Screening and referral for children with physical disabilities

Abstract

The clinical care of children with physical disabilities is a major priority for paediatricians and paediatric orthopaedic surgeons. Cerebral palsy (CP) is the prototypical condition and remains the most common cause of physical disability in developed countries. The incidence is approximately 2 per 1000 live births, translating to between 600 and 700 new children per annum in Australia, with approximately 34 000 children and adults currently living with CP. This figure is predicted to rise inexorably over the next 20 years. The care of children with physical disabilities, including those with CP, is usually coordinated by paediatricians, general practitioners and allied health teams including physiotherapists, with input from paediatric orthopaedic surgeons when appropriate. The emphasis in care for children with CP has moved from 'reactive' to 'proactive'. In the past, children are often referred when symptomatic, for example when a hip dislocation had occurred and became painful. The emphasis now is on coordinated, multidisciplinary care in which musculoskeletal manifestations of disability are identified by screening programmes. Systematic screening, especially when population-based and linked to a register, avoids children getting 'lost in the system'. Early and more effective interventions may be offered for the prevention of contractures, dislocation of the hip and spinal deformities. In this review, we will focus on the assessment of gait in children with physical disabilities, and monitoring for hip and spine deformity.

Barriers to providing healthcare to children living with cerebral palsy in Ghana: A qualitative study of healthcare provider perspectives

“…We also found that the necessary equipment for testing and diagnosis of CP was limited in most healthcare settings. HCPs reported that they often send CLWCPs to multiple locations to conduct diagnoses and access specialized treatments [37]. Due to the fragmentation of health services in Ghana, many families, especially those living in rural communities, struggle to access the required services promptly [15,20].…”

“…Caregivers also rely on alternative medicine, such as herbs or spiritual healing, due to the desire for a permanent cure for CP, symptoms that were not sufficiently addressed by the medical system, perceptions about disability, cost, family referral, and poor provider relationship [36]. Despite the availability of a few services, studies show that finding providers who can offer the specific interventions that CLWCPs need can be challenging for caregivers in low-resource settings [37,38].…”