Hornby Brittany, Paleg Ginny S, Williams Sîan A, Hidalgo-Robles Álvaro, Livingstone Roslyn W, Montufar Wright Parma E, Taylor Alice, Shrader Michael Wade
Physical Therapy Department, Kennedy Krieger Institute, Baltimore, MD 21205, USA.
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Children (Basel). 2024 Apr 25;11(5):515. doi: 10.3390/children11050515.
This study aimed to evaluate assessment and referral practices for the early detection and diagnosis of children at risk for or with cerebral palsy (CP) by health care and education providers in Maryland and Delaware. A secondary aim was to identify barriers for using early detection tools and identify opportunities for change to support early diagnosis and improve care. Seventy-two participants answered ≥ 50% of the survey questions. Most were occupational or physical therapists (86%) working in early intervention (61%). Eighty-eight percent indicated awareness that CP can be diagnosed by 12 months. Though 86% stated they typically suspect a diagnosis of CP between 0 and 12 months, only 19% reported that their patients received a CP diagnosis < 12 months. The Developmental Assessment of Young Children (73%) and the Peabody Developmental Motor Scales-2 (59%) were used most. Many respondents indicated never using magnetic resonance imaging (70%), the General Movements Assessment (87%), or the Hammersmith Infant Neurological Exam (69%). Participants identified clinical signs and symptoms prompting a referral for the diagnostic assessment of CP, most commonly stiffness in legs (95%), excessive head lag (93%), and persistent fisting (92%). Policy and organizational change, clinician education, and training are needed to support the implementation of CP early detection guidelines.
本研究旨在评估马里兰州和特拉华州的医疗保健及教育提供者针对有患脑瘫（CP）风险或已患脑瘫儿童进行早期检测和诊断的评估及转诊做法。次要目的是确定使用早期检测工具的障碍，并找出变革机会以支持早期诊断并改善护理。72名参与者回答了≥50%的调查问卷问题。大多数是从事早期干预工作（61%）的职业或物理治疗师（86%）。88%的人表示知晓脑瘫可在12个月时被诊断出来。尽管86%的人表示他们通常在0至12个月之间怀疑患有脑瘫，但只有19%的人报告称他们的患者在12个月之前被诊断为脑瘫。使用最多的是《幼儿发育评估》（73%）和《皮博迪发育运动量表 - 2》（59%）。许多受访者表示从未使用过磁共振成像（70%）、全身运动评估（87%）或哈默史密斯婴儿神经学检查（69%）。参与者确定了促使转诊进行脑瘫诊断评估的临床体征和症状，最常见的是腿部僵硬（95%）、头部过度后仰（93%）和持续握拳（92%）。需要政策和组织变革、临床医生教育及培训来支持脑瘫早期检测指南的实施。
