Evidence-Based Infant Assessment for Cerebral Palsy: Diagnosis Timelines and Intervention Access in a Newborn Follow-up Setting

Abstract

Evidence-based assessment pathways inform early detection of cerebral palsy and access to intervention. This study investigated the relationships between early evidence-based assessments, diagnosis timeline, and rehabilitation intervention access in a population of children with cerebral palsy who were seen between 2010 and 2022 at the University of Wisconsin Waisman Center Newborn Follow Up Clinic. Cerebral palsy-specific assessments were increasingly integrated after the publication of early detection guidelines by Novak et al. in 2017. Age at cerebral palsy first mention (high risk for cerebral palsy) decreased over time, although age at diagnosis remained similar. Infants who received multiple evidence-based assessments were diagnosed at a younger age. Ninety-nine percent of children were referred to rehabilitation therapies before diagnosis. Infant age at referral to outpatient therapies decreased over time. This study provides novel clinical data on diagnosis timelines and identifies remaining gaps related to implementation feasibility toward improved early diagnosis and intervention access.

Keywords: cerebral palsy; infant; neurodevelopment; rehabilitation.

Figure 1.

Assessments used before/after publication of early diagnosis guidelines (Novak 2017). 2010–2017 subgroup n = 44, 2018–2022 subgroup n = 47. AIMS, Alberta Infant Motor Scale; DAYC, Developmental Assessment of Young Children; GMA, General Movements Assessment; HINE, Hammersmith Infant Neurological Examination; MRI, Magnetic Resonance Imaging; TIMP, Test of Infant Motor Performance.

Figure 2.

Age at cerebral palsy first mention and diagnosis. (A) Age at cerebral palsy first mention grouped by year of diagnosis; (B) age at diagnosis grouped by year of diagnosis; (C) age at cerebral palsy first mention grouped by number of evidence-based assessments received (of MRI, GMA, HINE); (D) age at diagnosis grouped by number of evidence-based assessments received (of MRI, GMA, HINE). *t test P < .05, ^†1-way analysis of variance, Tukey post hoc test, P <.05. GMA, General Movements Assessment; HINE, Hammersmith Infant Neurological Examination; MRI, Magnetic Resonance Imaging.

Figure 3.

Age at referral to rehabilitation therapies (early intervention and outpatient). (A) Corrected age at referral to outpatient therapy (physical therapy, occupational therapy, or speech/language pathology) by year of diagnosis (r = −0.435, P < .001, n = 66). (B) Corrected age at referral to Early Intervention by year of diagnosis (r = 0.330, P = .009, n = 62). Gray lines represent linear regression fit lines.