AIM The objective of this longitudinal study was to describe the course of social functioning and communication in children with cerebral palsy (CP) over a 3-year period, its difference with the normative course, and its relationship with disease characteristics and personal and environmental factors.METHOD Participants in this study were 110 children with CP (70 males, 40 females) with a mean age of 11 years and 3 months (SD 1y 8mo). Social functioning and communication were measured with the Vineland Adaptive Behavior Scales. Comparisons were made with normative data; data were analysed with generalized estimating equations. According to the Gross Motor Function Classification System (GMFCS), 50 of the 110 children were categorized as GMFCS level I, 16 as level II, 13 as level III, 13 as level IV, and 18 as level V. RESULTSThe course of social functioning over a 3-year period showed an increase in restrictions in children with CP (p<0.001). Restrictions in communication increased more in children with the most severe forms of CP (p<0.001). In addition to disease characteristics (GMFCS category, presence of epilepsy, and speech problems), personal factors (externalizing behaviour problems) and environmental factors (having no siblings, low parental level of education, and parental stress) were associated with greater restrictions in social functioning and communication. INTERPRETATIONThe results indicate that it is important to focus not only on the medical treatment of children with CP, but also on their behavioural problems and social circumstances, and to support the parents so that social functioning and communication in these children may be improved.Children and adolescents with cerebral palsy (CP) are at risk of experiencing restrictions in activities and participation, particularly during adolescence; studies have shown that restrictions affecting participation in activities and the risk of social isolation are greater in older children.1,2 A broader understanding of factors that are associated with activities and participation may result in more effective support. 3 Recent studies focusing on activities and participation in (young) children and adolescents with CP have reported that restrictions are greater in children with more severe CP. [4][5][6] In a recent cross-sectional study, we also found that Gross Motor Function Classification System (GMFCS) level, intellectual ability, and the presence of epilepsy were important factors associated with the level of activities and participation. These findings may be explained by the more limited ability of children with CP to participate in childhood activities such as sports and play, as well as by the impact of visible differences on popularity and eligibility as a playmate. However, these factors explained less variance in the domains of mobility and daily living skills than in the domains of social functioning and communication. 7 The International Classification of Functioning, Disability and Health (ICF) 8 describes social function as (1) interperso...

AIM The aim of this study was to describe patterns for gross motor development by level of severity in a Dutch population of individuals with cerebral palsy (CP). METHOD This longitudinal study included 423 individuals (260 males, 163 females) with CP.The mean age at baseline was 9 years 6 months (SD 6y 2mo, range 1-22y). The level of severity of CP among participants, according to the Gross Motor Function Classification System (GMFCS), was 50% level I, 13% level II, 14% level III, 13% level IV, and 10% level V. Participants had been assessed up to four times with the Gross Motor Function Measure (GMFM-66) at 1-or 2-year intervals between 2002 and 2009. Data were analysed using nonlinear mixed effects modelling. For each GMFCS level, patterns were created by contrasting a stable limit model (SLM) with a peak and decline model (PDM), followed by estimating limits and rates of gross motor development. RESULTSThe SLM showed a better fit for all GMFCS levels than the PDM. Within the SLM, significant differences between GMFCS levels were found for both the limits (higher values for lower GMFCS levels) and the rates (higher values for GMFCS levels I-II vs level IV and for GMFCS levels I-IV vs level V) of gross motor development. INTERPRETATIONThe results validate the existence of five distinct patterns for gross motor development by level of severity of CP.Gross motor function concerns the use of large groups of muscles to maintain balance and change positions, for example sitting, crawling, standing, walking, running, and jumping. These abilities are typically well established by the age of 5 years.1 However, in children with cerebral palsy (CP) gross motor function is generally not fully established by the age of 5 years, nor at older ages. 2 Therefore, the key feature of CP is a disorder in the development of gross motor function, causing activity limitations, notwithstanding the additional disorders that individuals with CP can have. 3 An understanding of how gross motor function of persons with CP develops over time -from early childhood to adulthood -is clinically important for several reasons. First, it helps individuals with CP and their caregivers in understanding the outlook for gross motor function. 4 Second, it helps clinicians to evaluate individual function by making appropriate clinical comparisons with other individuals of a similar age and severity of CP.5 Third, knowledge of gross motor development helps caregivers and clinicians in planning therapies focused on improving gross motor function and, eventually, on improving functioning in daily life activities. 6Specific evidence-based information on gross motor function in persons with CP has been generated in the last two decades. In the 1990s, cross-sectional studies started to show different patterns for gross motor development by the severity of CP. 7 The description of the different patterns was further facilitated using a standardized 66-item test for gross motor function, the Gross Motor Function Measure (GMFM-66), 2 and a validated five-level ...

Levels of behaviour problems are elevated but diminish during adolescence for children with CP. Severity of CP plays a role as well as the family context in terms of the stress and support that caregivers experience.