Profile of children with cerebral palsy at a tertiary hospital in eastern Nepal

Abstract

Background The clinical spectrum of Cerebral palsy (CP) can differ in various places depending upon knowledge of the people and resources for prevention, diagnosis and management. Although studied extensively in high-resource countries, adequate data related to CP from resource-constraint settings are lacking. This study aims to describe the profile of children with CP at a tertiary care center in eastern Nepal. Methods This was a hospital-based cross-sectional descriptive study done from 2017 to 2018. Children 6 months to 15 years who presented with CP were enrolled and their clinical details recorded and described. Results Amongst 110 children with CP, 74.54% were male. Majority (76.36%) were 5 years or below with the median age being 3(2.00–4.75) years. Children with spastic quadriplegia (44.44%) and Gross Motor Function Classification System level III (41.81%) were most common. Etiologically, perinatal factors (64.54%) like perinatal asphyxia (35.45%) and prematurity (20.90%) and postnatal infections (25.45%) were common. The common comorbidities were intellectual disability (71.81%) and epilepsy (66.36%). The main treatment modalities were: antiepileptics (59.09%) and centre-based physiotherapy sessions (35.45%). School education was provided in 23.07% with special education in 11.53%. Conclusions This study describes the profile of CP at our centre in eastern Nepal. Predominance of perinatal complications and postnatal infections points towards the urgent need to further improve the perinatal and neonatal health care delivery system and practices.

Comorbidities in children with cerebral palsy: a single-centre cross-sectional hospital-based study from India

“…Third, our data demonstrate that among children who have CP: 2 in 3 could not walk, 9 in 10 had some visual impairment (2 in 10 were blind), 1 in 3 had hearing impairment, 8 in 10 had an intellectual disability, 1 in 3 had no understanding of communication, 1 in 2 had no communication (gestural/verbal), 4 in 10 had behavioural abnormalities, 2 in 3 had epilepsy, 6 in 10 had sleep impairments, 6 in 10 were in pain, 6 in 10 had persistent drooling and 1 in 4 had severe gastrointestinal dysfunction. While there is a paucity of studies assessing multiple comorbidities in the same cohort, the rates of co-occurring impairments were higher in our study group than reported earlier 5 6 11 16 20 30–34. The same is possibly related to the selection bias in our patients and the underlying aetiology of CP and related brain damage.…”

‘We did everything by phone’: a qualitative study of mothers' experience of smartphone-aided screening of cerebral palsy in Kathmandu, Nepal

“…The epidemiology of CP in Nepal is poorly known as most available studies are facility based and only one population-based provincial register exists [ 22 ]. In comparison to high-income countries, a larger proportion of children with CP are born term after birth asphyxia or suffer from post-natal complications [ 23 ]. Care for children affected by CP is provided by non-governmental organizations working together with the Ministry of Health utilizing the World Health Organization Community Based Rehabilitation model [ 24 ].…”

The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: A systematic review

“…[1,2,4] Social participation, independence, and self-e cacy are restricted in children with CP, and about 60% of them have problems with the effective use of the arm and hand during reach, grasp, release, and manipulation of objects resulting in limitations in the performance of daily activities. [1] CP has common comorbidities such as epilepsy, standing at 35%-66.36% [5,6] , speech impairment (43.5%), visual impairment (25%-58%), [6,7] and cognitive impairment (24%). [6] According to data from national cerebral palsy registries and population-based research in Europe, Australia, and the United States, the prevalence of CP is around 1.8-2.3% per 1000 children [8][9][10] .…”

“…While the main factors of CP in high-income countries are premature or low birth weight, [13] in Africa the major contributors are birth asphyxia, kernicterus, central nervous system infections and congenital and neonatal infections which are more easily preventable. [5,12] Although the consequences of CP are permanent, early intervention programs have been shown to increase children's independence and quality of life, especially when applied between the ages of birth and ve, when neuroplasticity is at its greatest. [14][15][16] Early intervention allows C-CP to reinforce their remaining potential abilities by tackling their initial movement limitations.…”