Using the Gross Motor Function Classification System to describe patterns of motor severity in cerebral palsy.
ABSTRACT The aim of this study was to describe the distribution of motor severity levels and temporal trends in an Australian population cohort and to review the distribution of Gross Motor Function Classification System (GMFCS) levels across cerebral palsy (CP) registries worldwide.
Data were extracted from the Victorian Cerebral Palsy Register for 3312 individuals (1852 males, 1460 females; mean age 21y 2mo [SD 9 y 6 mo]) with non-postneonatally acquired CP, born between 1970 and 2003. The proportions of each motor severity level were calculated and logistic regression analyses were used to assess trends over time. A systematic review of the literature was undertaken and GMFCS data were extracted based on previously devised criteria. The proportions were plotted and the degree of heterogeneity was assessed for each level.
Population data from Victoria suggested a proportional increase in mild motor impairment (GMFCS levels I/II) from 54% of all cases of CP in the 1970s to 61% in the 2000s. For nine CP registries worldwide, the mean proportions of each GMFCS level, from level I to V, were 34.2%, 25.6%, 11.5%, 13.7%, and 15.6% respectively. There was substantial heterogeneity between registries for all levels except level III.
Despite the usefulness and reported reliability of the GMFCS, substantial variability was found in the distribution of GMFCS levels between population registries, particularly between levels I and II, suggesting greater classification uncertainty between these levels. Further research would be useful to determine whether routine collection of extra clinical information may facilitate more reliable classification.
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ABSTRACT: Background/Aims Altered body composition is evident in school children with cerebral palsy (CP). Fat free mass and fat mass amounts differ according to functional ability and compared to typically developing children (TDC). The extent to which body composition is altered in preschool-aged children with CP is unknown. We aimed to determine the fat free mass index (FFMI) and body fat percentage (BF%) of preschool-aged children with CP and investigate differences according to functional ability and compared to TDC. Methods Eighty-five children with CP (68% male) of all functional abilities, motor types and distributions and 16 TDC (63% male) aged 1.4 to 5.1 years participated in this cross-sectional study. Body composition was determined via isotope dilution. Children with CP were classified into groups based on their gross motor function classification system (GMFCS) level. Statistical analyses were via ANOVA, ANCOVA, post-hoc Tukey HSD tests, independent t-tests and multiple regressions. Results There were no significant differences in FFMI or BF% when comparing all children with CP to TDC. Children classified as GMFCS levels III, IV and V had significantly lower FFMI levels compared to children classified as GMFCS I and II (p<0.05). Children of GMFCS IV and V had the highest mean (±SD) BF% of all children (24.6% (±10.7%)), significantly higher than children of GMFCS I and II (18.6% (±6.8%), p<0.05). Conclusions Altered body composition is evident in preschool-aged children with CP, with a trend towards lower FFMI levels and greater BF% across functional ability levels from GMFCS I to V. Further research is required to determine optimal body composition parameters and investigate contributing factors. Clinical trial registry Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12611000616976Clinical nutrition (Edinburgh, Scotland) 01/2014; · 3.27 Impact Factor
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ABSTRACT: Magnetic resonance imaging (MRI) is recommended in all children with cerebral palsy (CP) where the aetiology has not been established, and the major presenting problem in CP is reduced motor capacity. A systematic review of the literature was performed to investigate the relationship between brain structure on MRI and motor outcomes in children with CP. A total of 37 studies met inclusion criteria, and were analysed in terms of (a) population characteristics, (b) MRI data, (c) motor outcome data, and (d) the relationship between MRI data and motor outcomes. All studies used a qualitative system to classify brain lesions; however, few reported information about the location and extent of lesions. Valid and reliable classifications of motor abilities were not always used, and three studies did not link motor findings to MRI features. There was, however, a relationship between the type of brain lesion on MRI and two specific motor outcomes, namely gross motor functional classification (using GMFCS) and motor type. This relationship could aid in the prediction and optimisation of early interventions for children with CP. There is also need for a quantitative MRI classification measure which includes detailed information about the location and severity of lesions.Research in developmental disabilities 04/2013; 34(7):2234-2250. · 4.41 Impact Factor
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ABSTRACT: Abstract Purpose: To determine the reliability and validity of the Chinese version of Expanded and Revised Gross Motor Function Classification System (GMFCS-ER) for cerebral palsy (CP) and to explore if there existed differences between parents and the other raters. Method: The GMFCS-ER was translated into Chinese. Children with CP age 6 to 18 years from two special education schools were assessed by 6 physiatrists, 21 physiotherapists, 15 teachers and parents. Inter-rater reliability was analyzed with inter-rater correlation coefficients (ICC). Validity was assessed using Gross Motor Function Measure (GMFM) score as the criterion standard. Results: Mean (SD) age of the 130 children (93 boys, 37 girls) was 11.5 (2.8) years. Overall ICCs ranged between 0.84 and 0.92. Reliabilities between physiatrists, physiotherapists and teachers (ICCs from 0.86 to 0.92) were higher than those between parents and the other raters (ICCs from 0.80 to 0.84) in 6-to-12 year age band. The overall correlation for criterion-related validity was -0.83. Conclusion: The Chinese version of the GMFCS-ER is a valid measure of functional ability in school children with CP and reliable enough for use by Chinese healthcare providers and parents. Effects of environmental and personal factors should be considered when practicing GMFCS-ER assessment. Implications for Rehabilitation Cerebral palsy. Research about GMFCS-ER is needed to promote a more extensive use of GMFCS-ER in China for school children with CP. The Chinese version of the GMFCS-ER is a valid measure of functional ability in school children with CP and reliable enough for use by Chinese healthcare providers. Effects of environmental and personal factors should be considered when performing the GMFCS-ER assessment.Disability and Rehabilitation 05/2013; · 1.54 Impact Factor