The Relationship Between the Gross Motor Function Classification System, Functional Mobility Scale, Observational Gait Scale, and the Amsterdam Gait Classification in Children with Cerebral Palsy During Long-Term Treatment with Botulinum Toxin Injections and Combined Integrated, Intensive Rehabilitation.

Patients with cerebral palsy (CP) experience complex gait disorders that change with age, leading to reduced activity and social participation. This study aimed to analyse how gait patterns developed over five years and to examine the relationships between the Observational Gait Scale (OGS), Amsterdam Gait Classification (AGC), Gross Motor Function Classification System (GMFCS), and the Functional Mobility Scale (FMS) at 5 and 50 m (FMS 5/50) during treatment. This retrospective, single-centre observational study involved annual assessments over a five-year period, which were analysed. Patients underwent a rehabilitation programme including physiotherapy, orthotics, multilevel botulinum toxin type A injections (BoNT-A), and serial casting. Data regarding BoNT-A treatment, casting, physiotherapy, orthoses, GMFCS levels, and FMS 5/50 scores were obtained from medical records. OGS and AGC were evaluated through two-plane clinical video recordings conducted in the same gait laboratory for all children. A cohort of 200 pediatric subjects (120 boys and 80 girls) diagnosed with bilateral cerebral palsy, predominantly classified as GMFCS II (48%) and III (36%), was analyzed. The average initial age was 32.23 months (±6.96), and GMFCS levels improved in 33. 5% of children and worsened in 2% ( < 0.001). Improvements were observed in 50% of children with GMFCS III and 40% with GMFCS IV levels. FMS 5 and 50 improved by 54% and 52%, respectively. OGS scores showed improvement in 74% and 76% of patients, respectively, while deterioration was observed in 5% and 7% for the right and left lower limbs, respectively. Most changes in OGS scores ranged from 1 to 4 points. A negative correlation was found between OGS and GMFCS ( < 0.001), and a positive correlation was found between OGS scores and FMS 5 and FMS 50 ( < 0.001). Additionally, significant relationships were identified between AGC and GMFCS, as well as FMS at 5 and 50 m. Complex gait disorders identified by the AGC are associated with higher GMFCS E&R scores and lower FMS scores. During the five-year follow-up, relationships were observed among GMFCS, FMS, OGS, and AGC. Our findings indicate that integrated treatment has a positive effect on functional mobility and gait patterns in patients with CP.