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Probability of walking in children with cerebral palsy in Europe
Eva Beckung1, Gudrun Hagberg, Peter Uldall
1Queen Silvia Children's Hospital/Sahlgrenska, University of Göteborg, Göteborg, Sweden. eva.beckung@vgregion.se
Insights
Walking ability in children with cerebral palsy (CP) remains stable, with intellectual capacity being the strongest predictor. Severe intellectual impairment significantly increases the risk of non-ambulation in children with CP.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a group of disorders affecting movement and posture, with walking ability being a key functional outcome.
- Understanding factors influencing walking ability is crucial for targeted interventions and support for children with CP.
Purpose of the Study:
- To describe walking ability in children with cerebral palsy (CP) using data from the Surveillance of Cerebral Palsy in Europe (SCPE) database over 21 years.
- To identify and examine predicting factors associated with walking ability in this population.
Main Methods:
- Anonymized data from 9012 children diagnosed with CP, born between 1976 and 1996, were analyzed from 14 European centers.
- Descriptive statistics and logistic regression were employed to assess walking ability and associated factors.
Main Results:
- At age 5, 54% of children with CP walked unaided, 16% used assistive devices, and 30% were unable to walk. The proportion of non-walkers remained stable at approximately 28% across centers and over time.
- Walking ability significantly correlated with CP type (spastic unilateral, spastic bilateral, dyskinetic, ataxic), IQ level, epilepsy, and severe visual/hearing impairments.
- Severe CP (inability to walk and IQ <50) affected 20% of subjects. Intellectual capacity was the most significant predictor across all CP types; severe intellectual impairment increased the risk of non-ambulation by 56 times in unilateral spastic CP and 9 times in bilateral spastic CP.
Conclusions:
- The SCPE collaboration effectively monitors trends in CP and its functional outcomes.
- The proportion of children with CP who do not walk appears stable despite advances in neonatal care, highlighting the persistent challenges.
- Walking ability is strongly influenced by CP type and additional impairments, serving as an indicator of overall disability load.
Objectives:
The purpose of this work was to describe walking ability in children with cerebral palsy from the Surveillance of Cerebral Palsy in Europe common database through 21 years and to examine the association between walking ability and predicting factors.
Patients And Methods:
Anonymous data on 10042 children with cerebral palsy born between 1976 and 1996 were gathered from 14 European centers; 9012 patients were eligible for the analyses.
Results:
Unaided walking as the primary way of walking at 5 years of age was reported for 54%, walking with assistive devices was reported for 16%, and no walking ability was reported for 30%. The proportion of children who were unable to walk was rather stable over time in all of the centers, with a mean proportion of 28%. Walking ability related significantly to cerebral palsy types, that is, spastic unilateral, spastic bilateral, dyskinetic, and ataxic cerebral palsy, as well as to IQ level, active epilepsy, and severe visual and hearing impairment. Severe cerebral palsy, defined as both the inability to walk and an IQ of <50, was present in 20% of the subjects. Logistic regression revealed that intellectual capacity was the variable most associated with walking ability in all 4 of the cerebral palsy types. The presence of a severe intellectual impairment increased the risk of being unable to walk 56 times if the child had unilateral spastic cerebral palsy type and 9 times if the child had bilateral spastic cerebral palsy type.
Conclusions:
The collaboration Surveillance of Cerebral Palsy in Europe provides a powerful means of monitoring trends in cerebral palsy and its functional consequences. The proportion of nonwalking in children with cerebral palsy seems to be rather stable over years and across centers despite the changes that have occurred in neonatal care across Europe. As is well known and also shown in this study, walking ability varied strongly with cerebral palsy type. Additional impairments, as well as the presence of epilepsy, correlated significantly with walking ability and, thus, the walking ability can be an indicator of total disability load.
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