Motor Function Classification System Expanded Research Articles

The Correlation of Gross Motor Skills and the Quality of Life in Children with Cerebral Palsy

The quality of life in children with cerebral palsy is very important to be studied along with the factors that influence it to improve the quality of health services. The Problem of quality of life in children with cerebral palsy is not only influenced by socio-economic aspect, but also health aspect, such as physical health, pain and motor limitation which is experienced by children. This study aims to determine the relationship between gross motor skills and the quality of life of children with cerebral palsy in Makassar. This study used a cross-sectional design with thirty people as the sample (n = 30). They are students who got cerebral palsy at SLB YPAC Makassar, SLB Negeri 1 Pembina at South Sulawesi Province, SLB Laniang and SLB Reskiani Makassar. There are several primary data collected including gross motor skills and quality of life. The data were collected using the PedsQLTM 3.0 questionnaire for the cerebral palsy module and the GMFCS-E & R (Gross Motor Function Classification System Expanded and Resived) measurement guide. Based on the results of the analysis of the relationship test with the fisher exact test, it was found a significance value (p) of 0,037 (p <0.05) with a relative risk value for poor and very bad quality of life, namely 0.714, which means that there is a relationship between gross motor skills and quality of life, with children cerebral palsy who have mild and moderate gross motor skills have a chance to have very poor and poor quality of life 0.714 times less than cerebral palsu children who have severe gross motor skills (N = 30).

Spectrum of Movement Disorders and Correlation with Functional Status in Children with Cerebral Palsy.

To detail the spectrum of movement disorders (MD) among children with cerebral palsy (CP) and assess impact on functional status. In this cross-sectional study, children with CP were recruited and examined for various MDs. Tone abnormality was assessed using Hypertonia Assessment Tool (HAT), functional status using Gross Motor Function Classification System Expanded and Revised (GMFCS E&R), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). These scores were classified into mild-moderate (level I-III)/severe (level IV-V) categories. A total of 113 children (mean age 4.9 ± 3.4 y, 66.4% boys) were enrolled. MDs were noted in 52(46%) children; the most frequent were dystonia (28%), chorea (14%), choreoathetosis (8%). Of 64 children with quadriparetic CP, 27 (42.2%) demonstrated MDs. Of 19 children with hemiparetic CP, 2 (10.5%) had MDs. Of 16 children with dyskinetic CP, 15 (93%) had MDs. Children with dyskinetic CP had significantly higher frequency of MDs (p = 0.001). There was no difference in occurrence of all MDsor dystonia aloneamongst the two categories (mild-moderate/severe) of GMFCS E&R levels, CFCS levels or MACS levels. Although diverse MDs occur frequently in CP, these do not correlate with the broad functional status of the child. The study is limited by small sample size.

Six Months Guided Exercise Therapy Improves Motor Abilities and White Matter Connectivity in Children with Cerebral Palsy.

BackgroundDiffusion magnetic resonance imaging (dMRI) provides the state of putative connectivity from lesioned areas to other brain areas and is potentially beneficial to monitor intervention outcomes. This study assessed the effect of a 6 months guided exercise therapy on motor abilities and white matter diffusivity in the brains of cerebral palsy (CP) children.MethodsThis is a single arm pre-and post-test research design involving 10 spastic CP children, aged 8–18 years and whose Gross Motor Function Classification System Expanded and Revised (GMFCS-E & R) at least Level 21 with the ability to ambulate independently. They were recruited from Paediatric Neurology Clinic, Hospital Universiti Sains Malaysia (HUSM) from December 2015–December 2016. All participants underwent 6 months of therapist-guided exercise session comprising progressive strength training at a frequency of twice a week, 1 h duration per session. The effect of exercise on motor abilities was assessed using the Gross Motor Function Measures (GMFM)-88. Six out of the 10 children consented for dMRI. Probabilistic tractography of the corticospinal tract (CST) was performed to determine the connectivity index of the tracts pre-and post-intervention.ResultsAll the participants displayed statistically significant increment in GMFM-88 scores pre-to post-exercise intervention. This improvement was concurrent with increased connectivity index in the CST of upper limbs and lower limbs in the brain of these children.ConclusionOur findings demonstrated that 6 months guided exercise therapy improves motor abilities of CP children concurrent with strengthening the connectivities of the motor pathways in the brain.

