Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years



This article is corrected by:

  1. Errata: Corrigendum Volume 58, Issue 8, 885, Article first published online: 12 July 2016

  • Acknowledgements
    This research was supported by a grant for the ASQME project from the Canadian Institutes of Health Research (CIHR; MOP-53258). The OMG study was supported by grants from the CIHR (MT-13476) and the National Center for Medical Rehabilitation Research of the US National Institute of Child Health and Human Development (RO1-HD-34947). Dr Rosenbaum holds a CIHR Canada Research Chair in Childhood Disability and the Scotiabank Chair at the McMaster Child Health Research Institute. Dr Russell holds a Research Scholar award from the Ontario Federation of Cerebral Palsy. The CanChild Centre for Childhood Disability Research is supported by the Ontario Ministry of Health and Long-term Care. We thank the team of ASQME assessors across Ontario who worked to collect these data. Special thanks are owed to Barb Galuppi who coordinated the OMG and ASQME studies and supervised the collection of these data. We are indebted to the children, adolescents, and their families who were involved in these studies and were so willing to share their experiences.

Dr Steven E Hanna at CanChild Centre for Childhood Disability Research, McMaster University, IAHS 411, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada. E-mail:


This paper reports the construction of gross motor development curves for children and youth with cerebral palsy (CP) in order to assess whether function is lost during adolescence. We followed children previously enrolled in a prospective longitudinal cohort study for an additional 4 years, as they entered adolescence and young adulthood. The resulting longitudinal dataset comprised 3455 observations of 657 children with CP (369 males, 288 females), assessed up to 10 times, at ages ranging from 16 months to 21 years. Motor function was assessed using the 66-item Gross Motor Function Measure (GMFM-66). Participants were classified using the Gross Motor Function Classification System (GMFCS). We assessed the loss of function in adolescence by contrasting a model of function that assumes no loss with a model that allows for a peak and subsequent decline. We found no evidence of functional decline, on average, for children in GMFCS Levels I and II. However, in Levels III, IV, and V, average GMFM-66 was estimated to peak at ages 7 years 11 months, 6 years 11 months, and 6 years 11 months respectively, before declining by 4.7, 7.8, and 6.4 GMFM-66 points, in Levels III, IV, and V respectively, as these adolescents became young adults. We show that these declines are clinically significant.