Age of diagnosis, not dose of rehabilitation interventions, is related to severity of cerebral palsy
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Date
2020-02
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Abstract
Background: Early diagnosis of cerebral palsy (CP) is important for initiation of rehabilitation interventions to optimize motor and cognitive plasticity, prevent secondary complications, and improve parent well-being. Targeted interventions, including physical therapy (PT), occupational therapy (OT), and speech and language pathology (SL/P), are utilized to maximize function in all developmental domains to improve quality of life for children with CP and their families. Optimal dose (frequency, type, and duration) of these interventions is critical for best outcomes. The purpose of this study was to (1) describe medical history (age of CP diagnosis, gestational age at birth, weight at birth, length of stay in the neonatal intensive care unit (NICU), and insurance provider) and current dose of rehabilitation interventions (PT, OT, and SL/P) for school-aged children with CP, (2) evaluate the relationship between severity of CP (GMFCS level) and medical history, and (3) evaluate the relationship between severity of CP and dose of rehabilitation interventions.
Methods: N=114 children ages 2-8 years old with CP of all severity levels were included in this study. The participants were children from a larger pragmatic clinical trial (ACHIEVE- NCT02897024). A parent-report survey was used to collect data. The survey included medical history and dose of rehabilitation services their child received in the prior 6 months.
Results: The average age of CP diagnosis for all participants is 1.8±1.13 years old. There is a significant, moderate, negative relationship between GMFCS level and age of CP diagnosis (r=-.36, p=<.001). Children with CP receive between 0.9-1.2 hours of therapy for each discipline per month in the education setting for an average combined total of 2.2±3.7 hours per month. They receive between 1.5-2.0 hours of therapy for each discipline per month in the clinic setting for an average combined total of 2.2±3.5 hours per month. There is a significant, moderate, positive relationship between GMFCS level and PT hours/month in the clinic setting (r=.30, p=.02). No other service doses were related to severity of CP.
Discussion: The results from this study suggest that (1) earlier diagnosis of CP occurs for children with higher severities, (2) weekly frequency of intervention is standard, (3) overall total dose of rehabilitation interventions per month is very low (averaging between 1-2 hours), and (4) dose of rehabilitation interventions is not related to severity of CP, except for PT delivered in the clinic. Frequency of therapy seems to be based on convention, rather than unique characteristics of the patient, as most children received weekly services and are overall very low.
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Poster Division: Health Sciences: 3rd Place (The Ohio State University Edward F. Hayes Graduate Research Forum)
Keywords
cerebral palsy, dose, rehabilitation, intervention