“Comparison of Gross Motor Outcomes Between Children With Cerebral Palsy From Appalachian and Non-Appalachian Counties”

Abstract

“How could I apply this information?” Health care practitioners have suggested that many children from rural areas lack the resources to seek early identification and intervention services for a diagnosis of cerebral palsy (CP). This article did not identify a difference between the Appalachian and non-Appalachian groups for gross motor (GM) functioning; however, because both groups received services within the metropolitan health care system, this represents a limitation of the study. There are disparities identified in Appalachia, as stated in the purpose and within the literature review of this study. The authors suggest many families living in the Appalachian regions continue to have a higher risk of delivering a premature infant, have lower socioeconomic status, and a lack of resources and experience to ask their health care providers for referrals outside of their region. The pediatric physical therapist must continue to assist with identifying early signs of GM delay and provide education and resources to our families to seek interventions as early as possible for those infants born at high risk for CP. “What should I be mindful about when applying this information?” The authors, including Ms Blevins, the parent of a 2-year-old with CP, agree with the limitations of this study and the effect on the results as identified by the authors. She comments on her own child's difficulty in early identification of CP and the effect this might have had on his GM development had they not had availability of financial and interventional resources. She states, “I feel hospitals in Appalachia lack the resources and education of early identification and interventions that play a big part as to why many kids receive services later than maybe in a large city. For me, the signs were so clear that something was wrong but for whatever reason, they kept stalling. I also believe that we get the diagnosis later because of a financial strain on families. We had the privilege of being referred to specialists in our area like gastroenterology, cardiologist, and neurologist but nobody knew how to help and that's how we got sent to Cincinnati Children's. Most of our families would have just been left with unknown answers because of a financial strain to travel or the knowledge that they could seek other options.” This personal statement is in support of the authors' identified limitations. The limited sample size, and the sample taken only from a large metropolitan health care system, suggests that families in this study received services earlier than the many children in Appalachia. While this article is a beginning to identify GM skills within these 2 groups of children with CP, disparities remain among the Appalachian population. Lindsey Blevins, PTA Parent of a 2-year-old with cerebral palsy Marion, Virginia R. Bertie Gatlin, PT, DSc Associate Professor South College Knoxville, Tennessee Pediatric Physical Therapist Abingdon, Virginia