title: Physical risk factors influencing wheeled mobility in children with cerebral palsy: a cross-sectional study.
abstract: There is a lack of understanding of the factors that influence independent mobility and participation in meaningful activities. The purpose of this study was to analyse physical factors influencing independent use of manual and power wheelchairs in a total population of children with cerebral palsy (CP).
  
  
  
  A cross-sectional study based on the most recent examination of all children with CP, born 2002-2013, reported into the Swedish cerebral palsy registry (CPUP), from January 2012 to June 2014. There were 2328 children (58 % boys, 42 % girls), aged 0-11 years, at all levels of gross motor function and hand function. Hazard ratios adjusted for age and sex were used to calculate the risk for not being able to self-propel based on Gross Motor Function Classification System (GMFCS) levels, upper extremity range of motion and hand function including Manual Ability Classification System (MACS), House functional classification system, Thumb-in-palm deformity, Zancolli (spasticity of wrist/finger flexors) and bimanual ability.
  
  
  
  In total 858 children used wheelchairs outdoors (692 manual, 20 power, 146 both). Only 10 % of the 838 children self-propelled manual wheelchairs, while 90 % were pushed. In contrast 75 % of the 166 children who used power mobility outdoors were independent. Poor hand function was the greatest risk factor for being unable to self-propel a manual wheelchair, while classification as GMFCS V or MACS IV-V were the greatest risk factors for not being able to use a power wheelchair independently.
  
  
  
  The majority of children with CP, aged 0-11 years did not self-propel manual wheelchairs regardless of age, gross motor function, range of motion or manual abilities. Power mobility should be considered at earlier ages to promote independent mobility for all children with CP who require a wheelchair especially outdoors.
authors.affiliation: Centre for Clinical Research, Uppsala University, Vestmanland County Hospital, SE-721 89, Västerås, Sweden. elisabet.rodby_bousquet@med.lu.se.|Department of Clinical Sciences Lund, Orthopaedics, Lund University, University Hospital, Lund, Sweden. elisabet.rodby_bousquet@med.lu.se.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Rodby-Bousquet
authors.affiliation: Montgomery County Infants & Toddlers Program, Maryland, USA.
authors.forename: Ginny
authors.initials: G
authors.lastname: Paleg
authors.affiliation: Institute of Nursing and Health Research, School of Health Sciences, University of Ulster, Coleraine, Northern Ireland.
authors.forename: Jackie
authors.initials: J
authors.lastname: Casey
authors.affiliation: Department of Clinical Sciences Lund, Orthopaedics, Lund University, University Hospital, Lund, Sweden.
authors.forename: Alicja
authors.initials: A
authors.lastname: Wizert
authors.affiliation: Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Livingstone
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D051346:Mobility Limitation; D009048:Motor Skills; D016059:Range of Motion, Articular; D012307:Risk Factors; D013548:Sweden; D014910:Wheelchairs
keywords: Cerebral palsy; Children; GMFCS; Hand function; MACS; Mobility; Power; Range of motion; Wheelchairs