Development and reliability of a system to classify gross motor function in children with cerebral palsy

Abstract

To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five‐level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (k) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.

Development of The Viking Speech Scale to classify the speech of children with cerebral palsy

“…Like other schemes designed to classify children's performance, such as the GMFCS (Palisano et al, 1997), it relies on information from the domains of both body function and activity within the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001). The scale describes the children's speech performance at the level of the individual speech functions affected by dysarthria: breath support for speech, phonation, articulation and rhythm/prosody (Kim, Martin, Hasegawa-Johnson, & Perlman, 2010;Love, 2000;Patel, 2002aPatel, , 2002bSolomon & Charron, 1998).…”

“…Extensive, clinical assessments are rarely practicable for surveillance purposes because of the time taken for completion and variation in personnel reporting data. Easy to use scales have been developed to describe the gross motor performance (Palisano et al, 1997) and manual performance (Beckung & Hagberg, 2002;Eliasson et al, 2006) of children with cerebral palsy and are now used across surveillance registers rather than detailed clinical assessments such as the Gross Motor Function Measure (Russell et al, 1993) or the ABILHAND-Kids (Arnould, Penta, Renders, & Thonnard, 2004). The use of common, consistent measures by registers has enabled the comparison of prevalence rates by severity of impairment across time and regions (Arneson et al, 2009;Platt et al, 2007;SCPE, 2002).…”

“…Following usual practice in SCPE surveillance, IQ was classified by paediatricians from clinical observations and medical notes using a three point scale: 41 (29.54%) children were classified as having an IQ of less than 50; 25 (18.0%) had IQ 50-69; 56 (40.3%) had IQ above 70 and the IQ of 17 (12.25%) was unknown. Gross motor function was classified using the Gross Motor Function Classification System (GMFCS) (Palisano et al, 1997), upper limb function was classified using the Manual Ability Classification System (MACS) (Eliasson et al, 2006) and the Bimanual Fine Motor Function scale (BFMF) (Beckung & Hagberg, 2002) (Table 1). Vision was classified using a three point scale: 67 (48.2%) had no visual impairment; 52 (37.4%) had impairment but not severe; 16 (11.5%) had severe impairment and the visual function of four (2.9%) children was unknown.…”

Rare copy number variation in cerebral palsy

“…The gross motor function classification system (GMFCS) was used to measure severity: level 1, which indicated independent walking through to level 5 where the individual is wheelchair-dependent. 27 Twelve cases (24%) were documented at level 1, 8 cases (16%) at level 2, 4 cases (8%) at level 3, 5 cases (10%) at level 4, 8 cases (16%) at level 5, and for 13 cases GMFCS was not documented. Sixteen cases (32%) had intellectual disability, 16 cases (32%) had epilepsy, and autism was reported in 5 cases (10%).…”

Coronal Plane Knee Moments Improve After Correcting External Tibial Torsion in Patients With Cerebral Palsy

“…For this study, we included patients with spastic CP, Gross Motor Function Classification System Level I or II [18], and preoperative and 1-year postoperative comprehensive motion analysis evaluation, including physical examination and threedimensional (3D) gait analysis. We excluded 22 of the 44 patients: 11 had tibial osteotomy for correction of an internal rotation deformity, 10 were assisted ambulators (unable to obtain reliable force plate data), and one had additional coronal plane malalignment, which would affect moments across the knee.…”