Knudsen, Stadskleiv, O'Regan, Alriksson-Schmidt, Andersen, Hollung, Korsfelt & Ödman (2022): The implementation of systematic monitoring of cognition in children with cerebral palsy in Sweden and Norway
I: Disability and Rehabilitation. Open Access.
Maja Knudsen, Kristine Stadskleiv, Elisabeth O'Regan, Ann I. Alriksson-Schmidt, Guro L. Andersen, Sandra Julsen Hollung, Åsa Korsfelt & Pia Ödman.
Children with cerebral palsy (CP) are at risk of cognitive impairments and need to be cognitively assessed to allow for individualized interventions, if applicable. Therefore, a systematic protocol for the follow-up of cognition in children with CP, CPCog, with assessments offered at five/six and 12/13 years of age, was developed. This report presents and discusses assessment practices in Sweden and Norway following the introduction of CPCog and a quality improvement project in Norway aimed at increasing the number of children offered cognitive assessments.
Materials and methods
A questionnaire investigating assessment practices was sent to pediatric habilitation centers in Sweden and Norway. In Norway, the habilitation centers also participated in a quality improvement project aimed at increasing adherence to the CPCog protocol.
Of the respondents, 64–70% report that they assess cognition in children with all degrees of motor impairment, and 70–80% assess at the ages recommended in CPCog. Following the quality improvement project in Norway, the percentage of children assessed increased from 34 to 62%.
The findings illustrate that the provision of information is not sufficient to change practice. Implementation of new re/habilitation procedures is aided by targeting health care practices individually.
Implications for rehabilitation
- Children with cerebral palsy (CP) have increased risk of cognitive impairments that require intervention.
- Assessments of cognition should be offered to all children with CP because the nature of cognitive impairments may vary.
- Introducing a follow-up protocol of how and when to perform cognitive assessments is a step towards ensuring equal access to the services for all children with CP.
- A quality improvement project might be a viable method for implementing a protocol into everyday clinical practice.