Perspectives on classification of selected childhood neurodisabilities based on a review of literature

Jeevanantham, Deepa; Bartlett, Doreen

doi:10.3109/17518423.2016.1139009

Cited by 10 publications

(6 citation statements)

References 42 publications

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“…The descriptions of the levels of the Mini‐MACS are modified according to the age‐related activities of young children (<4y) with CP. The psychometric properties are essential criteria of utility …”

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Classifying the manual abilities of young children with cerebral palsy

Jeevanantham

2016

Develop Med Child Neuro

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Classifying the manual abilities of young children with cerebral palsy (CP) is important for early assessment and intervention. The Manual Ability Classification System (MACS) 1 classifies the bimanual handling of objects by children with CP between 4 years and 18 years of age. The level of assistance, precision, coordination, and the objects handled by younger children are different to children over 4 years of age. Therefore, a different version of the classification was required for these children.The Mini-MACS 2 is a revised version of the MACS that could be used to subgroup the manual abilities of children with CP at younger ages. The Mini-MACS also facilitates early communication between parents and therapists. Similar to the Gross Motor Function Classification System 3 and the MACS, the Mini-MACS is a five-level classification system scored on an ordinal scale, and focuses on performance in everyday tasks. The descriptions of the levels of the Mini-MACS are modified according to the agerelated activities of young children (<4 y) with CP. The psychometric properties are essential criteria of utility. 4The article by Eliasson et al.2 provides evidence of the reliability and validity of the Mini-MACS in classifying the manual abilities of young children with CP. The clear description of the levels, excellent reliability, and validity of the Mini-MACS enables its use by parents and therapists. Eliasson et al. also emphasize the need for reclassifying children with CP on an annual basis, because the diagnosis of CP is usually confirmed at the age of 4 years. Even though the lesion or injury is not progressive, the secondary impairments of CP may be progressive. Exploring the predictive validity of the Mini-MACS might help in selecting an early intervention. As stated in the literature, a stable classification with a clear and detailed focus on developmental pattern has the capacity to predict the course of a disorder. 4 Further research on the predictive validity and clinical utility of the Mini-MACS may facilitate its use in clinical practice. A review on the MACS demonstrated that it is primarily used as a sample descriptor.5 A classification system of the manual abilities of young children with CP may be helpful in widening the age range of sample selection by enabling the inclusion of young children with CP in research.

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confidence: 99%

“…Exploring the predictive validity of the Mini‐MACS might help in selecting an early intervention. As stated in the literature, a stable classification with a clear and detailed focus on developmental pattern has the capacity to predict the course of a disorder …”

mentioning

confidence: 99%

Classifying the manual abilities of young children with cerebral palsy

Jeevanantham

2016

Develop Med Child Neuro

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“…The psychometric properties are essential criteria of utility. 4 The article by Eliasson et al 2 provides evidence of the reliability and validity of the Mini-MACS in classifying the manual abilities of young children with CP. The clear description of the levels, excellent reliability, and validity of the Mini-MACS enables its use by parents and therapists.…”

mentioning

confidence: 99%

“…As stated in the literature, a stable classification with a clear and detailed focus on developmental pattern has the capacity to predict the course of a disorder. 4 Further research on the predictive validity and clinical utility of the Mini-MACS may facilitate its use in clinical practice. A review on the MACS demonstrated that it is primarily used as a sample descriptor.…”

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confidence: 99%

“…One might worry that suppressing excitability of the undamaged motor cortex would be unhelpful in patients with only ipsilateral corticospinal projections to the more-affected hand. In a recent study 4 combining CIMT with low-frequency repetitive TMS to depress the excitability of the undamaged motor cortex, children were excluded if they did not have a contralateral motor-evoked potential from the affected motor cortex. However, another study with a similar approach was more inclusive, 5 with no child showing deterioration in hand function.…”

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Mapping corticospinal tract projection patterns in unilateral cerebral palsy

Basu

2016

Develop Med Child Neuro

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This commentary is on the original article by Kuo et al. on pages 65-71 of this issue. Kuo et al.1 investigate whether diffusion tensor imaging (DTI) can be used to identify preserved corticospinal tract projections from the affected motor cortex in children with unilateral cerebral palsy (CP). Children in whom this projection is partly preserved have in general better hand function than those with a predominant ipsilateral corticospinal tract projection from the unaffected motor cortex.Traditionally, descending motor pathways have been investigated non-invasively in humans using transcranial magnetic stimulation (TMS). This method provides a functional assessment of corticospinal tract connectivity by measuring the motor-evoked response in muscle in response to a brief magnetic pulse from a coil held over the motor cortex. TMS is not always well tolerated though, and some children are considered ineligible because of an active seizure disorder. An alternative non-invasive structural imaging-based method would be valuable; however, non-invasive assessment of the corticospinal tract is not as easy as it sounds. Identification of the corticospinal tract with DTI is a complex reconstruction process involving a mixture of combining neuroanatomical prerequisites with tracking of 'fibres' based on adjacent voxels with properties consistent with a single, coherently oriented bundle of axons with high fractional anisotropy. Areas where fibres cross are difficult to track; errors could lead to tracking pathways which do not exist. In contrast to TMS, which assesses the whole motor pathway from cortex to muscle, DTI only provides information as far as the brainstem. In children with severe unilateral CP, it may be challenging to reconstruct a highly disorganized tract with DTI, leading to false negative results.TMS applied over the motor cortex does not exclusively stimulate the corticospinal tract. Oher pathways such as the bilaterally projecting reticulospinal tract can also be activated. But early latency motor-evoked potentials predominantly reflect the fastest-conducting corticospinal tract fibres. Some participants with unilateral CP may have high thresholds for activation of the affected corticospinal tract, potentially giving false negative results. Also, as the response to TMS is measured using surface electromyography over target muscles, altered peripheral nerve conduction times are a theoretical confounder.Before we rush to undertake both TMS and DTI in our patients with unilateral CP to obtain as clear a picture as possible of their corticospinal tract reorganization, we need to consider how this will help. Can we target children to optimal therapy interventions based on their 'wiring patterns'? In one study using constraint-induced movement therapy (CIMT), quality of movements improved in both groups but speed of performance only improved in children with preserved crossed projections. 2In contrast, Islam et al.3 saw improvements with CIMT, including speed of performance, in children with all forms of cortic...

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