Delays in diagnosis and rehabilitation among children with cerebral palsy: A retrospective study from a tertiary care centre in Sri Lanka

Introduction: Early identification of cerebral palsy is essential in receiving appropriate interventions, better patient outcomes, reducing the cost of rehabilitation. The aim of the study was to identify the delay in diagnosis and wait time for rehabilitation and factors associated with it. 
Methods: A retrospective descriptive cross-sectional study was conducted among 100 children with cerebral palsy attending rehabilitation services and neurology clinics at a leading tertiary children’s hospital in Sri Lanka. Consecutive eligible children were recruited using convenience sampling until the required sample size was achieved. Data were collected from parents or guardians using a pre-tested interviewer-administered questionnaire, supplemented by review of clinic records and clinical examination.
Results:  Majority of the children were male (66%), had spastic (78%) and quadriplegic (55%) CP, belonging mainly to GMFCS IV and V. In this study, 25% were born below 32 weeks. The most common associated factors were birth asphyxia (45%), neonatal jaundice (41%) and hypoglycaemia (24%). Maternal risk factors for sepsis was below 10%. The most common clinical presentation was developmental delay (82%), diagnosed mostly (58%) by general paediatricians. Mean age at diagnosis, at referral for physiotherapy, occupational therapy, speech and language therapy and cortical visual stimulation were 16 months, 20 months, 8.4 months and 8.0 months respectively. Financial status, appointment delay and missed dates were the common factors associated with delayed referral. 
Conclusions: In this sample of children with cerebral palsy in Sri Lanka, diagnosis was made generally after infancy, and delays were particularly evident in referral to and commencement of specialised rehabilitation services such as speech and language therapy and cortical visual stimulation. Financial constraints, appointment delays, and missed clinic dates were frequently reported barriers to timely rehabilitation. These findings highlight the need for strengthened early identification pathways, clearer referral systems, and improved access to multidisciplinary rehabilitation services for children with cerebral palsy.