Stability of motor impairment in children with cerebral palsy

Shevell, Michael; Majnemer, Annette; Poulin, Chantal; Law, Mary

doi:10.1111/j.1469-8749.2008.02029.x

Cited by 29 publications

(26 citation statements)

References 29 publications

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“…The figures presented in this table clearly demonstrate that preterm birth is the most important determinant of CP with an overall prevalence of 1% versus 0.07% in infants born at term. This finding, which also corresponds with a large Norwegian study, 4 is not commented upon. The majority of infants with CP with breech presentation was found in the preterm group and the CP cases were equally distributed between term (n=112) and preterm (n=107) deliveries, contrary to a large…”

Section: Michael Shevellsupporting

confidence: 82%

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Shevell

2010

Develop Med Child Neuro

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SIR-I read with interest and appreciation the thoughtful comments of Rosenbaum et al. The heterogeneity of cerebral palsy (CP) as a symptom complex (in all its ramifications) has been historically recognized and encapsulated in its current consensus definition. 1 It is this heterogeneity that has challenged over time our attempts to capture CP accurately in terms of a single classification scheme. Our paper was an attempt to explore a possible association or relationship between the classical classification scheme based on the distribution and quality of limb impairment and the more recently developed classification scheme based upon gross motor functional capabilities (Gross Motor Function Classification System [GMFCS]). 2 With regard to the specific comments put forward by Rosenbaum et al., I can offer the following responses at the present time.As noted by Rosenbaum et al., we share the view that classification of CP by topographical distribution of impairment is indeed useful for clinical and epidemiological purposes. We also share the opinion that the classification of the severity of gross motor limitations is best captured currently by the GMFCS. In our sample, we found that classification by topographical distribution of motor impairment performed in the child between the age of 2 and 5 years was associated with a dichotomous distinction of GMFCS levels between levels I to III and levels IV to V. This dichotomous distinction was selected because it best approximates the most important functional question posed by parents of young children with a diagnosis of CP: Will my child walk? Detailed examination of the data in our study and that of Gorter et al. reveals remarkable similarities. 2,3 In both, the vast majority of children with hemiplegic or diplegic variants of CP attained a GMFCS level of I to III. Similarly, the majority (roughly 75%) of children with the quadriplegic subtype of CP attained level IV to V. A slight variation was noted in GMFCS levels between the dyskinetic subtypes in the two studies, with roughly 75% attaining level IV to V in our study and 67% in the study of Gorter et al.We would agree with the comments put forward that '… activity limitations are determined only partly by the mere presence of motor impairments'. We never meant to suggest that the distribution of motor impairment is the entire reason for activity limitations. Indeed, other factors must be at play in order to account for the distribution within a subtype amongst GMFCS levels noted in our study and that of Gorter et al. We would also agree that interobserver reliability of neurological subtype assignment has never been objectively evaluated. Indeed, we have reported that neurological subtype may vary over time in a subset (approximately 25%). 4 This variation tends to occur in particular subtypes (i.e. quadriplegic and dyskinetic) and is likely to reflect the influence of central nervous system maturational and contextual factors. This variation in topographical distribution should give clinicians pause in their p...

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Section: Michael Shevellsupporting

confidence: 82%

“…Indeed, we have reported that neurological subtype may vary over time in a subset (approximately 25%). 4 This variation tends to occur in particular subtypes (i.e. quadriplegic and dyskinetic) and is likely to reflect the influence of central nervous system maturational and contextual factors.…”

Section: Michael Shevellmentioning

confidence: 99%

Shevell replies

Shevell

2010

Develop Med Child Neuro

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“…Independent neurologic examination confirmed the persisting diagnosis of CP, as per Badawi et al [16,17]. Children included in this study on inter-rater reliability were those in whom the parent and the research coordinator agreed that the child had the cognitive and language ability to self-report (either independently or with the assistance of the coordinator, by interview) to complete the PedsQL (child version).…”

Section: Subjectsmentioning

confidence: 90%

Reliability in the ratings of quality of life between parents and their children of school age with cerebral palsy

et al. 2008

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“…Cerebral Palsy (CP) refers to a group of permanent disorders in the development of motor and postural control that are of cerebral origin, acquired either before birth or during the first years of life (Rosenbaum et al, 2007;Shevell, Majnemer, Poulin, & Law, 2008). It is the leading cause of motor impairments in childhood (Kerr, McDowell, Parkes, Stevenson, & Cosgrove, 2011) with an estimated incidence of 2-3 occurrences per every 1000 live births in the developed world (Andersen, 2011).…”

Section: Introductionmentioning

confidence: 99%