Accessibility to Oral Health Care Services and Oral Health-Related Quality of Life among Children with Cerebral Palsy

ObjectivesTo investigate the correlation between the four dimensions of Oral Health-Related Quality of Life (OHRQoL) and Health-Related Quality of Life (HRQoL) constructs in a dental patient population.MethodsA cross-sectional study carried out at HealthPartners, Minnesota, USA. This study is a secondary data analysis of available adult dental patients’ data. The instruments used to assess the OHRQoL and HRQoL constructs were the Oral Health Impact Profile–version with 49 items (OHIP-49) and Patient-Reported Outcome Measures Information System (PROMIS) measures v.1.1 Global Health instruments Patient Reported Outcome Measures (PROMs), respectively. We used Structural Equation Modeling to determine the correlation between OHRQoL and HRQoL.ResultsTwo thousand and seventy-six dental patients participated in the study. OHRQoL and HRQoL scores correlated with 0.56 (95%CI:0.52–0.60). The OHRQoL and Physical Health dimension of HRQoL correlated with 0.55 (95%CI:0.51–0.59). The OHRQoL and Mental Health dimension of HRQoL correlated with 0.51 (95%CI:0.47–0.55). When adjusted for age, gender, and depression, the correlation coefficients changed only slightly and resulted in 0.52 between OHRQoL and HRQoL Physical Health, and 0.47 between OHRQoL and HRQoL Mental Health. Model fit statistics for all analyses were adequate and indicated a good fit.ConclusionsOHRQoL and HRQoL overlap greatly. For dental practitioners, the OHRQoL score is informative for their patients’ general health status and vice versa. Study results indicate that effective therapeutic interventions by dentists improve patients’ OHRQoL as well as HRQoL.

To examine interrater agreement and validity of the Functional Communication Classification System (FCCS) for young children with cerebral palsy (CP) aged 2 or 3 years. Speech-language pathologist (SLP) and parent FCCS ratings for 31 children with CP (aged 2y, n=16; aged 3y, n=15; 18 males, 13 females) were examined for interrater agreement using a weighted Cohen's kappa statistic. Relationships between FCCS (SLP) ratings and: (1) concurrent validity with the Language Use Inventory, a standardized pragmatic assessment for children aged 18 to 47 months, (2) gross motor and fine motor function, (3) associated impairments (visual and intellectual), and (4) primary expressive communication mode were examined using Spearman's correlation coefficients. Almost perfect interrater agreement between SLP and parent FCCS ratings were found (kw =0.94). Correlations with FCCS (SLP) were excellent for pragmatic function (rs =-0.83,p<0.001), intellectual function (rs =0.89, p<0.001), and primary expressive communication mode (rs =0.92,p<0.001). Correlations were good for gross motor function (rs =0.72,p<0.001) and visual impairment (rs =0.70,p<0.001) and fair for fine motor function (rs =0.53,p<0.002). Analysis was unwarranted for epilepsy (n=1 out of 31) and hearing-associated impairments (n=0 out of 31). The FCCS has excellent interrater agreement and validity for communication classification of children with CP aged 2 or 3 years and is highly suitable for surveillance and research purposes. What this paper adds The Functional Communication Classification System (FCCS) is a valid instrument for children with cerebral palsy (CP) aged 2 or 3 years. Excellent agreement exists between speech-language pathologist and parent FCCS ratings. The FCCS has excellent correlation with intelligence, pragmatic function, and primary expressive mode. Stronger correlations with the Gross Motor Function Classification System and vision exist for children aged 2 or 3 years. Weaker correlations with manual ability exist when compared to older children with CP.

