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Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review
Linnéa Hekne1, Cecilia Montgomery2, Kine Johansen2
1Pediatric Department, Västmanland Hospital Västerås, Västerås, Sweden.
Insights
Children with cerebral palsy (CP) face unequal access to timely physiotherapy, with those referred by neonatologists receiving earlier care. Early intervention through neonatal follow-up is crucial for identifying CP and ensuring prompt physiotherapy.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) diagnosis in infants necessitates timely intervention for optimal outcomes.
- Access to early physiotherapy is critical for managing motor impairments associated with CP.
- Referral pathways and timing can significantly impact the initiation of physiotherapy services.
Purpose of the Study:
- To determine if children with cerebral palsy (CP) have equitable access to prompt physiotherapy.
- To explore clinical characteristics of infants with CP based on referral source and age at referral.
- To compare neonatal clinical history and CP profiles between different referral groups.
Main Methods:
- Retrospective chart review of children diagnosed with CP in Uppsala County, Sweden (2010-2016).
- Analysis of medical records from Uppsala University Children's Hospital.
- Inclusion criteria: CP diagnosis by July 2019; data extracted on referral source and age at first physiotherapy visit.
Main Results:
- Children referred by neonatologists or in neonatal follow-up received physiotherapy significantly earlier (median 1.9 months) than those referred by other professionals (median 7.6 months).
- Referral source was a significant predictor of physiotherapy timing, explaining variance in access.
- Infants referred earlier or via neonatal pathways exhibited different clinical histories and CP profiles, often with more severe forms (e.g., bilateral spastic CP), compared to those referred later or by other means (milder CP forms).
Conclusions:
- Unequal access to timely physiotherapy for infants with CP exists, with high-risk infants identified through neonatal follow-up benefiting from earlier intervention.
- Evidence-based motor performance assessments in early neonatal follow-up are effective for early CP identification, unlike milestone attainment measures.
- Standardized training and evidence-based methods for developmental surveillance are essential for all professionals; physiotherapy should precede formal CP diagnosis.
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.
