Abstract
BackgroundThe Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP). The Manual Ability Classification System (MACS) was developed recently as a corresponding classification of manual ability. The aim of this study was to describe the association between gross motor function and manual ability in a total population of children with cerebral palsy.Methods365 children, born 1992 to 2001, who were registered in a population-based health care programme (CPUP) for children with CP living in the south of Sweden were included in the study. GMFCS was evaluated by the child's physiotherapist and MACS by the occupational therapist. CP diagnosis and subtype were determined by the neuropaediatrician at or after the age of four.ResultsGMFCS levels were available in all 365 children, MACS levels in 359 (98%). There was a poor overall correlation between gross motor function and manual ability. However, different associations between gross motor function and manual ability were found in the different diagnostic subtypes. Children with spastic hemiplegia generally had a lower level of manual ability than gross motor function (p < 0.001). The reverse association was generally found in children with spastic diplegia (p < 0.001). Children with dyskinetic CP had large limitations in both gross motor function and manual ability, with no significant discrepancy between GMFCS and MACS levels.ConclusionGross motor function and manual ability are often discrepant in children with CP, and the patterns seem to vary across the different subgroups based on the predominant neurological findings. To give a complete clinical picture when evaluating these children, both aspects have to be described. The GMFCS and the MACS seem to work well in this context and seem very useful in population-based studies, in health care registers for children with CP, and in clinical practice.
Highlights
The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP)
The Swedish classification (SC) of clinical CP subtypes [5] has been accepted and used internationally, but recently the Surveillance of Cerebral Palsy in Europe (SCPE) group proposed a new classification of CP subtypes [6,7]
Of the 283 children with the spastic type, 121 had a unilateral and 162 a bilateral type according to the SCPE system
Summary
The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP). The aim of this study was to describe the association between gross motor function and manual ability in a total population of children with cerebral palsy. Cerebral Palsy (CP) is the commonest cause of physical disability in early childhood. It has been defined as a group of motor impairment syndromes secondary to a defect or lesion of the immature brain [1], and children with CP display a variety of functional limitations of varying severity [2,3]. The Swedish classification (SC) of clinical CP subtypes [5] has been accepted and used internationally, but recently the Surveillance of Cerebral Palsy in Europe (SCPE) group proposed a new classification of CP subtypes [6,7]. The SC subtypes spastic tetraplegia and diplegia are not separated, instead children are described according to functional level in lower and upper extremities, cognitive development, visual function, hearing, epilepsy etc
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