Severity of Cerebral Palsy—The Impact of Associated ImpairmentsFunding 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.
26 August 2019
28 December 2019
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.
- 1 Surveillance of Cerebral Palsy in Europe (SCPE). Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002; 44 (09) 633-640
- 2 Surveillance of Cerebral Palsy in Europe (SCPE). A collaboration of cerebral palsy registers. Dev Med Child Neurol 2000; 42: 816-824
- 3 Himmelmann K, McManus V, Hagberg G, Uvebrant P, Krägeloh-Mann I, Cans C. ; SCPE collaboration. Dyskinetic cerebral palsy in Europe: trends in prevalence and severity. Arch Dis Child 2009; 94 (12) 921-926
- 4 Sellier E, Surman G, Himmelmann K. , et al. Trends in prevalence of cerebral palsy in children born with a birthweight of 2,500 g or over in Europe from 1980 to 1998. Eur J Epidemiol 2010; 25 (09) 635-642
- 5 Platt MJ, Cans C, Johnson A. , et al. Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study. Lancet 2007; 369 (9555): 43-50
- 6 Sellier E, Platt MJ, Andersen GL, Krägeloh-Mann I, De La Cruz J, Cans C. ; Surveillance of Cerebral Palsy Network. Decreasing prevalence in cerebral palsy: a multi-site European population-based study, 1980 to 2003. Dev Med Child Neurol 2016; 58 (01) 85-92
- 7 World Health Organization. World Health Organization classification of functioning, disability and health. Children and youth version. Geneva: WHO; 2007
- 8 Fauconnier J, Dickinson HO, Beckung E. , et al. Participation in life situations of 8-12 year old children with cerebral palsy: cross sectional European study. BMJ 2009; 338: b1458
- 9 Dickinson HO, Parkinson KN, Ravens-Sieberer U. , et al. Self-reported quality of life of 8-12-year-old children with cerebral palsy: a cross-sectional European study. Lancet 2007; 369 (9580): 2171-2178
- 10 Christine C, Dolk H, Platt MJ, Colver A, Prasauskiene A, Krägeloh-Mann I. ; SCPE Collaborative Group. Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy. Dev Med Child Neurol Suppl 2007; 109 (49) 35-38
- 11 Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39 (04) 214-223
- 12 Bax M, Goldstein M, Rosenbaum P. , et al; Executive Committee for the Definition of Cerebral Palsy. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2005; 47 (08) 571-576
- 13 Himpens E, Van den Broeck C, Oostra A, Calders P, Vanhaesebrouck P. Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review. Dev Med Child Neurol 2008; 50 (05) 334-340
- 14 Colver AF, Sethumadhavan T. The term diplegia should be abandoned. Arch Dis Child 2003; 88 (04) 286-290
- 15 Himmelmann K, Beckung E, Hagberg G, Uvebrant P. Gross and fine motor function and accompanying impairments in cerebral palsy. Dev Med Child Neurol 2006; 48 (06) 417-423
- 16 Krägeloh-Mann I, Hagberg G, Meisner C. , et al. Bilateral spastic cerebral palsy--a comparative study between south-west Germany and western Sweden. I: clinical patterns and disabilities. Dev Med Child Neurol 1993; 35 (12) 1037-1047
- 17 Bottos M, Granato T, Allibrio G, Gioachin C, Puato ML. Prevalence of cerebral palsy in north-east Italy from 1965 to 1989. Dev Med Child Neurol 1999; 41 (01) 26-39
- 18 Stanley FJ, Blair E, Hockey A, Petterson B, Watson L. Spastic quadriplegia in Western Australia: a genetic epidemiological study. I: case population and perinatal risk factors. Dev Med Child Neurol 1993; 35 (03) 191-201
- 19 Edebol-Tysk K. Epidemiology of spastic tetraplegic cerebral palsy in Sweden. I. Impairments and disabilities. Neuropediatrics 1989; 20 (01) 41-45
- 20 Uvebrant P. Hemiplegic cerebral palsy. Aetiology and outcome. Acta Paediatr Scand Suppl 1988; 345: 1-100
- 21 Himmelmann K, Hagberg G, Wiklund LM, Eek MN, Uvebrant P. Dyskinetic cerebral palsy: a population-based study of children born between 1991 and 1998. Dev Med Child Neurol 2007; 49 (04) 246-251
- 22 Esscher E, Flodmark O, Hagberg G, Hagberg B. Non-progressive ataxia: origins, brain pathology and impairments in 78 Swedish children. Dev Med Child Neurol 1996; 38 (04) 285-296
- 23 Steinlin M, Zangger B, Boltshauser E. Non-progressive congenital ataxia with or without cerebellar hypoplasia: a review of 34 subjects. Dev Med Child Neurol 1998; 40 (03) 148-154
- 24 Delacy MJ. Reid SM on behalf of the Australian Cerebral Palsy Register Group. Profile of associated impairments at age 5 years in Australia be cerebral palsy subtype and Gross Motor Function Classification System level for birth years 1996–2005. Dev Med Child Neurol 2016; 58: 50-56
- 25 Krägeloh-Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Dev Med Child Neurol 2007; 49 (02) 144-151
- 26 Staudt M, Pavlova M, Böhm S, Grodd W, Krägeloh-Mann I. Pyramidal tract damage correlates with motor dysfunction in bilateral periventricular leukomalacia (PVL). Neuropediatrics 2003; 34 (04) 182-188
- 27 Krägeloh-Mann I, Petersen D, Hagberg G, Vollmer B, Hagberg B, Michaelis R. Bilateral spastic cerebral palsy--MRI pathology and origin. Analysis from a representative series of 56 cases. Dev Med Child Neurol 1995; 37 (05) 379-397
- 28 Krägeloh-Mann I, Helber A, Mader I. , et al. Bilateral lesions of thalamus and basal ganglia: origin and outcome. Dev Med Child Neurol 2002; 44 (07) 477-484