Children and adolescents living with HIV (CALHIV) have a higher risk of hard and soft oral tissue diseases as compared with their healthy peers. It is important to increase awareness regarding the need to integrate oral health within medical care among pediatric HIV populations. Studies on associations of oral diseases with oral health-related quality of life (OHRQoL) in CALHIV are lacking. This study examined the association between oral diseases and OHRQoL in Kenyan CALHIV. This cross-sectional analysis was nested in a longitudinal cohort study of CALHIV in Nairobi. CALHIV received oral examinations, and the World Health Organization's Oral Health Surveys and Record Form was administered. OHRQoL was measured with the Parental-Caregiver Perceptions Questionnaire, with the subdomains of global, oral symptoms, function limitations, and emotional and social well-being, with higher scores indicating poorer OHRQoL. Linear regression was used to model associations between OHRQoL and oral diseases, adjusting for age at the time of oral examination, CD4 counts, and caregiver's education. Among 71 CALHIV, the mean age was 12.6 y (SD, 2.9; range, 10 to <21), and the mean composite OHRQoL score was 12.6 (SD, 11.2). Ulcers (not herpes simplex virus or aphthous) were associated with the worst overall OHRQoL (mean, 21.8; SD, 11.1; P = 0.055) and oral symptoms subdomain (mean, 7.0, SD, 2.5; P = 0.003). Children with dry mouth and untreated caries had significantly higher mean global OHRQoL scores than those without disease (P < 0.0001). In the multivariate analysis, the OHRQoL composite score was 6.3 units (95% CI, -0.3 to 12.9) higher for those who had dry mouth and untreated dental caries; dry mouth accounted for the highest percentage of variability of OHRQoL (9.6%) and the global subdomain (31.9%). Ulcers accounted for the highest percentage of variability of the oral symptoms domain (15.4%). Oral ulcers, dry mouth, and untreated caries were associated with poorer OHRQoL in CALHIV. Integrating oral health into the primary care of CALHIV may improve their OHRQoL. This study aimed to determine the association of oral diseases with the oral health-related quality of life of children and adolescents living with HIV (CALHIV). The findings will form part of the evidence to incorporate oral health protocols into care programs for CALHIV. Oral health monitoring has the potential to increase the surveillance of HIV clinical status, monitor the effectiveness of antiretroviral therapy, and improve the oral health-related quality of life of CALHIV.

Objective: Cerebral palsy refers to a group of postural and movement disorders that limit movements and can be related to a non-progressive disorder in the developing brain. The international classification of disability emphasizes the child's functional abilities and routine performance. Some classification tools have been developed to describe and evaluate child's functions in daily activities such as walking, manipulating objects, and everyday communication. The present study aimed to investigate the relationship between classification systems (gross motor function, manual ability, communication function, and eating and drinking ability) in children with cerebral palsy. Materials &amp; Methods: This study was performed by cross-sectional correlation method and of descriptive analytical type. Children with cerebral palsy aged 12-144 months were recruited by convenience sampling from patients referred to clinics and public and private rehabilitation centers in Tehran and Arak cities, Iran, in 2019-2020. After completing the demographic information questionnaire by the child's primary caregiver, the gross motor function classification system (GMFCS), manual ability classification system (MACS), Communication function classification system (CFCS), and eating and drinking ability classification system (EDACS) were completed by a child therapist. Results: In the present study, 154 children with a Mean±SD age of 49.45±32.22 months participated. also, 87 children (56.5%) were boys, and 67(43.5%) were girls. According to GMFCS, the highest percentage distributions at levels II and IV were 31.2% and 26%, respectively. In other words, more than 57% of children were distributed in these two levels. According to MACS, the distributions of the highest percentages at levels II, III, and IV were 28.6%, 22.1%, and 20.8%, respectively. In other words, more than 70% of the children were distributed in these three levels. According to EDACS, the distribution of almost all levels was equal except the V level, with 4.3% having the lowest percentage. According to CFCS, the distribution of the highest percentage at levels V and IV was 23.5%. In examining the relationship between functional systems, significant relationships were observed in all cases: MACS and GMFCS, r=0.672; CFCS and GMFCS, r=0.581; EADCS and GMFCS, r=0.593; CFCS and MACS, r=0.555; EADCS and MACS, r=664; EADCS and CFCS, r=0. 547 (P&lt;0.01). Conclusion: It seems that children with more motor function limitations show more limitations in other performance classification systems, too. Of course, the number of studies in this field is limited and needs further investigation.

