Assessment of Gross Motor Function in Children with Spastic Cerebral Palsy Before Treatment and Two Years After Medical Rehabilitation

Background: Spastic cerebral palsy (spastic tetraplegia) is an irreversible brain injury that causes motor dysfunction, sensory disturbances, and cognitive impairments in children.Motor dysfunction leads to difficulties with balance when standing, sitting, and walking.Movements are often chaotic and uncoordinated.Although it results from a brain injury and is unpredictable, motor problems may worsen as the child grows, making early physical rehabilitation and occupational therapy essential.Patients with spastic tetraplegia frequently face vision and hearing impairments, intellectual and behavioral issues, lack tactile sensations, and experience speech deficits.Objectives: The study focused on children with spastic cerebral palsy.It involved patients who were relatively compliant with treatment and not severely affected by the condition.The study included 33 patients, divided into four age groups: nine patients aged 5-6 years, eight patients aged 7-8 years, nine patients aged 9-10 years, and seven patients aged 11-12 years.Methods: Patients underwent a Gross Motor Function Measure (GMFM).The outcomes were quantitative values (in percentages) for six qualitative characteristics: (i) Lying and rolling; (ii) Sitting; (iii) Crawling and kneeling; (iv) Standing; (v) Walking; and (vi) Total gross motor function score.The GMFM-88 scale was used, with each item scored on a scale of 0 to 3. The severity of spastic diplegia was assessed based on independent mobility, categorizing disease severity into five levels.Results: Statistical analysis showed a significant difference (p < 0.05) in gross motor function scores between the pre-treatment period and two years after rehabilitation.When comparing age groups 5-6 and 7-8 years, all six characteristics displayed significant differences after two years of treatment (U < U_{crit}, p < 0.05), indicating better outcomes in the 5-6-year-old group.Before treatment, the comparison between age groups 7-8 and 9-10 found no significant differences in the second (sitting) and fourth (standing) characteristics (U > U_{crit}, U_{crit} = 15, p > 0.05).The other four characteristics showed significant differences (U < U_{crit}, p < 0.05).After two years, all six characteristics significantly improved in favor of the 7-8-year-old group (U < U_{crit}, p < 0.05).Comparing the third (crawling and kneeling) and fifth (walking) characteristics (U > U_{crit}, p > 0.05).However, the remaining four characteristics showed significant differences (p < 0.05).After two years of treatment, all six characteristics were significantly better in the 9-to 10-year-old group (U < U_{crit}, p < 0.05).Conclusions: In patients diagnosed with spastic cerebral palsy, especially spastic tetraplegia, treatment planning should go beyond just age and sex.Instead, a personalized approach must be based on a thorough multidisciplinary assessment.This evaluation, done collaboratively by various healthcare professionals, should focus on identifying and prioritizing the patient's most affected functional areas, ensuring interventions target the most critical needs.In addition to patient-specific clinical factors, it is also essential to consider the unique sociocultural and healthcare conditions of the country where the patient resides.Our study clearly shows a trend: the earlier a structured two-year rehabilitation program begins, containing 384 therapeutic procedures, the greater the improvement in gross motor function scores.This highlights the importance of early intervention in managing spastic cerebral palsy.Regular monitoring of gross motor function outcomes throughout treatment provides a complete picture of the patient's progress.Such data help clinicians determine which areas are improving significantly and which may require increased attention or adjustments to therapy.