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Phys Occup Ther Pediatr. 2018;38(5):548-561. doi: 10.1080/01942638.2018.1462288. Epub 2018 May 1.

Factors Associated with Enhanced Gross Motor Progress in Children with Cerebral Palsy: A Register-Based Study.

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a Habilitation Centre, Nord-Trøndelag Hospital Trust , Levanger , Norway.
b Department of Clinical Neuroscience for Children , Oslo University Hospital , Oslo , Norway.
c Department of Clinical and Molecular Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.
d Department of Knowledge Development , Public Health Agency of Sweden , Østersund , Sweden.
e Department of Research, Nord-Trøndelag Hospital Trust, Levanger , Norway and Faculty of Nursing and Health Sciences, Nord University , Levanger , Norway.



To examine associations between interventions and child characteristics; and enhanced gross motor progress in children with cerebral palsy (CP).


Prospective cohort study based on 2048 assessments of 442 children (256 boys, 186 girls) aged 2-12 years registered in the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Gross motor progress estimates were based on repeated measures of reference percentiles for the Gross Motor Function Measure (GMFM-66) in a linear mixed model. Mean follow-up time: 2.9 years.


Intensive training was the only intervention factor associated with enhanced gross motor progress (mean 3.3 percentiles, 95% CI: 1.0, 5.5 per period of ≥3 sessions per week and/or participation in an intensive program). Gross motor function was on average 24.2 percentiles (95% CI: 15.2, 33.2) lower in children with intellectual disability compared with others. Except for eating problems (-10.5 percentiles 95% CI: -18.5, -2.4) and ankle contractures by age (-1.9 percentiles 95% CI: -3.6, -0.2) no other factors examined were associated with long-term gross motor progress.


Intensive training was associated with enhanced gross motor progress over an average of 2.9 years in children with CP. Intellectual disability was a strong negative prognostic factor. Preventing ankle contractures appears important for gross motor progress.


Cerebral palsy; GMFM-66 percentiles; gross motor function; intensive training; prognosis

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