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

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

Subgroups of CP CPOP 214 n=188

Gross Motor Function Classification System Palisano 1997, CPOP 214 171

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

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

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 8 7 6 5 4 3 2 1 Underekstremiteter Overekstremiteter

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

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

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)

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

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 4 35 3 25 2 15 1 5 34% of the children use standing support

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 214 55% of the children had occupational therapy (n=644) 1 % JA Ergoterapi 214 NEI Ergoterapi 214 8 % 6 % 4 % 2 % %

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 214 45% 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

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

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) 4 4 74 8 13 6 13 (93) 4 6 18 2 79 5 66 (94) 2 2 3 5 46 1 79 (96) 2 1 4 13 53 5 112 (97) 1 3 21 (26) 6 (17) 48 (34) 36 (51) 28 (34) 28 (24) 2 419 (59) 186 166 148 (43) 18 91 88 (63) 3 22 46 (66) 7 17 55 (67) 17 1 3 7 85 15 1 73 (63) 22 21 15 (94) 1 1 12 1 9 (56) 2 5

Antall barn Orthopedic surgery (n=188) 4 35 3 25 2 15 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

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