The life long perspective of the progressive functional limitations based on types of mobility among individuals with cerebral palsy

Chercheurs: T. Furui (a) PhD PT, M. Furui (b), K. Shiraishi (b)
(a) University of Pittsburgh, Pittsburgh PA, USA
(b) Office IL the Center of Independent Living, Kohriyama, Japan

Objectives:
To investigate the relationship between types of mobility and changes in functional performance among ambulatory adults with cerebral palsy (CP) from a life history perspective.

Methods:
Subjects were recruited through 18 Japanese supportive organizations for people living with disabilities. Inclusion criteria were adults with CP aged 38 or older who were ambulatory at age 18, were living in the community, and with no obvious cognitive impairment. Standardized interview, physical evaluation and data collection were all performed while visiting at his/her home. Present mobility devices were noted upon home visit, and device usage history was gathered through public documents such as certificate of physical handicapped and others. Developmental information, such as when walking began, were gathered through medical records from children’s hospitals, records from special school dormitories, and other documentations after each subject was consented. Subjects were divided into three groups based on changes in the five levels of the Gross Motor Function Classification System (GMFCS) between age 18 and at present: No change (GROUP 1), one or two level decrease (GROUP 2), three or four level decrease (GROUP3).

Results:
Thirty-two adults total (16 female) participated in this study. Mean age was 49.2 (±7.0), and 19 individuals were married, thirteen single, or divorced. Majority (59.4%) of participants had dyskinetic CP. Majority (53.1%) of present outdoor mobility types were Power Mobility (PM). The average walking age in GROUP 1 was younger than GROUP 2. The age individuals began using PM in GROUP 1 was younger than GROUP2. GROUP 1 (n=4) used PM (18±6.9 years) longer than other two groups (8.9±4.1 years, 9.2±4.9 years, respectively). GROUP 3 had highest frequency of cervical problems. Factors leading to the loss of independent walking included four individuals, all in Group3, with fracture or falls caused by traffic accidents because poor balance. Some of the GROUP 3 participants commented they attempted to walk despite becoming marginal ambulators because they felt PM was lazy approach to living independently.

Conclusions:
Those who had drastically progressive functional limitations tended to delay or abandon the use of mobility devices. Nevertheless, PM was unexpectedly used by over 50% of participants and appeared to be the optimal choice mobility for individuals living with CP long term. Consequently, successful mobility transition is a key to minimize functional limitations among ambulatory individuals with CP.