Cerebral Palsy Types Based on Kind of Disability Correlated with The Functional Independence

Cerebral palsy is a collection of motor disorders caused by brain damage that occur before, during or after birth which can be caused by many factors such as, congenital, genetic, inflation, infection and poisoning during pregnancy, trauma and metabolic disorders. Children with cerebral palsy will mostly have problems with posture. Therefore, to find out the level of independence in children with cerebral palsy, it is necessary to have an examination carried out by health workers, especially physiotherapy. The purpose of this study was to determine the prevalence of the most common type of CP that occurred in CP events which were correlated with the level of activities functional independence of the child's movements. This research was an observational descriptive study with a measuring instrument for the Gross Motor Function Classification System Expanded and Resived. Based on the analysis of the data obtained in the independent category of 33 children (6,3%) with quadriplegia spastic CP type, 34 children (6,5%) with diplegia spastic CP type, 15 children (2,9%) with spastic hemiplegia CP type , 19 children (3,6%) with atetoid CP type, and 28 children (5,4%) with hyponia CP type. On the other hands, in the dependent category there were 149 children (28,5%) with quadriplegia spastic CP type, 156 children (29,8%) with diplegia spastic CP type, 18 children (3,4%) with spastic hemiplegia CP type, 27 children (5,2%) with atetoid CP type, and 44 children (8,4%) with hyponia CP type. Conclusion the type of CP that has the highest prevalence was spastic group CP with a low or dependent level of independence, and correlates perfectly (+1) between the types of cerebral palsy with the level of functional independence of children based on pearson product moment.

Trunk Control in Children With Ataxic Cerebral Palsy.

This study aimed to investigate the clinical characteristics of trunk control in children with ataxic cerebral palsy (CP). We included 15 children with ataxic CP with a mean age of 9.46 years (SD = 1.08 years, 5-17 years) and 15 healthy children with a mean age of 9.06 years (SD = 0.84 years, 5-13 years). While the small sample size and large age range used here were not ideal for generalizability, they were made necessary by the rarity of this clinical sample. We used the Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R) to classify the children's functional levels, and we tested trunk control with the Trunk Control Measurement Scale (TCMS). We then used the Gross Motor Function Measurement-88 (GMFM-88) to assess their gross motor functions. We compared the total and subscale scores of the TCMS in healthy children and children with ataxic CP by using the Mann-Whitney U Test. We also analyzed differences between TCMS scores according to the children's GMFCS levels with the Mann-Whitney U Test and also compared TCMS scores with the GMFM-88 by means of Spearman correlation analysis. Spearman correlation analysis was used to compare the scores of the TCMS with the GMFM-88. Our results showed that healthy children showed significantly higher scores than children with ataxic CP in total and subscale scores of TCMS (p < .05).There was no significant difference between the TCMS scores in children of different GMFCS levels, but the GMFM-88B subscale was significantly correlated with the static sitting balance (rho = .568, p < .05) and dynamic sitting balance (rho = .547, p < .05) TCMS subscales and with the TCMS total score (rho = .590, p < .05). We concluded that trunk control, especially its dynamic aspects, was impaired in children with ataxic CP.

Mobility and joint range of motion in adults with cerebral palsy: A population-based study

Objective. The aim of this study was to describe the methods of mobility used in the community in relation to subtypes of cerebral palsy (CP), level of gross motor function and passive joint range of motion (PROM) in the lower limbs in young adults. Methods. From a total population of people with CP, 102 young adults (63 males) aged 18–23 years (median 20 years) participated. All subtypes were represented and the Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R) levels were I n = 38, II n = 21, III n = 13, IV n = 10 and V n = 20. The Functional Mobility Scale 500 metres (FMS500m) level was analysed in relation to PROM using chi-squared tests. Relative risk was used to investigate the relationship between PROM and mobility. Results. All participants either walked without aids or used a wheelchair to move or transport themselves 500 m. Significant associations were found between FMS500m and PROM in the knee and ankle joints. Limited PROM in popliteal angle and knee extension was associated with use of a wheelchair, while limited foot dorsiflexion was associated with walking without support in the community. Conclusion. Method of mobility was associated with PROM of the knee and ankle joints for all GMFCS-E&R levels and subtypes of CP. To be able to continue to walk in adulthood, successful prevention of severe knee contractures, and avoiding excessive lengthening of the calf muscles and tendons, seem important for children with CP who are able to walk.

