compared to 24% of adults in the general population. This includes conditions such as anxiety, substance abuse, schizophrenia, and mood-related disorders like bipolar disorder, manic episodes, and depression. Cognitive health is also impacted. Individuals who are 45-64 years old and have CP are nine times more likely to develop Alzheimer’s disease and related dementia than those without the disability.
The varied healthcare needs associated with CP often lead to a high utilization of medical services, resulting in higher out-of-pocket costs than those of the general population. As individuals with CP transition from pediatric to adult services, it can also become increasingly difficult to access providers who are properly equipped to address their complex needs. As a result, these individuals often must either continue to receive care from a pediatrician, despite being an adult, or receive care from a primary care physician who lacks training in CP.
Engaging for impact
To properly care for patients with CP, it is important for clinicians to understand the unique health risks they face, especially in adulthood. Peterson uses his expertise to draw attention to the historical lack of focus on CP across the lifespan, and informs practice and policy at the local, state, national and international levels.
In 2012, Peterson joined the University of Michigan (U-M) Adult Cerebral Palsy Clinic, established by Dr. Edward Hurvitz, the first such facility in the nation dedicated to this population. He also currently serves as a member of the U-M Center for Disability Health & Wellness, where he contributes to efforts to enhance healthcare access and quality for individuals with disabilities across the lifespan.
Additionally, Peterson has partnered with the Cerebral Palsy Foundation on the Cerebral Palsy Grows Up (CPGU) initiative, where he leads the Clinical Practice Guideline Working Group for Adults Living with Cerebral Palsy. These novel clinical guidelines will help establish a standard of care focused on prevention for adults with CP. To inform the final recommendations, the group is in the process of conducting 11 systematic reviews on key focus areas. As of February 2026, the group’s reviews on pain and gastroenterological disorders and hepatic disease have been published.
Peterson’s work on CP-related pain shows that 80% of patients who exhibit more than one pain-type receive an opioid prescription, even when it may not be an appropriate therapy option. Interestingly, the CPGU systematic review found people who received pharmacological and surgical interventions had no improvement in pain. Instead, the team’s findings indicate that an active lifestyle and engaging in sports may be the most effective treatment for CP pain.
Long an advocate for increasing physical activity and reducing sedentary behavior among those with CP, Peterson has also developed exercise and physical activity recommendations for CP, and serves as the co-lead of the International Society for Physical Rehabilitation Medicine (ISPRM) task force on Physical Activity for Persons with Disabilities. He has previously highlighted the effectiveness of recumbent cross-training for those with motor impairments, and has called for combining exercise with a healthy diet plan for CP care.
Peterson’s research also highlights the importance of developing improved clinical screening algorithms and early behavioral interventions to address the psychological, cardiometabolic, and musculoskeletal conditions observed in the CP population, as well as for mood disorders, fracture risk, and potential nutrient deficiencies.
Throughout his work, Peterson has continued to call for updating CP’s classification as a pediatric disability to instead be reframed as a lifelong condition. Doing so would not only help lead to better understanding of secondary health risks, but also improve continuity of care between pediatric and adult caregivers, encourage disability-related training among family physicians, and broaden our understanding of the CP population. By not recognizing the realities of CP, individuals with the disability may continue to face a lack of adequately trained specialists as they age, as well as high rates of potentially preventable hospitalizations.
To further advance scientific understanding of CP’s effects across the lifespan, Peterson also recommends that the National Institutes of Health (NIH) consider increased support for adult-based CP research. NIH funding for CP research has grown overall, from $22 million in 2014 to $24.8 million in 2023, however, only 2.3% of CP-related funds focus on adults. Increased attention and financial support would help provide opportunities for researchers to lead first-of-their kind clinical trials on chronic disease treatment in the adult CP population, explore precision medicine in order to provide personalized care for individuals with CP, as well as answer many other crucial questions related to the long-term health and well-being of those living with CP.
In addition to serving as a scientific advisor for the Cerebral Palsy Foundation, Peterson is an active member of the American Academy of Cerebral Palsy and Developmental Medicine, the Australasian Academy of Cerebral Palsy and Developmental Medicine, the ISPRM, and the American College of Sports Medicine. He has previously served as a member of the Scientific Committee for the International Alliance of Academies for Childhood Disability, and as a member of the Lifespan Committee for the American Academy of Developmental Medicine and Neurology. His research has been cited in policy documents published by the U.S. Agency for Healthcare Research and Quality, the Assistant Secretary for Planning and Evaluation, and by Indiana, New York State, and Ohio. Internationally, Peterson’s work has been referenced in policy documents and reports published by the World Health Organization, the European Union, and by Denmark, Finland, New Zealand, Sweden, and the United Kingdom, among others.
More information about Mark Peterson's work can be found on his IHPI Profile and in Michigan Experts.
