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Relationship between gross motor capacity and daily-life mobility in children with cerebral palsy
Dirk-Wouter Smits1, Jan Willem Gorter, Marjolijn Ketelaar
1Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, the Netherlands.
Insights
Gross motor function strongly predicts daily mobility in children with cerebral palsy (CP). However, this relationship weakens in those with unilateral spastic CP, showing a dissociation similar to typically developing peers.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Movement science
Background:
- Cerebral palsy (CP) affects motor function, impacting daily mobility.
- Understanding the relationship between gross motor capacity and functional mobility is crucial for targeted interventions in children with CP.
Purpose of the Study:
- To investigate the association between gross motor capacity and daily-life mobility in children with CP.
- To determine if CP severity, specifically limb distribution, moderates this relationship.
Main Methods:
- Cross-sectional analysis of 116 children with CP (aged 4-7 years).
- Assessed gross motor capacity using the Gross Motor Function Measure (GMFM-66).
- Evaluated daily-life mobility via the Pediatric Evaluation of Disability Inventory (PEDI): Functional Skills Scale (FSS) and Caregiver Assistance Scale (CAS).
Main Results:
- GMFM-66 scores explained a significant portion of the variance in PEDI-FSS mobility (90%) and PEDI-CAS mobility (84%).
- Limb distribution moderated the GMFM-66 and PEDI-FSS mobility relationship.
- A weaker association was found in children with unilateral spastic CP (24% variance explained) compared to bilateral spastic CP (91% variance explained).
Conclusions:
- Gross motor capacity is a strong predictor of daily mobility in children with CP.
- Children with unilateral spastic CP may exhibit a dissociation between gross motor capacity and functional mobility, similar to typically developing children.
- Limb distribution is a key factor influencing the relationship between motor capacity and mobility in pediatric CP.
Aim:
The aim of this study was to examine the relationship between gross motor capacity and daily-life mobility in children with cerebral palsy (CP) and to explore the moderation of this relationship by the severity of CP.
Method:
Cross-sectional analysis in a cohort study with a clinic-based sample of children with CP (n=116; 76 males, 40 females; mean age 6 y 3 mo, SD 12 mo, range 4 y 8 mo-7 y 7 mo) was performed. Gross motor capacity was assessed by the Gross Motor Function Measure (GMFM-66). Daily-life mobility was assessed using the Pediatric Evaluation of Disability Inventory (PEDI): Functional Skills Scale (FSS mobility) and Caregiver Assistance Scale (CAS mobility). Severity of CP was classified by the Gross Motor Function Classification System (48% level I, 17% level II, 15% level III, 8% level IV, 12% level V), type of motor impairment (85% spastic, 12% dyskinetic, 3% ataxic), and limb distribution (36% unilateral, 49% bilateral spastic).
Results:
Scores on the GMFM-66 explained 90% and 84% respectively, of the variance of scores on PEDI-FSS mobility and PEDI-CAS mobility. Limb distribution moderated the relationship between scores on the GMFM-66 and the PEDI-FSS mobility, revealing a weaker relationship in children with unilateral spastic CP (24% explained variance) than in children with bilateral spastic CP (91% explained variance).
Interpretation:
In children aged 4 to 7 years with unilateral spastic CP, dissociation between gross motor capacity and daily-life mobility can be observed, just as in typically developing peers.
