Cerebral palsy: new developmental curves for mobility, self-care

  • Lancet Child Adolesc Health

  • International Clinical Digest
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Takeaway

  • Application of the Pediatric Evaluation of Disability Inventory (PEDI) allowed definition of developmental trajectories for mobility and self-care among pediatric patients aged 1-21 years with cerebral palsy.

Why this matters

  • Better understanding of developmental trajectories may improve care.

Key results

  • For both mobility and self-care, rates and limits of development differed across the 5 Gross Motor Function Classification System (GMFCS) levels.
  • For patients at GMFCS level I (least severe cerebral palsy), estimated mean limits out of a possible 100 were high:
    • Mobility: 95.6 (95% CI, 94.5-96.7),
    • Self-care: 91.8 (95% CI, 90.1-93.4).
  • For patients at GMFCS levels II-V, estimated mean limits were lower:
    • Mobility: from 83.0 (95% CI, 80.3-85.7) to 23.6 (95% CI, 20.7-26.4),
    • Self-care: from 80.4 (95% CI, 77.0-83.9) to 32.4 (95% CI, 28.9-35.9).
  • Substantial interindividual variation seen in development for both mobility, self-care within a given GMFCS level.

Expert comment

  • In a comment, Sylvain Brochard, MD, PhD, and Christelle Pons, MD, MSc, write, “The early prediction of functional outcomes and the plateau around age 7 years shown … creates a new challenge for communication between professionals and parents. Discussions should include the fact that there is high variability within developmental curves, particularly for children with more severe forms of cerebral palsy, that rehabilitation approaches and methods can vary, and that an individual child’s development is also affected by different health-care systems and cultures.”

Study design

  • Longitudinal cohort study of 551 children, adolescents initially aged 1-17 years with cerebral palsy recruited from rehabilitation centers, university medical centers in Netherlands, Canada.
  • Main outcomes: mobility, self-care capability.
  • Funding: the Netherlands Organisation for Health Research and Development; Canadian Institutes of Health Research.

Limitations

  • Inability to control for some factors.
  • Losses to follow-up.
  • Unknown generalizability.