Ambulation, activity, and participation of young adults with cerebral palsy

Ambulation, activity, and participation of young adults with cerebral palsy
1Physical Therapy Department, University of Hartford, West Hartford, CT;
2Clinical Outcomes Assessment Laboratory, Shriners Hospital for Children, Springfield, MA;
3Physical Therapy Department, Shriners Hospital for Children, Springfield, MA, USA

Background/Objectives: To accurately assess the long term impact of orthopedic interventions, more information is needed about changes in the walking abilities of people with cerebral palsy (CP) that occur from adolescence to young adulthood. Additional information about current levels of activity and participation can document the interrelationships among walking abilities and other aspects of health. The purpose of this study was to document changes in walking abilities from adolescence to young adulthood in people with CP, and current level of activity and participation.
Design: Outcomes research
Participants and Setting: Thirty-three (50/191 located, 17 cancelled or refused) people with spastic CP who had a previous motion analysis evaluation (3 DGA) at a tertiary care hospital (initial gross motor functional classification system [GMFCS] levels I [n=1], II [n=14], IV [n=4]; ages: 20-36 years; time between evaluations: 5-19 years).
Materials/Methods: Follow-up evaluation included GMFCS level, functional abilities (FIM TM), Gillette Gait Index (GGI), living arrangements , employment, level of education, Canadian occupational performance measure (COPM), short form health survey (SF-36@, and 5 year goals.
Results: Thirty out of 33 maintained or improved GMFCS Level since initial evaluation; 22/26 maintained or improved GGI. Sixteen out of 33 were living with parents, 15/33 apart from parents , and two in skilled care facilities. Twenty-two out of 33 had education or specialized training past high school. Nineteen worked outside the home for pay, eight were students, six were not employed. Family values, medical issues, and lack of personal care attendants were reasons for unemployment. Lack of transportation, employment, socialization, and personal care attendants were the most frequently cited perceived problems. No relationships were found among changes in GMFCS levels or GGI with FIMTM scores, SF-36@ sub-domain scores, COPM barriers, level of education, employment, or living arrangements. The two subjects with the greatest declines in walking abilities were either working full time or married, with children. Subgroup analysis of subjects who did not decline demonstrated an association of orthopedic interventions with maintained or improved walking abilities (R^2+0.82, F=35.0, P=0.000).
Conclusions/Significance: The majority of the subjects maintained walking abilities into young adulthood, and the relationship between changes in walking abilities, orthopedic interventions, personal and environmental characteristics, and participation in society requires additional; investigation.

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