To assess and compare the oral health status and parental perception of child oral health-related quality of life (OHRQoL) among children with and without cerebral palsy (CP). A cross-sectional comparative study was conducted among 300 children aged 5-15 years with and without CP in Bangalore city. Oral health status was assessed using WHO 2013 criteria, and malocclusion was assessed using Angle's classification of malocclusion. Parental perception of child OHRQoL was assessed using parental caregivers perceptions questionnaire. Chi-square test, Student's t-tests and logistic regression were applied. Majority of the study participants were males with a mean age of 10 years. Caries experience, gingivitis, dental trauma, and dental erosion were significantly higher among children with CP than the comparison group. Mean parental perception of child OHRQoL score among CP was significantly higher than that of comparison group (P<.001). Odds of having caries experience, gingivitis, dental trauma, and Angle's Class II/III malocclusion were significantly higher among CP children with poor OHRQoL compared to those without these conditions. Oral health status among children with CP was poor than the children without CP. Parents perceived poor OHRQoL among children with CP when compared to those without CP. Hence CP has an impact on oral health necessitating preventive care.

To systematically review and meta-analyse the measurement properties of the Gross Motor Function Classification System (GMFCS), Gross Motor Function Classification System-Expanded & Revised (GMFCS-E&R), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) in children with cerebral palsy (CP). Six databases were searched. Articles on the measurement properties of the GMFCS, GMFCS-E&R, MACS, and CFCS administered to children with CP were included. Quality was assessed by means of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The level and grading of evidence were defined for each measurement property. Forty-four articles were included in the systematic review and 37 articles were included in the meta-analysis. The level (grading) of evidence was strong (positive) for reliability and construct validity. Content validity displayed an unknown level of evidence for the GMFCS, limited evidence (positive) for the MACS, and moderate evidence (positive) for the CFCS. There was moderate (positive) evidence for measurement error in the GMFCS and MACS. The level of evidence for responsiveness was unknown. No studies investigated cross-cultural validity. These instruments can be used by health care professionals and caregivers to quantify the constructs needed to measure ability in children with CP. Current high-quality evidence supports the use of these tools to classify ability in children with CP. Adopting the COSMIN guidelines, content, and cross-cultural validity should be investigated further. What this paper adds Strong evidence supports the reliability and construct validity of the GMFCS, GMFCS-E&R, MACS, and CFCS as functional classification systems in children with cerebral palsy. The GMFCS, GMFCS-E&R, MACS, and CFCS can be used by both health care professionals and caregivers. The GMFCS, GMFCS-E&R, MACS, and CFCS should not be used to detect change.

Functional classifications for cerebral palsy: correlations between the gross motor function classification system (GMFCS), the manual ability classification system (MACS) and the communication function classification system (CFCS).

Communication ability in cerebral palsy: A study from the CP register of western Sweden

