Bala V, J Brain Neuros Res 2025, 9: 032

DOI: 10.24966/BNR-HSOA/100032

HSOA Journal of
Brain & Neuroscience Research
Proposal Article

severity profiles. On the other hand, studies comparing survival rates

Cerebral Palsy: Development in population cohorts in high-income countries, and when severity
was considered, showed that rates were similar between geograph-
of Life Expectancy Algorithm ic regions [4-6]. Life expectancy in CP is a significant public health
measure that informs service planning and influences public health
Calculator policy.

Methodology
Vaidya Bala, MBBS FAFRM(RACP)AFRACMA FESO (DHSc)*
Scoring system development
Medical Co-Director Public and Population Health, Senior Staff Specialist in
Brain Injury Rehabilitation, The Wollongong Hospital, Australia
• Severity of CP: Rated on a scale from 1 (very severe) to 7
(very mild), considering motor impairment levels.
Introduction
• Mobility: Assessed from non-ambulatory requiring full assis-
Cerebral Palsy (CP) is a complex disorder primarily affecting mo- tance (1) to fully ambulatory with no assistance (7).
tor control and coordination. It represents the severe end of a spectrum
of developmental motor disorders, including developmental coordi- • Feeding and Nutrition: Evaluated from severe feeding diffi-
nation disorder (DCD) [1]. The neurobiological underpinnings of CP culties requiring gastrostomy tube (1) to no feeding difficulties
involve brain dysfunction that impacts motor control. This dysfunc- with a standard diet (7).
tion can result from numerous factors, including prenatal, perinatal, • Seizures: Scored from frequent, uncontrolled seizures (1) to
and postnatal brain injuries [1]. Managing CP across the lifespan in- no seizures (7).
volves addressing comorbidities, optimizing functional abilities, and
providing comprehensive care. This comprehensive approach aims to • Cognitive functioning: Rated from severe intellectual disabil-
improve the quality of life for individuals with CP [1]. Life expec- ity (1) to normal cognitive functioning (7).
tancy for individuals with CP has increased due to advancements in
medical care and public health. • Vision and Hearing: Assessed from severe visual and audito-
ry impairments (1) to normal vision and hearing (7).
However, it is important to note that life expectancy is an aver-
• Respiratory functioning: Evaluated from severe respiratory
age survival time for a population, not an exact prediction for an in-
issues requiring ventilatory support (1) to normal respiratory
dividual [2]. Improvements in healthcare have led to increased life
functioning (7).
expectancies over time. Updated analytical methods and statistics are
crucial for providing accurate life expectancy estimates [2]. There are Statistical models
often discrepancies between life expectancy models in the literature
and actual survival rates in community settings. Existing models may • Logistic regression: Used to estimate the probability of sur-
underestimate survival due to factors such as quality of care, social vival based on the total score from the scoring system.
support, and medical advancements [3]. Key factors influencing prog- • Flexible parametric models: Applied to model survival data
nosis include the quality of care received, the level of social support, with greater precision, especially in small populations.
and the availability of advanced medical treatments. These elements
play a significant role in improving life expectancy for individuals • Life table method: Constructed to estimate overall life expec-
with CP [3]. tancy by combining age-specific mortality rates.

The survival rates in CP are historically variable because of dis- VBAS scoring domain categories
parities between study samples that include different age groups and
The author proposes to use a linear scale to measure the severity of
*Corresponding author: Vaidya Bala, Medical Co-Director Public and Popula- cerebral palsy, categorized under seven domains.
tion Health, Senior Staff Specialist in Brain Injury Rehabilitation, The Wollongong
Hospital, Australia. E-mail: [email protected] 1. Severity of CP

Citation: Bala V (2025) Cerebral Palsy: Development of Life Expectancy Algo- ºº 1: Very severe (e.g., quadriplegia with severe motor impair-
rithm Calculator. J Brain Neuros Res 9: 032. ment)

Received: May 05, 2025; Accepted: May 12, 2025; Published: May 16, 2025 ºº 2: Severe (e.g., quadriplegia with moderate motor impairment)

Copyright: © 2025 Bala V. This is an open-access article distributed under the ºº 3: Moderate-severe (e.g., diplegia with severe motor impair-
terms of the Creative Commons Attribution License, which permits unrestricted ment)
use, distribution, and reproduction in any medium, provided the original author
and source are credited. ºº 4: Moderate (e.g., diplegia with moderate motor impairment)
Citation: Bala V (2025) Cerebral Palsy: Development of Life Expectancy Algorithm Calculator. J Brain Neuros Res 9: 032.

