Abstract - Motio

Celebral Palsy: Organization of Service in 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
Assoc. Prof. Ivan Chavdarov MD PhD
Specialized Rehab. Hospital for Children with Cerebral
Palsy “St.Sofia”, Sofia, Bulgaria
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