Gait function and decline in adults with cerebral palsy: a systematic review.

PURPOSE: The aim of this systematic review was to identify, appraise and synthesize the evidence describing gait decline in adults with cerebral palsy (CP).

METHOD: Comprehensive searches were conducted in MEDLINE (1970-), EMBASE (1980-), CINAHL (1982-) and AMED (1985-) databases to June 2012. Two reviewers independently completed data extraction and analysis using a modified version of the Downs and Black quality tool.

RESULTS: From the 485 papers identified, 16 met the inclusion criteria. Most studies used samples of convenience. The reported mean ages of the study groups varied from 22 to 42.6 years. Decline in gait function was measured variably with the period of decline undefined or from an unknown reference time during childhood. Results suggest that mobility decline occurs in 25% or more of adults with CP. Those at higher risk of gait decline are those with worse initial gait ability, bilateral rather than unilateral motor impairment, older age and higher levels of pain or fatigue.

CONCLUSION: Many ambulant adults with CP experience mobility decline earlier than their nondisabled peers. More information regarding the natural history of mobility change over the lifespan in adults with CP augmented with self-efficacy qualitative data is needed to direct health advice and appropriate interventions for this group.

IMPLICATIONS FOR REHABILITATION: The literature suggests 25% or more of ambulant adults with cerebral palsy experience gait decline. Higher risk of gait decline occurs in those who are older, less independent in gait, have bilateral motor impairment and higher levels of pain or fatigue. Use of standardized gait measurement tools augmented with self-efficacy measures will aid provision of health advice and interventions.