Lennon Nancy, Church Chris, Shrader M Wade, Robinson William, Henley John, Salazar-Torres Jose de Jesus, Niiler Tim, Miller Freeman
Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
Gait Posture. 2021 Oct;90:374-379. doi: 10.1016/j.gaitpost.2021.09.177. Epub 2021 Sep 20.
Previous studies have looked at the short-term effectiveness of conservative and surgical treatment of children with cerebral palsy (CP), but few have explored the long-term outcomes into adulthood using gait analysis and patient-reported outcome measures.
How do gait, mobility, and patient-reported outcomes in adults with CP who received specialized pediatric orthopedic care change from adolescence?
We identified 645 adults with 1) CP, 2) age 25-45 years, and 3) an adolescent instrumented gait analysis (IGA) at our center. Measurement outcomes included physical examination, IGA, and select domains of the Patient-Reported Outcomes Measurement Information System (PROMIS).
Participants included 136 adults with CP; Gross Motor Function Classification System levels I (21 %), II (51 %), III (22 %), and IV (7%); 57 % males; and average age 16 ± 3/29 ± 3 years (adolescent/adult visits). There was no significant difference in gait deviation index, stride length, or gross motor function between adolescent and adult visits. There were statistically significant but not clinically meaningful declines in gait velocity. At adulthood, PROMIS results revealed limitations in physical function compared with a normative sample but no differences in depression, participation, or pain interference.
In this relatively homogeneous group of adults with CP who received orthopedic care from one center, gait and gross motor function showed no clinically meaningful change from adolescence, which differs from recent reports of declining mobility in adulthood. Expert orthopedic care, guided by IGA, may prevent losses in functional mobility for adults with CP.
以往研究关注了脑瘫（CP）患儿保守治疗和手术治疗的短期疗效，但很少有人使用步态分析和患者报告结局指标来探究其成年后的长期结局。
接受专业小儿骨科护理的成年CP患者的步态、活动能力和患者报告结局从青春期开始有何变化？
我们确定了645名成年人，他们满足以下条件：1）患有CP，2）年龄在25 - 45岁之间，3）在我们中心进行过青少年仪器化步态分析（IGA）。测量结局包括体格检查、IGA以及患者报告结局测量信息系统（PROMIS）的选定领域。
参与者包括136名成年CP患者；粗大运动功能分类系统水平为I（21%）、II（51%）、III（22%）和IV（7%）；男性占57%；青少年/成人就诊时的平均年龄为16±3/29±3岁。青少年和成人就诊时，步态偏差指数、步长或粗大运动功能无显著差异。步态速度有统计学意义但无临床意义的下降。成年时，PROMIS结果显示与正常样本相比，身体功能存在局限性，但在抑郁、参与度或疼痛干扰方面无差异。
在这组相对同质的、在一个中心接受骨科护理的成年CP患者中，步态和粗大运动功能从青春期开始没有出现具有临床意义的变化，这与近期关于成年后活动能力下降的报道不同。在IGA指导下的专业骨科护理可能会防止成年CP患者的功能活动能力丧失。
