The implementation of systematic monitoring of cognition in children with cerebral palsy in Sweden and Norway

Abstract

Purpose 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. Results 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%. Conclusions 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.