Cerebral palsy grown up

Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care

Objective: We evaluated the impact of Medicaid managed care (MMC) on health service use and state costs among adults with early-acquired physical disabilities. Method: Using claims data, we tracked utilization of the emergency department (ED), inpatient admissions, outpatient physician visits, and state expenditures on enrollees who transitioned to MMC (n = 881). The inverse propensity score weight and a difference-in-differences regression model were used to estimate the impact of MMC using their counterparts who remained in fee-for-service (n = 1,552) as the comparison group. Results: MMC reduced ED use by 3.2% points/month (p < .001). Relative to younger enrollees (age ⩽45 years), MMC reduced inpatient admissions of older enrollees (age ⩾46 years) by 3.3% points/month (p < .001), and state expenditures by US$839/month (p < .01). Discussion: MMC could reduce the hospital service use of and state spending on enrollees with early-acquired physical disabilities. This impact may vary depending on the enrollees' age.

Physical Activity in Adolescents and Young Adults with Cerebral Palsy

The aim of this study was to examine the level of physical activity in adults with cerebral palsy (CP) and to analyse its relationship with physical activity as adolescents, pain, and gross motor function. A prospective cohort study was performed using data from the Swedish National CP Registry (CPUP) for all 129 individuals born in 1991–1993 living in Skåne and Blekinge who reported to CPUP at 14–16 years of age. Physical activity as adult was analysed relative to physical activity as adolescents, pain, and the Gross Motor Function Classification System (GMFCS). Seventy-one individuals at GMFCS I–V were followed up as adults and included in the analyses. Of these, 65% were physically active, but only 56% performed physical activity at least once a week. Their physical activity as adults differed relative to their physical activity as adolescents (p = 0.011) but not to pain or GMFCS. Being physically active as an adolescent doubled the probability of being active as an adult (OR 2.1; p = 0.054), indicating that physical activity in adults with CP is related to their physical activity as adolescents. Therefore, interventions to increase physical activity among adolescents with CP are likely also to improve physical activity in adulthood.

A novel sensorized shoe system to classify gait severity in children with cerebral palsy

The clinical management of children with Cerebral Palsy (CP) relies upon periodic assessments of changes in the severity of gait deviations in response to clinical interventions. Current clinical practice is limited to sporadic assessments in a clinical environment and hence it is limited in its ability to estimate the impact of CP-related gait deviations in real-life conditions. Frequent home-based quantitative assessments of the severity of gait deviations would be extremely useful in scheduling clinical visits and gathering feedback about the effectiveness of intervention strategies. The use of a wearable system would allow clinicians to gather information about the severity of gait deviations in the home setting. In this paper, we present ActiveGait, a novel sensorized shoe-based system for monitoring gait deviations. The ActiveGait system was used to gather data, under supervised and unsupervised conditions, from a group of 11 children with various levels of CP-related gait deviation severities. We present a methodology to derive severity measures based on features extracted from Center of Pressure (CoP) trajectories. Results show that a Random Forest classifier is able to estimate severity scores based on the Edinburgh Visual Scale with a level of accuracy >80% adequate for clinical use.