Education and employment prospects in cerebral palsy

Abstract

Parents and paediatric neurologists need information on the long-term social prognosis of children with cerebral palsy (CP). No large population-based study has been performed on this topic. On 31 December 1999, to find predictors in childhood of subsequent education and employment, 819 participants with CP born between 1965 and 1978 (471 males; mean age 28y 10mo, SD 4y, range 21 to 35y) in the Danish Cerebral Palsy Registry were compared with 4406 controls without CP born between 1965 and 1978 (2546 males; mean age 28y 10mo, SD 4y, range 21 to 35y). Diagnostic subtypes of the 819 participants with CP were: 31% hemiplegia, 43% diplegia, 18% tetraplegia, and 8% other types. Level of motor impairment with respect to walking ability was: 62% able to walk without assistance, 21% with assistance, and 16% not able to walk (for 1% of study children walking ability was not known). Relevant information was obtained from Denmark's unique registries. Of the participants with CP, 33% vs 77% of controls, had education beyond lower secondary school (i.e. after age 15-16y), 29% were competitively employed (vs 82% of controls), 5% were studying, and 5% had specially created jobs. Excluding participants with CP with an estimated developmental quotient (DQ) of less than 50 or inability to walk at age 5 to 6 years, the odds ratios (multivariate analysis) for not being competitively employed were 1.9 for diplegia versus hemiplegia, 22.5 for DQ 50 to 85 versus DQ greater than 85, and 3.7 for those with epilepsy versus those without epilepsy. The severity of motor impairment among participants with CP able to walk had just a minor influence. Only half the participants with CP who had attended mainstream schooling were employed. In conclusion several childhood characteristics seemed to predict long-term social prognosis.

Cerebral Palsy—Long-Term Medical, Functional, Educational, and Psychosocial Outcomes

“…Data from the Danish cerebral palsy register reported that 38% received schooling beyond lower secondary school. 31 There seems to be a tendency for more integration in the younger group of our study population, with 60% visiting mainstream high schools. This might reflect the implementation of legislation promoting inclusion, with increasing numbers of children with disabilities being fully integrated or put in self-contained classes (special education classes within the inclusive school).…”

“…27 Michelsen et al have recently reported similar findings in Denmark. 31 Slightly above a third of the respondents are currently working, 23% in competitive employment and 15% in sheltered work places. A few small studies have been published on employment among young adults with cerebral palsy.…”

Upper-Limb Botulinum Toxin A Injection and Occupational Therapy in Children With Hemiplegic Cerebral Palsy Identified From a Population Register: A Single-Blind, Randomized, Controlled Trial

“…42 Children with hemiplegia are more likely to function in mainstream school environments alongside their typically developing peers when compared with other CP types, 43 and improvements in self-worth are likely to influence their socialization, peer relations, and other areas of functioning. The use of BTX-A has been noted to enhance self-esteem by diminishing inappropriate motor responses 44 ; however, these were not evaluated in our study.…”

Cerebral Palsy—Don't Delay

“…Epilepsy. Epilepsy can potentially severely limit the quality of life for the person with CP and their family, and adults with CP and epilepsy are less likely to find employment [Michelsen et al, 2005]. Epilepsy occurs in 30% of individuals with CP [Arnaud et al, 2008;ACPR Group, 2009].…”