Cerebral palsy in a total population of 4–11 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems

Westbom, Lena; Hägglund, Gunnar; Nordmark, Eva

doi:10.1186/1471-2431-7-41

Cited by 156 publications

(178 citation statements)

References 34 publications

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“…For example, which parent accompanies a child to the habilitation ward, distance to the habilitation ward, socioeconomic status, and ethnicity might all be important factors that we did not assess. Additional data such as the different dominating symptoms [6,8,12], place of birth, place of residence, additional diagnoses, and data on activities and participation should be included in future studies. Surveys or interviews that provide the perspective of the children with CP, their parents, and physiotherapists in the habilitation wards that focus on PTIs, physical activity, and habilitation on equal terms, would enrich our knowledge.…”

Section: Discussionmentioning

confidence: 99%

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Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives

Degerstedt

Wiklund

Enberg

2017

Global Health Action

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Background: Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services. Objectives: To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective. Methods: A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS). Results: In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028). Conclusion: Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions.

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Section: Discussionmentioning

confidence: 99%

“…Among children in Sweden, cerebral palsy is the most common cause of physical disability [7–9]. Approximately two of 1000 children aged 5–12 years are diagnosed with cerebral palsy [10], and boys are overrepresented by a factor of 1:1.4 in Sweden and western countries [11,12]. …”

Section: Introductionmentioning

confidence: 99%

Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives

Degerstedt

Wiklund

Enberg

2017

Global Health Action

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“…3 For this study we took advantage of data from two prospective longitudinal studies of gross motor development of children with CP. Although one study is a clinic-based cohort in the Netherlands (PERRIN CP 0)5 study) and the other a population-based study in Canada (OMG study) the distribution over the five GMFCS levels is good, representing the spectrum of severity in CP as seen in larger population based studies 16,17 The inclusion of children from North America and Europe and their distribution over the five levels of the GMFCS provides preliminary evidence that the findings can be generalized to all children with CP less than 2 years of age. We did not study the interrater reliability of the GMFCS in this study, but as reclassifications were seen both in children classified by the same observer and in children classified by different observers at Time 1 and Time 2, we do not think that this has influenced our results.…”

Section: Movements In and Outmentioning

confidence: 99%

Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older

Gorter

Ketelaar

Rosenbaum

et al. 2008

Develop Med Child Neuro

131

103

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The stability of the Gross Motor Function Classification System (GMFCS) over time is described in 77 infants (41 boys, 36 girls) with cerebral palsy (CP; mean age 19.4mo [SD 1.6 mo]; 27 unilateral spastic, 42 bilateral spastic, eight dyskinetic type) and in the same children at follow‐up at age 2 to 4 years. The overall level of agreement over time (linear weighted kappa) was 0.70 (95% confidence interval [CI] 0.61−0.79). The overall percentage of children whose GMFCS level changed one or two levels was 42%, of which the majority were reclassified to a less functional level (McNemar’s Chi2 test p=0.11). The chance that children initially classified in the combination of GMFCS Levels I, II, and III would subsequently be classified in the same level in early childhood was 96% (positive predictive value [PPV] 0.96, 95% CI 0.85−0.99), whereas the PPV for the combination of Levels I and II was 0.88, 95% CI 0.70−0.96. These findings indicate that GMFCS classification in infants is less precise than classification over time in older children. In conclusion, children can be classified by the GMFCS early on, but there is a need for reclassification at age 2 or older as more clinical information becomes available.

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“…The number of children with CP in the area corresponds to a prevalence of 2.4-2.6 per 1,000 living births [9,10].…”

Section: Methodsmentioning

confidence: 99%

Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

Larsson

Hägglund

Wagner

2012

Journal of Children's Orthopaedics

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Background Varus osteotomy of the proximal femur (VOPF) is one treatment option to prevent hip dislocation in children with cerebral palsy (CP). It is questioned whether the osteotomy should be performed in the displaced hip only, or if it should be performed bilaterally to prevent later displacement of the contralateral hip. CPUP is a register and healthcare programme for children with CP that was initiated in 1994 in southern Sweden. In the programme, range-of-motion and radiographic examination of the hips is performed regularly. These data have been analysed preoperatively and for 5 years postoperatively in children treated with unilateral VOPF. Methods Children with CP living in the counties of Skåne and Blekinge in the south of Sweden, who were treated with unilateral VOPF at least 5 years ago, were included in the study. The degree of hip displacement and the range of hip motion were analysed preoperatively and after 5 years. Repeat hip operations after the index operation were recorded. Results Twenty-four children fulfilled the inclusion criteria. Mean age at index operation was 7.6 (2.8-13.2) years. No child died within 5 years postoperatively, and no child was lost from follow-up. At follow-up after 5 years, 2 of the 24 children had been operated on with VOPF in the contralateral hip. The range of motion in both hips decreased, but the difference between the index hip and the contralateral hip did not change significantly. Conclusion Children with CP and unilateral hip displacement have a low risk of later contralateral displacement after being operated on with unilateral VOPF. This supports healthcare programmes that advocate unilateral VOPF in children with unilateral hip displacement.

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Cerebral palsy in a total population of 4–11 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems

Abstract: Background: The aim of this study was to investigate the prevalence of cerebral palsy (CP) as well as to characterize the CP population, its participation in a secondary prevention programme (CPUP) and to validate the CPUP database.

Cited by 156 publications

References 34 publications

Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives

Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives

Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older

Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

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