Prognosis

The outlook in patients with CP depends primarily on disease severity, intellectual ability and potential for communicating, as well as the compensatory and corrective actions brought about by the continuing treatment program. The outlook is also dependent on the presence of complications/comorbidities such as epilepsy and hearing/visual loss. A combination of various assessment measures best captures participation of children with CP in home, school, and in community environments.[225]

Communication and mobility

Reflexes and reactions in early infancy that are poor prognostic factors for the development of independent walking include:

  • Retention of asymmetric and symmetric tonic neck reflexes

  • Retention of Moro (startle) reflex

  • Retention of neck righting reflex

  • Presence of lower-extremity extensor thrust response

  • Lack of parachute reaction

  • Lack of foot placement reaction.[82]

The primary goal for patients with CP is communication. For most people, this will not be difficult, but many require the use of technology (augmentative and alternative communication systems) or the use of signs to make their needs known.

Patients also require a variety of aids depending on their physical abilities. Aids for walking include braces, crutches, canes, and walkers.

People with functional upper extremities who require assistance for balance and stability may use a standard walker with wheels. Those with poor trunk control or persistent scissoring may use a gait trainer, which also provides trunk and pelvic stability. Children with difficulty advancing the limbs during swing may use a reciprocating gait orthosis; however, gait trainers and reciprocating orthoses are typically used with assistance for therapeutic purposes and are not considered independent mobility aids.

Walking may not be the key to success if it requires so much energy that it leaves the person exhausted when performing activities for daily living.

For nonambulatory patients, mobility aids such as specially adapted scooters, tricycles, and automobiles, as well as positioning equipment for electric and nonelectrically driven wheelchairs, may be used. Adaptive technology both to enhance communication and to enable access to computers can be provided.

Education and social integration

Most children with CP attend regular classes (mainstreaming); some require special education classes and some require full-time helpers in order to attend classes. For younger children, activities such as special sports leagues, hippotherapy (horseback riding), wheelchair-adapted swimming pools, and other adapted sports activities are key to social integration.

Many people with CP who have motor involvement without an intellectual disability will work in the community in the career of their choice, with reasonable accommodations for their physical impairments. People with more involvement or intellectual impairment may find that sheltered workshops, day programs, and special transportation considerations are key to avoiding isolation.

Long-term prognosis

A child with CP becomes an adult with CP. Except for patients with the most severe involvement, people with CP survive to senior age status, though some require lifelong help and accommodation. Most patients are helped by family, friends, and community resources.

Life expectancy has increased over recent decades due to a variety of factors including better medical care for respiratory infections and better nutrition, in concert with increased use of percutaneous gastrostomy for those who fail to gain weight.[224]​[226]​​ Gains have been most notable in the most vulnerable children.[227] For younger patients who walk unaided, life expectancy lags by a decade compared with children without CP. The longer a person has survived, the more his or her additional years of life expectancy will approach that of patients without CP. However, younger patients and those with severe involvement have a greater mortality.[228]

Adults with CP have an increased risk of noncommunicable diseases such as stroke, COPD, or cardiac conditions and an increased risk of related deaths.[229] This may be associated with decreased levels of physical activities in comparison with the general population. One study showed that 31% of adults with CP lived independently, 12% were married, 24% completed a tertiary or vocational level of education, and 28% participated in paid employment. Around 41% were unemployed and not in school or training.[230] For young adults with CP, emotional support from family plays an important role in overall satisfaction with life.[231]

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