Predictors of Independent Walking in Young Children With Cerebral Palsy

Abstract

Background: The attainment of walking is a focus of physical therapy intervention in children with cerebral palsy (CP) and may affect their independence in mobility and participation in daily activities. However, knowledge of determinants of independent walking to guide physical therapists' decision making is lacking.

Objective: The aim of this study was to identify child factors (postural control, reciprocal lower limb movement, functional strength, and motivation) and family factors (family support to child and support to family) that predict independent walking 1 year later in young children with CP at Gross Motor Function Classification System (GMFCS) levels II and III.

Design: A secondary data analysis of an observational cohort study was performed.

Methods: Participants were 80 children with CP, 2 through 6 years of age. Child factors were measured 1 year prior to the walking outcome. Parent-reported items representing family factors were collected 7 months after study onset. The predictive model was analyzed using backward stepwise logistic regression.

Results: A measure of functional strength and dynamic postural control in a sit-to-stand activity was the only significant predictor of taking ≥3 steps independently. The positive likelihood ratio for predicting a "walker" was 3.26, and the negative likelihood ratio was 0.74. The model correctly identified a walker or "nonwalker" 75% of the time.

Limitations: Prediction of walking ability was limited by the lack of specificity of child and family characteristics not prospectively selected and measurement of postural control, reciprocal lower limb movement, and functional strength 1 year prior to the walking outcome.

Conclusions: The ability to transfer from sitting to standing and from standing to sitting predicted independent walking in young children with CP. Prospective longitudinal studies are recommended to determine indicators of readiness for independent walking.

© 2016 American Physical Therapy Association.

Figures

Figure 1.

Receiver operating characteristic (ROC) curve for functional strength variable. Coordinates of the optimal level at which to first predict walking: (1 − specificity)=0.14, sensitivity=0.52. Diagonal segments are produced by ties.

Figure 2.

Receiver operating characteristic (ROC) curve for postural control variable. Coordinates at which to optimally predict walking: (1 − specificity)=0.44, sensitivity=0.76. Diagonal segments are produced by ties.