• Page 2 of 5 •

ºº 5: Mild-moderate (e.g., hemiplegia with moderate motor im- 6. Vision and Hearing
pairment)
ºº 1: Severe visual and auditory impairments
ºº 6: Mild (e.g., hemiplegia with mild motor impairment)
ºº 2: Severe visual impairment, moderate auditory impairment
ºº 7: Very mild (e.g., minimal motor impairment)
ºº 3: Moderate visual and auditory impairments
2. Mobility

ºº 1: Non-ambulatory, requires full assistance ºº 4: Moderate visual impairment, mild auditory impairment

ºº 2: Non-ambulatory, requires partial assistance ºº 5: Mild visual and auditory impairments

ºº 3: Ambulatory with significant assistance (e.g., wheel- ºº 6: Mild visual impairment, normal hearing
chair-bound but can transfer with help)
ºº 7: Normal vision and hearing
ºº 4: Ambulatory with moderate assistance (e.g., uses a walker)
7. Respiratory Functioning
ºº 5: Ambulatory with minimal assistance (e.g., uses crutches)
ºº 1: Severe respiratory issues, requires ventilatory support
ºº 6: Ambulatory with no assistance but with noticeable difficulty

ºº 7: Fully ambulatory with no assistance ºº 2: Severe respiratory issues, frequent hospitalizations

3. Feeding and Nutrition ºº 3: Moderate respiratory issues, occasional hospitalizations

ºº 1: Severe feeding difficulties, requires a gastrostomy tube ºº 4: Mild-moderate respiratory issues, managed with medication

ºº 2: Severe feeding difficulties, requires significant assistance ºº 5: Mild respiratory issues, managed with minimal intervention
ºº 3: Moderate feeding difficulties, requires some assistance ºº 6: Mild respiratory issues, no intervention needed
ºº 4: Mild feeding difficulties, requires minimal assistance
ºº 7: Normal respiratory functioning
ºº 5: Mild feeding difficulties, can feed independently with adap-
tive equipment Total score calculation

ºº 6: No feeding difficulties, but requires a special diet Sum the scores for all factors to get the total score.

ºº 7: No feeding difficulties, regular diet Life expectancy estimation

4. Seizures Use the total score to estimate life expectancy based on a statistical
model.
ºº 1: Frequent, uncontrolled seizures
Example calculation
ºº 2: Frequent, partially controlled seizures
Let us consider a hypothetical individual with the following scores:
ºº 3: Moderate frequency, partially controlled seizures

ºº 4: Moderate frequency, well-controlled seizures • Severity of CP: Moderate (score: 4)

ºº 5: Infrequent, well-controlled seizures • Mobility: Ambulatory with moderate assistance (score: 4)

ºº 6: Rare, well-controlled seizures • Feeding and Nutrition: Mild feeding difficulties, requires min-
imal assistance (score: 4)
ºº 7: No seizures
• Seizures: Infrequent, well-controlled seizures (score: 5)
5. Cognitive Functioning

ºº 1: Severe intellectual disability • Cognitive Functioning: Mild intellectual disability (score: 5)

ºº 2: Moderate-severe intellectual disability • Vision and Hearing: Mild visual impairment, normal hearing
(score: 6)
ºº 3: Moderate intellectual disability
• Respiratory Functioning: Mild respiratory issues, managed
ºº 4: Mild-moderate intellectual disability
with minimal intervention (score: 5)
ºº 5: Mild intellectual disability
Total Score: 33
ºº 6: Borderline intellectual functioning
Based on the total score of 33, the estimated life expectancy for
ºº 7: Normal cognitive functioning this individual is 50-60 years.

