Gross and fine motor function and accompanying impairments in cerebral palsy

Abstract

The aim of this study was to describe and analyze gross and fine motor function and accompanying neurological impairments in children with cerebral palsy (CP) born between 1991 and 1998 in western Sweden. A population-based study comprised 411 children with a diagnosis of CP ascertained at 4 to 8 years of age. Gross Motor Function Classification System (GMFCS) levels were documented in 367 children (205 males, 162 females). Bimanual Fine Motor Function (BFMF) classification levels of 345 of the children and information on learning disability, epilepsy, visual and hearing impairments, and hydrocephalus from 353 children were obtained. For spastic CP, a new classification according to the Surveillance of Cerebral Palsy in Europe of uni- and bilateral spastic CP was applied. GMFCS was distributed at Level I in 32%, Level II in 29%, Level III in 8%, Level IV in 15%, and Level V in 16%. The corresponding percentages for BFMF were 30.7%, 31.6%, 12.2%, 11.9%, and 13.6% respectively. Learning disability was present in 40%, epilepsy in 33%, and severe visual impairment in 19% of the children. Motor function differed between CP types. More severe GMFCS levels correlated with larger proportions of accompanying impairments and, in children born at term, to the presence of adverse peri/neonatal events in the form of intracranial haemorrhage/stroke, cerebral infection, and hypoxic-ischaemic encephalopathy. GMFCS Level I correlated positively to increasing gestational age. We conclude that the classification of CP should be based on CP type and motor function, as the two combine to produce an indicator of total impairment load.

Influence of gestational age on nosologic CP characteristics in a high-risk population

“…In general, scientific data [5,10,18,19,23,24] regarding the influence of gestational age on nosologic characteristics of CP are narrowed down to either preterm or term infants. In preterm infants, spastic CP is clearly predominant.…”

“…Regarding the degree of severity of CP, most articles report either on the extreme and/or very premature group only [6,13,26] or do not take GA into account [10,14,28]. In the study of Himmelmann [10], considering different gestational age groups, the proportion of children with the mildest motor impairment, i.e.…”

“…In the study of Himmelmann [10], considering different gestational age groups, the proportion of children with the mildest motor impairment, i.e. Gross Motor Function Classification System (GMFCS) level 1, increased significantly (p<0.001) with gestational age.…”

Multiple Treatments of Pediatric Constraint-Induced Movement Therapy (pCIMT): A Clinical Cohort Study

“…These models continue to be used despite the fact that they have repeatedly been proven ineffective (Novak et al, 2013) and despite widespread recognition that the functional demands on children with CP change during development and their skill acquisition typically lags behind that of age-matched peers (Beckung, Carlsson, Carlsdotter, & Uvebrant, 2007;Himmelmann, Beckung, Hagberg, & Uvebrant, 2006;Novak et al, 2013;Rosenbaum et al, 2002;Sakzewski, Ziviani, & Boyd, 2009).…”

Impact of mastery motivation on occupational performance outcomes following upper limb intervention for school-aged children with congenital hemiplegia

“…xxviii often display signs of spasticity and weakness, decreased range of movement, slowness of movement, poor coordination and calibration, mirror movements, impaired finger isolation, and sensory impairment (Eliasson, 2005;Himmelmann, Beckung, Hagberg, & Uvebrant, 2006).…”