Severity of Cerebral Palsy-The Impact of Associated Impairments.

Objective This article describes associated impairments in children with cerebral palsy (CP) and its subtypes. Method Children born between 1990 and 2006 recorded in the Surveillance of Cerebral Palsy in Europe common database were studied. An "impairment index" characterized severity of impairments and their combinations. Results Amongst the 11,015 children analyzed, 56% ( n = 5,968) could walk unaided, 54% (4,972) had normal or near-normal intellect (intelligence quotient >= 70). Except for ataxic CP, associated impairments were less frequent when walking ability was preserved. The impairment index was low (walking unaided and normal or near-normal intellect) in 30% of cases; 54% ( n = 1,637) in unilateral spastic, 24% ( n = 79) in ataxic, 18% ( n = 913) in bilateral spastic, and 7% ( n = 50) in dyskinetic CP. Around 40% had a high impairment index (inability to walk and/or severe intellectual impairment +/- additional impairments)-highest in dyskinetic (77%, n = 549) and bilateral spastic CP (54%, n = 2,680). The impairment index varied little in birth weight and gestational age groups. However, significantly fewer cases in the birth weight group <= 1,000 g or gestational age group <= 27 weeks had a low impairment index compared to the other birth weight and gestational age groups (23 and 24% vs. between 27 and 32%). Conclusion Thirty percent of the children with CP had a low impairment index (they were able to walk unaided and had a normal or near-normal intellect). Severity in CP was strongly associated to subtype, whereas the association was weak with birth weight or gestational age.