title: Gait and participation outcomes in adults with cerebral palsy: a series of case studies using mixed methods.
abstract: BACKGROUND
  There is a paucity of information on long-term outcomes of adults with cerebral palsy (CP) who received orthopedic interventions in childhood. Clinical effectiveness research requires assessment of outcomes that account for personal and environmental factors that may mediate the effects of treatment, in addition to body structures & function, activity, and participation.
  
  
  OBJECTIVE
  The purpose of this study is to provide a descriptive analysis of characteristics associated with gait and participation outcomes in a series of case studies of adults with CP.
  
  
  METHODS
  Participants had follow up gait analysis and clinical evaluation in adulthood and assessment of outcomes with the FIM instrument, the SF-36 Health survey, the Canadian Occupational Performance Measure, and semi-structured questions.
  
  
  RESULTS
  Twenty-two out of 26 participants (mean age = 25 years; GMFCS level I (n = 9); II (n = 3); III (n = 11); IV (n = 3)) maintained or improved childhood gait abilities, with levels of participation in society similar to age matched peers. Higher level of severity and personal choices impacted gait abilities in the four who declined. Majority of participants lost range of motion in hip flexion and knee extension, had pain, reported a fitness program, and increased in weight status. Personal factors and environmental factors played a role in both gait and participation outcomes.
  
  
  CONCLUSIONS
  Promotion of fitness activities and social advocacy are warranted for adults with CP. Clinical effectiveness research of long-term impact of orthopedic interventions should account for treatment effects on body structures & function, activity, participation, and modifying effects of personal, and environmental factors.
authors.affiliation: Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT 06117, USA. gannotti@hartford.edu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Gannotti
authors.forename: George E
authors.initials: GE
authors.lastname: Gorton
authors.forename: Maureen T
authors.initials: MT
authors.lastname: Nahorniak
authors.forename: Peter D
authors.initials: PD
authors.lastname: Masso
mesh_terms: D000328:Adult; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D002648:Child; D004493:Education; D004651:Employment; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000628:therapy*; D006615:Hip; D006801:Humans; D057187:Independent Living; D007717:Knee; D008297:Male; D019637:Orthopedic Procedures; D010146:Pain / Q000209:etiology; D010809:Physical Fitness; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain; D055815:Young Adult