BackgroundIrregular use of oral healthcare is associated with oral disease burden, leading to poorer oral health-related quality of life (OHRQoL). There is evidence suggesting an association between dental care visits or access and OHRQoL. However, no studies have assessed the relationship of use of oral healthcare services on OHRQoL in countries where universal health coverage, including oral health, has been prioritized. Therefore, this study aimed to evaluate whether choosing either public or private oral healthcare service mediates the association between oral health treatment need and OHRQoL. Another aim was to compare the difference in treatment need between two cohorts born 20 years apart.MethodsThis study utilized the data of two birth cohorts from the two northernmost provinces of Finland, the Northern Finland Birth Cohort 1966 (NFBC1966) and the Northern Finland Birth Cohort 1986 (NFBC1986). A clinical oral examination was conducted when NFBC1966 were 45–46-year-olds (n = 1964), and NFBC1986 were 33–35-year-olds (n = 1807). Participants in both cohorts were asked to complete an oral health-related questionnaire before their clinical examination. A Structural Equation Model was employed to examine the impact of choosing either public or private oral healthcare services.ResultsAlmost half of the study participants in the older cohort and almost two-thirds of the participants in the younger cohort used private oral healthcare services. The younger cohort had a greater need for restorative treatment than the older cohort. In contrast, the need for extensive periodontal treatment was higher in the older cohort than in the younger cohort. Oral health treatment needs had a direct association with OHRQoL (β = 0.432, p < 0.001). Additionally, choosing public oral healthcare services also had a direct association with OHRQoL (β = 0.057, p = 0.014). There was no indirect association between choice of oral healthcare service and oral health treatment need and OHRQoL (β = 0.008, 95% CI: -0.022 to 0.029).ConclusionThe association between oral health treatment needs and OHRQoL persisted, independent of the relationship with Oral Healthcare Service choice. Additionally, younger cohorts exhibited a greater need for restorative treatment compared to older cohorts.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-025-07079-8.

Background: Some classification systems have been designed to measure domains of function of children with cerebral palsy (CP), including the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Eating and Drinking Ability Classification System (EDACS), and Communication Function Classification System (CFCS). The purpose of the present study was to develop a Social Participation Classification System for children with cerebral palsy (SPCS) with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) and assess its reliability. Methods: In this cross-sectional analytic study, 274 parents of 6 to 12 year-old children with CP were asked to complete the questionnaires (CPAS-P, MACS, GMFCS, and CFCS) for their child. The expert review consisting of 10 occupational therapists with at least 5 years of experience working with children with CP was asked to rate the level of social participation with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) of these children according to the variables (intelligent quotient [IQ], CP type, walking ability, GMFCS, CFCS, and MACS). Then, these data were analyzed using the polynomial discriminant function. After performing discriminant function, a flowchart model was determined for the level of children's social participation. To calculate the reliability of the model, 53 new samples were collected and their level of social participation was determined based on the flowchart model. The experts were then asked to determine the social participation level of these 53 new samples in the same manner as before, and then to calculate reliability, intraclass correlation coefficient (ICC) and Cronbach alpha. The SPSS Version 22 (SPSS Inc) and discriminant function model analysis was used for statistical analysis. Results: Based on the discriminant function model, the results between the predicted classification and expert review are over 88% consistent. The ICC and Cronbach alpha values were 0.952 and 0.975, respectively, with absolute agreement and multivariate mixed effects. Conclusion: Based on the results of the present study, the SPCS was developed in 5 levels (very low, low, moderate, high, and very high) and to determine it, the GMFCS, MACS, and CFCS scores, CP type, and IQ level should be calculated.

To investigate the relationships among the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) in children with cerebral palsy (CP). Using questionnaires describing each scale, mothers reported GMFCS, MACS, and CFCS levels in 222 children with CP aged from 2 to 17 years (94 females, 128 males; mean age 8 y, SD 4). Children were referred from pediatric developmental/behavioral, physiatry, and child neurology clinics, in the USA, for a case-control study of the etiology of CP. Pairwise relationships among the three systems were assessed using Spearman's correlation coefficients (r(s) ), stratifying by age and CP topographical classifications. Correlations among the three functional assessments were strong or moderate. GMFCS levels were highly correlated with MACS levels (r(s) = 0.69) and somewhat less so with CFCS levels (r(s) = 0.47). MACS and CFCS were also moderately correlated (r(s) = 0.54). However, many combinations of functionality were found. Of the 125 possible combinations of the three five-point systems, 62 were found in these data. Use of all three classification systems provides a more comprehensive picture of the child's function in daily life than use of any one alone. This resulting functional profile can inform both clinical and research purposes.

