Prognosis for ambulation in cerebral palsy: a population-based study.
OBJECTIVE
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(1/2) 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.


CONCLUSIONS
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 12 years of age will eventually walk with or without support.
Wu
Yvonne W
YW
Department of Neurology, Box 0136, University of California-San Francisco, 500 Parnassus Ave, Room 411, San Francisco, CA 94143-0136, USA. wuy@neuropeds.ucsf.edu
Day
Steven M
SM
Strauss
David J
DJ
Shavelle
Robert M
RM
D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000503:physiopathology*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009043:Motor Activity; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016138:Walking