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Impact of Age on Gait Deviations and Function After Single Event Multilevel Surgery in Children With Cerebral Palsy
Alison M Hanson1, Jason T Nadeau1, Eva M Ciccodicola1
1Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles.
Insights
Children with cerebral palsy (CP) undergoing single event multi-level surgery (SEMLS) show gait improvements at any age. However, those under 11 years experience enhanced improvements in stride length and participation scores.
Area of Science:
- Orthopaedic surgery
- Pediatric rehabilitation
- Gait analysis in cerebral palsy
Background:
- Single event multi-level surgery (SEMLS) is a standard treatment for children with cerebral palsy (CP).
- Optimal surgical timing remains debated, with varying outcomes reported across age groups.
- Few studies integrate gait analysis with activity and participation measures.
Purpose of the Study:
- To evaluate the impact of age on gait parameters, activity, and participation following SEMLS in children with CP.
- To compare outcomes between younger (<11 years) and older (≥11 years) age groups.
- To analyze the influence of age on functional mobility and patient-reported outcomes.
Main Methods:
- Retrospective comparative study of 128 children with CP undergoing SEMLS.
- Participants categorized into two age groups: under 11 years (n=91) and 11 years or older (n=37).
- Gait deviation index (GDI), walking velocity, stride length, Functional Mobility Scale (FMS), and Pediatric Outcomes Data Collection Instrument (PODCI) scores were assessed pre- and post-operatively. The Gross Motor Function Classification System (GMFCS) level was a covariate.
Main Results:
- All participants showed improved GDI post-SEMLS, irrespective of age.
- The younger group (<11 years) demonstrated significant improvements in GDI, stride length, and global/upper extremity PODCI scores.
- The older group (≥11 years) showed significant GDI improvement only; PODCI upper extremity scores were significantly impacted by age group (P=0.02).
Conclusions:
- SEMLS benefits children with CP across all ages, primarily through GDI improvement.
- Younger children (<11 years) achieve broader functional gains, including enhanced stride length and participation.
- Older children (≥11 years) are more likely to maintain existing function rather than achieve significant improvements in activity and participation.
Background:
Single event multi-level surgery (SEMLS) is the standard of orthopaedic care for children with cerebral palsy (CP). The optimal age to perform SEMLS is unclear, with studies showing positive results from childhood to adulthood. Few studies have combined clinical gait analysis with participation and activity outcome measures. The purpose of this study was to examine the effect of age on changes in gait parameters, activity, and participation in children with CP who underwent SEMLS with a follow-up time of 8 to 48 months.
Methods:
One hundred twenty-eight participants met the inclusion criteria. Ninety-one participants (71%) were aged under 11 years and 37 participants (29%) were 11 years or older. Changes in gait deviation index (GDI), walking velocity, stride length, functional mobility scale (FMS), and pediatric outcomes data collection instrument (PODCI) scores were calculated. The impact of age on outcomes was analyzed in age groups (<11 vs. ≥11 y) using linear and ordered logistic regression. The Gross Motor Function Classification System level was included as a covariate in all analyses.
Results:
There was no difference between age groups for preoperative to postoperative change in GDI, walking velocity, or FMS. The younger group significantly improved GDI, stride length, and global and upper extremity PODCI scores after SEMLS, while the older group significantly improved GDI only. The PODCI upper extremity subscale was the only variable impacted by age group ( P =0.02).
Conclusion:
Children with CP who undergo SEMLS at any age are likely to see improvements in the GDI. Those under 11 years at the time of SEMLS also show improvements in stride length and global and upper extremity PODCI scores, while those older than 11 years are likely to maintain but not improve their levels of activity and participation.
Level Of Evidence:
Level III-retrospective comparative study.
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