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Published on: November 3, 2016
Prognosis for ambulation in cerebral palsy: a population-based study
Yvonne W Wu1, Steven M Day, David J Strauss
1Department of Neurology, Box 0136, University of California-San Francisco, 500 Parnassus Ave, Room 411, San Francisco, CA 94143-0136, USA. wuy@neuropeds.ucsf.edu
Insights
This study identified key predictors of walking ability in children with cerebral palsy (CP). Early motor skills like sitting and pulling to stand significantly increase the likelihood of ambulation, aiding in prognosis.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) affects motor function, with ambulation being a key developmental milestone.
- Predicting walking potential in nonambulatory children with CP is crucial for intervention planning.
Purpose of the Study:
- To identify independent predictors of ambulation in children with CP.
- To develop a predictive tool for estimating a child's probability of walking.
Main Methods:
- Retrospective analysis of medical and functional data from 5366 children with CP (1987-1999).
- Logistic regression identified predictors of independent walking by age 6.
- Multistate survival analysis estimated probabilities of ambulation over time.
Main Results:
- 12.8% achieved independent walking and 18.4% walked with support by age 6.
- Key predictors included early motor milestones (sitting, pulling to stand), CP type (non-spastic quadriparesis), and preserved visual function.
- Ambulation charts were developed to predict outcomes through age 14.
Conclusions:
- Ambulation charts offer a simple method to estimate the likelihood of walking in nonambulatory children with CP.
- These charts aid in predicting ambulation with or without support for children aged 2-3.5 years.
Objectives:
To determine independent predictors of ambulation among children with cerebral palsy and to develop a simple tool that estimates the probability that a child will walk.
Methods:
In a retrospective study of all children with cerebral palsy who were not yet walking at 2 to 3(1/2) years of age, while receiving services from the California Department of Developmental Services during the years 1987-1999, we analyzed medical and functional data obtained annually by Department of Developmental Services physicians and social workers. Using logistic regression analyses, we determined independent predictors of a child's ability to walk well alone at least 20 feet, without assistive devices, by age 6. We then estimated the probabilities of walking at various levels of ability over time, using multistate survival analysis.
Results:
Of 5366 study subjects, 2295 (43%) were evaluated at age 6; 12.8% could walk independently and 18.4% walked with support. Independent predictors of successful ambulation included early motor milestones such as sitting (odds ratio: 12.5; 95% confidence interval: 5.8-27.2) and pulling to a stand (odds ratio: 28.5; 95% confidence interval: 13.4-60.4) when compared with lack of rolling at age 2, cerebral palsy type other than spastic quadriparesis (odds ratio: 2.2; 95% confidence interval: 1.5-3.1), and preserved visual function (odds ratio: 2.4; 95% confidence interval: 1.1-5.4). Our ambulation charts depict the probability of remaining nonambulatory, transitioning to 1 of 3 possible ambulatory states, or expiring at all subsequent ages through age 14.
Conclusion:
The ambulation charts provide a simple straightforward way to estimate the probability that a child with cerebral palsy who is nonambulatory at 2 to 3 12 years of age will eventually walk with or without support.
