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路径清晰但道路仍未铺设:脑性瘫痪早期检测工具实施情况的范围综述

The Pathway Is Clear but the Road Remains Unpaved: A Scoping Review of Implementation of Tools for Early Detection of Cerebral Palsy.

作者信息

Hidalgo-Robles Álvaro, Merino-Andrés Javier, Cisse Mareme Rose Samb, Pacheco-Molero Manuel, León-Estrada Irene, Gutiérrez-Ortega Mónica

机构信息

Facultad de Educación, Universidad Internacional de La Rioja, 26006 Logroño, Spain.

INAT (Early Intervention Research Team-Equipo de Investigación en Atención Temprana), Universidad Internacional de La Rioja, 26006 Logroño, Spain.

出版信息

Children (Basel). 2025 Jul 17;12(7):941. doi: 10.3390/children12070941.

DOI:10.3390/children12070941
PMID:40723133
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12293170/
Abstract

: International guidelines recommend the combined use of the General Movement Assessment (GMA), Hammersmith Infant Neurological Examination (HINE), and magnetic resonance imaging (MRI) to support early and accurate diagnosis of cerebral palsy (CP). However, their implementation remains inconsistent. This study aimed to map their reported global use and identify associated enablers and barriers. : A scoping review was conducted following JBI and PRISMA-ScR guidelines. Systematic searches were performed in PubMed, Cochrane, PEDro, ProQuest, Web of Science, and Scopus. Eligible studies were charted and thematically analyzed, focusing on tools use and implementation factors at individual, organizational, and system levels. : Fourteen articles (seven surveys, seven implementation studies) from seven countries met the inclusion criteria. While awareness of GMA, HINE, and MRI was generally high, routine clinical use was limited-particularly outside structured implementation initiatives. Major barriers emerged at the system level (e.g., limited training access, time constraints, lack of standardized referral pathways) and social level (e.g., unclear leadership and coordination). : The limited integration of GMA, HINE, and MRI into routine practice reflects a persistent "know-do" gap in early CP detection. Since implementation is shaped by the dynamic interplay of capability, opportunity, and motivation, bridging this gap demands sustained and equitable action-by addressing system-wide barriers, supporting professional development, and embedding early detection within national care pathways.

摘要

国际指南建议联合使用全身运动评估(GMA)、哈默史密斯婴儿神经学检查(HINE)和磁共振成像(MRI),以支持脑瘫(CP)的早期准确诊断。然而,它们的应用仍然不一致。本研究旨在梳理其在全球范围内的应用情况,并确定相关的促进因素和障碍。

按照循证卫生保健国际合作中心(JBI)和系统评价与Meta分析扩展版首选报告项目(PRISMA-ScR)指南进行了一项范围综述。在PubMed、Cochrane、PEDro、ProQuest、科学网和Scopus中进行了系统检索。对符合条件的研究进行了制表和主题分析,重点关注个体、组织和系统层面的工具使用和实施因素。

来自七个国家的14篇文章(7项调查、7项实施研究)符合纳入标准。虽然对GMA、HINE和MRI的认知度普遍较高,但常规临床应用有限,尤其是在结构化实施计划之外。主要障碍出现在系统层面(如培训机会有限、时间限制、缺乏标准化转诊途径)和社会层面(如领导和协调不明确)。

GMA、HINE和MRI在常规实践中的整合有限,这反映了在脑瘫早期检测中持续存在的“知行”差距。由于实施受到能力、机会和动机动态相互作用的影响,弥合这一差距需要持续且公平的行动,即解决全系统障碍、支持专业发展,并将早期检测纳入国家护理路径。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e188/12293170/df555315e251/children-12-00941-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e188/12293170/232b15d9a456/children-12-00941-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e188/12293170/86d8ddbdf5c2/children-12-00941-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e188/12293170/df555315e251/children-12-00941-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e188/12293170/232b15d9a456/children-12-00941-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e188/12293170/86d8ddbdf5c2/children-12-00941-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e188/12293170/df555315e251/children-12-00941-g003.jpg

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本文引用的文献

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BMC Health Serv Res. 2025 Apr 4;25(1):503. doi: 10.1186/s12913-025-12621-z.
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Prediction of cerebral palsy and cognitive delay among high-risk children in a developing nation: A successful early detection programme.
发展中国家高危儿童脑瘫和认知延迟的预测:一项成功的早期检测计划。
Dev Med Child Neurol. 2025 Jul;67(7):892-900. doi: 10.1111/dmcn.16197. Epub 2024 Dec 28.
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Development and Initial Outcomes of the Interdisciplinary 'Early Identification and Intervention for Infants Network' (Ei3) in Los Angeles.洛杉矶跨学科“婴儿早期识别与干预网络”(Ei3)的发展及初步成果
J Clin Med. 2024 Dec 6;13(23):7442. doi: 10.3390/jcm13237442.
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Upper Limb Therapy for Infants and Young Children with Unilateral Cerebral Palsy: A Clinical Framework.单侧脑瘫婴幼儿的上肢治疗:临床框架
J Clin Med. 2024 Nov 15;13(22):6873. doi: 10.3390/jcm13226873.
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