To determine the stability of the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) over 1-year and 2-year intervals using a process for consensus classification between parents and therapists. Participants were 664 children with cerebral palsy (CP), 18months to 12years of age, one of their parents, and 90 therapists. Consensus between parents and therapists on level of function was ≥92% for the GMFCS, MACS, and CFCS. A linearly weighted kappa coefficient of ≥0.75 was the criterion for stability. Kappa coefficients varied from 0.76 to 0.88 for the GMFCS, 0.59 to 0.73 for the MACS, and 0.57 to 0.77 for the CFCS. For children younger than 4 years of age, level of function did not change for 58.2% on the GMFCS, 30.3% on the MACS, and 39.3% on the CFCS. For children 4 years of age or older, level of function did not change for 72.3% on the GMFCS, 49.1% on the MACS, and 55% on the CFCS. The findings support repeated classification of children over time. The kappa coefficients for the GMFCS are attributed to descriptions of levels for each age band. Consensus classification facilitates discussion between parents and professionals that has implications for shared decision-making. The findings support repeated classification of children over time. Stability was higher for the Gross Motor Function Classification System than the Manual Ability Classification System and Communication Function Classification System. The function of younger children was more likely to be reclassified. Percentage agreement between parents and therapists using consensus classification varied from 92% to 97%. The intraclass correlation coefficient overestimated stability compared with the weighted kappa coefficient.

Cognitive functioning in dyskinetic cerebral palsy: Its relation to motor function, communication and epilepsy.

To examine the relationship among the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) in children with cerebral palsy (CP) and to determine the average number and effect of health conditions. Participants were 671 children with CP aged 2 to 12 years from Canada and the United States. Cross-tabulation of functional classifications and averages were computed for the number and impact of health conditions and comparisons among groups. A total of 78 of the 125 possible classification combinations were recorded. Most frequent were GMFCS I, MACS I, CFCS I; GMFCS I, MACS II, CFCS I; and GMFCS II, MACS II, CFCS I. With lower levels of function, the average number and average impact of associated health conditions increased. The use of functional profiles across classification systems, with data on the associated health conditions, provides a more comprehensive picture of CP than any single classification or measure.

BackgroundChildren with cerebral palsy (CP) frequently experience chronic pain. The burden and severity of such pain is often underestimated in relation to their other impairments. Recognition and awareness of this chronic pain among children with CP constitute the cornerstone for caretakers and clinicians to improve the quality of life of those children. This study aimed to determine the prevalence of chronic pain among children with CP, and the factors associated.MethodsA cross-sectional study of children with CP, aged 2–12 years, attending the CP rehabilitation clinic and Pediatric Neurology Clinic at Mulago Hospital, Uganda from November 2017 to May 2018. A detailed history and clinical examination were performed and the co-morbidities were determined. CP was classified using the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, Communication Function Classification System (CFCS), and the Eating and Drinking Ability Classification System (EDACS) and documented with the level of impairment in the different domains. Pain was assessed by using the revised Face, Legs, Activity, Consolability, Cry pain scale.ResultsA total of 224 children with CP were enrolled. The prevalence of chronic pain was 64.3%. The majority had spastic bilateral CP (77.8%), moderate pain lasting over 6 months, and none of them was on long-term pain management. Epilepsy (60.9%), behavioral problem (63.2%), hearing impairment (66,7%), learning problem (67,6%), dental caries (75%), gastro-esophageal reflux (75%), sleep disorders (79.5%), vision impairment (80%), and malnutrition (90%) were co- morbid conditions of chronic pain in children with CP in this study. The factors independently associated with chronic pain among children with CP were the GMFCS level IV & V, CFCS level IV & V, EDACS level IV & V, female children, and caretaker aged more than 30 years.ConclusionsTwo-thirds of children with CP attending rehabilitation in this hospital had chronic pain. None was receiving pain management. Chronic pain was associated with the presence of multiple co-morbidities and more severe disability. Rehabilitation and care programs for children with CP should include assessment of pain in routine care and provide interventions for pain relief in children with CP even at an early age.