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Better walking performance in older children with cerebral palsy
Elisabet Rodby-Bousquet1, Gunnar Hägglund
1Department of Orthopaedics, Lund University, University Hospital, 221 85 Lund, Sweden. elisabet.rodby_bousquet@med.lu.se
Insights
Children with cerebral palsy (CP) show improved independent walking with age, especially on uneven surfaces. Mobility aids are used by a small percentage, with performance varying by CP subtype and gross motor function.
Area of Science:
- Pediatric Rehabilitation
- Movement Science
- Clinical Biomechanics
Background:
- Children with cerebral palsy (CP) often experience challenges with walking speed and energy expenditure.
- Environmental factors and mobility choices significantly impact their daily function.
- Independent mobility is crucial for fostering activity and participation in children with CP.
Purpose of the Study:
- To describe walking performance across various distances and environments.
- To analyze walking performance in relation to gross motor function, CP subtype, and age.
- To understand factors influencing independent mobility in children with CP.
Main Methods:
- A cross-sectional study of 562 children (3-18 years) with CP in southern Sweden.
- Data collected from a Swedish CP register and healthcare program.
- Functional Mobility Scale (FMS) used to assess mobility at 5m, 50m, and 500m, analyzed against GMFCS level, CP subtype, and age.
Main Results:
- 57%-63% of children walked 5-500m without aids; 4%-8% used aids.
- Significant correlation found between FMS scores and GMFCS levels.
- Walking performance varied by CP subtype, with spastic unilateral CP showing higher independence (96%-98%) than dyskinetic CP (16%-24%).
- Independent walking on all surfaces increased with age.
Conclusions:
- Walking performance generally improves up to age 7, with continued gains in independent walking on uneven surfaces up to age 18.
- The ability to navigate uneven terrain is vital for community ambulation.
- Age and CP subtype are key determinants of walking independence.
Background:
Children with cerebral palsy (CP) often walk with a slower speed and a higher energy cost. Their walking performance and choice of mobility method may vary in different environments. Independent mobility is important for activity and participation.
Questions/Purposes:
We described walking performance at different distances and environments in relation to gross motor function, CP subtype, and age.
Patients And Methods:
We performed a cross-sectional study including all 562 children 3 to 18 years with CP living in southern Sweden during 2008. Data were extracted from a Swedish CP register and healthcare program. The Functional Mobility Scale (FMS) was used for rating mobility at home (5 m), at school (50 m), and in the community (500 m). The FMS scores were analyzed in relation to Gross Motor Function Classification System (GMFCS) level, CP subtype, and age.
Results:
In this population, 57% to 63% walked 5 to 500 m without walking aids and 4% to 8% used walking aids. We found a correlation between FMS and GMFCS. The walking performance varied between the subtypes from 96% to 98% in those with spastic unilateral CP to 16% to 24% in children with dyskinetic CP. An increased proportion of children walked independently on all surfaces in each successive age group.
Conclusions:
The overall walking performance increased up to 7 years of age, but the proportion of children walking independently on uneven surfaces was incrementally higher in each age group up to 18 years. The ability to walk on uneven surfaces is important for achieving independent walking in the community.
