Children with cerebral palsy must often undergo various surgical interventions to improve and maintain their ambulatory status throughout their life. The use of instrumented gait analysis systems by an interdisciplinary team of providers has improved the ability to better target surgical and non-surigcal interventions to maintain gait function over time. This presentation discusses results from a study providing evidence supporting the current surigcal standards of care which allows for individuals with cerebral palsy to maintain gait function (walk speed, gait deviation index, and gross motor function classification system level) and quality of life over time.
Objectives: To investigate the association between childhood surgical interventions, walking ability, and gross motor function in adults with Cerebral Palsy.
Design: Prospective cross-sectional study
Participants: Male (47.2%) and female (52.8%) adults (Mean age: 25.0±5.3; Range: 18.5-48.7) all with CP (N=72).
Setting: An accredited clinical motion laboratory from a regional children’s hospital.
Main Outcomes: Medical history was collected through chart review, pediatric surgeries were categorized into bony or soft tissue. Individuals were grouped either into those with improved outcomes or non-improved outcomes groups. Pediatric and adult Gait Deviation Index (GDI), normalized walking speed (WS), Gross Motor Function Classification System Levels (GMFCS) were evaluated from two time points (childhood and adulthood).
Results: Adults with hemiplegic CP were more likely to improve in their gait performance compared with non-hemiplegic CP, p<0.05, chi square test. Individuals with non-hemiplegic CP whom improved in functional metrics had increased number of surgeries compared with the non-improved group, p=0.05, Wilcoxon rank sum test. 33 individuals had soft tissue surgeries (group 1), 35 had boney with/out soft tissue surgeries (group 2), 4 had no surgeries and were excluded. There was a statistically significant difference, T test (p<0.05), in WS and GDI between group 1 (GDI=79.5, WS=62.33 m/s, GMFCS=1.6) and group 2 (GDI=70.6, WS=42.5 m/s, GMFCS=2.1).
Conclusions: In adults with CP gait is stable over time. There is an association between childhood surgeries and improved gait performance in adulthood. Adults with hemiplegic CP were most likely to improve in adult gait performance measures. The number of pediatric surgeries did correlate to improved functional outcomes in individuals with non-hemiplegic CP. Individuals with lower GMFCS tended to have more significant orthopedic surgeries in childhood. These results support current orthopedic clinical practice.
Author Disclosures: No disclosures.