Muscle Activation and Energy-Requirements for Varying Postures in Children and Adolescents with Cerebral Palsy

To determine energy expenditure and muscle activity among children and adolescents with cerebral palsy (CP), across several conditions that approximate sedentary behavior, and standing. Subjects with spastic CP (n = 19; 4-20 years of age; Gross Motor Function Classification System Expanded and Revised [GMFCS-E&R] levels I-V) participated in this cohort study. Energy-expenditure and muscle activity were measured during lying supine, sitting with support, sitting without support, and standing. Energy-expenditure was measured using indirect calorimetry and expressed in metabolic equivalents (METs). Muscle activation was recorded using surface electromyography. The recorded values were calculated for every child and then averaged per posture. Mean energy expenditure was >1.5 METs during standing for all GMFCS-E&R levels. There was a nonsignificant trend for greater muscle activation for all postures with less support. Only for children classified at GMFCS-E&R level III did standing result in significantly greater muscle activation (P < .05) compared with rest. Across all GMFCS-E&R levels, children and adolescents with CP had elevated energy expenditure during standing that exceeded the sedentary threshold of 1.5 METs. Our findings suggest that changing a child's position to standing may contribute to the accumulation of light activity and reduction of long intervals of sedentary behavior.

A Review of Gross Motor Function in Children with Cerebral Palsy in Zaria, North-Western Nigeria

Background: Impaired motor function is the hallmark of cerebral palsy and could present with grave implications particularly in resource limited settings. Consequently the identification of motor function and mobility needs in children with cerebral palsy in such settings is vital to providing optimal care. Objective: To describe the gross motor function in children with cerebral palsy presenting to a child neurology service in Zaria, north-western Nigeria. Methods: A review of the gross motor function, using the Gross Motor Function Classification System Expanded and Revised (GMFCS- E&R), of children with cerebral palsy (Subjects) who were in steady state of health and who presented at Neurology Clinic of the Departments of Paediatrics and Physiotherapy, of the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria over a five year period was under taken. Other parameters assessed were: age, sex, identified predisposing factor for cerebral palsy, clinical type of cerebral palsy, mode of transport and social class of the subjects. Results: A total of 235 subjects with age range 5 months to 11 years (mean 2.6 ± 2.4 years) were studied. Of the subjects 148 were males and 87 females (M.F, 1.7:1). Most of the subjects were under 2 years of age (169, 71.91%), in the upper social classes (182, 77.45%), had the spastic clinical type of cerebral palsy (184, 78.30%) and birth asphyxia (106, 45.1%) as the commonest identifiable predisposing factor. Majority of the subjects (143, 60.9%) had severe limitation (GMFCS-E&R Levels IV&V) in gross motor function and this was significantly (pE‚0.05) associated with age less than 2 years and spastic type of cerebral palsy. Out of the 205 (87.2%) Subjects who needed a transport mobility device only 14(6.8%) of them utilized one. Conclusion: The study was characterized by severe limitation in gross motor function and limited utilization of mobility devices in the subjects. It underscores the need to address mobility issues in children with cerebral palsy in the environment.

Validity and Clinical Utility of Functional Assessments in Children With Cerebral Palsy

ObjectiveTo examine the validity and clinical utility of functional assessments (1-minute walk test, 10-meter walk test, Timed Up & Go [TUG] test, Timed Up and Down Stairs [TUDS] test, sit-to-stand [STS] test, and lateral step-up [LSU] test). DesignCross-sectional study. SettingFour special schools for adolescents with physical disabilities. ParticipantsAdolescents with spastic tetraplegia and diplegia (at levels I–III) were selected through convenience sampling (N=35; mean age, 14.97±2.03y). InterventionsNot applicable. Main Outcome MeasuresGMFM-88 (dimensions D and E), 1-minute walk, 10-meter walk, TUG, TUDS, STS, and LSU tests. Data were analyzed using Pearson intercorrelations, multiple regression analysis, and multivariate analysis of variance (MANOVA). ResultsSignificant moderate to high intercorrelations were found. Three significant positive predictors emerged (1-minute walk, 10-meter walk, and LSU) with the following regression equation: YGMFM-88 (dimensions D and E) = 5.708 + .402 × X1-minute walk + .920 × XLSU + .404 × X10-meter walk The MANOVA was significant (Λ=.163, F=14.732, P<.001, η2=.596), and post hoc comparisons revealed significant differences across Gross Motor Function Classification System Expanded and Revised levels in all paired comparisons for the 1-minute walk and LSU tests. For the 10-meter walk test, significant differences were evident in the level I versus level III and level II versus level III comparisons. No significant differences were found in the 10-meter walk test between levels I and II. ConclusionsThese functional assessments (1-minute walk, LSU, and 10-meter walk tests) are simple to administer, quick, low cost, and user-friendly. Although these assessments are not a substitute for the criterion standard (GMFM-88), they may be used for a quick assessment in adolescents with cerebral palsy (levels I–III) either at school or during rehabilitation, especially when time is limited.

