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Early Independent Wheeled Mobility in Children with Cerebral Palsy: A Norwegian Population-Based Registry Study
Anne Kilde1,2, Kari Anne I Evensen2,3,4, Nina Kløve5
1Division of Pediatric and Adolescent Medicine, Akershus University Hospital, 1478 Lørenskog, Norway.
Insights
Two-thirds of children with cerebral palsy (CP) achieve independent wheeled mobility before age seven, with powered wheelchairs being most common. Early interventions focusing on hand function and powered mobility are crucial for enhancing mobility in children with CP.
Area of Science:
- Pediatric Rehabilitation
- Assistive Technology
- Developmental Pediatrics
Background:
- Cerebral palsy (CP) significantly impacts motor function, necessitating exploration of independent mobility solutions.
- Understanding predictors and trends in wheeled mobility is vital for early intervention and improved outcomes in children with CP.
Purpose of the Study:
- To investigate independent wheeled mobility in children with CP.
- To identify predictors for achieving early independent wheeled mobility.
- To analyze changes in independent wheeled mobility across birth cohorts over time.
Main Methods:
- Utilized data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) (n=1780).
- Employed Cox proportional hazard regression to identify predictors of early independent wheeled mobility.
- Used Kaplan-Meier survival curves to compare mobility trends across birth cohorts (2002-2019).
Main Results:
- 67% of wheelchair users (n=511) achieved independent wheeled mobility, with most using powered wheelchairs.
- Two-thirds (n=337) achieved independent mobility before age 7; average age decreased from 9.5 to 4.0 years (2002-2019).
- Higher Gross Motor Function Classification System (GMFCS) levels (III-IV) and better Manual Ability Classification System (MACS) levels (I-II) predicted earlier independent mobility.
Conclusions:
- Independent wheeled mobility is achievable for a majority of children with CP, with significant improvements observed over two decades.
- Early independent mobility is associated with better hand function (MACS levels I-II).
- Intervention programs should prioritize powered mobility, adaptive steering, and hand function development to enhance participation and mobility in children with CP.
Abstract:
Background: The aim was to explore independent wheeled mobility in children with CP, and identify predictors of early independent wheeled mobility and changes over time across birth cohorts. Methods: We included data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) comprising 11,565 assessments of 1780 children born in 2002-2019. Variables included demographic data, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, wheelchair use, and independent wheeled mobility. Cox proportional hazard regression was used to identify predictors for early independent wheeled mobility. Kaplan-Meier survival curves were used to compare birth cohorts. Results: Of 769 (43%) children who used a wheelchair, 511 (67%) had independent wheeled mobility. Two thirds of the children (n = 337) achieved independent wheeled mobility before age 7. Most children with independent wheeled mobility used powered wheelchairs. Children at GMFCS levels III and IV were more likely to reach independent wheeled mobility at an early age. Children at MACS levels III-V had a lower probability of early independent wheeled mobility. The average age of achieving independent mobility decreased from 9.5 to 4.0 years between birth years 2002 and 2019. Conclusions: Two in three children were independent wheelchair users before 7 years of age, and the age of obtaining independent wheeled mobility has decreased over the last 20 years. Children with better hand function were more likely to obtain early independent wheeled mobility. Early intervention programs to promote mobility, development and participation should include powered mobility, adapted steering options, and interventions for hand function.
