Prospective longitudinal study of gross motor function in children with cerebral palsy

Objectives: To describe the course of gross motor function over 2 years in children with cerebral palsy (CP) aged 9 to 15 years, and to investigate its relationship with impairments and age. Design: Prospective cohort study. Setting: Rehabilitation department of a university medical center in the Netherlands. Participants: Seventy boys and 40 girls with CP (mean age standard deviation, 11.2 +/- 1.7y). Interventions: Not applicable. Main Outcome Measure: The Gross Motor Function Measure (GMFM). Results: GMFM item scores were stable over the 2 years for the whole group. No difference was found in the course of GMFM item scores between the Gross Motor Function Classification System (GMFCS) levels. We found significant differences in the course of GMFM item scores (corrected for GMFCS) for the different levels of limb distribution, selective motor control, muscle strength, range of motion in the hip and knee, spasticity of the hamstrings, and type of education. There were significantly larger decreases in the more severely affected children. Multivariable analysis showed that a poor selective motor control was the most important determinant of a less favorable course of gross motor function. Conclusions: Some impairment characteristics may be used to identify children who are at risk for deterioration in gross motor function, and may serve as a guide for interventions.