Fwd: Know What: Cerebral Palsy Prognosis Charts

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From: knowwhat@...

Subject: Know What: Cerebral Palsy Prognosis Charts

Date: Friday, September 27, 2002

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Here is today's Know What topic:

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Cerebral Palsy Prognosis Charts

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New motor development charts allow accurate prediction of prognosis in cerebral

palsy

Background:

Cerebral palsy (CP) is an umbrella term that refers to a group of problems with

movement that result from abnormalities in brain development or brain damage in

the first year of life. One important feature of the condition is that it is not

progressive, meaning that conditions where the brain damage continues to get

worse are not included under CP. However, as all parents and professionals who

treat CP know, the movement problems suffered by the child certainly change with

time, growth and development. Problems with movement are the hallmark of CP, but

children often have other problems as well, including intellectual disability

(from mild to very severe) and problems with sensation (including vision etc).

It is believed that CP affects about one in every 500 live births.

When parents are first told that their child has CP, one of their first concerns

is understanding how the CP will evolve in the future – its severity, how bad

things will become, and particularly whether their child will ever walk.

Unfortunately, health professionals have very limited information to base

answers upon for any individual child. Firstly, the course of CP is highly

individual and variable. Secondly, until recently we were limited to information

that merely told us about links between the child’s developmental stage at age

two years (for example whether the child could sit unaided) and later walking.

However, this information was very crude and only really applied to the common

forms of CP (e.g. spastic CP) and not to the rarer forms such as ataxic CP where

coordination problems are the main issue. Also, this information has been

derived from children with CP seen in hospitals, which tends to bias the results

towards predicting a worse outcome, as many of the children with milder CP (who

do better) go to hospital much less rarely. This results in parents being given

a worse prognosis than they should, or one that is simply hopelessly inaccurate.

More recently, new data on the motor outcomes for CP have been developed from

surveys of large numbers of children with CP. Unfortunately, this data was

cross-sectional, meaning that the survey was undertaken at a single point in

time. Quality data on what happens to children with CP can only be gathered

longitudinally, meaning by following individual children as they grow and

develop and linking their earlier development with their later outcomes (such as

walking). It is also important that this sort of study is undertaken on a

“community” sample, meaning that it includes all the children with CP in a

community, not just the severe cases attending hospital clinics. This data has

not previously been available. However, these Canadian researchers followed up a

large group of children with CP over four years with the aim of creating “motor

development curves”. These are graphs rather like growth charts, which could be

useful for individual parents as the development of a child with CP can be

charted at different ages and compared with what happened to the children in the

research study, thus giving a more accurate idea of the prognosis (outcome) for

that child and their parents.

Findings:

The researchers concluded that evidence-based prognostication about gross motor

progress in children with cerebral palsy is now possible, providing parents and

clinicians with a means to plan interventions and to judge progress over time.

However further work is needed to describe motor function of older adolescents

with cerebral palsy.

Comments:

These charts are the first to use longitudinal data on a community sample of

children with CP to allow doctors to give parents accurate prognoses of how

their children with CP will fare. Using these charts does not require any skills

in performing GMFM assessments, as the charts can be used by any therapist who

has undertaken a detailed assessment of the child’s physical capabilities. This

is a great advance for parents of small children with CP, and will go a long way

towards reducing uncertainty and worry for parents. Unfortunately the charts do

not extend up into adolescence, which may be their next piece of work.

Action Points:

* Accurate prognosis charts are now available for children with CP of all types

and severity

For more information:

<a

href= " http://newsletters.keepkidshealthy.com/cgi-bin/knowwhat.cgi?l=development/\

cp_prognosis_charts.html " >Cerebral Palsy Prognosis Charts</a>

<a href= " http://newsletters.keepkidshealthy.com/cgi-bin/knowwhat.cgi " >more Know

What topics</a>

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