Advertising Disclaimer
Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1264-1271 (doi:10.1542/peds.2004-0114)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (5)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wu, Y. W.
Right arrow Articles by Shavelle, R. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wu, Y. W.
Right arrow Articles by Shavelle, R. M.
Related Collections
Right arrow Neurology & Psychiatry
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Prognosis for Ambulation in Cerebral Palsy: A Population-Based Study

Yvonne W. Wu, MD, MPH*, Steven M. Day, PhD{ddagger}, David J. Strauss, PhD{ddagger}, Robert M. Shavelle, PhD, MBA{ddagger}

* Departments of Neurology and Pediatrics, University of California, San Francisco, California
{ddagger} University of California Life Expectancy Project, San Francisco, California

Objectives. To determine independent predictors of ambulation among children with cerebral palsy and to develop a simple tool that estimates the probability that a child will walk.

Methods. In a retrospective study of all children with cerebral palsy who were not yet walking at 2 to 3 Formula years of age, while receiving services from the California Department of Developmental Services during the years 1987–1999, we analyzed medical and functional data obtained annually by Department of Developmental Services physicians and social workers. Using logistic regression analyses, we determined independent predictors of a child's ability to walk well alone at least 20 feet, without assistive devices, by age 6. We then estimated the probabilities of walking at various levels of ability over time, using multistate survival analysis.

Results. Of 5366 study subjects, 2295 (43%) were evaluated at age 6; 12.8% could walk independently and 18.4% walked with support. Independent predictors of successful ambulation included early motor milestones such as sitting (odds ratio: 12.5; 95% confidence interval: 5.8–27.2) and pulling to a stand (odds ratio: 28.5; 95% confidence interval: 13.4–60.4) when compared with lack of rolling at age 2, cerebral palsy type other than spastic quadriparesis (odds ratio: 2.2; 95% confidence interval: 1.5–3.1), and preserved visual function (odds ratio: 2.4; 95% confidence interval: 1.1–5.4). Our ambulation charts depict the probability of remaining nonambulatory, transitioning to 1 of 3 possible ambulatory states, or expiring at all subsequent ages through age 14.

Conclusion. The ambulation charts provide a simple straightforward way to estimate the probability that a child with cerebral palsy who is nonambulatory at 2 to 3 Formula years of age will eventually walk with or without support.

Key Words: cerebral palsy • ambulation • prognosis

Abbreviations: GMFCS, Gross Motor Function Classification System • GMFM, Gross Motor Function Measure • CDER, Client Development Evaluation Report • DDS, Department of Developmental Services

Accepted May 6, 2004.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Neurorehabil Neural RepairHome page
Transformational Technologies in Single-Event Neurological Conditions: Applying Lessons Learned in Stroke to Cerebral Palsy (August 14-15, 2008)
Neurorehabil Neural Repair, September 1, 2009; 23(7): 747 - 765.
[PDF]