Clinical spectrum and associated comorbidities of cerebral palsy among children in Eastern India.

Cerebral palsy (CP) remains a leading cause of childhood disability, with varying clinical presentations and comorbidity patterns. This study explored the clinical spectrum, functional severity, and perinatal risk factors of CP among children aged 4-14 years in eastern India to identify priority areas for early intervention and support. A cross-sectional study was conducted over one year at a tertiary care centre. Data were collected through structured caregiver interviews and clinical assessments using standardized tools-the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS). Associations between demographic, perinatal, and clinical variables and CP severity were analysed using likelihood ratio tests and partial correlation analyses. Among 127 children with CP (median age: 5.9 years; 74.0% male), spastic CP was the predominant subtype (75.6%), followed by dyskinetic (9.4%), ataxic (7.9%), and mixed (7.1%) forms. Severe motor impairments (GMFCS IV-V) were present in 63.8% of participants, and manual ability severity increased proportionally with GMFCS levels (ρ = 0.702; p < 0.001). Significant correlates of severe impairment included younger age, parental age (20-29 years), high birth weight (> 4000 g), home delivery, absence of crying at birth, neonatal seizures, hypoxic-ischemic encephalopathy, and jaundice. Comorbidities were common-language (78.7%), cognitive (62.2%), and personal-social (58.3%) impairments were most frequent. Only 12.6% of children attended school; attendance was positively associated with older age, male gender, lower GMFCS and MACS levels, and absence of cognitive, language, fine-motor, personal-social impairments, and seizure history. Spastic CP was the most frequent subtype, commonly associated with severe motor limitations and multiple comorbidities that significantly restricted educational participation. Strengthening perinatal care, early screening, and multidisciplinary rehabilitation are essential to improve functional outcomes and inclusion for children with CP in resource-limited settings.