Cerebral palsy can’t slow this coxswain

cerebral palsyFor the women’s crew team at College of the Holy Cross and rowers everywhere, all eyes are on the Head of the Charles Regatta. It’s a long journey for every rower participating in the sport’s ultimate competition. But few have come so far as Caroline Laurendeau, the 4’11” coxswain for the Holy Cross Crusaders women’s rowing team.

Caroline, who was born weighing just 1 lb. 11 oz., spent the first four-and-a-half months of her life in Neonatal Intensive Care Units (NICUs) at Boston Children’s Hospital and Beth Israel Deaconess Medical Center.

Those first few months were hectic and scary for Caroline’s family. At one point, she suffered a pericardial effusion — fluid had accumulated around her heart. “The mortality rate from that can be really high,” explains Dr. Jane Stewart, director of the Boston Children’s Infant Follow-up Program. Physicians at Boston Children’s tapped the effusion to release the fluid and save her life.

After Caroline was discharged from the NICU, Stewart continued as the family’s primary contact for care. The Infant Follow-Up Program monitors infants and toddlers born prematurely, connecting families with clinical services as needed and also with appropriate early intervention services including developmental specialists, physical therapists and occupational therapists.

Caroline’s diagnosis: Cerebral palsy

Shortly before Caroline turned 2, she started showing signs of cerebral palsy. “Caroline didn’t put her right foot down and didn’t walk until she was 22 months old,” recalls her mother Laurie.

Stewart referred Caroline to a neurologist at Boston Children’s, who diagnosed her with right-side cerebral palsy. Because Caroline’s symptoms included spasticity, or short tight muscles and tendons, Stewart referred her to Dr. Brian Snyder in the Boston Children’s Orthopedic Center.

Caroline also had hip dysplasia, a shallow hip socket and abnormally rotated thigh bone, which is common in children with cerebral palsy.

Despite her size and some minor motor challenges, Caroline did her best to keep up with her athletic parents and older brother and sister.

But what Stewart remembers most is Caroline’s giant sense of humor. “She was always a pistol. Even at two-and-a-half-years old, she’d have me in stitches with her jokes.”

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Caroline after surgery to correct her hip dysplasia

Snyder treated her hip dysplasia with physical therapy and serial casting and told her family that she could benefit from surgery in the future.

“Physical therapy and casting is a way to buy time and maintain range of motion by stretching out tight muscles and tendons, but it doesn’t address the underlying cerebral palsy,” explains Snyder.

Similarly, elective orthopedic procedures can’t cure cerebral palsy. What they can do is re-orient muscles, tendons and bones to provide a foundation for more normal motor skills and better functionality.

When Caroline was five years old,  Snyder performed Caroline’s first surgery, an osteotomy, which entailed rotating the ball of her hip to straighten her femur, and over the next few years, she had three more procedures, including a split tendon transfer, to lengthen tendons in her heel. This allowed Caroline to straighten her foot. “We use physics to our advantage and transfer the muscle tendon unit from the side that is tight due to spasticity to the opposite side,” says Snyder.

A kid in constant motion

Through it all Caroline never slowed down. She learned to downhill ski at age 6 and started playing field hockey in middle school.

“My parents encouraged me to try anything I wanted to,” says Caroline. It’s an approach to parenting a preemie that Stewart wholeheartedly supports. “Be a great advocate for your child. Don’t be afraid to question anything and try different things,” says Stewart.

Caroline played field hockey until her sophomore year of high school, but as she started to think about the transition from junior varsity to varsity, she realized the sport was taking a toll on her body. She had suffered through pulled muscles and knew that her risk for injury would increase with competition at the varsity level.

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From field hockey to rowing

“I wanted to find a sport where I could still be competitive but also reduce my risk of injury.”

A field hockey teammate casually mentioned rowing to her. “’You’re small,’ she said. ‘You’d make a good coxswain.’ I tried it and fell in love with it.”

During her final two years of high school, Caroline rowed with Community Rowing Inc., a large, highly competitive rowing club.

“It took some time to get used to a sport I had never done before and knew nothing about. With the help of some great coaches I picked up on the dialogue and an understanding of what it took to make a good coxswain. Once I had the foreground developed, I used each practice and race to push both myself and my rowers with confidence to be successful,” recalls Caroline.

When the time came to look for college, Caroline knew that she wanted to continue rowing. She followed in the footsteps of her father, who played football at Holy Cross and her brother, who played baseball at the school.

She was admitted into the school and earned a spot on its Division I rowing team.

“Rowing has taught me the importance of teamwork, and over time my team has become my family. There is a constant feeling of support that comes from this group of hardworking and dedicated rowers. As a result of constantly being around such hardworking, determined people, I have learned a sense of discipline as well as learning to hold myself to a high standard, which I hadn’t done in the past,” explains Caroline.

“Caroline is a great example of how orthopedic surgery at the right time can help people have a more functional life, whether it’s elite sports, Special Olympics or walking independently in the community,” says Snyder.

Her experience, along with her fierce resilience, is commemorated on a plaque hung in the Hall of Hope outside of the NICU at Beth Israel.

Twenty years after she was born, Caroline reflects on the sentiment on the plaque.

I love the sense of hope it offers. I want to reassure parents that just because a child has challenges in the beginning doesn’t mean she can’t have a rewarding life.

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Learn more about the Boston Children’s Cerebral Palsy Program.