Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review

Abstract

Aim This study aimed to investigate whether children with cerebral palsy (CP) had equal access to timely physiotherapy. Additionally, to learn more about clinical characteristics of infants with CP, we explored differences in neonatal clinical history and CP profile between children referred by a neonatologist or enrolled in neonatal follow-up and those referred by other healthcare professionals as well as those referred before and after 5 months corrected age. Methods We conducted a retrospective chart review study including children born in Uppsala County, Sweden, from 2010 to 2016, who had received a CP diagnosis by July 2019. Entries by doctors and physiotherapists working at Uppsala University Children’s Hospital were reviewed. Results Thirty-eight children were included (21 girls, 55.3%) in the study. Twenty-two (57.9%) were born at term. Twenty-five children (66%) had their first visit to a physiotherapist before 5 months corrected age, and this included all children (n = 22, 57.9%) referred by a neonatologist or enrolled in neonatal follow-up. The latter group had significantly earlier access to physiotherapy compared to children referred by other healthcare professionals, with a median of 1.9 (min-max: -1-4) and 7.6 (min-max: 1–24) months, respectively (p < 0.0001). Referral source explained unique variance in predicting time of referral to physiotherapist (R2 0.550, B 4.213, p < 0.0001) when controlling for both number of risk factors and severity of motor impairment. However, number of risk factor was vital for early access to physiotherapy for children referred by other health care professionals. Children referred by a neonatologist or enrolled in neonatal follow-up or referred before 5 months corrected age differed on all measured variables concerning neonatal clinical history and CP profile, compared to children referred by other healthcare professionals or after 5 months corrected age. The latter groups had milder forms of CP. In total, twenty-eight children (73.7%) were ambulatory at 2 years of age. Bilateral spastic CP was most common among those referred by a neonatologist or enrolled in neonatal follow-up or referred before 5 months corrected age, while unilateral spastic CP was most common among those referred by other healthcare professionals or after 5 months corrected age. Conclusion Infants with CP have unequal access to timely physiotherapy, and children considered at low risk for CP receive therapy later. Neonatal follow-up of infants considered at high risk for CP that involves an assessment of motor performance using an evidence-based method during the first months of life corrected age seems to be effective in identifying CP early. Conversely, measuring milestone attainment seems to be a less reliable method for early identification. To provide safe and equal care, all professionals performing developmental surveillance should receive proper training and use evidence-based assessment methods. Physiotherapy should be available prior to formal medical diagnosis.

Infantile Cocktail of Erythropoietin and Melatonin Restores Gait in Adult Rats with Preterm Brain Injury

“…Indeed, the lack of proven, effective interventions to restore motor deficits after CP is diagnosed in young children that often drives families of children with few options to seek unproven, costly, and potentially dangerous treatments [9]. Moreover, recognition of the need for safe, effective, resource-conscious pharmacological interventions for infants at high risk of CP aligns with the growing international trend toward earlier diagnosis and intervention for CP using physical, occupational, speech, and cognitive therapeutic programs for infants and children [10][11][12][13][14][15][16].…”

Characterization of Infants’ General Movements Using a Commercial RGB-Depth Sensor and a Deep Neural Network Tracking Processing Tool: An Exploratory Study

“…Families have been identified as the cornerstone of early intervention [ 13 ] and exploration of a more integral role for families in neurodevelopmental monitoring and therapy may result in earlier detection of developmental delays as well as earlier application of appropriate therapies. Engagement of families of infants with CP whose early signs of impairment are subtle may be particularly helpful given that these infants have been shown to be at greater risk for not receiving early diagnosis and intervention than are more profoundly affected infants [ 14 ]. Computationally assisted screening procedures likewise suggest a way to manage the increased clinical workflow that would result from broader application of neuromotor assessment among infants.…”