Early Detection and Intervention for Children with High Risk of Cerebral Palsy: A Survey of Physical Therapists and Occupational Therapists in Brazil

The purpose of this study was to assess the current clinical practice of physiotherapists and occupational therapists on early detection and early intervention for children with cerebral palsy (CP) in Brazil. This was a cross-sectional study. A purpose-developed electronic survey was disseminated across the country to physiotherapists and occupational therapists working with young children with or at risk of CP. A total of 205 anonymous respondents were included. Most participants (64.4%) agree that the diagnosis of CP can be made before 6 months of age. General Movements Assessment (26.8%) and Hammersmith Infant Neurological Examination (37.1%) were used infrequently. Infants at risk for CP receive therapy twice a week or more by 58.5% of therapists, 93.2% identified parents’ goals as the most important factor in customizing the early intervention program. The most frequent intervention strategies for this age group were active stimulation of the child (<i>n</i> = 182), family training (<i>n</i> = 161), strategies to optimize the environment (<i>n</i> = 143), and neurodevelopmental treatment/Bobath (<i>n</i> = 99). Currently, pediatric physiotherapists and occupational therapists in Brazil do not fully incorporate best practice tools for early identification of children with CP, nor sufficient best evidence-based interventions.

本研究旨在评估巴西境内物理治疗师与作业治疗师针对脑性瘫痪（cerebral palsy, CP）儿童开展早期识别与早期干预的当前临床实践现状。本研究为横断面研究。研究团队自行研制了电子调查问卷，面向巴西境内服务于脑性瘫痪患儿或存在脑性瘫痪患病风险幼儿的物理治疗师与作业治疗师进行发放，最终共回收205份匿名有效问卷。绝大多数参与者（64.4%）认可脑性瘫痪可在患儿年满6月龄前作出诊断。全身运动评估（General Movements Assessment）与哈默史密斯婴儿神经检查表（Hammersmith Infant Neurological Examination）的使用率分别仅为26.8%与37.1%，两类工具均较少被临床采用。58.5%的治疗师会为存在脑性瘫痪患病风险的幼儿提供每周两次及以上的康复干预；93.2%的受访者认为，家长的康复目标是定制早期干预方案的核心考量因素。该年龄段幼儿最常用的干预策略依次为：对患儿实施主动刺激训练（n=182）、家属康复指导培训（n=161）、环境优化策略（n=143）以及神经发育治疗/博巴斯疗法（neurodevelopmental treatment/Bobath）（n=99）。当前巴西的儿科物理治疗师与作业治疗师尚未充分应用脑性瘫痪早期识别的最佳实践工具，也未全面落实基于最佳证据的早期干预措施。