INTRODUCTION
Cerebral Palsy (CP) is a clinical diagnosis used to describe a spectrum of movement disorders caused by non-progressive lesion/abnormalities that occurred in the developing brain.1,2 Although the incidence is declining due to improvements in care,2,3CP is still considered the most common physical disability in childhood, affecting 1.4 per 1000 in high-income countries.3Increasing evidence points to the importance of early intervention for motor disorders in children.3–7 To take full advantage of the plasticity of the developing brain it should begin during the first months of life.3,4,6,7
Several systems are in place to identify children with developmental disabilities. The Swedish Child Health Services (CHS), a free-of-charge primary healthcare service for children aged 0-5 years,8 offers a comprehensive well-child surveillance program including twelve scheduled visits during the child’s first year of life. Children born prematurely (gestational age <28 weeks) or with other neonatal morbidities are also enrolled in neonatal follow-up programs guided by national guidelines and adjusted to local routines.9 In the current organizations, the early detection tools used are different. Within routine CHS practice, motor development is assessed using milestone achievement,8while neonatal follow-up use evidence-based assessment methods.
Children with a complicated birth history are considered at risk for developmental disabilities and are routinely enrolled in neonatal follow-up.5,7 However, these high-risk infants only constitutes half of all children with CP.5,10–13Studies have shown that children considered at low risk for CP have delayed access to intervention,11–13 and have revealed that the Swedish CHS only makes minor contributions to early detection of CP and severe health problems.14,15Hence, children considered at low risk for CP are deprived interventions that are known to improve outcomes.3,6,10 This is contrary not only to the Health Care Act (HSL 2017:30), which aims to achieve good health and equal care for the entire population, but also the Convention on the Rights of the Child (SFS 2018:1197). The latter became Swedish law in January 2020 and states that children shall have access to the highest attainable standard of health and that no child should be deprived access to healthcare or rehabilitation services.
As physiotherapy is essential in promoting motor development and preventing secondary consequences, we investigated whether children with CP have equal access to timely physiotherapy. Furthermore, we describe their birth history and CP profile to learn more about typical features that might enable earlier identification.