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Physical risk factors influencing wheeled mobility in children with cerebral palsy: a cross-sectional study
Elisabet Rodby-Bousquet1,2, Ginny Paleg3, Jackie Casey4
1Centre for Clinical Research, Uppsala University, Vestmanland County Hospital, SE-721 89, Västerås, Sweden. elisabet.rodby_bousquet@med.lu.se.
Insights
Most children with cerebral palsy (CP) do not self-propel manual wheelchairs. Power mobility devices should be considered earlier to enhance independent mobility for children with CP using wheelchairs.
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Assistive Technology
Background:
- Understanding factors influencing independent mobility in children with cerebral palsy (CP) is limited.
- Independent mobility and participation in meaningful activities are crucial for child development.
Purpose of the Study:
- To analyze physical factors affecting independent manual and power wheelchair use in children with CP.
- To identify barriers to self-propulsion in young wheelchair users with CP.
Main Methods:
- Cross-sectional study of 2328 children (0-11 years) with CP from the Swedish CP registry (CPUP).
- Analysis included Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and other functional measures.
- Hazard ratios adjusted for age and sex were used to assess risks for inability to self-propel.
Main Results:
- Only 10% of children self-propelled manual wheelchairs; 90% were pushed.
- 75% of children using power mobility devices outdoors were independent.
- Poor hand function (MACS IV-V) and high GMFCS levels (V) were significant risk factors for inability to self-propel.
Conclusions:
- The majority of young children with CP do not self-propel manual wheelchairs.
- Early consideration of power mobility is recommended to promote independence in children with CP.
- Addressing physical factors like hand function is key to improving wheelchair mobility outcomes.
Background:
There is a lack of understanding of the factors that influence independent mobility and participation in meaningful activities. The purpose of this study was to analyse physical factors influencing independent use of manual and power wheelchairs in a total population of children with cerebral palsy (CP).
Methods:
A cross-sectional study based on the most recent examination of all children with CP, born 2002-2013, reported into the Swedish cerebral palsy registry (CPUP), from January 2012 to June 2014. There were 2328 children (58 % boys, 42 % girls), aged 0-11 years, at all levels of gross motor function and hand function. Hazard ratios adjusted for age and sex were used to calculate the risk for not being able to self-propel based on Gross Motor Function Classification System (GMFCS) levels, upper extremity range of motion and hand function including Manual Ability Classification System (MACS), House functional classification system, Thumb-in-palm deformity, Zancolli (spasticity of wrist/finger flexors) and bimanual ability.
Results:
In total 858 children used wheelchairs outdoors (692 manual, 20 power, 146 both). Only 10 % of the 838 children self-propelled manual wheelchairs, while 90 % were pushed. In contrast 75 % of the 166 children who used power mobility outdoors were independent. Poor hand function was the greatest risk factor for being unable to self-propel a manual wheelchair, while classification as GMFCS V or MACS IV-V were the greatest risk factors for not being able to use a power wheelchair independently.
Conclusions:
The majority of children with CP, aged 0-11 years did not self-propel manual wheelchairs regardless of age, gross motor function, range of motion or manual abilities. Power mobility should be considered at earlier ages to promote independent mobility for all children with CP who require a wheelchair especially outdoors.
