Change in ambulatory ability of adolescents and young adults with cerebral palsy
Change in ambulatory ability of adolescents and young adults with cerebral palsy
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DOI：
10.1111/j.1469-8749.2007.00647.x
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发表时间：
2007-09-01
影响因子：
3.8
通讯作者：
Reynolds, Robert J.
中科院分区：
文献类型：
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作者：
Day, Steven M.;Wu, Yvonne W.;Reynolds, Robert J.
这项研究旨在确定脑性瘫痪(CP)儿童在青春期和青春期丧失或获得行走能力的可能性。我们回顾分析了1987-2002年加州脑性瘫痪患者的数据，这些患者最初年龄为10岁(SD 0.9y；n=7550[SD 0.9y；n=7550[4304男性，3246女性])和25岁(SD 0.8y；n=5721[3261男性，2460女性])，他们具有不同水平的步行能力(初始粗大运动功能分类系统I-IV级)。我们使用Aalen-Johansen估计器来估计将来过渡到其他水平的步行能力的可能性。那些在10岁时行走和爬楼梯没有困难的人，15年后下降的可能性只有23%(需要扶手才能爬楼梯，甚至更糟)。那些行走有一些困难但没有使用轮椅的人有很大的改善机会(33%)(能够独自行走至少3米或更好)，而变成不能行走的可能性很小(11%)。那些使用轮椅的人更有可能失去行走能力(34%)或死亡(6%)。那些在25岁时走路和爬楼梯都很好的人15年后可能会保持这种能力(76%)，而那些需要支撑才能爬楼梯的人更有可能失去这种能力。在25岁之后，行走能力不太可能有所改善。患有脑性瘫痪的儿童和年轻人在接下来的15年里可能会保持他们的步行能力。一些在10岁时行走困难的人在青春期可能会有所改善，但那些使用轮椅的人更有可能下降。到25岁时，行走能力改善的可能性不大，而下降的可能性更大。然而，大多数情况在未来15年内不会改变。
This study aimed to determine the probability that a child with cerebral palsy (CP) will lose or gain ambulatory ability through adolescence and young adulthood. We analyzed retrospectively data from 1987 to 2002 on Californians with CP initially aged 10 years (SD 0.9y; n=7550 [4304 males, 3246 females]) and 25 years (SD 0.8y; n=5721 [3261 males, 2460 females]) who had varying levels of ambulatory ability (initial Gross Motor Function Classification System Levels I-IV). We used the Aalen-Johansen estimator to estimate probabilities of transition to other levels of ambulatory ability in the future. Those who walked and climbed stairs without difficulty at age 10 had only a 23% chance of decline (to requiring a handrail to manage stairs, or worse) 15 years later. Those who ambulated with some difficulty but did not use a wheelchair had a significant chance (33%) of improvement (to being able to walk unsteadily alone at least 3m or better) and only a small chance (11%) of becoming non-ambulatory. Those who used a wheelchair were more likely to lose ambulatory ability (34%) or die (6%). Those who walked and climbed stairs well at age 25 were likely to maintain that ability 15 years later (76%), while those needing support to climb stairs were more likely to lose ability. Improvement in ambulation after age 25 was unlikely. Children and young adults with CP are likely to maintain their ambulatory ability during their next 15 years. Some who ambulate with difficulty at age 10 may improve through adolescence, but those who use a wheelchair are more likely to decline. By age 25 improvement in ambulation is unlikely and decline more likely. Most, however, will not change over the next 15 years.