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      Perspectives on cerebral palsy in Africa: Exploring the literature through the lens of the International Classification of Functioning, Disability and Health

      1 , 2 , , 1 , 2 , 3 , 1 , 2 , 3
      John Wiley and Sons Inc.
      Africa, cerebral palsy, disability, ICF

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          The prevalence of cerebral palsy (CP) in countries in Africa is suggested to be higher than in Western countries. Research in Western resource‐rich contexts has demonstrated the importance of environmental factors in the activities and participation of individuals with CP, as illustrated by the International Classification of Functioning, Disability and Health (ICF). Although the domains of the ICF are often acknowledged in research on CP in western contexts, the extent to which these domains have been explored in resource‐limited areas is unknown. The current review aims to describe the nature of the current published literature on CP in African countries and how it aligns with the domains of the ICF.


          Key informants familiar with the literature on CP in Africa were consulted, and a literature search was conducted to identify articles on CP originating from countries in Africa. Identified articles were assessed to determine the ICF domains that align with the studies. Themes relating to each domain were identified.


          Twenty‐seven studies were included. The majority of studies were quantitative (70.3%) and focused on children or caregivers. Most studies included a body functions and structures component (70.4%), focusing on impairment rather than functioning. Activities and participation domains were addressed, but often focused solely on mobility. Environmental factors typically related to resources and policies and personal factors were often unexplored.


          Research on CP in Africa tends to be grounded in a biomedical approach to disability and does not explicitly use the ICF as a guiding framework. Studies exploring body function and structures tend to be descriptive in nature, whereas activities and participation, and environmental and personal factors, represent modifiable factors that may be addressed with interventions. Knowledge translation activities that promote the ideas of the ICF in an African context should therefore be considered.

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          Most cited references34

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          A report: the definition and classification of cerebral palsy April 2006.

          For a variety of reasons, the definition and the classification of cerebral palsy (CP) need to be reconsidered. Modern brain imaging techniques have shed new light on the nature of the underlying brain injury and studies on the neurobiology of and pathology associated with brain development have further explored etiologic mechanisms. It is now recognized that assessing the extent of activity restriction is part of CP evaluation and that people without activity restriction should not be included in the CP rubric. Also, previous definitions have not given sufficient prominence to the non-motor neurodevelopmental disabilities of performance and behaviour that commonly accompany CP, nor to the progression of musculoskeletal difficulties that often occurs with advancing age. In order to explore this information, pertinent material was reviewed on July 11-13, 2004 at an international workshop in Bethesda, MD (USA) organized by an Executive Committee and participated in by selected leaders in the preclinical and clinical sciences. At the workshop, it was agreed that the concept 'cerebral palsy' should be retained. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, health officials, families and the public and would provide a common language for improved communication. Panels organized by the Executive Committee used this information and additional comments from the international community to generate a report on the Definition and Classification of Cerebral Palsy, April 2006. The Executive Committee presents this report with the intent of providing a common conceptualization of CP for use by a broad international audience.
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            The epidemiology of cerebral palsy: incidence, impairments and risk factors.

            Describing the epidemiology of cerebral palsy (CP), its impairments and risk factors. Literature review 1965-2004. Search terms: Cerebral palsy, incidence, prevalence, impairments, risk factors. In the last 40 years the prevalence of CP has risen to well above 2.0 per 1000 life births. In this time span the proportion of low-birthweight infants rose, the proportion of diplegia decreased, while the proportion of hemiplegia increased. CP is more prevalent in more deprived socio-economic populations. The majority of people with CP have the spastic syndrome of which the diplegic group is the smallest. Dependent on the subgroup of CP, 25-80% have additional impairments. A large proportion has some kind of cognitive impairment; the prevalence varies with the type of CP and especially increases when epilepsy is present. Epilepsy is present in 20-40%; it is most common among the hemi- and tetraplegics. Sensibility of the hands is impaired in about half. Chronic pain is reported by more than a quarter of the adults. Up to 80% have at least some impairment of speech. Low visual acuity is reported in almost three-quarters of all children. Half of all children have gastrointestinal and feeding problems. Stunted growth occurs in a quarter, while under- or overweight problems are present in half of the children. Almost 70% of people with spastic CP have abnormal brain CT findings; abnormal cranial ultrasounds is most strongly associated with hemiplegia, normal cranial ultrasounds with diplegia. The most important risk factors for CP are low birthweight, intrauterine infections and multiple gestation.
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              The 'F-words' in childhood disability: I swear this is how we should think!

              The 21st century is witnessing a sea change in our thinking about 'disability'. Nowhere are these developments more apparent than in the field of childhood disability, where traditional biomedical concepts are being incorporated into--but expanded considerably by--new ways of formulating ideas about children, child development, social-ecological forces in the lives of children with chronic conditions and their families, and 'points of entry' for professionals to be helpful. In this paper, we have tried to package a set of ideas, grounded in the World Health Organization's International Classification of Functioning, Disability and Health (the ICF), into a series of what we have called 'F-words' in child neurodisability--function, family, fitness, fun, friends and future. We hope this will be an appealing way for people to incorporate these concepts into every aspect of clinical service, research and advocacy regarding disabled children and their families.

                Author and article information

                Child Care Health Dev
                Child Care Health Dev
                John Wiley and Sons Inc. (Hoboken )
                22 January 2020
                March 2020
                : 46
                : 2 ( doiID: 10.1111/cch.v46.2 )
                : 175-186
                [ 1 ] School of Rehabilitation Science McMaster University Hamilton Ontario Canada
                [ 2 ] CanChild Centre for Childhood Disability Research McMaster University Hamilton Ontario Canada
                [ 3 ] Department of Paediatrics McMaster University Hamilton Ontario Canada
                Author notes
                [*] [* ] Correspondence

                Sandra Abdel Malek, School of Rehabilitation Science, McMaster University. Hamilton, ON, Canada.

                Email: abdels11@ 123456mcaster.ca

                Author information
                CCH12733 CCH-2019-0402
                © 2019 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                : 04 October 2019
                : 14 December 2019
                Page count
                Figures: 1, Tables: 3, Pages: 12, Words: 7982
                Review Article
                Review Articles
                Custom metadata
                March 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.5 mode:remove_FC converted:18.02.2020

                africa,cerebral palsy,disability,icf
                africa, cerebral palsy, disability, icf


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