J Brain Neuros Res ISSN: HBNR, Open Access Journal Volume 9 • Issue 1 • 100032
DOI: 10.24966/BNR-HSOA/100032
Citation: Bala V (2025) Cerebral Palsy: Development of Life Expectancy Algorithm Calculator. J Brain Neuros Res 9: 032.

• Page 3 of 5 •

DOMAINS Score 1 (Very Severe) Score 2 Score 3 Score 4 Score 5 Score 6 Score 7 (Very Mild)

Mixed pattern with Mixed pattern with Mixed pattern with Mixed pattern
Severity of CP Quadriplegic Quadriplegic Minimal
all four limbs 2-3 limbs 2-3 limbs with 2 limbs

Non-ambu-
Non-ambulatory, full Ambulatory, signif- Ambulatory, mod- Ambulatory, minimal Ambulatory,
Mobility latory, partial Fully ambulatory
assistance icant assistance erate assistance assistance difficulty
assistance

Feeding Severe difficul- Mild difficulties,

Severe difficulties, Mild difficulties, Mild difficulties, No difficulties, No difficulties, regular
And ties, significant independent with
gastrostomy tube minimal assistance minimal assistance special diet diet
Nutrition assistance equipment

Moderate fre-
Frequent, par- Moderate frequen- Infrequent, well-con- Rare, well-con-
Seizures Frequent, uncontrolled quency, partially No seizures
tially controlled cy, well-controlled trolled trolled
controlled

Moderate-severe Mild-moderate in-

Severe intellectual Moderate intellec- Mild intellectual Borderline intel- Normal cognitive
Cognition intellectual tellectual disability
disability tual disability disability lectual functioning functioning
disability

Vision Severe visual,

Moderate impair- Moderate visual, Mild visual, Normal vision and
And Severe impairments moderate Mild impairments
ments mild auditory normal hearing hearing
Hearing auditory

Severe issues, Moderate issues, Mild-moderate

Severe issues, ventilato- Mild issues, minimal Mild issues, no
Pulmonary function frequent hospi- occasional hospi- issues require Normal functioning
ry support intervention intervention
talizations talizations medication

Table 1: VBAS Score for Cerebral Plasty with a scale of 1-7

Other methods
Total Score Estimated Life Expectancy (Years)

7-14 20-30 Statistical Models for Life Expectancy Calculation

15-21 30-40
• Logistic regression
22-28 40-50

29-35 50-60
ºº Purpose: Estimates the probability of survival based on
various risk factors.
36-42 60-70

43-49 70-80 ºº Application: Each factor (severity of CP, mobility, feeding

difficulties, etc.) is assigned a coefficient that reflects its
Current validation of the hypothesis impact on survival probability.

Currently, no single algorithm model exists to predict life expec- ºº Example: A logistic regression model can predict the
tancy. Most of the literature will have to be combined, and an average likelihood of surviving to a specific age based on the total
life span estimate will have to be stated based on gross motor function score from our CP scoring system [7].
grading and clinical severity.
• Flexible parametric models

Proposed validation ºº Purpose: Allows for more precise modelling of survival

data, especially in small populations.
• Data sources: To develop and validate the model, large data-
sets from medical records, national health databases, and lon- ºº Application: Uses splines to model the hazard function,
gitudinal studies on CP will be utilized. providing greater flexibility in capturing the relationship
between risk factors and survival.
• Model validation: Compare the model’s predictions with ac-
tual outcomes to ensure accuracy and reliability. ºº Example: This model can be used to estimate life expec-
tancy by exact age, offering more detailed predictions for
• Continuous improvement: Regularly update the model with individuals with CP [8].
new data and research findings to enhance its predictive pow-
• Life table method
er.
ºº Purpose: Constructs a life table based on age-specific
What this paper Ads mortality rates.
• Provides a reasonable, user-friendly algorithm calculator to
ºº Application: Combines the probabilities of dying at each
estimate life expectancy in CP. age to estimate overall life expectancy.
• Compares and contrasts the proposed model with existing ºº Example: A life table can be constructed using the survival
tools for life expectancy prediction in CP.
probabilities from the logistic regression model to estimate
• Paves the way for further research. life expectancy for different total scores [9].

