Motor severity, growth and rehabilitation models accessed by children and adolescents with cerebral palsy in four provinces of central and northwestern Argentina

Abstract

The rehabilitation processes of children with cerebral palsy (CP) should be directed to improve motor skills, to develop skills for activities of daily life and for healthy lifestyles. These processes are recommended to be plan in the framework of the international classification of functioning and health (ICF). In Argentina it is unknown how rehabilitation processes occur.
 
The aim of this study was to analyze access to health and rehabilitation in children and adolescents from 2 to 19 years with PC, and to characterize their diagnosis and nutritional status, in four provinces of Argentina (Cordoba, Catamarca, Santiago del Estero and Jujuy) in the year 2018-2019.
 
A descriptive and cross-sectional study was carried out. Data were collected from children in six rehabilitation centers from surveys and medical records. Also, interviews were carried out with coordinators of thirteen rehabilitation centers. Nutritional status was assessed with WHO Anthro Plus. The severity level was assessed with the international classification of gross motor function(GMFCS). The discrete data were described in percentage with 95%CI, and the normal continuous in means ±SD, and not normal in medians with IQR. Multicentre study funded by the Ministry of Health and Social Development of the Nation. This study was approved by the CIEIS of the HNC.
 
Data was obtained from 236 children with CP. 105 children had a GMFCS I-III (45% 95%CI 38.5,51.6) and 131 GMFCS IV-V (55% 95%CI 48.4,61.5), with similar prevalence of severe levels in each province. 46 children presented moderate undernutrition (21% 95%CI15.8.27) and 84 severe undernutrition (38.35% 95%CI31.8,45.1) according to WHO standards (2007). Despite the differences in GMFCS, the average number of weekly sessions and duration that children receive were similar. Coordinators from 13 centers were interviewed. Although 84.6% know the CIF, only one of the centers responded that it was used in rehabilitation processes. According to rehabilitation centers the model of rehabilitation was linked to the interdisciplinary model, with a focus on the team of professionals.
 
It can be concluded that in Argentina there are high prevalence of CP with severe gross motor compromise and undernutrition. The international classifications and ICF are not yet systematically applied. It is necessary to review the treatments, strategies and policies in rehabilitation