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Predictors of independent walking in children with spastic diplegia
E Fedrizzi1, P Facchin, M Marzaroli
1Department of Developmental Neurology, C Besta Neurological Institute, Milan, Italy. efedrizzi.besta@interbusiness.it
Insights
Predicting independent walking in children with cerebral palsy is possible. Early gross motor skills, normal visual acuity, and a good developmental quotient are key indicators for achieving this milestone.
Area of Science:
- Neurology
- Pediatrics
- Developmental Pediatrics
Background:
- Spastic diplegia and triplegia are common forms of cerebral palsy affecting motor function.
- Predicting ambulatory outcomes in children with cerebral palsy is crucial for early intervention and management.
Purpose of the Study:
- To identify predictors of independent walking in children diagnosed with spastic diplegia or triplegia.
- To establish correlations between early motor skill acquisition and later ambulatory status.
Main Methods:
- A prospective study followed 31 children with cerebral palsy from 9-18 months of age.
- An 18-item scheme assessed prelocomotor, sitting, and locomotor skills every 6 months via videotaped examinations.
- Developmental quotient and visual acuity were also evaluated.
Main Results:
- 58% of children achieved walking, with 23% walking independently.
- Independent walkers typically had normal visual acuity and a high developmental quotient (86%).
- Early weight-bearing on hands in prone and rolling by 18 months predicted independent walking.
Conclusions:
- Early gross motor skill acquisition, particularly prone weight-bearing and rolling, are significant predictors of independent walking in children with cerebral palsy.
- Normal visual acuity and developmental quotient are strongly associated with achieving independent ambulation.
- The ability to sit independently became a significant predictor around 24 months of age.
Abstract:
A prospective study was carried out to identify predictors of independent walking in 31 children with either spastic diplegia or triplegia, observed from the age of 9 to 18 months (mean, 11 months) and followed for a mean period of 30 months (range, 24 to 36 months). Mean age at most recent examination was 41 months (range, 36 to 54 months). We used an 18-item scheme to chart the acquisition, from the prone position, of prelocomotor, sitting, and locomotor skills. Examinations were conducted every 6 months and videotaped according to a standardized procedure. At latest assessment 18 (58%) of the 31 children had achieved walking, 7 (23%) independently and 11 (35%) with assistance; 13 (42%) did not achieve walking. Ambulatory status was related to developmental quotient and visual acuity: all the children who became independent walkers had normal visual acuity and in 86% of cases a normal general development quotient. Moreover, we found a significant correlation between the number of gross motor skills achieved and the rate of achievement before 2 years of age and ambulatory status at 3 to 5 years of age. Ability to put weight on the hands while prone and to roll from supine to prone position by 18 months of age were significantly related to independent walking, while ability to sit without support was predictive only at around 24 months of age.