Unilateral cerebral palsy: a population-based study of gait and motor function

AIM To investigate the spectrum and relationships between gait patterns and motor function in a population-based cross study of children with unilateral cerebral palsy (CP). METHOD Children identified with unilateral CP born in Victoria, Australia, from 1990 to 1992 were eligible to participate. Characteristics were reported using the Winters, Gage, and Hicks (WGH) classification for gait patterns, the Gross Motor Function Classification System(GMFCS) and Functional Mobility Scale (FMS) for gross motor function, and Manual Ability Classification System( MACS) and House classification for upper-limb function. RESULTS A recruitment rate of 71% was achieved (42 males, 27 females; mean age 11y 4mo, SD 2y 4mo). Children were classified in levels I and II of the GMFCS and levels I, II, and III of the MACS whereas there was a greater range of scores using the FMS and House classification. The association was moderate between categorizations of lower-limb and upper-limb involvement (Kendall's tau(b) = 0.46-0.47, p < 0.001), accounting for around 21% of the explained variance. The proportions of gait-pattern groups in the current cohort were rather similar to the original WGH cohort (chi(2) = 7.07, degrees of freedom [df] = 3, p = 0.070). INTERPRETATION Unilateral CP embraces a wide spectrum of clinical phenotypes. There were only moderate associations between categorizations of upper-and lower-limb function, supporting the need for separate classification systems of upper- and lower-limb functioning in this diverse group of children.