Predictors of Independent Walking in Children With Spastic Diplegia

Abstract

A prospective study was carried out to identify predictors of independent walking in 31 children with either spastic diplegia or triplegia, observed from the age of 9 to 18 months (mean, 11 months) and followed for a mean period of 30 months (range, 24 to 36 months). Mean age at most recent examination was 41 months (range, 36 to 54 months). We used an 18-item scheme to chart the acquisition, from the prone position, of prelocomotor, sitting, and locomotor skills. Examinations were conducted every 6 months and videotaped according to a standardized procedure. At latest assessment 18 (58%) of the 31 children had achieved walking, 7 (23%) independently and 11 (35%) with assistance; 13 (42%) did not achieve walking. Ambulatory status was related to developmental quotient and visual acuity: all the children who became independent walkers had normal visual acuity and in 86% of cases a normal general development quotient. Moreover, we found a significant correlation between the number of gross motor skills achieved and the rate of achievement before 2 years of age and ambulatory status at 3 to 5 years of age. Ability to put weight on the hands while prone and to roll from supine to prone position by 18 months of age were significantly related to independent walking, while ability to sit without support was predictive only at around 24 months of age.

Change in ambulatory ability of adolescents and young adults with cerebral palsy

“…[7][8][9][10][11][12][13] For example, a recent study illustrated that prospects for future ambulation of 2-to 3-year-old non-ambulatory children with CP vary according to their level of gross motor functioning (e.g. rolling and sitting ability).…”

The forward parachute reaction and independent walking in infants with brain lesions

“…A few studies have previously suggested that gross motor milestones such as head control and ability to sit or stand unsupported may predict independent walking in children with cerebral palsy (CP). [1][2][3] Other studies performed in typically developing infants and in late walkers have suggested that the forward parachute reaction (FPR) is strongly correlated with independent walking, 4,5 as the late appearance of FPR is associated with a delayed ability to walk independently. The FPR is evoked by suspending the infant ventrally and by dropping him suddenly with eyes open and the head directed towards a surface.…”

Ambulatory capacity in cerebral palsy: prognostic criteria and consequences for intervention

“…seizure disorders, intellectual deficit, visual acuity, and microcephaly) have been considered in several studies. [6][7][8][9] However, there is no general agreement on which of these factors might influence the achievement of independent walking. Consequently the three groups described by Sala and Grant are generally considered to be the most significant for the prognosis of the achievement or non-achievement of ambulatory capacity.…”

“…[6][7][8][9]11,14,18,19 Different motor skills, such as head control in prone, 14 turning from prone to supine, 8 propping in prone, and rolling from supine to prone, 9 have been taken into consideration; however, the most analyzed motor skills are the ability to maintain independent sitting and the quality of locomotor patterns on the floor. The main results obtained in four studies, where these factors were specifically considered, are summarized in Table I.…”

“…27 First, a significant group of children with CP cannot achieve ambulatory capacity 1,8 and this final outcome can be predicted quite early. 6,7,9,[11][12][13][14]18,19 Second, a rather high proportion of individuals who achieve walking lose it sooner or later, [2][3][4] or there is a significant deterioration in independent walking. 5 Unfortunately, even when the prognosis for ambulation is poor or limited, primary, if not exclusive, attention is given to physical therapy, surgical procedures, and ambulatory aids, all intended to promote eventual ambulation.…”