Affiliations: Department of Pediatric Rehabilitation, Medical
University of Bialystok, Bialystok, Poland | Department of Pediatric Radiology, Medical University
of Bialystok, Bialystok, Poland
Note: [] Correspondence: Dr. Wojciech Kulak M.D., Ph.D., Department of
Pediatric Rehabilitation, Medical University of Bialystok, 17 Waszyngtona Str,
15-274, Bialystok, Poland. Tel.: +48 85 7450601; Fax: +48 85 7421838; E-mail:
kneur2@wp.pl
Abstract: The aim of the study was to analyze the risk factors and clinical
picture of cerebral palsy in non-ambulatory children. The study included
133 children (77 boys and 56 girls) with cerebral palsy aged 6– 17 years. The
patients remained under the care of the Outpatient Clinic and Department of
Pediatric Rehabilitation of the Medical University of Bialystok. Ninety-eight
of the studied patients had spastic tetraplegia, 14 diplegia and 21 hemiplegia.
The average duration of pregnancy was 35.21 ± 1.32 weeks, the mean Apgar
score was 4.31 ± 3.60 and the mean birth weight was 2448.3 ± 384.7 g.
The patients exhibited the following types of motor dysfunctions: spasticity
was found in 91 (68.9%) of the patients, hypotonia in 24 (18.2%),
extrapyramidal symptoms in 13 (9.8%) and ataxia in 4 (3.0%) cases. More
than 3/4 (79%) of the children were
classified as level V on the Gross Motor Functional Classification System
(GMFCS) scale, and 21% as level IV. All the children had mental retardation:
10 (7.5%) mild, 45 (33.3%) moderate and 78 (58.6%) severe. Most
children (69.2%) with cerebral palsy did not speak, although 41 (30.8%)
managed to utter single words and sentences. More than half (64.6%) required
assistance in order to eat, whereas 47 (35.4%) had to be fed. Nearly half
(44%) of the patients suffered from epilepsy. Periventricular leukomalacia
and atrophy of the cerebral cortex were the most frequent findings on magnetic
resonance imaging. Low birth weight, a low Apgar score, and preterm birth were
factors that had a negative impact on the ability of children with cerebral
palsy to ambulate independently. Spasticity of the lower limbs, mental
retardation, lack of speech development and inability to eat without
assistance, as well as changes observed on magnetic resonance imaging were also
factors determining lack of independent walking.
