To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five‐level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (k) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.

ABSTRACT. Objective. Most children enjoy healthy childhoods with little need for specialized health care services. However, some children experience difficulties in early childhood and require access to and utilization of considerable health care resources over time. Although impaired motor function is the hallmark of the cerebral palsy (CP) syndromes, many children with this development disorder also experience sensory, communicative, and intellectual impairments and may have complex limitations in self-care functions. Although caregiving is a normal part of being the parent of a young child, this role takes on an entirely different significance when a child experiences functional limitations and possible longterm dependence. One of the main challenges for parents is to manage their child's chronic health problems effectively and juggle this role with the requirements of everyday living. Consequently, the task of caring for a child with complex disabilities at home might be somewhat daunting for caregivers. The provision of such care may prove detrimental to both the physical health and the psychological well-being of parents of children with chronic disabilities. It is not fully understood why some caregivers cope well and others do not. The approach of estimating the "independent" or "direct" effects of the care recipient's disability on the caregiver's health is of limited value because (1) single-factor changes are rare outside the context of constrained experimental situations; (2) assumptions of additive relationships and perfect measurements rarely hold; and (3) such approaches do not provide a complete perspective, because they fail to examine indirect pathways that occur between predictor variables and health outcomes. A more detailed analytical approach is needed to understand both direct and indirect effects simultaneously. The primary objective of the current study was to examine, within a single theorybased multidimensional model, the determinants of physical and psychological health of adult caregivers of children with CP.Methods. We developed a stress process model and applied structural equation modeling with data from a large cohort of caregivers of children with CP. This design allowed the examination of the direct and indirect relationships between a child's health, behavior and functional status, caregiver characteristics, social supports, and family functioning and the outcomes of caregivers' physical and psychological health. Families (n ‫؍‬ 468) of children with CP were recruited from 19 regional children's rehabilitation centers that provide outpatient disability management and supports in Ontario, Canada. The current study drew on a population available to the investigators from a previous study, the Ontario Motor Growth study, which explored patterns of gross motor development in children with CP. Data on demographic variables and caregivers' physical and psychological health were assessed using standardized, self-completed parent questionnaires as well as a face-to-face home interview...

SUMMARY This paper reports the results of a study to validate a measure of gross motor function in detecting change in the motor function of disabled children. Physiotherapists used this instrument to assess 111 patients with cerebral palsy, 25 with head injury and 34 non‐disabled preschool children on two occasions, the second after an interval of four to six months. Parents and therapists independently rated the children's function within two weeks of each assessment, and a sample of paired assessments was videotaped for ‘blind’ evaluation by therapists. Correlations between scores for change on this measure and the judgments of change by parents, therapists and ‘blind’ evaluators supported the hypothesis that the instrument would be responsive to both negative and positive changes. RÉSUMÉ Appréciation de la fonction motrice globale: validation de la fidélité d'un instrument de mesure L'article rapporte les résultats d'une étude de validation de mesure de la fonction motrice globale, en relevant les modifications de la fonction motrice chez des enfants infirmes. Des kinésithérapeutes ont utilisé cet instrument pour évaluer 111 I.M.C., 25 séquelles de traumatisme cranien, et 34 enfants non‐infirmes d'âge préscolaire, cela à deux occasions, la seconde distante de quatre à six mois de la première. Parents et rééducateurs apprécièrent indépendamment l'activité des enfants dans les deux semaines suivant chaque évaluation, et un échantillon d'évaluations appariées fut enregistré en vidéo pour étude ‘en aveugle’ par les rééducateurs. Les corrélations obervées entre les notes de changement à cette mesure, les appréciations de changement par les parents et les rééducateurs, les évaluations en aveugle, favorisent l'hypothèse de la sensibilité de l'instrument de mesure aux modifications négatives et positives. ZUSAMMENFASSUNG Bewertung der grobmotorischen Funktion: Validisierung einer Methode Diese Arbeit berichtet über die Ergibnisse einer Untersuchung, die das Ziel hatte, einen Bewertungsmaßstab der grobmotorischen Funktion zu validisieren, um Veränderungen der Motorfunktion bei behinderten Kindern. Physiotherapeuten benutzten diese Methode, um 111 Patienten mit Cerebralparese, 25 mit Kopfverletzungen und 34 nicht behinderte Vorschulkinder an zwei Terminen, der zweite fand nach einem Interval von vier bis sechs Wochen statt, zu untersuchen. Eltern und Therapeuten beurteilten die Funktion der Kinder unabhängig innerhalb von zwei Wochen nach jeder Untersuchung. Aus beiden Untersuchungen wurden Beispiele für eine ‘blinde’ Beurteilung durch Therapeuten auf Video aufgenommen. Korrelationen zwischen den Scores für Veränderungen nach dieser Bewertungsmethode und die Beurteilung der Veränderungen durch die Eltern, Therapeuten und ‘blinden’ Gutachter stützen die Hypothese, daß die Methode sowohl negative als auch positive Veränderungen erfassen würde. RESUMEN Medición de la función motora grosera: validación de la capacidad de respuesta de un instrumento evaluativo Esta publicación aporta los resultados de un estudio para valida...

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