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Cerebral palsy: predictive value of selected clinical signs for early prognostication of motor function
Insights
Early prediction of walking ability in children with cerebral palsy (CP) is possible. Key indicators like sitting by age two and primitive reflex suppression help determine ambulation prognosis in various CP types.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) presents diverse motor impairments, making early prognostication of ambulation challenging.
- Accurate prediction of functional walking is crucial for timely intervention and management in children with CP.
Purpose of the Study:
- To identify early prognostic signs for ambulation in a cohort of children with cerebral palsy.
- To correlate specific clinical types of CP with ambulatory outcomes.
- To establish reliable predictors for ambulation by two years of age.
Main Methods:
- Prospective longitudinal study of 233 children diagnosed with cerebral palsy, followed from 12 months to 3-11 years.
- Classification of CP into congenital hemiplegia, diplegia, spastic quadriparesis, spastic-athetoid, athetoid, ataxic, and hypotonic types.
- Assessment of developmental milestones (e.g., sitting) and primitive reflex activity for predictive value.
Main Results:
- 78.7% of children achieved functional walking.
- Congenital hemiplegic and ataxic CP types showed consistently favorable prognoses; hypotonic CP had a poor outlook.
- Sitting by age two reliably predicted ambulation.
- Suppression of primitive reflexes between 18-24 months distinguished potential walkers in non-sitters.
- Mental retardation was associated with poorer ambulatory outcomes.
Conclusions:
- Early prognostic indicators for ambulation can be identified by age two in children with CP.
- Sitting ability and primitive reflex suppression are key predictors, particularly for spastic diplegic, quadriparetic, and athetoid types.
- These findings aid in early prognostication for children with cerebral palsy, guiding therapeutic strategies.
Abstract:
A prospective longitudinal study involving 233 children with cerebral palsy was carried out to select signs useful for early prognostication of ambulation. All patients were followed from the time they were 12 months old and their progress was observed until they reached the age of 3 to 11 years. The population consisted of 61 children having congenital hemiplegia, 37 having diplegia, 85 having spastic quadriparesis and 28 having the spastic-athetoid clinical type of cerebral palsy. In addition, there were 14 children with athetoid, 6 with ataxic and 2 with hypotonic cerebral palsy. Of the total population, 78.7% achieved some degree of functional walking. Findings indicated that the probability of ambulation was related to the clinical type of cerebral palsy. In some the ultimate functional outcome was rather uniform, as in those with congenital hemiplegic and ataxic types where the prognosis was consistently favorable or in those with hypotonic cerebral palsy in whom the outlook was poor. In spastic diplegic, quadriparetic, spastic-athetoid and athetoid types, on the other hand, expectations varied considerably. For this group of patients, sitting by two years was found to be a predictive sign of high reliability since all children who sat by this age eventually walked. For the group of patients not sitting by two years which included more than half of the eventual ambulators, suppression of obligatory primitive reflex activity between 18 and 24 months provided a sensitive indicator to distinguish the children who ultimately walked from those who would not be expected to do so. These data offer a possibility for predicting future ambulatory status by two years of age in those clinical types of cerebral palsy where difficulties of early accurate prognostication are most likely to be encountered. Observations also suggested that the presence of mental retardation adversely affects ambulation.