# Early Independent Wheeled Mobility in Children with Cerebral Palsy: A Norwegian Population-Based Registry Study

## TL;DR

This study shows that most children with cerebral palsy in Norway gain independent wheeled mobility before age 7, with improvements in early access over two decades.

## Contribution

The study identifies predictors and trends in early independent wheeled mobility for children with cerebral palsy using a large national registry.

## Key findings

- Two-thirds of children with cerebral palsy achieved independent wheeled mobility before age 7.
- Children at GMFCS levels III and IV were more likely to gain early independent mobility.
- The average age for independent mobility dropped from 9.5 to 4.0 years between 2002 and 2019.

## Abstract

Background: The aim was to explore independent wheeled mobility in children with CP, and identify predictors of early independent wheeled mobility and changes over time across birth cohorts. Methods: We included data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) comprising 11,565 assessments of 1780 children born in 2002–2019. Variables included demographic data, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, wheelchair use, and independent wheeled mobility. Cox proportional hazard regression was used to identify predictors for early independent wheeled mobility. Kaplan–Meier survival curves were used to compare birth cohorts. Results: Of 769 (43%) children who used a wheelchair, 511 (67%) had independent wheeled mobility. Two thirds of the children (n = 337) achieved independent wheeled mobility before age 7. Most children with independent wheeled mobility used powered wheelchairs. Children at GMFCS levels III and IV were more likely to reach independent wheeled mobility at an early age. Children at MACS levels III–V had a lower probability of early independent wheeled mobility. The average age of achieving independent mobility decreased from 9.5 to 4.0 years between birth years 2002 and 2019. Conclusions: Two in three children were independent wheelchair users before 7 years of age, and the age of obtaining independent wheeled mobility has decreased over the last 20 years. Children with better hand function were more likely to obtain early independent wheeled mobility. Early intervention programs to promote mobility, development and participation should include powered mobility, adapted steering options, and interventions for hand function.