Early Physical Therapy and Mobility Outcomes in Youth with Cerebral Palsy who Undergo High Burden Multi-Level Surgery

• Katie Bushong, Biological Sciences, Wilmington University

• Nancy Lennon, Nemours Childrens Hospital, Nemours Childrens Hospital

Early Physical Therapy and Mobility Outcomes in Youth with Cerebral Palsy who Undergo High Burden Multi-Level Surgery

Katie Bushong; Nancy Lennon, DPT; Chris Church, MPT; Brittany Virgil, DPT; Jose Salazar, PhD; Thomas Shields, BS; Freeman Miller, MD; Michael Shrader, MD; Arianna Trionfo, MD

Cerebral palsy (CP) is the most common physical disability of childhood affecting 17 million people worldwide. Many children with CP undergo multi-level surgery (MLS) to improve mobility and gait. Rehabilitation after surgery is standard clinical practice, although there is limited evidence describing the role physical therapy (PT) plays in functional outcomes. This interim report examines early PT in children with CP who underwent high burden MLS. PT frequency and setting are described for the first 16 weeks post-op and the association of PT with mobility outcomes are investigated.

This IRB approved retrospective study, includes children with CP diagnosis, age 4-20, who underwent high burden MLS and had pre/post-op gait analysis. Outcome measures are gait deviation index (GDI), the Gross Motor Function Measure (GMFM), walking speed, and the Pediatric Outcomes Data Collection Instrument (PODCI). We populated PT data on sessions per week and setting for the first 16 weeks post-op.

Analysis of GMFM baseline versus post-op change in GMFM reveals that children with lower baseline tended to increase GMFM score or not change and those with higher baseline tended to decrease GMFM score or not change. Additionally, patients who lost more gross motor function received more PT sessions, suggesting that patients with the highest needs received more care during early rehab. A correlation between global PODCI score and total number of PT sessions reveals that families of patients with more PT sessions reported loss of function. This negative correlation also suggests that patients with the highest needs received more care during early rehab. Due to missing PT data, we were unable to analyze in this interim report how early PT influences other gait and mobility outcomes. Future work will define clinical rehabilitation guidelines for children with CP who undergo MLS so that every child sees improvement in functional mobility.