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.

Classification of cerebral palsy: association between gender, age, motor type, topography and Gross Motor Function

“…As for the relation between body topography and motor levels, most hemiplegic children were predominantly motor level I, which has also been found in other studies [17][18][19]25 . In this study there was only one child with hemiplegics cP different from level I and she was classified in Motor level III according to the GMFcS.…”

“…The child was 8 months old and had late development; it is possible that such condition reaches the lowest lower limbs because of its neurological maturation. himmelmann et al 25 found out cases of hemiplegia in all motor levels; Beckung et al 19 established that the cases varied between levels I and IV; howard et al 16 found levels I, II, III and V and Voorman et al 18 classified the cases under levels I, II and III. diplegic children in this study were similar (with no significant difference) in the first four levels and there were no examples of level V; in their study Voorman et al 18 had the same results and only 3 cases (6.4%) were level V. In their study himmelmann et al 25 had diplegic children in all levels, most of them were level II (37.5%) and only 4.9% of the children were classified in level V. Similar results were found in the study of Beckung et al 19 in which they observed that most children were classified in the first two levels while only 4% were classified in level V. The results in the study of howard et al 16 were very similar in the first three levels; only 4 cases (5%) were level IV and no diplegic children were level V.…”

“…In the studies of Beckung et al 19 the participants were divided according to motor type and the spastic ones were divided according to topography; quadriplegic spastic ones were all level V, dyskinetic children were classified from level I to V, with a predominance of level III and the ataxic ones were classified in levels I and II; there were no cases of mixed cerebral palsy. himmelmann et al 25 had similar results, in that quadriplegic spastic children were classified in levels IV and V and most of them were level V; diskinetic children were classified in all levels but the majority was levels IV and V. The study of howard et al 16 reported that most of quadriplegic spastic children were level IV and V, diskinetic children were levels II, III and IV and the mixed ones were all levels; the ataxic children were classified in the first three levels and the hypotonic ones were all levels except level II. regarding the relation between motor level and age, our study found a certain tendency to association through Fisher' s exact test (p=0.075) although it did not present significance.…”

Reliability of the Dutch‐language version of the Communication Function Classification System and its association with language comprehension and method of communication

“…3,5,6 Because the diagnosis of CP is based on clinical features but does not describe all the consequences of the disability, 7 the diagnosis must be used in combination with functional classifications. [8][9][10] Using a five-level approach, the Communication Function Classification System (CFCS) can classify the everyday communication of a person with CP, including communication with AAC systems. 11 Distinctions between the five levels of the CFCS are based on important aspects of functional communication, namely the performance of the sender and receiver roles, the pace of the conversation, and the type of communication partner.…”

Trends in prevalence of cerebral palsy in children born with a birthweight of 2,500 g or over in Europe from 1980 to 1998

“…[5] Less research has been carried out on the epidemiology of CP in children of NBW than in those of very low birthweight (< 1500 g). As the number and severity of impairments increase with increasing gestational age [6,7] and birthweight, [8] the type of brain lesion among term or NBW children tends to exhibit a different pattern to that of preterm or low birthweight births. [9][10][11] Time trends for CP prevalence in NBW children vary across studies.…”