Walking abilities of young adults with cerebral palsy: changes after multilevel surgery and adolescence

Although there is some evidence to support the efficacy of single event multilevel surgery (SEMLS) in the short term for improving walking abilities in children with cerebral palsy (CP), long term effects are not known. It is hypothesized: (1) SEMLS improves walking abilities; (2) in young adulthood abilities deteriorate beyond pre-operative status; (3) walking abilities deteriorate from adolescence to young adulthood and are associated with weight status increase. Twenty-three young adults (mean age 25.5 years, range 20-36) with spastic CP Gross Motor Functional Classification Scale Level II (n=11) or III (n=12) returned for follow up three dimensional gait analysis (3DGA). Gillette Gait Index (GGI) was used as a general indicator of walking abilities. Eleven subjects had 3DGA prior to multilevel orthopedic surgery and 12 subjects had 3DGA after the age of 10 with no interventions in the interim. GGI(s) were graphed over time. Ten of 11 subjects (91%) who had multilevel surgery either improved (n=6) or maintained pre-operative walking abilities (n=4) based on GGI. Ten of 12 subjects (83%) who had 3DGA after the age of 10 but no interventions in the interim maintained (n=8) or improved (n=2) walking abilities. No associations were found between declines in walking abilities and increased weight status. After SEMLS, walking abilities in young adulthood were comparable to pre-operative status. A decline in walking abilities was not observed from adolescence to young adulthood.