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Purpose <p>Independent walking in children with Dyskinetic Cerebral Palsy (DCP) profoundly influences long-term quality of life.However, studies on the relationship between independent walking and high-risk factors in children with Dyskinaetic Cerebral Palsy (DCP) remain limited, and a predictive model for independent walking in this population has not yet been established.This study aimed to develop and validate a nomogram model based on multivariate clinical indicators to predict the probability of achieving independent walking by 7 years of age, thereby supporting early clinical decision-making and individualized rehabilitation planning.</p> Methods <p>The study was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR2300068075) on February 6, 2023. This retrospective study included 456 children with DCP registered in the Henan Provincial Children’s Cerebral Palsy Registration Management Platform and the medical record system of the Third Affiliated Hospital of Zhengzhou University from January 2004 to December 2022. The primary outcome was independent walking achieved at or before age 7. Follow-up was conducted through on-site assessments and telephone/WeChat interviews from January 2023 to December 2024. Using the R caret package, participants were randomly divided into training and validation sets (7:3 ratio). Independent predictors were identified through univariate and multivariate Cox regression analyses, and a nomogram was constructed. Model performance was assessed using the concordance index (C-index), Area Under the Receiver Operating Characteristic Curve (AUC), calibration curves, and Decision Curve Analysis (DCA).</p> Results <p>Of the 456 children, 167 (36.60%) achieved independent walking at or before age 7. The numbers of children achieving independent walking at ages 2 to 7 were 17 (3.73%), 20 (4.38%), 25 (5.48%), 25 (5.48%), 33 (7.23%), and 47 (10.30%), respectively. Multivariate Cox regression identified neonatal seizures, cognitive impairment, GMFCS level at 2 years, epilepsy, and independent sitting before age 2 as significant predictors (<i>P</i> &lt; 0.05). The nomogram demonstrated excellent discrimination, with a C-index of 0.926 in the training set and 0.942 in the validation set. Calibration curves indicated strong agreement between predicted and observed outcomes, and DCA confirmed substantial clinical net benefit within the threshold probability range of 4–7 years.</p> Conclusion <p>We developed and validated a clinically applicable nomogram model for predicting independent walking by age 7 in children with DCP. Key predictors included early sitting ability, GMFCS level at 2 years, cognitive impairment, neonatal seizures, and epilepsy. This quantitative tool supports individualized rehabilitation strategies, facilitates informed clinical decisions, and may improve long-term outcomes for affected children.</p>

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Prediction tool for independent walking in children with dyskinetic cerebral palsy: a modeling study

  • 期刊论文

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  • 发表日期：

    2026年3月2日

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  • Lusha Qiao,
  • Gongxun Chen,
  • Yiwen Wang,
  • Zhiwei Cheng,
  • Zhichong Hui,
  • Wenli Gao,
  • Kaili Shi,
  • Mingmei Wang,
  • Xuexing Ding,
  • Yongxia Wang,
  • Guangyu Zhang,
  • Lei Yang,
  • Sansong Li,
  • Dengna Zhu

摘要

Purpose

Independent walking in children with Dyskinetic Cerebral Palsy (DCP) profoundly influences long-term quality of life.However, studies on the relationship between independent walking and high-risk factors in children with Dyskinaetic Cerebral Palsy (DCP) remain limited, and a predictive model for independent walking in this population has not yet been established.This study aimed to develop and validate a nomogram model based on multivariate clinical indicators to predict the probability of achieving independent walking by 7 years of age, thereby supporting early clinical decision-making and individualized rehabilitation planning.

Methods

The study was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR2300068075) on February 6, 2023. This retrospective study included 456 children with DCP registered in the Henan Provincial Children’s Cerebral Palsy Registration Management Platform and the medical record system of the Third Affiliated Hospital of Zhengzhou University from January 2004 to December 2022. The primary outcome was independent walking achieved at or before age 7. Follow-up was conducted through on-site assessments and telephone/WeChat interviews from January 2023 to December 2024. Using the R caret package, participants were randomly divided into training and validation sets (7:3 ratio). Independent predictors were identified through univariate and multivariate Cox regression analyses, and a nomogram was constructed. Model performance was assessed using the concordance index (C-index), Area Under the Receiver Operating Characteristic Curve (AUC), calibration curves, and Decision Curve Analysis (DCA).

Results

Of the 456 children, 167 (36.60%) achieved independent walking at or before age 7. The numbers of children achieving independent walking at ages 2 to 7 were 17 (3.73%), 20 (4.38%), 25 (5.48%), 25 (5.48%), 33 (7.23%), and 47 (10.30%), respectively. Multivariate Cox regression identified neonatal seizures, cognitive impairment, GMFCS level at 2 years, epilepsy, and independent sitting before age 2 as significant predictors (P < 0.05). The nomogram demonstrated excellent discrimination, with a C-index of 0.926 in the training set and 0.942 in the validation set. Calibration curves indicated strong agreement between predicted and observed outcomes, and DCA confirmed substantial clinical net benefit within the threshold probability range of 4–7 years.

Conclusion

We developed and validated a clinically applicable nomogram model for predicting independent walking by age 7 in children with DCP. Key predictors included early sitting ability, GMFCS level at 2 years, cognitive impairment, neonatal seizures, and epilepsy. This quantitative tool supports individualized rehabilitation strategies, facilitates informed clinical decisions, and may improve long-term outcomes for affected children.