Gross Motor Function Classification System and outcome tools for assessing ambulatory cerebral palsy: a multicenter study

Abstract

The relationships between different levels of severity of ambulatory cerebral palsy, defined by the Gross Motor Function Classification System (GMFCS), and several pediatric outcome instruments were examined. Data from the Gross Motor Function Measure (GMFM), Pediatric Orthopaedic Data Collection Instrument (PODCI), temporal-spatial gait parameters, and oxygen cost were collected from six sites. The sample size for each assessment tool ranged from 226 to 1047 participants. There were significant differences among GMFCS levels I, II, and III for many of the outcome tools assessed in this study. Strong correlations were seen between GMFCS level and each of the GMFM sections D and E scores, the PODCI measures of Transfer and Mobility, and Sports and Physical Function, Gait Velocity, and Oxygen Cost. Correlations among tools demonstrated that the GMFM sections D and E scores correlated with the largest number of other tools. Logistic regression showed GMFM section E score to be a significant predictor of GMFCS level. GMFM section E score can be used to predict GMFCS level relatively accurately (76.6%). Study data indicate that the assessed outcome tools can distinguish between children with different GMFCS levels. This study establishes justification for using the GMFCS as a classification system in clinical studies.

Avaliação do desempenho funcional de crianças com paralisia cerebral de acordo com níveis de comprometimento motor

“…The comparison between the functional areas or domains is quite limited because each scale has a different number of items. Thus, to make this comparison possible, the net scores obtained in the PEDI were added and then converted to continuous scores according to the children's levels of disability (0-100) 1,9,17 .…”

“…The heterogeneity of the health conditions of children with CP does not allow a classification of motor impairment levels, and it is also a challenge for multiprofessional rehabilitation teams to use measures based on children's functional performance. This occurs because several studies 5,[9][10][11][12][13][14] present the functional scenario of the severity levels of CP in daily activities but do not describe the impact of the isolated disorder or the disability during the performance of these tasks.…”

“…Thus, the GMFCS would help to classify motor impairment into severity levels according to the limitations and to the need for assistive technology while the PEDI would assess children's functional capacity, skills and performance. This would allow the early detection of disorders at higher levels of impairment [9][10][11][12][13] .…”

The Reliability and Concurrent Validity of the GMFCS for Children with Cerebral Palsy

“…Formal CP classification methods, such as the GMFCS, have been developed in order to standardize the clinical variability, which is one of the major characteristics of CP 3) . In addition, the GMFCS is now extensively used in developmental research and clinical practice 4) , and its relation with measures of gait 5) , energy efficacy 6) , participation restriction 7) , and healthrelated quality of life 8) in the population with CP has been explored. It has been noted that traditional classification systems describing CP type by limb distribution (hemiplegia, diplegia, and quadriplegia), albeit useful for clinical and epidemiological purposes, have limited value as indicators of mobility.…”

Interobserver agreement of the Gross Motor Function Classification System in an ambulant population of children with cerebral palsy

“…It is now used extensively in developmental research and clinical practice, 3 and its relation with measures of gait, 4,5 energy efficiency, 4,6 participation restriction, 7 and health-related quality of life [8][9][10] in the population with CP has been explored. Although increasing numbers of papers lend weight to the validity of the GMFCS, 1,4,11,12 very few papers have explored the reliability of the classification system. Palisano et al's landmark paper 1 demonstrated good interrater reliability (κ=0.75) between all five GMFCS levels in 40 children with CP aged 2 to 12 years.…”