Assessment of the state of patients with spastic cerebral palsy at transition to adult medical institutions: a cross-sectional study

Abstract

Introduction The purpose of this cross-sectional study was anamnestic evaluation of the treatment performed in patients with GMFCS levels I, II, III spastic cerebral palsy and to assess their motor status, quality of life and anatomical disorders in the lower extremities in the age range from 17 to18.5 years.Material and methods A cross-sectional study was conducted in patients with spastic types of cerebral palsy at the age of 17-18.5 years. The completeness and consistency of previous treatment (according to medical documentation), motor abilities, quality of life, radiographic anatomy of the lower extremities were studied.Results We selected 73 patients meeting the inclusion criteria out of 201 cases. Insufficient systematic implementation of complex therapeutic measures was revealed, which was reflected in a high rate of orthopedic interventions (93.1 %). Fibromyotomies, triceps lengthening surgeries performed at an early age (6-7 years) contribute to the development of an iatrogenic crouch gait pattern, a decrease in motor abilities and quality of life by the age of 17-18 years. The probability of maintaining a positive result and improving motor ability by the end of the childhood period is significantly higher in the subgroup of multilevel orthopedic interventions than in patients after fibromyotomies or who did not undergo orthopedic treatment; the differences are significant as the chi-square test for binary samples shows (p = 0.012).Conclusions The severity of impairment of motor abilities, quality of life, incidence of the crouch gait pattern in patients with spastic types of cerebral palsy are close between subgroups at the time of transition to adult medical and diagnostic institutions. The quality of life and motor status after multi-level intervention improves and remains stable by the end of the childhood. Early surgical interventions for lengthening the triceps, fibromyotomy reduce motor potential in the long term, cause the development of the iatrogenic crouch gait pattern, and decrease the quality of life of adolescents with mild neurological disorders.