Factors Associated with Enhanced Gross Motor Progress in Children with Cerebral Palsy: A Register-Based Study

ABSTRACT

Aim: To examine associations between interventions and child characteristics; and enhanced gross motor progress in children with cerebral palsy (CP). Methods: Prospective cohort study based on 2048 assessments of 442 children (256 boys, 186 girls) aged 2–12 years registered in the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Gross motor progress estimates were based on repeated measures of reference percentiles for the Gross Motor Function Measure (GMFM-66) in a linear mixed model. Mean follow-up time: 2.9 years. Results: Intensive training was the only intervention factor associated with enhanced gross motor progress (mean 3.3 percentiles, 95% CI: 1.0, 5.5 per period of ≥3 sessions per week and/or participation in an intensive program). Gross motor function was on average 24.2 percentiles (95% CI: 15.2, 33.2) lower in children with intellectual disability compared with others. Except for eating problems (–10.5 percentiles 95% CI: –18.5, –2.4) and ankle contractures by age (–1.9 percentiles 95% CI: –3.6, –0.2) no other factors examined were associated with long-term gross motor progress. Conclusions: Intensive training was associated with enhanced gross motor progress over an average of 2.9 years in children with CP. Intellectual disability was a strong negative prognostic factor. Preventing ankle contractures appears important for gross motor progress.

KEYWORDS:

• Cerebral palsy
• gross motor function
• GMFM-66 percentiles
• prognosis
• intensive training

Acknowledgments

We thank all of the children and their families who participate in CPRN and CPOP and thus made our research possible. Thanks are due to Bjørn Størvold for software development and Petter Holan for graphic design. We also thank Associate Professor Turid Follestad, Unit for Applied Clinical Research, NTNU, for statistical supervision.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

About the Authors

Gunfrid V. Størvold, PT, MSc, PhD student, PT at Habilitation Centre, Nord-Trøndelag Hospital Trust, Levanger, Norway and ph.d student at Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU). Extensive clinical competence in CP. Reidun B. Jahnsen, PT, PhD, Professor at University of Oslo and leader of the CP-surveillance program, CPOP, at Oslo University Hospital. Has extensive research and clinical competence on CP in a life course perspective. She is also Head of the Research Department at Beitostølen Healthsports Centre, a rehabilitation centre with adapted physical activity as the main intervention. Kari Anne I. Evensen, PT, PhD, Associate professor at the Norwegian University of Science and Technology (NTNU), head of the NTNU Low Birth Weight in a Lifetime Perspective research group. Has long experience in clinical research of low birth weight children, adolescents and adults. She is also one of the principal investigators in a large national physiotherapy study in primary health care (FYSIOPRIM), building a database of patients receiving physiotherapy and implementing evidence-based practice. Ulla K. Romild, PhD in Statistics, Analyst at department of Knowledge Development, Public Health Agency of Sweden, Østersund, Sweden. Grete H. Bratberg, Dr Philos., Professor at Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway. Epidemiology, children and adolescents, public health and health related behaviors.

Additional information

Funding

The main funding for the study was provided by the Sophie Minde Foundation. One of the authors also received a minor contribution from the Norwegian Fund for Post-graduate Training in Physiotherapy.