Prognosis for Ambulation
Shortly after caregivers are given the diagnosis of cerebral palsy, they will often want to know if their child will walk. Many studies have been published on this subject, and the best predictors of eventual ambulation appear to be persistence of primitive reflexes, gross motor development, and type of cerebral palsy.
The persistence of primitive reflexes or the absence of postural reactions at age 2 years is associated with a poor prognosis for ambulation (222). A longitudinal study of 233 children with mixed types of CP found that all of the children who were sitting by the age of 2 years eventually ambulated and that only 4% of the children who were not sitting by 4 years ever gained the ability to ambulate (223). Prognosis for eventual ambulation is also closely related to the type of cerebral palsy. Children with spastic hemiparesis have the best prognosis for ambulation, with nearly 100% achievement. More than 85% of children with spastic diparesis will eventually ambulate. The likelihood for ambulation is much less with spastic quadriparesis, but the studies have revealed a wide range of eventual ambulation of 0% to 72% (222). This wide range is likely due to differences in the population of children studied and the definition of ambulation that was used. The presence of severe intellectual impairment also is a poor predictor for walking. A large population-based study in Europe found that a severe intellectual impairment increased the risk of being unable to walk 56 times in hemiplegic CP and 9 times in bilateral spastic CP (224). If one takes into account all of these potential predictors, it possible to make a relatively accurate prognosis for ambulation by the age of 2 to 3 years. This will help the child's caregivers set realistic goals and guide appropriate therapeutic intervention.
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