The question of whether a child with Cerebral Palsy (CP) will walk is a primary concern for parents. CP is a group of permanent disorders affecting movement and posture, resulting from non-progressive disturbances in the developing brain, typically before birth. The term “cerebral” refers to the brain, and “palsy” refers to problems with movement. Although the brain damage is fixed and the condition itself does not worsen, its effects on the growing body can change. The potential for walking is highly variable, depending on the specific severity and type of motor impairment present.
Understanding Cerebral Palsy and Mobility
CP is classified based on the type of movement disorder, which directly dictates the nature of a child’s mobility challenges. The most common form, affecting about 80% of children with the condition, is Spastic Cerebral Palsy, characterized by stiff, tight muscles and exaggerated reflexes due to damage in the motor cortex. This increased muscle tone, or spasticity, causes stiff and awkward movements, which can lead to a gait characterized by walking on the toes or a “scissoring” motion of the legs.
Other classifications present different motor obstacles to walking and movement. Dyskinetic CP involves involuntary movements that are slow, writhing, or rapid and jerky, with muscle tone fluctuating between too tight and too loose. This instability makes controlled, coordinated actions like walking difficult. Ataxic CP, the least common type, impacts the cerebellum, leading to issues with balance, depth perception, and coordination, often resulting in a shaky, wide-based gait when attempting to walk.
The location of the brain damage also determines which limbs are affected, further classifying the mobility profile. Spastic diplegia primarily affects the legs, often allowing children to walk, though with difficulty or assistance. Spastic hemiplegia affects one side of the body, meaning a child may drag one arm and leg but can still achieve independent walking. Quadriplegia, which affects all four limbs and the trunk, is the most severe form and presents the greatest challenge to independent walking.
Classifying Potential for Walking
Clinicians use the Gross Motor Function Classification System (GMFCS) to determine a child’s current mobility and predict their long-term potential for walking. This five-level system provides a standardized description of a child’s gross motor function based on their ability to sit, walk, and use wheeled mobility. Since a child’s GMFCS level is generally stable after the age of five, it allows families and care teams to plan for the future.
Children classified at Level I walk without limitations, although they may experience decreased speed, balance, and coordination compared to their peers. Level II children walk in most settings but have limitations when walking long distances or on uneven terrain and may use a handheld device or wheeled mobility outdoors. Those at Level III require a handheld mobility device, such as a walker or crutches, to walk and may use wheeled mobility over longer distances.
Children at Level IV use methods of mobility that require physical assistance or powered mobility in most settings, often relying on a body support walker or powered wheelchair for self-mobility. Level V represents the most severe physical impairments, restricting voluntary movement control and the ability to maintain head and neck position against gravity. These children are typically transported in a manual wheelchair and have minimal ability to move independently, even with extensive adaptive equipment.
Maximizing Mobility Through Interventions
Regardless of a child’s classification level, interventions can maximize functional mobility and independence. Physical Therapy (PT) focuses on improving strength, flexibility, balance, and motor development through targeted exercises and training. Occupational Therapy (OT) complements this by helping children develop the skills needed for daily activities, such as dressing, bathing, and feeding, often by integrating movement goals into functional tasks.
Medical interventions are frequently used to manage the muscle stiffness common in spastic CP. Injections of botulinum toxin (Botox) are often administered into specific muscles beginning around two years of age to temporarily reduce spasticity and allow for stretching and improved movement. Oral medications such as baclofen or diazepam can also be prescribed to relax muscles, and in severe cases, baclofen can be delivered continuously through a surgically implanted pump directly to the spinal fluid.
Surgical options are used when non-invasive treatments are no longer sufficient to manage spasticity or correct deformities. Orthopedic procedures may involve lengthening tendons or releasing muscle contractures to improve joint alignment and gait mechanics. A neurosurgical procedure called Selective Dorsal Rhizotomy (SDR) involves identifying and cutting overactive sensory nerve rootlets in the spinal cord to permanently reduce stiffness in the legs and improve walking ability.
Adaptive Movement and Assistive Devices
When independent walking is not feasible, the focus shifts to achieving functional movement through adaptation and technology. Assistive devices provide the necessary support to stabilize the body, conserve energy, and facilitate independent mobility. Orthotics, such as ankle-foot orthoses (AFOs), are commonly used to provide support to the lower leg and foot, helping to control ankle position and improve walking patterns.
For children who can bear weight but need support, a range of devices can be used:
- Crutches
- Canes
- Walkers
- Gait trainers
Gait trainers offer comprehensive support for the trunk and pelvis, allowing children with more significant mobility challenges to practice the walking motion. These devices enable children to explore their environment upright, which also supports bone density and organ function.
For those with more extensive limitations, wheeled mobility is the primary means of independent movement. Manual wheelchairs require arm strength to propel, while powered wheelchairs allow children with severe motor involvement to navigate their surroundings using specialized controls like joysticks or head switches. This assisted movement is a significant developmental asset, promoting exploration, social interaction, and overall independence, proving that functional mobility is achievable across the full spectrum of Cerebral Palsy.