Clinical patterns of gait dysfunction across GMFCS levels in ambulatory children with cerebral palsy: a cross-sectional exploratory study in low-resource settings

Background Despite GMFCS utility, children at the same level show different impairment combinations. This study examined multi-domain clinical patterns of gait dysfunction across GMFCS severity in ambulatory cerebral palsy.Aim To characterize cross-sectional associations between GMFCS level and multi-domain clinical measures using scalable assessment tools suited to low-resource rehabilitation settings.Method Fifty-three ambulatory children with cerebral palsy (GMFCS I n = 18, II n = 26, III n = 9; ages 3-11 years) were assessed using EVGS, GMFM-88, SCALE, MAS, PBS, CTSIB, and SSP. Children with prior surgery or botulinum toxin exposure were excluded. Associations were examined using Spearman correlations and Cliff's delta effect sizes.Results EVGS showed a strong positive association with GMFCS severity (ρ=0.70, p p n = 9).Interpretation Gait dysfunction in ambulatory cerebral palsy demonstrates systematic multi-domain variation across GMFCS levels. Selective motor control closely associates with motor capacity; spasticity shows relative dissociation from gait quality. These patterns support severity-stratified, multi-domain clinical assessment using accessible tools in low-resource settings, moving away from tone-centric rehabilitation models toward capacity-associated functional targets.