Multiple Motor Types in Children and Young People with CP

KEY FINDINGS

This recent study provides a comprehensive description of multiple motor disorders in children and young adults with Cerebral Palsy and found that over half of these young individuals have more than one motor (movement) disorder, which is more common than previously thought.

BACKGROUND

The purpose of this data collection was to identify and distinguish between various motor (movement) disorders seen in children and young people with CP (spasticity, dystonia, choreoathetosis, ataxia, hypotonia with increased reflexes)  and where these motor disorders present on the body (such as on one side of the body, both sides, or impacting all 4 limbs); and to better understand the relationship between these different motor disorders, a person’s functional abilities, and co-occurring conditions such as intellectual disability, epilepsy, visual and/or hearing impairments. 

WHAT HAPPENED DURING DATA COLLECTION?

This study was conducted between May 2018-March 2020, at an Australian specialty children’s hospital rehabilitation clinic. An experienced multidisciplinary treatment team collected data from 582 children and young people with CP between the ages of 11 months and 19 years 9 months. The team used a standardized form called the Australian Cerebral Palsy Register CP Description Form while performing standardized motor disorder, functional assessments and physical examinations for accuracy. 

WHAT WERE THE FINDINGS?

They found that fifty-five percent of children and young people with CP presented with multiple motor disorders, often affecting the same limb(s). In total, 18 different motor disorder combinations were identified, including choreoathetosis, ataxia, and generalized hypotonia with increased reflexes. There were no individuals identified that had choreoathetosis only. Importantly, dystonia was identified in 60% of individuals in this study and was associated with more functional limitations and other non-motor impairments

The most common motor disorders were:
Spasticity and dystonia (50%)
Spasticity only (36%)
Dystonia only (6%)

Functional and non-motor implications:
Children with spasticity only had less severe functional deficits and lower rates of associated intellectual disability and epilepsy than those with both spasticity and dystonia or dystonia only. Children with generalized hypotonia had higher rates of intellectual disability, epilepsy, hearing and visual impairment.

WHAT DOES THIS MEAN FOR FAMILIES?

1)    Multiple motor disorders are common in children and young people with CP and are associated with more severe functional impairment.

2)    Accurate assessment of motor disorders is essential to guide prognosis and treatment decisions with evidence-based interventions. For example, the treatments for dystonia are not the same as treatments for spasticity

3)    Accurate assessment of motor disorders is also important for participation in clinical trials.  Dystonia is often an exclusion in clinical trials. 

REFERENCE

Dar H, Stewart K, McIntyre S, Paget S. Multiple motor disorders in cerebral palsy. DevMed Child Neurol. 2024;66:317–325. https://doi.org/10.1111/dmcn.15730