Article

Using the Gross Motor Function Classification System to describe patterns of motor severity in cerebral palsy.

Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Developmental Medicine & Child Neurology (Impact Factor: 2.68). 11/2011; 53(11):1007-12. DOI: 10.1111/j.1469-8749.2011.04044.x
Source: PubMed

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.

0 Bookmarks
 · 
169 Views
  • [Show abstract] [Hide abstract]
    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: ACTRN12611000616976
    Clinical nutrition (Edinburgh, Scotland) 02/2014; · 3.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background The information on fine motor and basic cognitive functions in spastic diplegia is sparse in literature. The aim of this study was to investigate index finger tapping speed and cognitive functions in categorization and old/new recognition of pictures in patients with mild spastic diplegia (MSD). Methods Fifteen preterm-born male teenagers with MSD and 15 healthy male teenagers participated in this study. Finger tapping tests and cognitive tests were performed on all participants. Between the two groups outcomes were compared. Results In the finger tapping tests, the tapping speed was significantly slower in patients than in controls. In the tests of tapping one key persistently and tapping two keys alternately, the reaction time (RT) gaps between the left and right digit were larger in patients than in controls. In the categorization tests, the accuracies and RTs for animal/plant and girl face pictures, but not for boy face pictures, were significantly worse in patients than in controls. In the recognition tests, the accuracies for old/new animal/plant and boy/girl face pictures were significantly lower in patients than in controls. The RTs for old/new animal/plant and new face pictures, but not for old face pictures, were significantly longer in patients compared to controls. Conclusions The results demonstrate delayed finger tapping and cognitive responses in preterm-born male teenagers with MSD. Our experimental paradigm is sensitive for the study of fine motor and cognitive functions between patients and healthy controls.
    Pediatric Neurology 04/2014; · 1.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Total hip arthroplasty (THA) is one of the treatment options in patients with cerebral palsy (CP) with painful osteoarthritis of the hip. However, the risk of dislocation of the prosthesis is higher in patients with CP when compared with physically normal patients. In this retrospective study of ten consecutive cases, we hypothesized that the use of a dual-mobility cup could reduce this risk of dislocation combined with good functional results.From January 2008 until October 2010, eight patients (ten hips) with CP who consecutively received a THA using a dual-mobility cup were identified. At the time of surgery, the average age of the patient group was 54 years (range 43–61). Latest follow-up took place after on average 39 months (range 22–56 months). All patients or their caregivers were interviewed by telephone. They were asked if dislocation of the prosthesis had occurred. To evaluate quality of life and health in general, patients completed the SF-36 questionnaire.None of the prostheses had dislocated at the latest follow-up. Reoperation was needed in one patient after a periprosthetic fracture. Radiologic evaluation showed a mean cup inclination of 46 (range 27–58). On average, the quality of life of patients in this study was found to be limited in particular on the domains of physical health and functioning, while a fair to good score was measured at the six other different domains.The use of a dual-mobility cup in THA in patients with CP can lead to favourable results with respect to dislocation and clinical outcome.
    Archives of Orthopaedic and Trauma Surgery 01/2013; 133(7). · 1.31 Impact Factor

Preview

Download
0 Downloads