Severity of Cerebral Palsy-The Impact of Associated Impairments.

OBJECTIVE: This article describes associated impairments in children with cerebral palsy (CP) and its subtypes.

METHOD: Children born between 1990 and 2006 recorded in the Surveillance of Cerebral Palsy in Europe common database were studied. An "impairment index" characterized severity of impairments and their combinations.

RESULTS: Amongst the 11,015 children analyzed, 56% ( n  = 5,968) could walk unaided, 54% (4,972) had normal or near-normal intellect (intelligence quotient ≥ 70). Except for ataxic CP, associated impairments were less frequent when walking ability was preserved. The impairment index was low (walking unaided and normal or near-normal intellect) in 30% of cases; 54% ( n  = 1,637) in unilateral spastic, 24% ( n  = 79) in ataxic, 18% ( n  = 913) in bilateral spastic, and 7% ( n  = 50) in dyskinetic CP. Around 40% had a high impairment index (inability to walk and/or severe intellectual impairment ± additional impairments)-highest in dyskinetic (77%, n  = 549) and bilateral spastic CP (54%, n  = 2,680). The impairment index varied little in birth weight and gestational age groups. However, significantly fewer cases in the birth weight group ≤ 1,000 g or gestational age group ≤ 27 weeks had a low impairment index compared to the other birth weight and gestational age groups (23 and 24% vs. between 27 and 32%).

CONCLUSION: Thirty percent of the children with CP had a low impairment index (they were able to walk unaided and had a normal or near-normal intellect). Severity in CP was strongly associated to subtype, whereas the association was weak with birth weight or gestational age.