Factors Affecting Ambulatory Status in Children with Cerebral Palsy: A Cross-sectional Study

Introduction: Cerebral Palsy (CP) is one of the most common causes of physical disabilities in childhood. Most children with CP are facing limitations of walking and other physical activities. Limitation in ambulation presents potential barriers to activities of daily life, participation in physical, recreational, and social activities, which further hampers the quality of life. Thus, attainment of walking is an important goal for the children with CP, as well as doctors for optimum rehabilitation plan.

Aim: To study the ambulatory status in different types of CP and factors affecting ambulatory status in children with CP.

Materials and Methods: This observational, cross-sectional study was conducted in the Outpatient Department of Physical Medicine and Rehabilitation (PMR) of VMMC and Safdarjung Hospital, New Delhi, India, from November 2018 to April 2020. Total 100 children with CP of age group 2-18 years were enrolled in the study. The type of CP was determined based on tone pattern and limb involvement. Walking ability was assessed using Gross Motor Function Classification System (GMFCS), Functional Mobility Scales (FMS) and Gillette Functional Assessment Questionnaire (FAQ). Factors such as age of independent sitting, presence of accompanying impairments which may influence the walking ability were also studied. Quantitative variables were compared using Kruskal-Wallis test and qualitative variables were compared using Chi-square test.

Results: In the study population of 100 children with CP, 68 were males and 32 were females. Total 55% were independent ambulators, 14% were ambulatory with aids and 31% were non ambulators. 86% had spastic CP, 6% had dyskinetic CP, 6% had mixed CP and 2% had hypotonic CP. Among spastic CP (86), 56% had diplegia, 16.2% had quadriplegia, 24.4% had hemiplegia and 3.4% had triplegia. Children with spastic hemiplegia showed highest potential for independent walking. Among 100 children with CP, 56% achieved independent sitting by 2 years of age, 31% achieved independent sitting after 2 years of age and 13% did not achieve sitting. Total 82.14% of children who achieved independent sitting by 2 years of age were ambulatory without aids. Total 36% of total children had no impairments, 44% had one or two impairments and 20% had three or more impairments. Total 88.8% of children who had no impairments were ambulatory without aids, thus showed good walking potential. Where as 70% of children who had three or more impairments were non ambulators.

Conclusion: The spastic hemiplegia type of CP, achievement of independent sitting by 2 years of age and absence of accompanying impairments are good prognostic predictors of ambulation in children CP.