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.