Celebral Palsy: Organization of Service in Bulgaria Assoc. Prof. Ivan Chavdarov MD PhD Specialized Rehab. Hospital for Children with Cerebral Palsy “St.Sofia”, Sofia, Bulgaria
The cerebral palsy (CP) is a well-known disease and the goal of this paper is to introduce the model of its service in Bulgaria. CP consisting of many specific problems in different fields of brain functions and the whole muscularskeleton system and one of the most important is the spasticity and correlated problems. To solve all problems of CP is a delicate matter that depends on the acquired medical knowledge and experience, the available technical aids and devices and economic environment in every single country, which is hinting the answer there is no widespread or universal model. There are 3 Rehab hospitals for children with CP or other Neuro-Muscular Diseases (NMD) in Bulgaria. 1989 in Sofia-town was established a Specialized Rehab Hospital for Children with CP (SRHCCP) and was specially designed. In 2003 a Medical Centre for Child Neuro-Habilitation was founded too, in the area of the same hospital. A consensus paper for diagnosis, therapy, rehabilitation and service of children with CP was created from specialists of physical and rehabilitation medicine (PRM) and child neurologists, published in 2006 (Iv.Chavdarov, N.Bojinova). In the same consensus there is general information about orthopedic and neurosurgery treatment as a part of complex land-mark rehabilitation, but no surgeons have got a participation in it. The spasticity and related land-mark problems as common and
important issue of CP, are treated differently depending on the doctors point of view: neurologists with drugs per os; PRM-specialists with physio-therapy, electric stimulations, thermo/crio-therapy, extra-corporal shock-wave therapy, orthoses, intra-muscular BoTA; orthopedic surgeons – with orthoses and operative treatment. There is not neuroorthopedic surgery, as education and specialists in Bulgaria. A team of professionals developed the strategy of complex, land-mark medico-pedagogical rehabilitation according to the form, clinical picture and severity of the CP and the personal needs of the child. The team consists from PRM-specialist, neurologist, therapists - physio, ergo, electro, thermo, speech; psychologist, special teacher. No orthopedic surgeon take place in that a team, even in SRHCCP, and his decisions for operative-treatment do not correspond always with team point of view. The National Health Insurance Fund (NHIF) reimburse the hospital treatment of CP including rehabilitation and/or operative treatment according to the specific rules. The rehabilitation for children till 18 years old included 10 consecutive days, every single month, with 3 procedures daily, as well for adolescents over 18 years old – four, 10-day course yearly, with 3 procedures daily. Municipality of Sofia-town reimburse the 9