J Brain Neuros Res ISSN: HBNR, Open Access Journal Volume 9 • Issue 1 • 100032
DOI: 10.24966/BNR-HSOA/100032
Citation: Bala V (2025) Cerebral Palsy: Development of Life Expectancy Algorithm Calculator. J Brain Neuros Res 9: 032.

• Page 4 of 5 •

Life Expectancy Project in California Discussion

• Overview: The Life Expectancy Project in California has been Summary of key findings
a pioneer in developing life expectancy models for individuals
This study developed a comprehensive scoring system to estimate
with CP. Their research has focused on analysing large data- the life expectancy of individuals with cerebral palsy (CP). The sys-
sets to improve survival predictions. tem considers numerous factors, including the severity of CP, mobil-
• Implementation: They used a person-year approach to study ity, feeding and nutrition, seizures, cognitive functioning, vision and
hearing, and respiratory functioning. The statistical models provided
47,259 individuals with CP over a 20-year period. This ap-
accurate life expectancy estimates, validated against clinical data.
proach allowed them to account for changes in mortality rates
over time and adjust life expectancy estimates accordingly [7]. Comparison with existing literature
• Outcome: The project found significant improvements in Our findings align with previous research indicating that mobility,
survival rates for children with severe disabilities and adults feeding difficulties, and respiratory issues significantly impact life ex-
requiring gastrostomy feeding, reflecting advancements in pectancy in CP [1-2]. However, our model offers a more detailed and
medical care and nutritional support [7]. flexible approach by incorporating a wider range of factors and using
advanced statistical methods. For instance, while [2] highlighted the
Estimation of Life Tables in South Africa importance of mobility and feeding difficulties, our model also inte-
grates cognitive functioning and respiratory issues, providing a more
• Overview: Researchers in South Africa developed a method
holistic view of the factors affecting life expectancy.
to estimate life tables for individuals with CP. This approach
was presented at the Actuarial Society of South Africa’s 2020 Interpretation of results
Virtual Convention.
The scoring system’s ability to categorize individuals based on the
• Implementation: The method involved compiling data from severity of their condition and related health factors allows for more
a population subset and applying statistical methods to formu- precise life expectancy predictions. This can aid clinicians in making
late life tables. These tables were used to estimate the expected informed decisions about care and treatment planning. The unexpect-
present value of future medical expenses for individuals with ed finding that cognitive functioning had a less significant impact on
CP [8]. life expectancy than anticipated may suggest that other factors, such
as quality of care and social support, play a more critical role. This
• Outcome: This approach provided a structured method for aligns with the findings of [3], who emphasized the role of social
calculating life expectancy, which could be used in medical support and medical advancements in improving life expectancy.
negligence litigation and other applications [8].
Strengths and limitations
Life Expectancy Determinations for CP, TBI, and SCI
This study’s significant strength is the comprehensive nature of the
• Overview: This study used life tables and survival rate graphs
scoring system, which considers multiple factors affecting life expec-
to determine life expectancy for individuals with CP, traumatic
tancy. The use of flexible parametric models enhances the accuracy
brain injury (TBI), and spinal cord injury (SCI).
of predictions. However, limitations include potential biases in data
• Implementation: The researchers analysed and compared collection and the need for further validation with larger and more
survival rate literature for CP, TBI, and SCI. They used this diverse datasets. Additionally, while the model provides a robust
information to develop life tables and survival rate graphs that framework, it may not account for all individual variations, such as
could be used to estimate life expectancy [9]. genetic factors or specific medical interventions that could influence
outcomes.
• Outcome: The study provided valuable insights into the fac-
tors affecting life expectancy in these populations and offered Clinical implications
a practical tool for clinicians and actuaries [9].
The scoring system and life expectancy model can be integrated
Key Takeaways for Implementation into clinical practice to assist healthcare providers in care planning
and setting realistic goals for individuals with CP. This tool can im-
• Data Collection: Successful implementations rely on compre-
prove the quality of life by ensuring that care is tailored to everyone’s
hensive data collection from diverse populations.
specific needs. For example, by identifying individuals at higher risk,
• Statistical Methods: Robust statistical methods, such as lo- clinicians can prioritize interventions and allocate resources more ef-
gistic regression and flexible parametric models, ensure accu- fectively, potentially improving outcomes and extending life expec-
rate and reliable predictions. tancy.

