Changes in Walking Performance between Childhood and Adulthood in Cerebral Palsy: A Systematic Review

Area of Science:

• Neurology
• Pediatrics
• Rehabilitation Medicine

Background:

• Cerebral palsy (CP) affects motor function, with walking ability varying significantly among individuals.
• Longitudinal data on walking performance changes from childhood to adulthood in CP are crucial for understanding disease progression and planning interventions.

Purpose of the Study:

• To investigate the longitudinal changes in walking performance in individuals with cerebral palsy (CP) from childhood to adulthood.
• To identify patterns of change in Gross Motor Function Classification System (GMFCS) levels related to walking ability over time.

Main Methods:

• A systematic review and meta-analysis of cohort studies was conducted.
• Included studies followed individuals with CP (GMFCS Levels I-IV) from childhood (initial measurement by age 13) to adulthood (follow-up by age 30).

Main Results:

• Among individuals initially classified as GMFCS Level I+II, 7% declined to GMFCS Level III.
• Within GMFCS Level III, 4% declined to Level IV, while a significant 31% improved to GMFCS Level I+II.
• Individuals at GMFCS Level IV showed improvement, with 2% moving to Level III and 3% to Level I+II.

Conclusions:

• Walking performance in cerebral palsy tends to be stable in early childhood and late adulthood for those with the most and least severe impairments.
• Individuals with moderate walking impairments (GMFCS Level III) exhibit the most significant changes, with substantial proportions improving or declining in functional mobility.
• These findings highlight the dynamic nature of walking ability in CP during developmental and early adult years, emphasizing the need for tailored rehabilitation strategies.