Prediction of Independent Walking in Young Children with Cerebral Palsy

Independent walking for even short distances is an important goal for families and focus of physical therapy intervention in young children with cerebral palsy (CP) classified Gross Motor Function Classification System (GMFCS) levels II-III. The aims of this research were to: 1) identify child factors (postural control, reciprocal lower limb movement, functional strength, and motivation) and family factors (family support to child and support to family) that indicate readiness for independent walking; and 2) examine whether a parent reported focus and amount of physical therapy (PT) predicted usual methods of walking in daily settings. Participants in the first study were 80 children with CP, 2-6 years of age. Backward stepwise logistic regression was used to analyze a person-environment model of child and family factors that predicted children’s ability to take steps independently. Functional strength measured in a dynamic sit to stand task that incorporates components of postural control and coordinated body movements was the only variable that predicted taking 3 or more steps independently after one year. The model had a 79% probability of predicting not walking and a 54% probability of predicting walking. Participants in the second study were 84 children with CP, 2-6 years of age, also classified GMFCS levels II-III. For each of four settings, (home, preschool, community, outdoors), multiple linear regression was used to analyze a model of the parent reported focus of PT services on balance activities for postural control, strengthening exercises, transfer training, and mobility training and the amount of PT received. A focus on strengthening exercises was the only significant predictor of walking performance at preschool only, (P<.05), explaining 17% of variance in children’s usual method of walking. The regression model was not predictive of walking at home, inside community buildings, or in outdoors settings. These studies add to previous research supporting strengthening activities for children with CP, indicating that a child who is able to stand from a bench may be ready for a focus on walking, and a focus on strengthening exercises in physical therapy may optimize walking independence in preschool. Future studies measuring child and family factors at frequent intervals are needed to determine precise indicators of readiness for independent walking. Prospective studies are recommended to examine the relationship between strengthening in closed chain functional activities in therapy and during daily activities and children’s usual method of walking in everyday settings. Physical therapists, parents, and other providers are encouraged to provide frequent opportunities for practice of functional strengthening, i.e., sitting to standing from a bench or climbing the ladder on the slide, and other components of walking to promote more independence in walking in young children with CP. Task-specific practice of walking throughout the child’s day may be influenced by the people and settings providing opportunities for practice. Effective collaboration, consultation, and coordination between therapists and others may be indicated to maximize opportunities for walking practice.Ph.D., Rehabilitation Sciences -- Drexel University, 201