Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands;
Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Pediatrics. 2018 Nov;142(5). doi: 10.1542/peds.2017-3723. Epub 2018 Oct 4.
: media-1vid110.1542/5804911840001PEDS-VA_2017-3723 OBJECTIVES: Describe development curves of motor and daily activity performance in individuals with cerebral palsy (CP).
Participants with CP aged 1 to 20 years at baseline ( = 421) and Gross Motor Functioning Classification System (GMFCS) levels I to V (27% of participants with intellectual disability [ID]) were longitudinally assessed up to a 13-year follow-up period. Motor and daily activity performance were assessed using the relevant subdomains of the Vineland Adaptive Behavior Scales survey. Nonlinear mixed effects analyses were used, estimating the limit (average maximal performance level) and the age by which individuals reached 90% of the limit (age).
Limits of motor performance decreased with each lower functional level. Age for motor performance was reached at ∼6 to 8 years of age in children with GMFCS levels I to III, and at younger ages in those with lower functional levels. Limits of daily activity performance did not differ between individuals without ID with GMFCS levels I to III. The ages of daily activities were reached between 11 and 14 (personal), 26 and 32 (domestic), and 22 and 26 years of age (community). Individuals with ID reached lower daily activity performance limits earlier.
Individuals with CP continue to develop motor performance after gross motor capacity limits are reached. For those without ID, daily activities continue to develop into their 20s. Individuals who are severely affected functionally have the least favorable development of motor performance, and those with ID have the least favorable development of daily activity performance.
描述脑性瘫痪（CP）个体运动和日常活动表现的发展曲线。
在基线时年龄为 1 至 20 岁（=421）且粗大运动功能分级系统（GMFCS）级别 I 至 V（27%的参与者存在智力障碍[ID]）的 CP 参与者进行了长达 13 年的随访期的纵向评估。使用适应行为量表调查的相关子领域评估运动和日常活动表现。使用非线性混合效应分析来估计限制（平均最大表现水平）以及个体达到限制的 90%的年龄（年龄）。
运动表现的限制随每个较低的功能水平而降低。GMFCS 级别 I 至 III 的儿童在 6 至 8 岁左右达到运动表现的年龄，而功能水平较低的儿童在更年幼的年龄达到运动表现的年龄。无 ID 的 GMFCS 级别 I 至 III 的个体之间，日常活动表现的限制没有差异。日常活动的年龄在 11 至 14 岁（个人）、26 至 32 岁（家庭）和 22 至 26 岁（社区）之间达到。ID 个体较早地达到较低的日常活动表现限制。
在达到粗大运动能力限制后，CP 个体继续发展运动表现。对于无 ID 的个体，日常活动会持续发展到 20 多岁。功能严重受限的个体运动表现的发展最不利，而 ID 个体日常活动表现的发展最不利。