Characteristics of Dysphagia in Children with Cerebral Palsy, Related to Gross Motor Function

The aim of this study was to report the characteristics of dysphagia in children with cerebral palsy (CP), related to gross motor function. Videofluoroscopic swallow study was performed in 29 children with CP, according to the manual of Logemann. Five questions about oromotor dysfunction were answered. Gross motor function level was classified by the Gross Motor Function Classification System Expanded and Revised. The results of the videofluoroscopic swallowing studies showed that reduced lip closure, inadequate bolus formation, residue in the oral cavity, delayed triggering of pharyngeal swallow, reduced larynx elevation, coating on the pharyngeal wall, delayed pharyngeal transit time, multiple swallow, and aspiration were significantly more common in the severe group (Gross Motor Function Classification System Expanded and Revised IV or V). As for aspiration, 50% of the children with severe CP had problems, but only 14.3% of them with moderate (Gross Motor Function Classification System Expanded and Revised III) CP and none of them with mild CP had abnormalities. In addition, five of the seven aspiration cases occurred silently. This study shows that dysphagia is closely related to gross motor function in children with CP. Silent aspiration was observed in the moderate to severe CP groups. Aspiration is an important cause of medical problems such as acute and chronic lung disease, and associated respiratory complications contribute significantly in increasing morbidity and mortality in these patient groups. Therefore, the authors suggest that early dysphagia evaluation including videofluoroscopic swallow study is necessary in managing feeding problems and may prevent chronic aspiration, malnutrition, and infections.

Gross Motor Function Classification System Expanded &amp;amp; Revised (GMFCS E &amp;amp; R): reliability between therapists and parents in Brazil

Several studies have demonstrated the importance of using the Gross Motor Function Classification System (GMFCS) to classify gross motor function in children with cerebral palsy, but the reliability of the expanded and revised version has not been examined in Brazil (GMFCS E & R). To determine the intra- and inter-rater reliability of the Portuguese-Brazil version of the GMFCS E & R applied by therapists and compare to classification provided by parents of children with cerebral palsy. Data were obtained from 90 children with cerebral palsy, aged 4 to 18 years old, attending the neurology or rehabilitation service of a Brazilian hospital. Therapists classified the children's motor function using the GMFCS E & R and parents used the Brazilian Portuguese version of the GMFCS Family Report Questionnaire. Intra- and inter-rater reliability was obtained through percentage agreement and Cohen's unweighted Kappa statistics (k). The Chi-square test was used to identify significant differences in the classification of parents and therapists. Almost perfect agreement was reached between the therapists [K=0.90 (95% confidence interval 0.83-0.97)] and intra-raters (therapists) with K=1.00 [95% confidence interval (1.00-1.00)], p<0.001. Agreement between therapists and parents was substantial (k=0.716, confidence interval 0.596-0.836), though parents classify gross motor impairment more severely than therapists (p=0.04). The Portuguese version of the GMFCS E & R is reliable for use by parents and therapists. Parents tend to classify their children's limitations more severely, because they know their performance in different environments.

Reliability and validity of short‐term performance tests for wheelchair‐using children and adolescents with cerebral palsy

To investigate the test-retest reproducibility of the Muscle Power Sprint Test (MPST), the 10 × 5-m sprint test, and the arm-cranking Wingate Anaerobic Test (WAnT) in children and adolescents with cerebral palsy (CP). A secondary objective was to assess the construct validity of the MPST. Twenty-three participants with spastic CP (mean age 13 y 3 mo, range 7-18 y, SD 3.6 y; 18 males, five females, two classified as having spastic unilateral CP, 21 as having spastic bilateral CP) using a manual wheelchair for at least part of the day were recruited and tested in different rehabilitation settings in the Netherlands. Participants were classified as in Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R) levels III and IV. Intraclass correlation coefficients (range 0.93-0.99; 95% confidence interval 0.82-1.0) for all variables indicated highly acceptable reproducibility. Limits of agreement analysis revealed satisfactory levels of agreement. The MPST variables demonstrated very strong significant positive correlations for peak power and mean power from both tests (peak power: r=0.91, p<0.001; mean power: r=0.88, p<0.001). The MPST, the 10 × 5-m sprint test, and the arm-cranking WAnT are reproducible tests for measuring anaerobic performance and agility in adolescents with spastic CP who self-propel a manual wheelchair. The MPST has been shown to be a valid test to measure anaerobic performance in this population.

