Outcomes of Pediatric Orthopedic Management of Ambulatory Cerebral Palsy Utilizing a Closely Monitored, Lifespan-Guided Approach

Bibliographic Data

ID15718827
AuthorsZhe Yuan (0000-0002-3656-8840, Nemours Children's Health System), Nancy Lennon (0000-0002-7719-6465, Nemours Children's Health System), Chris Church (0000-0003-1006-0632, Nemours Children's Health System), M Wade Shrader (0000-0002-8207-2109, Nemours Children's Health System), Freeman Miller (0000-0002-0033-5623, Nemours Children's Health System, corresponding author)
Year2025
Volume12
Issue9
Pages1252-1252
Publication date2025-09-17
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueChildren (JOURNAL)
Journal identifiersISSN: 2227-9067 • E-ISSN: 2227-9067
PublisherMultidisciplinary Digital Publishing Institute (PUBLISHER • CH)
DOI10.3390/children12091252
PMID41007117
OpenAlexW4414283680
LanguageEN
Citations received1
References cited88

Background: Cerebral palsy (CP) is a static, non-progressive brain pathology that affects mobility and musculoskeletal health. Objective: This review aims to describe the pediatric orthopedic management strategy at one specialty center with focus on optimal lifelong mobility function for ambulatory CP. Methods: Beginning in the 1990s, a protocol was developed to proactively monitor children with surgical or conservative interventions. After three decades, we undertook a prospective institutional review, board-approved 25-45-year-old adults callback study. Inclusion criteria were all children treated through childhood who could be located and were willing to return for a full evaluation. Results: Pediatric orthopedic interventions focused on regular surveillance with proactive treatment of progressive deformities. When function was impacted, we utilized multi-level orthopedic surgery guided by instrumented gait analysis. Childhood outcomes of this approach were evaluated through retrospective studies. Results show high correction rates were achieved for planovalgus foot deformity, knee flexion contracture, torsional malalignments, and stiff-knee gait. Our prospective adult callback study evaluated 136 adults with CP, gross motor function classification system levels I (21%), II (51%), III (22%), and IV (7%), with average ages of 16 ± 3 years (adolescent visit) compared with 29 ± 3 years (adult visit). Adults in the study had an average of 2.5 multi-level orthopedic surgery events and 10.4 surgical procedures. Compared with adults without disability, daily walking ability was lower in adults with CP. Adults with CP had limitations in physical function but no increased depression. A higher frequency of chronic pain compared with normal adults was present, but pain interference in daily life was not different. Adults demonstrated similar levels of education but higher rates of unemployment, caregiver needs, and utilization of Social Security disability insurance. Conclusions: The experience from our center suggests that consistent, proactive musculoskeletal management at regular intervals during childhood and adolescence may help maintain in gait and mobility function from adolescence to young adulthood in individuals with CP

Ambulatory · Cerebral palsy · Gait · Gross Motor Function Classification System · Orthopedic Procedures · Orthopedic surgery · Prospective cohort study · Sports medicine · Tetraplegia · Cerebral Palsy and Movement Disorders · Family and Disability Support Research · Infant Development and Preterm Care

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