A 10.5-year follow-up of walking with unilateral spastic cerebral palsy

Alice Bonnefoy-Mazure; Geraldo De Coulon; Pierre Lascombes; Aline Bregou; Stéphane Armand

doi:10.1177/18632521231154975

A 10.5-year follow-up of walking with unilateral spastic cerebral palsy

J Child Orthop. 2023 Mar 6;17(2):173-183. doi: 10.1177/18632521231154975. eCollection 2023 Apr.

Authors

Alice Bonnefoy-Mazure¹, Geraldo De Coulon², Pierre Lascombes³, Aline Bregou⁴, Stéphane Armand¹

Affiliations

¹ Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
² Pediatric Orthopedic Service, Department of Child and Teenage Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
³ University of Medicine, Nancy, France.
⁴ Pediatric Orthopedic Service, Department of Child and Adolescent Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Abstract

Purpose: The purpose of this study was to describe gait evolution in patients with unilateral spastic cerebral palsy (USCP) using modified Gait Profile Score (mGPS without hip rotation), Gait Variable Score (GVS), walking speed, and the observed effects of single-level surgery (SLS) after 10 years.

Methods: Fifty-two patients with USCP (Gross Motor Function Classification System I) and data from two Clinical Gait Analyses (CGAs) were included. The evolution of patients' mGPS, GVS, and walking speed were calculated. Two "no surgery" and "single-level surgery" patient categories were analyzed. Paired t-tests were used to compare the data between CGAs and as a function of treatment category. Pearson's correlations were used to examine relationships between baseline values and evolutions in mGPS and walking speed.

Results: Mean ages (SD) at first and last CGAs were 9.3 (3.2) and 19.7 (6.0) years old, respectively, with an average follow-up of 10.5 (5.6) years. Mean mGPS for the patients' affected side was significantly lower at the last CGA for the full cohort: baseline = 8.5° (2.1) versus follow-up = 7.2° (1.6), effect size = 0.73, p < 0.001. Significant improvements in mGPS and GVS for ankle and foot progression were found for the SLS group. The mGPS change and mGPS at baseline (r = -0.79, p < 0.001) were negatively correlated.

Conclusions: SLS patients demonstrated a positive long-term change in gait pattern over time. The group that had undergone surgery had worse gait scores at baseline than the group that had not, but the SLS group's last CGA scores were relatively closer to those of the "no surgery" group.

Level of evidence: This was a retrospective comparative therapeutic study (level III).

Keywords: Clinical gait analysis; long-term follow-up; single-level surgery; unilateral spastic cerebral palsy.