Longitudinal trajectories of physical activity and walking performance by gross motor function classification system level for children with cerebral palsy

Abstract

Purpose: This study aims to present developmental trajectories for physical activity (PA) and walking performance for children with cerebral palsy (CP).

Materials and methods: Seventy-nine children with CP, 39 (49%) female, Gross Motor Functional Classification System levels I–V, and mean age 91.3 months (+/−27.7 SD) participated. Participants in levels I–V wore the Actigraph to capture PA and children in levels I-II also wore a StepWatch (SW) (n = 43) to measure walking performance. Trajectories for average PA counts/minute and number of minutes of moderate to vigorous PA were generated for levels I, II, and III/IV/V (aggregate). Single leg strides/day and average strides faster than 30 strides/min trajectories were generated for levels I–II.

Results: Participants did not display plateaus in PA or walking performance based on functional level. Children in all levels showed a decrease in amount and intensity of PA from 3.0 to 12 years old, with participants in level I demonstrating the steepest decline. Children in level I decreased slightly, and level II increased slightly in both walking performance measures from 3.0 to 12 years old.

Conclusions: Longitudinal curves demonstrate variations in PA and walking performance by functional level and provide prognostic information as to what changes may be anticipated for children with CP.

Implications for rehabilitation

• Longitudinal developmental trajectories for physical activity and walking performance for children with cerebral palsy across functional levels are documented.

• Trajectories have potential to support collaborative intervention planning between therapists and families relative to physical activity and walking performance.

Keywords:

• Cerebral palsy
• physical activity
• walking performance
• accelerometry

Acknowledgements

We acknowledge additional On Track Study Team members including academic researchers: Doreen Bartlett, Sarah Westcott McCoy, Lisa Chiarello, Robert Palisano, Lynn Jeffries, and Jan Willem Gorter; Canadian project coordinator Barb Galuppi; US project coordinator Monica Smersh; and parent researchers: Lisa Diller, Paula Drew, Nancy Ford, Marquitha Gilbert, tina hjorngaard, Kimberly Rayfield, and Barbara Sieck Taylor. We thank the participating children and families, whose continued involvement made this study possible. We also acknowledge the important contributions of the regional coordinators as well as the 90 therapists across North America who assessed children during the course of the full On Track study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The research study was funded by The Canadian Institutes of Health Research, MOP-119276 and The Patient-Centered Outcomes Research Institute, CE-12–11-5321. The statements presented in this work are solely the responsibility of the authors and do not necessarily represent the views of either the Canadian Institutes of Health Research or the Patient-Centered Outcomes Research Institute (PCORI), including its Board of Governors or Methodology Committee.