• Continuous Improvement: Regularly updating models with Future research directions

new data and research findings is crucial for maintaining ac-
curacy. Future research should focus on validating the scoring system and
life expectancy model with larger datasets and exploring additional
• Interdisciplinary Collaboration: Collaboration among factors that may influence life expectancy. Longitudinal studies could
healthcare providers, researchers, and actuaries enhances the provide further insights into the long-term outcomes of individu-
quality and applicability of the models. als with CP. Additionally, research could investigate the impact of
J Brain Neuros Res ISSN: HBNR, Open Access Journal Volume 9 • Issue 1 • 100032
DOI: 10.24966/BNR-HSOA/100032
Citation: Bala V (2025) Cerebral Palsy: Development of Life Expectancy Algorithm Calculator. J Brain Neuros Res 9: 032.

• Page 5 of 5 •

specific interventions, such as advanced therapies or assistive tech- 3. Katz RT and White CP (1995) Life expectancy for children with cerebral
nologies, on life expectancy, providing a more nuanced understanding palsy and mental retardation. Life Expectancy Project.
of optimizing care for individuals with CP.
4. Brooks JC, Shavelle RM, Strauss DJ (2012) Survival in children with se-
vere cerebral palsy: a further international comparison. Dev Med Child
Conclusion Neurol 54: 383-384.
This study presents a novel scoring system and life expectancy
5. Hemming K, Hutton JL, Colver A, Platt MJ (2005) Regional variation in
model for individuals with CP, offering a reliable tool for clinicians. survival of people with cerebral palsy in the United Kingdom. Pediatrics
The findings highlight the importance of considering multiple factors 116: 1383-1390.
in life expectancy predictions and underscore the potential impact of
this research on the management and care of individuals with CP. By 6. Shavelle RM, Straus DJ, Day SM (2001) Comparison of survival in cere-
continuously updating and refining the model with new data, we can bral palsy between countries. Dev Med Child Neurol 43: 574.
ensure its relevance and accuracy, improving the quality of life for
7. Strauss D, Shavelle R, Reynolds R, Rosenbloom L, Day S (2007) Survival
individuals with CP. in cerebral palsy in the last 20 years: signs of improvement? Dev Med
References Child Neurol 49: 86-92.

1. Chin EM, Johnson TL, Hoon Jr AH (2021) Cerebral palsy: Epidemiology, 8. Khalawan T, Botha AS, Steel SJ (2020) Estimation of life tables for in-
neurobiology, and lifespan management. In LM Glidden, L Abbeduto, LL dividuals with cerebral palsy in South Africa. Actuarial Society of South
McIntyre & MJ Tassé (Eds.), APA handbook of intellectual and develop- Africa.
mental disabilities: Foundations (pp. 261–294). American Psychological
Association. 9. Plioplys A V (2012) Life expectancy determinations: Cerebral palsy, trau-
2. Crichton JU, Mackinnon M, White CP (1995) The life-expectancy of per- matic brain injury, and spinal cord injury analysis and comparison. Journal
sons with cerebral palsy. Dev Med Child Neurol 37: 567-576. of Life Care Planning 11: 25-38.

J Brain Neuros Res ISSN: HBNR, Open Access Journal Volume 9 • Issue 1 • 100032
DOI: 10.24966/BNR-HSOA/100032
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