Clinical patterns of gait dysfunction across GMFCS levels in ambulatory children with cerebral palsy: a cross-sectional exploratory study in low-resource settings
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Despite GMFCS utility, children at the same level show different impairment combinations. This study examined multi-domain clinical patterns of gait dysfunction across GMFCS severity in ambulatory cerebral palsy.Aim To characterize cross-sectional associations between GMFCS level and multi-domain clinical measures using scalable assessment tools suited to low-resource rehabilitation settings.Method Fifty-three ambulatory children with cerebral palsy (GMFCS I n = 18, II n = 26, III n = 9; ages 3–11 years) were assessed using EVGS, GMFM-88, SCALE, MAS, PBS, CTSIB, and SSP. Children with prior surgery or botulinum toxin exposure were excluded. Associations were examined using Spearman correlations and Cliff’s delta effect sizes.Results EVGS showed a strong positive association with GMFCS severity (ρ=0.70, p < .001). Motor capacity (GMFM: ρ=−0.83) and selective motor control (SCALE: ρ=−0.67 left /−0.57 right) demonstrated strong inverse associations. Balance (PBS: ρ=−0.70) and sensory integration (CTSIB: ρ=−0.58) showed significant associations (all p < .001). Very large effect sizes were observed across domains (Cliff’s δ = 0.76–1.00). Hierarchical clustering revealed two distinct patterns: capacity–control (GMFM–SCALE coupling) and spasticity burden (MAS), indicating domain dissociation. GMFCS II demonstrated multi-domain heterogeneity; GMFCS III showed uniform global impairment. Findings are exploratory for secondary analyses and GMFCS III (n = 9).Interpretation Gait dysfunction in ambulatory cerebral palsy demonstrates systematic multi-domain variation across GMFCS levels. Selective motor control closely associates with motor capacity; spasticity shows relative dissociation from gait quality. These patterns support severity-stratified, multi-domain clinical assessment using accessible tools in low-resource settings, moving away from tone-centric rehabilitation models toward capacity-associated functional targets.
Institution: Nil Ratan Sircar Medical College and Hospital
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7219757818