Functioning multidisciplinary care and referral center for cerebral palsy children.

Abstract

This presentation will attempt to give the history of the Developmental Neurology Service at the Istituto Neurologico, Milano, where children affected by cerebral palsy, spina bifida and other developmental disorders are followed up and treated. In order to achieve this goal, it is necessary to give a brief overview of the Italian Health Care System for handicapped children from 1950 to 1992, including the history of the service where I am working. During the first period, from 1950 to 1970, the Italian Health Care System for handicapped children was very poorly organized. There were residential centers, mainly managed by the Catholic Church, where children older than 3 years of age affected by cerebral palsy (CP) and other developmental diseases were admitted. Some of them provided rehabilitation treatment and special teaching; most of them provided only nursing care and assistance. There were also community centers for daily care; they were very few in number and 0nly located in big cities (e.g., Milan and Rome). The children with CP only went to the rehabilitation service and special classes during the day. At that time the approach to treating CP children was orthopedic and similar to the one used in children with poliomyelitis, i.e., orthesis and orthopedic operations. The history of the Developmental Neurology Service at the Istituto Neurologico in Milan, during this period (from 1950 to 1970) is characterized by an important step: in 1954 a Cerebral Palsy Center was founded by Prof. A. Grisoni Colli and was officialy recognized by the Ministry of Health for the treatment of handicapped children. The Center was the first Service in Italy for the treatment of outpatients and for children less than 3 years of age. CP children coming from various areas of northern Italy were treated and then followed up until 18 years of age. The rehabilitation program, in part using the Bobath approach and in part focusing on daily living activities, was explained to the family. The mothers had to treat their children at home. Family and psychosocial support was provided by a psychologist. The staff comprised a pediatric neurologist, 2 physiotherapists, 1 psychologist and 1 consultant orthopedic surgeon. All the members of the staff met weekly for a discussion of clinical problems in order to define rehabilitation plans. The following period, from 1970 to 1985, was characterized by a radical change in the Italian Health Care System for Handicapped Children. Between 1972 and 1974, following the new health political reforms, most of the residential centers for CP children and all the special classes were closed. From a theoretical point of view these reforms had many positive aspects. A new plan for a network of territorial rehabilitation service was designed with the aim of helping the families treat their children at home. A new law was passed that said that every handicapped child must be admitted to a normal school. From a practical point of view, our experience during this period showed had negative aspects. The new care system was introduced too suddenly: it took about ten years to organize the territorial services and to train physiotherapists, special teachers and social workers involved in the care and treatment of CP children. Very often at that time the family, therapists and teachers were left alone to cope with the various clinical and social problems of handicapped children. From 1970 to 1985 the knowledge and experience in diagnosis and rehabilitation of CP gained previously induced a modification in the function and organization of our service, which subsequently became a Referral Center Model for Multidisciplinary Care. The goals were as follows: