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Outcome of Community-Based Early Intervention and Rehabilitation for Children with Cerebral Palsy in Rural
Tasneem Karim1,2,3, Mohammad Muhit1,2, Israt Jahan1,2,4
1CSF Global, Dhaka 1213, Bangladesh.
Insights
A community-based caregiver-led intervention significantly improved outcomes for children with cerebral palsy (CP) in Bangladesh. This approach shows promise for early intervention and habilitation in low- and middle-income countries (LMICs).
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Global Health
Background:
- Cerebral palsy (CP) presents significant challenges for children and families, particularly in low- and middle-income countries (LMICs).
- Early intervention and habilitation are crucial for improving functional outcomes in children with CP.
- Community-based, caregiver-led programs can enhance accessibility and sustainability of care.
Purpose of the Study:
- To evaluate the effectiveness of a community-based, caregiver-led early intervention program for children with CP in Bangladesh.
- To compare the outcomes of the intervention group with a control group receiving standard care.
- To assess the impact on children's motor function, communication, speech, and caregivers' mental health.
Main Methods:
- A quasi-experimental study involving 156 children with CP recruited from the Bangladesh CP Register (BCPR).
- Group A received a six-month community-based caregiver-led intervention at "Shishu Shorgo" centers.
- Group B received standard care. Data collected at baseline, 6 months, and 12 months using GMFM-66, CFCS, VSS, and DASS 21.
Main Results:
- The intervention group (Group A) showed statistically significant improvements in Gross Motor Functional Measure (GMFM-66), Communication Function Classification System (CFCS), and Viking Speech Scale (VSS) (p < 0.05).
- The control group (Group B) showed deterioration in these measures.
- The intervention demonstrated particularly promising results for children with CP under five years of age.
Conclusions:
- Community-based, caregiver-led early intervention programs are effective in improving outcomes for children with CP.
- This model of care is particularly beneficial for children under five.
- There is a significant need to implement and scale such programs in LMICs to address the challenges faced by children with CP and their families.
Abstract:
We evaluated the outcome of a community-based early intervention and habilitation for children with cerebral palsy (CP) in Bangladesh. Children registered on the Bangladesh CP Register (BCPR) were recruited in two groups for this study: Group A received a comprehensive six-month long community-based caregiver-led intervention program at the "Shishu Shorgo" (Bengali title, which translates to 'Children's Heaven') Early Intervention and Rehabilitation Centres developed to support participants from the BCPR. Group B received standard care. A quasi-experimental study was conducted. Data were obtained at baseline, at the end of the program (i.e., 6 months), and at a 12-month follow-up. Outcome measures for children included gross motor functional measure (GMFM-66), Communication Function Classification System (CFCS), and Viking Speech Scale (VSS) and, for adult caregivers, the depression, anxiety, and stress scale (DASS 21). Between October 2016 and March 2017, 156 children with CP were recruited (77 in Group A and 79 in Group B). The total score of GMFM-66, CFCS level, and VSS level significantly improved statistically in Group A (p < 0.05 for all) and deteriorated in Group B (p < 0.001, p = 0.095, p = 0.232). The intervention showed promising outcomes particularly for children with CP under five years of age. There is a need for caregiver-led community-based programs for children with CP in LMICs.
