Background: Cerebral palsy (CP) is characterized by motor impairment but commonly involves
more widespread difficulties, including cognitive impairment. However, cognitive impairment
in CP - especially of a more subtle nature - is often overlooked, despite being associated
with substantial academic, social, and emotional problems. In Denmark, the CP follow-up
program (CPOP) includes systematic assessment of physical functions, but cognitive assessment
is omitted. Prior to starting school, professionals evaluate the school readiness of children
with CP, sometimes including a test of general cognitive functioning. Thereafter, cognitive
assessments are rarely offered in mainstream schools (Folkeskolen) and can only be accessed
if the difficulties are clearly disabling. Recent studies indicate that cognitive assessment
needs to be implemented in the follow-up program for school children. For example, one study
found that only 42% of students with CP complete mainstream school in Denmark, and
international neurocognitive studies have found global cognitive difficulties (lower IQ) and
specific impairments in visuo-spatial functions, executive functions, and processing speed in
youth with CP. User organizations in the Nordic countries have called for action in recent
years, leading to the development of a proposed cognitive follow-up program for children and
adolescents with CP, the CPCog, which has yet to be evaluated and implemented in Denmark.
Taken together, prior studies and patient experiences emphasize the need for systematic
assessment of cognitive functioning in children and adolescents with CP to document the type
and extent of cognitive difficulties, secure qualified intervention, and prevent the
development of social and emotional problems.
Objective: The main purpose of this study is to characterize cognitive functioning in
children and adolescents with CP in Danish mainstream schools. By documenting the extent and
type of cognitive impairment associated with CP, we aim to inform future clinical practice
and make recommendations for systematic assessment and intervention.
Method: The study is a cross-sectional study with 100 children and adolescents with CP (11-15
years). Each participant will undergo cognitive assessment with the core battery proposed in
the Nordic CPCog protocol, including assessment of general cognitive functioning
(intelligence), executive functions, and visuo-motor skills. Additionally, participants will
undergo supplemental tests of memory, attention, fatigue, and symptoms of psychopathology.
Cognitive assessments will take place at two sites: the Neurocenter for Children and
Adolescents, Center for Rehabilitation of Brain Injury, and the Center for Clinical
Neuropsychology, Children and Adolescents, Rigshospitalet, Copenhagen, Denmark. The project
is carried out in collaboration between the neuropediatric and neuropsychological teams
associated with the two sites of assessment, as well as the Center for Cerebral Palsy,
Rigshospitalet, Aarhus University Hospital, CPOP, and an external advisory board including
leading international CP experts.
Results: The CPCog-Youth-DK study will help characterize the cognitive difficulties
associated with CP in children and adolescents in mainstream school, which will guide
clinical practice and the development and implementation of systematic cognitive assessment
and intervention programs. The cognitive assessment protocol will also be evaluated from the
perspectives of children and adolescents with CP, parents, and professionals (e.g., assessors
and school personnel) to evaluate whether the protocol is tolerable and helpful. Study
results will be published in international, peer-reviewed journals, and will be made publicly
available via other relevant platforms (such as the websites for the CP clinic at
Rigshospitalet, Center for Rehabilitation of Brain Injury, and the Elsass Foundation).
Several of the study investigators are directly involved in the current CP follow-up program
in Denmark which will aid the process of turning our research into practice.