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Longitudinal changes in mobility following single-event multilevel surgery in ambulatory children with cerebral palsy
Adrienne Harvey1, Peter Rosenbaum, Steven Hanna
1Murdoch Children's Research Institute, Hamilton, Canada and Murdoch Children’s Research Institute, Melbourne, Victoria, Australia. harvey.adrienne@gmail.com
Insights
Single-event multilevel surgery generally maintained or improved mobility in children with cerebral palsy (CP). However, some children, particularly those with Gross Motor Function Classification System (GMFCS) III, required increased assistive devices long-term.
Area of Science:
- Pediatric Orthopedics
- Cerebral Palsy Research
- Rehabilitation Medicine
Background:
- Ambulant children with cerebral palsy (CP) using assistive devices are at higher risk of gross motor function decline.
- Longitudinal mobility changes after single-event multilevel surgery (SEMS) in this population require investigation.
Purpose of the Study:
- To longitudinally examine mobility changes after SEMS in ambulant children with CP.
- To focus on children using assistive devices, who are most vulnerable to declining gross motor function.
Main Methods:
- A cohort of 156 ambulant children with CP (GMFCS I-III) underwent SEMS.
- Gross Motor Function Classification System (GMFCS) and Functional Mobility Scale (FMS) were assessed pre-operatively and at 2 and 5 years post-operatively.
- Logistic regression analyzed assistive device needs in GMFCS III children based on baseline FMS.
Main Results:
- Children in GMFCS III demonstrated greater mobility changes at home and school compared to GMFCS I/II.
- Pre-operative crutch users in GMFCS III were likely to continue using them; walker users transitioned to crutches or wheelchairs.
- Wheelchair use was prevalent in the community both before and after SEMS.
Conclusions:
- SEMS generally resulted in stable or improved mobility at 5 years post-surgery.
- A subset of children required increased assistive device use for mobility facilitation following SEMS.
Objective:
To examine changes in mobility longitudinally following single-event multilevel surgery in ambulant children with cerebral palsy, focusing on those using assistive devices for functional mobility because they are most at risk of declining gross motor function.
Participants:
A consecutive sample of 156 ambulant children with cerebral palsy (99 males), 96 without devices (Gross Motor Function Classification System (GMFCS) I/II), 60 with devices (GMFCS III) who had single-event multilevel surgery at mean age 11 years 1 month.
Methods:
GMFCS and Functional Mobility Scale (FMS) ratings were recorded pre-operatively and at 2 and 5 years post-operatively. A proportional odds logistic regression model was used for the GMFCS III group to predict the probability of assistive device requirements post-operatively conditional on baseline FMS.
Results:
Children in GMFCS III showed more change than those in I/II at home and school. Those in GMFCS III using crutches pre-operatively at home and school were more likely to continue using them at 5 years, whereas those using walkers were more likely to change to crutches or wheelchairs. Wheelchairs were most commonly used in the community before and after single-event multilevel surgery.
Conclusion:
Mobility was generally stable or improved at 5 years after single-event multilevel surgery; however, a small number of children used more assistance to facilitate mobility.