Physical activity in a total population of children and adolescents with cerebral palsy

The aims of this study were to describe the participation in physical activity of children with cerebral palsy (CP) at school and during leisure time and to identify characteristics associated with physical activity. The frequency of receiving physiotherapeutic interventions were described as a variable of interest. A total population of 364 children with verified CP aged 7-17 years living in the Skåne region in Sweden was studied using cross-sectional data from the CP follow-up programme (CPUP). Proportional odds ratios showed the most severe gross motor limitations Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R) to be a characteristic for low participation in physical education at school (PE) and GMFCS-E&R level III to be a characteristic for low participation in regular physical leisure activity. The age group of 7-11 years and obesity were characteristics associated with high participation in PE, whereas thinness was associated with low participation in regular physical leisure time activities. The highest proportion of children receiving physiotherapeutic interventions was found in GMFCS-E&R level III, while mental retardation, especially if moderate or severe, proved to be an independent characteristic associated with low frequency of physiotherapeutic interventions. Gender and epilepsy did not influence the odds for participation in physical activities. Special considerations are needed when planning interventions for increased physical activity in children with CP, as the individual prerequisites differ, even among children with the same gross motor function level according to the GMFCS-E&R.

Relationship Between Gross Motor and Intellectual Function in Children With Cerebral Palsy: A Cross-Sectional Study

Dalvand H, Dehghan L, Hadian MR, Feizy A, Hosseini SA. Relationship between gross motor and intellectual function in children with cerebral palsy: a cross-sectional study. ObjectiveTo explore the relationship between gross motor and intellectual function in children with cerebral palsy (CP). DesignA cross-sectional study. SettingOccupational therapy clinic. ParticipantsChildren with CP (N=662; 281 girls, 381 boys; age range, 3–14y). InterventionsNot applicable. Main Outcome MeasuresIntelligence testing was carried out by means of the Wechsler Preschool and Primary Scale of Intelligence and the Wechsler Intelligence Scale for Children–Revised. Gross motor function level was determined by the Gross Motor Function Classification System Expanded and Revised (GMFCS E&R). ResultsOf the children, 10.4% were at level I of the GMFCS E&R, 38% at levels II and III, and 51.5% at levels IV and V. The lowest level of intelligence or profound intellectual disability was found in children with spastic quadriplegia (n=28, 62.2%). Children at the lowest levels (I–IV, GMFCS E&R) obtained higher ratings in terms of intelligence in comparison with children at level V. Based on the present results, the diagnosis was statistically related to the intellectual level as dependent variable (P<.01); accordingly, hypotonic, quadriplegic, and hemiplegic patients had the highest odds to assign higher ratings in abnormal intelligence, respectively. Sex and age were not statistically related to the dependent variable. ConclusionsThe study results demonstrated a significant association between GMFCS E&R and intellectual function. Therefore, we suggest that particular attention should be paid to the intellectual level in terms of evaluations of gross motor function. These results, in respect, might be interested for occupational and physical therapists who are involved in rehabilitation programs for these children.

Selective Control Assessment of the Lower Extremity (SCALE): development, validation, and interrater reliability of a clinical tool for patients with cerebral palsy

Normal selective voluntary motor control (SVMC) can be defined as the ability to perform isolated joint movement without using mass flexor/extensor patterns or undesired movement at other joints, such as mirroring. SVMC is an important determinant of function, yet a valid, reliable assessment tool is lacking. The Selective Control Assessment of the Lower Extremity (SCALE) is a clinical tool developed to quantify SVMC in patients with cerebral palsy (CP). This paper describes the development, utility, validation, and interrater reliability of SCALE. Content validity was based on review by 14 experienced clinicians. Mean agreement was 91.9% (range 71.4-100%) for statements about content, administration, and grading. SCALE scores were compared with Gross Motor Function Classification System Expanded and Revised (GMFCS-ER) levels for 51 participants with spastic diplegic, hemiplegic, and quadriplegic CP (GMFCS levels I - IV, 21 males, 30 females; mean age 11y 11mo [SD 4y 9mo]; range 5-23y). Construct validity was supported by significant inverse correlation (Spearman's r=-0.83, p<0.001) between SCALE scores and GMFCS levels. Six clinicians rated 20 participants with spastic CP (seven males, 13 females, mean age 12y 3mo [SD 5y 5mo], range 7-23y) using SCALE. A high level of interrater reliability was demonstrated by intraclass correlation coefficients ranging from 0.88 to 0.91 (p<0.001).