Interventions in the Cerebral palsy follow-up program: Reidun Jahnsen, PT PhD

Transkript

1 Interventions in the Cerebral palsy follow-up program: Reidun Jahnsen, PT PhD

2 Subgroups of CP CPOP 214 n=188

3 Gross Motor Function Classification System Palisano 1997, CPOP

4 CPOP 213 n=856 Manual Ability Classification System Classifies the ability to handle objects in daily life with two hands on a 5 point scale. Level one describes the best performance and level five the most severe impairment Arner et al 24

5 Registration of interventions Spasticity treatment Botulinum toxin-a Intrathecal Baklofen Orthoses Upper and lower extremities Intensive goal-directed training Physio and occupational therapy Standing support, wheelchairs Preventive surgery Soft tissue and bone surgery Hägglund et al 25

6 Oslo Akershus Østfold Hedmark Oppland Vestre Viken Vestfold Telemark Aust-Agder Vest-Agder Stavanger Haugesund Bergen Førde Ålesund Kristiansund Sør-Trøndelag Nord-Trøndala Nordland Troms Finnmark Antall barn Botulinum toxin-a 44% have had BoNT-A in the lower extremities and 18% in the upper extremities BoNT-A i under- og overekstremiter Underekstremiteter Overekstremiteter

7 Intrathecal baklofen (ITB) (n=972) 3% of the children have ITB

8 Oslo 52 Akershus 91 Østfold 49 Hedmark 36 Oppland 37 Vestre Viken 41 Vestfold 4 Telemark 3 Aust-Agder 6 Vest-Agder 27 Stavanger 4 Haugesund 15 Bergen 65 Førde 14 Ålesund 12 Kristiansund 9 Sør-Trøndelag 15 Nord-Trøndalag 15 Nordland 21 Troms 26 Finnmark 3 Norge 644 Hand orthoses (n=644) Ortose overekstremiteter 1 % 8 % 6 % 4 % 2 % % JA Ortose NEI Ortose

9 Hand orthoses related to MACS level Ortosebruk fordelt på MACS-nivå 1 % 9 % 8 % 7 % 6 % 5 % 4 % 3 % 2 % 1 % % I II II IV V MACS-nivå JA Ortose NEI Ortose 25% of the children use hand orthoses (n=644)

10 Ankle-foot-orthoses n=972 71% use AFOs at all GMFCS levels. 27% at level I 54% at level II 64% at level III 66% at level IV 57% at level V

11 Oslo Akershus Østfold Hedmark Oppland Vestre Viken Vestfold Telemark Aust-Agder Vest-Agder Stavanger Haugesund Bergen Førde Ålesund Kristiansund Sør-Trøndelag Nord-Trøndala Nordland Troms Finnmark Standing support n=188 Ståstativ NF-Walker Ståskall % of the children use standing support

12 Oslo Akershus Østfold Hedmark Oppland Vestre Viken Vestfold Telemark Aust-Agder Vest-Agder Stavanger Haugesund Bergen Førde Ålesund Kristiansund Sør-Trøndelag Nord-Trøndala Nordland Troms Finnmark Norge Occupational therapy In % of the children had occupational therapy (n=644) 1 % JA Ergoterapi 214 NEI Ergoterapi % 6 % 4 % 2 % %

13 Oslo 52 Akershus 91 Østfold 49 Hedmark 36 Oppland 37 Vestre Viken 41 Vestfold 4 Telemark 3 Aust-Agder 6 Vest-Agder 27 Stavanger 4 Haugesund 15 Bergen 65 Førde 14 Ålesund 12 Kristiansund 9 Sør-Trøndelag 15 Nord-Trøndalag 15 Nordland 21 Troms 26 Finnmark 3 Norge 644 Hand training In % of the children performed training to improve hand function 1 % 9 % 8 % 7 % 6 % 5 % 4 % 3 % 2 % 1 % % Håndtrening JA Håndtrening NEI Håndtrening n = 644

14 Hand training related to MACS level MACS-nivå hos barn med håndtrening 1 % 9 % 8 % 7 % 6 % 5 % 4 % 3 % 2 % 1 % % I II III IV V MACS-nivå JA håndtrening NEI Håndtrening Who performed hand training? 52% had unilateral CP 52% (7% of those tested with AHA) 36% with bilateral CP MACS I-III n = 289

15 Physiotherapy related to GMFCS Physiotherapy Total N= 771 N (%) GMFCS I N=347 N (%) GMFCS II N=14 N (%) GMFCS III N=7 N (%) GMFCS IV N=82 N (%) GMFCS V N=116 N(%) Not Classified N=16 N (%) Yes No Missing <1/month 1-3/month 1-2/week 3-5/week >5 /week Intensive training Goals Yes No Missing 75 (92) 49 (6) 17 (2) 12 (14) 126 (18) 45 (57) 43 (6) 1 33 (87) (93) (94) (96) (97) (26) 6 (17) 48 (34) 36 (51) 28 (34) 28 (24) (59) (43) (63) (66) (67) (63) (94) (56) 2 5

16 Antall barn Orthopedic surgery (n=188) Ortopedisk kirurgi 2% of the children have had surgery in the lower extremities and 3% in the upper extremities 1 5 Oslo Akershus Østfold Hedmark Oppland Vestre Viken Vestfold Telemark Aust-Agder Vest-Agder Stavanger Haugesund Bergen Førde Ålesund Kristiansund Sør-Trøndelag Nord-Trøndala Nordland Troms Finnmark Underekstremiteter Overekstremiteter

17 National follow-up program The goal is to have services that are: Evidence based and effective Safe and sound Involving the users giving them influence on the services Coordinated and continuous Using the resources in an optimal way Available and equally distributed