Clinical aspects of cerebral palsy. A population based study of pre-school children
This study has added to the current knowledge on some of the clinical aspects of CP among preschool children. The overall prevalence of CP did not change among Icelandic children born 1990 to 2003, whereas among term births the prevalence and severity of CP decreased. We observed this same trend when comparing the current results with those of Gudmundsson but his study was carried out in Iceland in the middle of the 20th century. Thus the stable prevalence of CP may obscure significant changes in the rate and severity of the condition among individual subgroups. We have shown that objective assessment of intellectual capacity or developmental status is possible for almost all children affected by CP and that such assessments can unfold cognitive skills which may affect educational planning. Preschool children with CP are likely to exhibit impairing behavioural and emotional symptoms not only when rated by parents but also on assessment in the preschool environment. The majority of 5-year old children with CP express themselves in sentences and almost half of them have normal verbal cognition. Nonverbal status and severe dysarthria are associated with intellectual disability, greater motor impairment and the quadriplegic and dyskinetic subtypes. Our study indicates that associated impairments of higher cognitive functions are more prevalent among children with severe motor impairment than among those with mild motor impairment, which makes intervention more challenging.
Our study could have wide implications both for health and social authorities as well as clinicians working in the field of childhood disability. From an epidemiological perspective, the results may assist health care providers and administrators to allocate resources efficiently. From a clinical perspective, identifying the child’s real abilities in the various cognitive and communicative areas is imperative in order to plan adequate educational and habilitative programmes which identify realistic objectives. Early identification of maladaptive behaviours and emotional instability in young children affected by CP is important as parent-child interaction styles and the psychosocial environment may contribute to these symptoms. Furthermore, for children with average intellectual potential who are hampered by a physical disability which precludes manual employment, recognition and remediation of learning difficulties and attention deficit is of uttermost importance.
The results of this study emphasise that CP is not only a condition of movement and motor control but rather a complex disability involving all streams of development. The most current definition of CP indeed takes into account this view as well as the framework of ICF focusing on activity or participation.
Behavioural and emotional symptoms of preschool children with cerebral palsy: a population-based study.
Dev Med Child Neurol 2010 Nov;52(11):1056-61.
PMID: 20497458 - Inngår i doktorgradsavhandlingen
Speech, expressive language, and verbal cognition of preschool children with cerebral palsy in Iceland.
Dev Med Child Neurol, Jan 2011.