Will my child with cerebral palsy walk?

Why is it hard to predict walking early?

Cerebral palsy is a group of permanent movement and posture disorders caused by injury to or differences in the developing brain before, during or shortly after birth. The brain injury does not worsen, but its effects on movement become clearer as the child grows and is expected to reach new milestones.

In the first two years, motor development varies widely, and classifications made very early are less reliable. The Gross Motor Function Classification System had an interrater reliability of 0.55 for children under two, compared with 0.75 for children aged 2 to 12 2.

How does the GMFCS help predict walking?

The Gross Motor Function Classification System (GMFCS) groups children into five levels based on their usual movement abilities, from level I, walking without limitations, to level V, where children are transported in a wheelchair 2.

A longitudinal study of 657 children with cerebral palsy aged 1 to 13, with 2,632 assessments, created five motor development curves showing different rates and limits of gross motor development by GMFCS level 1. There was also substantial variation within each level 1. These curves help families and clinicians plan realistic goals.

Which early signs suggest a child will walk?

In a population-based study of 5,366 children with cerebral palsy who were not yet walking at 2 to 3.5 years of age, being able to sit independently at age 2 (odds ratio 12.5) and pull to stand (odds ratio 28.5) strongly predicted walking by age 6, compared with children who could not roll 3.

In the same study, among the 2,295 children evaluated at age 6, 12.8 per cent walked independently and 18.4 per cent walked with support 3. Cerebral palsy types other than spastic quadriplegia and preserved vision were also associated with walking 3. Children who walk before age 2 to 3 were not included in this group, so the overall proportion of children with cerebral palsy who walk is higher.

What therapies support walking?

A systematic overview of interventions for cerebral palsy identified effective allied health approaches that include goal-directed and task-specific training, mobility training, treadmill training, strength training, casting and home programmes. Medical treatments such as botulinum toxin, and selective dorsal rhizotomy for selected children, are also supported 4.

Therapy focuses on practising meaningful activities, such as standing, stepping and using walking aids, rather than passive stretching alone. Ankle-foot orthoses often support walking by improving foot position.

What if my child does not walk independently?

Mobility is about getting around, participating and being independent, not only walking. Walkers, crutches, manual and powered wheelchairs allow children to explore, play and join in with peers. Early access to powered mobility supports development and independence.

Many children use different mobility methods in different settings, for example walking short distances at home and using a wheelchair for longer distances.

Can walking ability change as children grow?

Gross motor function often improves most in early childhood and then levels off. During growth spurts and adolescence, some children, particularly at GMFCS levels III and IV, may find walking harder because of increased body size, muscle tightness or pain.

Ongoing therapy, strength training, monitoring of the hips and spine and management of spasticity help maintain mobility over time.

When should families seek review?

Seek assessment if a child loses skills they previously had, develops new pain, has a hip that seems painful or stiff, or shows changes in spine shape.

Loss of skills is not typical of cerebral palsy and should be assessed to rule out other conditions.

Frequently asked questions