Mobility limitations

Mobility and cerebral palsy

As a movement disorder, cerebral palsy almost always affects a child’s mobility. Mobility is defined as the ability to move in one’s environment with ease and without restriction. Problems with walking, rolling over in bed or transitioning positions are examples of mobility limitations.

Children with cerebral palsy have varying degrees of difficulty with movement depending on the type and severity of their condition, as well as the area of the body affected. The following are the most common movement issues based on each type of cerebral palsy:

• Spastic - Those with spastic cerebral palsy experience jerky movements, stiff and tight muscles, and an awkward gait or manner of walking.
• Athetoid - Athetoid cerebral palsy is also known as dyskinetic CP. It is characterized by involuntary movements, fluctuations in muscle tone and problems with posture.
• Ataxic - People with ataxic cerebral palsy have shaky movements and problems with balance and depth perception. They often spread their feet apart when walking.
• Mixed - A child with mixed cerebral palsy will have a combination of spastic, athetoid or ataxic movement difficulties.

The location of a child’s movement problems is an important factor when it comes to mobility. For example, a child with spastic hemiplegia will likely have better mobility than one with spastic diplegia or quadriplegia. The following categories describe the location of movement difficulties associated with CP:

• Monoplegia - Only one limb is affected. Monoplegia is very rare.
• Diplegia - Both legs are affected. The arms may be affected to a lesser extent.
• Hemiplegia - One side of the body — one arm and one leg — is affected.
• Triplegia - Three limbs, usually both legs and one arm, are affected. This is sometimes referred to as diplegia with a hemiplegic overlay.
• Quadriplegia - Both arms and both legs are affected. The muscles of the trunk, face and mouth may also be affected.
• Double hemiplegia - Both arms and both legs are affected, but the arms are usually more affected.

The severity of a child’s cerebral palsy can be mild, moderate or severe. 

Gross motor function classification system

The Gross Motor Function Classification System (GMFCS) for cerebral palsy measures voluntary movements. Specifically, the GMFCS measures a child’s ability to function and move around in their daily life with an emphasis on how well they can sit, move between positions and walk.

The GMFCS has five classification levels:

• Level 1 - Walks without limitations
• Level 2 - Walks with limitations
• Level 3 - Walks using a hand-held mobility device
• Level 4 - Self-mobility with limitations; may use powered mobility
• Level 5 - Transported in a manual wheelchair

Generally, a low GMFCS level would indicate a mild case of CP, whereas a level 5 would likely result in a more severe cerebral palsy diagnosis.

Gait and motion analysis

Gait and motion analysis can also help with identifying and treating mobility issues. Gait and motion analysis involves using computer technology to capture what happens to a patient’s muscles, joints and other forces acting across the joints when they walk. The process usually takes a few hours and it may take several weeks to receive the results.

During gait and motion analysis, the patient will undergo several tests and/or evaluations. A typical gait and motion analysis visit may include the following:

• Videotaping the patient walking
• A physical exam
• Applying sensors and reflective balls to the patient’s body. The sensors record when the patient’s muscles are active or at rest. The reflective balls will be tracked by special cameras in the lab as the patient walks
• Plantar pressure testing (the patient walks along a mat on the floor that records patterns and the distribution of pressure)

The data gathered during testing is then used to create a virtual 3-D model of the patient’s gait. This detailed look allows doctors and/or therapists to identify specific walking issues and how to best correct or treat them.

Treating mobility limitations

Mobility limitations associated with cerebral palsy can often be managed or improved with quality treatment and care. Treatment may include physical therapy, occupational therapy, surgery, medications and/or the use of mobility aids.

It’s important to address a child’s mobility issues as early as possible to ensure other areas of their development are not affected. Any form of mobility, be it independent or assisted, will greatly improve a child’s quality of life and can even increase their life expectancy.

To learn more about the mobility and support options available, try downloading our free Cerebral Palsy Guide, which includes over 12 pages of in-depth information for children and parents of a child with CP.