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Acquisition and loss of best walking skills in children and young people with bilateral cerebral palsy

Research output: Contribution to journalArticlepeer-review

Gillian Baird, Susie Chandler, Adam Shortland, Elspeth Will, Emily Simonoff, David Scrutton, Charlie Fairhurst

Original languageEnglish
JournalDevelopmental Medicine and Child Neurology
DOIs
Accepted/In press2021

Bibliographical note

Funding Information: We thank all the families, especially the young people, for their participation. We also thank Anne Greaney and Alison Davis for data collection. The study was funded by the Charles Wolfson Charitable Trust, Cerebra, One Small Step, and the Hickman Fund (Guy’s & St Thomas’ Charity). The South‐East MREC granted ethical approval, reference number 06/MRE01/18. The authors have stated that they had no interests that might be perceived as posing conflict or bias. Publisher Copyright: © 2021 Mac Keith Press Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Aim: To explore factors predicting acquisition and loss of best walking ability in young people with bilateral cerebral palsy (CP). Method: In our population cohort (Study of Hips And Physical Experience) of 338 children (201 males, 137 females) with bilateral CP, age at achieving walking was recorded and walking ability predicted from early motor milestones. Walking was assessed at 5 to 8 years (mean 7y) and in 228 of 278 survivors at 13 to 19 years (mean 16y). Parent carers reported their view of any loss of best achieved walking. Factors potentially associated with loss of best achieved walking were explored: severity and type of motor disorder; intellect and communication; manipulative skill; general health and comorbidity; pain; orthopaedic surgery; musculoskeletal spine and lower limb deformity; weight; fatigue; mood; and presence of regular exercise regime. Results: The ability to walk independently was reliably predicted by the motor milestone ‘getting to sit and maintain sitting’ by the age of 36 months (without aids) and 55 months (with aids). Forty-five per cent of the cohort never walked 10 steps independently. Not all who achieved walking without aids were still doing so by a mean age of 16 years, which was associated with later age at achieving walking and the degree of musculoskeletal deformity, as was the parent carers’ report of loss of best walking. Interpretation: In this study, development of musculoskeletal deformity was a significant factor in not maintaining best achieved walking by mean age 16 years, which is most likely to occur in young people whose walking ability is with aids over short distances or in therapy only. Prediction of future walking ability in a child with bilateral CP can be made from early motor milestones.

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