Neuropediatrics 2020; 51(02): 120-128
DOI: 10.1055/s-0040-1701669
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Severity of Cerebral Palsy—The Impact of Associated Impairments

Veronka Horber
1   Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
Asma Fares
2   Public Health Department, University Hospital of Lyon, Lyon, France
Mary Jane Platt
3   Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
Catherine Arnaud
4   UMR Inserm U1027, team SPHERE University Toulouse III Paul Sabatier, Toulouse, France
5   Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
Ingeborg Krägeloh-Mann
1   Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
Elodie Sellier
6   University Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
› Author Affiliations
Funding This study was supported by European Commission funds: DGXII-BIOMED2-Contract N°BMH4–983701; DGXII-FP5-Contract N°QLG5-CT-2001–30133; DG SANCO Contract n°20033131.
Further Information

Publication History

26 August 2019

28 December 2019

Publication Date:
02 March 2020 (online)


Objective This article describes associated impairments in children with cerebral palsy (CP) and its subtypes.

Method Children born between 1990 and 2006 recorded in the Surveillance of Cerebral Palsy in Europe common database were studied. An “impairment index” characterized severity of impairments and their combinations.

Results Amongst the 11,015 children analyzed, 56% (n = 5,968) could walk unaided, 54% (4,972) had normal or near-normal intellect (intelligence quotient ≥ 70). Except for ataxic CP, associated impairments were less frequent when walking ability was preserved. The impairment index was low (walking unaided and normal or near-normal intellect) in 30% of cases; 54% (n = 1,637) in unilateral spastic, 24% (n = 79) in ataxic, 18% (n = 913) in bilateral spastic, and 7% (n = 50) in dyskinetic CP. Around 40% had a high impairment index (inability to walk and/or severe intellectual impairment ± additional impairments)—highest in dyskinetic (77%, n = 549) and bilateral spastic CP (54%, n = 2,680). The impairment index varied little in birth weight and gestational age groups. However, significantly fewer cases in the birth weight group ≤ 1,000 g or gestational age group ≤ 27 weeks had a low impairment index compared to the other birth weight and gestational age groups (23 and 24% vs. between 27 and 32%).

Conclusion Thirty percent of the children with CP had a low impairment index (they were able to walk unaided and had a normal or near-normal intellect). Severity in CP was strongly associated to subtype, whereas the association was weak with birth weight or gestational age.