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Gross Motor Capability and Performance of Mobility in Children With Cerebral Palsy: A Comparison Across Home, School, and Outdoors/Community Settings

BL Tieman, PT, PhD, is Assistant Professor, Department of Physical Therapy, Georgia State University, MSC 8L0388, 33 Gilmer St SE, Unit 8, Atlanta, GA 30303-3088 (USA) (btieman{at}gsu.edu)
RJ Palisano, PT, ScD, is Professor, Programs in Rehabilitation Sciences, Drexel University, Philadelphia, Pa, and Co-investigator, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
EJ Gracely, PhD, is Associate Professor, Department of Family, Community, and Preventive Medicine, Drexel University
PL Rosenbaum, MD, FRCP(C), is Professor of Paediatrics, McMaster University, Co-Director, CanChild Centre for Childhood Disability Research, and Canada Research Chair in Childhood Disability, Ontario, Canada

Address all correspondence to Dr Tieman

Background and Purpose. Mobility of children with cerebral palsy (CP) has generally been examined in terms of capability (what a child can do) in a controlled environment, rather than performance (what a child does do) in everyday settings. The purpose of this study was to compare gross motor capability and performance across environmental settings in children with CP. Subjects. The subjects were 307 children with CP, aged 6 to 12 years, who were randomly selected across Ontario, Canada. Methods. Children were grouped by capability (the highest of 3 items achieved on the Gross Motor Function Measure). Performance was measured via a parent-completed questionnaire on usual mobility methods in the home, at school, and in the outdoors or community. Results. There were statistically significant differences in performance across settings for children in all capability groups. Children who were capable of crawling performed crawling more at home than at school or in the outdoors or community. Children who were capable of walking with support performed walking with support more at school than in the outdoors or community. Children who were capable of walking alone performed walking alone more at home than at school or in the outdoors or community, and more at school than in the outdoors or community. Discussion and Conclusion. The results provide evidence that children with CP with similar capability demonstrate differences in performance across settings. The results suggest that physical therapists should examine performance in the settings that are important to the child's daily life.

Key Words: Capability • Cerebral palsy • Environment • Locomotion • Mobility • Pediatrics • Performance

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