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Does sex influence outcome in ambulant children with bilateral spastic cerebral palsy?
M Gough1, R Shafafy, A P Shortland
1One Small Step Gait Laboratory, Guy's and St Thomas' NHS Foundation Trust, London, UK. martin.gough@gstt.nhs.uk
Insights
Sex influences the gait patterns and treatment recommendations in children with bilateral spastic cerebral palsy (CP). Males exhibit greater knee flexion and higher Gillette Gait Index scores, impacting intervention strategies.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Bilateral spastic cerebral palsy (CP) is a common childhood motor disability.
- Understanding sex-based differences in CP phenotypes is crucial for tailored interventions.
Purpose of the Study:
- To investigate the influence of sex on the gait phenotype of children with bilateral spastic CP.
- To identify sex-specific differences in gait parameters and treatment recommendations.
Main Methods:
- Retrospective review of gait analysis data from 116 children with bilateral spastic CP.
- Data included patient demographics, Gross Motor Function Classification System (GMFCS) levels, and gait parameters.
- Comparison of gait characteristics and intervention history between male and female participants.
Main Results:
- No significant differences were found in gestational age, chronological age, or GMFCS level between sexes.
- Males demonstrated greater knee flexion during the stance phase of walking (p=0.003).
- Males exhibited a higher Gillette Gait Index (p<0.001) and were more likely to have undergone nonoperative intervention (p=0.024) or be recommended for surgery (p<0.001).
Conclusions:
- Sex significantly influences the musculoskeletal development and mobility patterns in ambulant children with bilateral spastic CP.
- These sex-based differences should be considered in the planning and assessment of interventions for pediatric CP.
Abstract:
To investigate the effect of sex on the phenotype of bilateral spastic cerebral palsy (CP) we reviewed the gait analysis data of 116 children (78 males, mean age 8 y 1 mo [SD 3 y 1 mo] and 38 females, mean age 8 y 9 mo [3 y 1 mo]) with bilateral spastic CP (Gross Motor Function Classification System [GMFCS] Levels I [four males, six females]; II [41 males, 19 females]; III [26 males, 12 females]; and IV [7 males, 1 female]) who had been referred for gait analysis to inform treatment. Although there were no differences between males and females in terms of gestational age, chronological age, or GMFCS level, males were more likely to have had nonoperative intervention before the referral (p=0.024), had a greater degree of knee flexion in stance phase when walking (p=0.003), and had a higher Gillette Gait Index (p<0.001) when compared with females. Males were also more likely to have surgery recommended on the basis of gait analysis (p<0.001). Sex seems to influence the development of the musculoskeletal system and mobility in ambulant children with bilateral spastic CP, and this may need to be considered when planning intervention or when assessing the outcome of intervention.
