No abstract

The concurrent validity of a 1 minute walk test at a child's maximum walking speed was assessed in children with bilateral spastic cerebral palsy (BSCP). The distance covered during the 1 minute walk test was compared with the children's gross motor function as assessed by the Gross Motor Function Measure (GMFM). Twenty-four male and 10 female children with CP (mean age 11y, range 4 to 16y) participated in the study. Gross Motor Function Classification System (GMFCS) levels were; level I (n=3), level II (n=17), level III (n=10), and level IV (n=4). Participants had clinical diagnoses of symmetrical diplegia (n=19), asymmetrical diplegia (n=14), and quadriplegia (n=1). Results showed a significant correlation between GMFM score and the distance covered during the 1 minute walk (r=0.92; p<0.001). There was also a significant decrease in the distance walked with increasing GMFCS level (p<0.001). We concluded that the 1 minute walk test is a valid measure for assessing functional ability in children with ambulatory BSCP. Its cost-effectiveness and user friendliness make it a potentially useful tool in the clinical setting. Further study needs to address its reliability and ability to detect change over time.

In ambulatory children with CP, better physical function is associated with a lesser impact of disability; however, the relationship between function and participation is complex. Measures of participation restriction may assist with goal setting appropriate to the specific needs of the child and family.

A randomized placebo-controlled trial was carried out to investigate the efficacy of neuromuscular electrical stimulation (NMES) and threshold electrical stimulation (TES) in strengthening the quadriceps muscles of both legs in children with cerebral palsy (CP). Sixty children (38 males, 22 females; mean age 11y [SD 3y 6mo]; age range 5-16y) were randomized to one of the following groups: NMES (n=18), TES (n=20), or placebo (n=22). Clinical presentations were diplegia (n=55), quadriplegia (n=1), dystonia (n=1), ataxia (n=1), and non-classifiable CP (n=2). Thirty-four children walked unaided, 17 used posterior walkers, six used crutches, and the remaining three used sticks for mobility. Peak torque of the left and right quadriceps muscles, gross motor function, and impact of disability were assessed at baseline and end of treatment (16wks), and at a 6-week follow-up visit. No statistically significant difference was demonstrated between NMES or TES versus placebo for strength or function. Statistically significant differences were observed between NMES and TES versus placebo for impact of disability at the end of treatment, but only between TES and placebo at the 6-week follow-up. In conclusion, further evidence is required to show whether NMES and/or TES may be useful as an adjunct to therapy in ambulatory children with diplegia who find resistive strengthening programmes difficult.

Gross Motor Function Classification System (GMFCS) level was reported by three independent assessors in a population of children with cerebral palsy (CP) aged between 4 and 18 years (n=184; 112 males, 72 females; mean age 10y 10mo [SD 3y 7mo]). A software algorithm also provided a computed GMFCS level from a regional CP registry. Participants had clinical diagnoses of unilateral (n=94) and bilateral (n=84) spastic CP, ataxia (n=4), dyskinesia (n=1), and hypotonia (n=1), and could walk independently with or without the use of an aid (GMFCS Levels I-IV). Research physiotherapist (n=184) and parent/guardian data (n=178) were collected in a research environment. Data from the child's community physiotherapist (n=143) were obtained by postal questionnaire. Results, using the kappa statistic with linear weighting (κ κ lw ), showed good agreement between the parent/guardian and research physiotherapist (κ κ lw =0.75) with more moderate levels of agreement between the clinical physiotherapist and researcher (κ κ lw =0.64) and the clinical physiotherapist and parent/guardian (κ κ lw =0.57). Agreement was consistently better for older children (>2y). This study has shown that agreement with parent report increases with therapists' experience of the GMFCS and knowledge of the child at the time of grading. Substantial agreement between a computed GMFCS and an experienced therapist (κ κ lw =0.74) also demonstrates the potential for extrapolation of GMFCS rating from an existing CP registry, providing the latter has sufficient data on locomotor ability.In 1997 Palisano et al. 1 presented an alternative approach to the classification of cerebral palsy (CP) with publication of the Gross Motor Function Classification System (GMFCS). Based upon the concepts of disability and functional limitation as laid out by the World Health Organization, 2 it classifies children on the level of their motor ability. It is represented by a 5-point ordinal scale in which the higher the level, the less able the child. 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. A subsequent study demonstrated excellent interrater reliability between a developmental paediatrician and a senior physiotherapist using retrospective chart review. 13 In two recent studies 14,15 a concise questionnaire, used to obtain family report of GMFCS level, demonstrated excellent reliability with that assigned by various health professionals.So far, no study has reported the feasibility of assigning a child with CP to a GMFCS level using data it...