Prognosis for gross motor function in cerebral palsy: creation of motor development curves

JAMA. 2002 Sep 18;288(11):1357-63. doi: 10.1001/jama.288.11.1357.


Context: Lack of a valid classification of severity of cerebral palsy and the absence of longitudinal data on which to base an opinion have made it difficult to consider prognostic issues accurately.

Objective: To describe patterns of gross motor development of children with cerebral palsy by severity, using longitudinal observations, as a basis for prognostic counseling with parents and for planning clinical management.

Design: Longitudinal cohort study of children with cerebral palsy, stratified by age and severity of motor function and observed serially for up to 4 years during the period from 1996 to 2001.

Setting: Nineteen publicly funded regional children's ambulatory rehabilitation programs in Ontario.

Participants: A total of 657 children aged 1 to 13 years at study onset, representing the full spectrum of clinical severity of motor impairment in children with cerebral palsy.

Main outcome measures: Severity of cerebral palsy, classified with the 5-level Gross Motor Function Classification System; function, formally assessed with the Gross Motor Function Measure (GMFM).

Results: Based on a total of 2632 GMFM assessments, 5 distinct motor development curves were created; these describe important and significant differences in the rates and limits of gross motor development among children with cerebral palsy by severity. There is substantial within-stratum variation in gross motor development.

Conclusions: Evidence-based prognostication about gross motor progress in children with cerebral palsy is now possible, providing parents and clinicians with a means to plan interventions and to judge progress over time. Further work is needed to describe motor function of adolescents with cerebral palsy.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Cerebral Palsy / physiopathology*
  • Cerebral Palsy / rehabilitation
  • Child
  • Child, Preschool
  • Humans
  • Longitudinal Studies
  • Motor Skills*
  • Prognosis
  • Reproducibility of Results
  • Severity of Illness Index*