Classifying the manual abilities of young children with cerebral palsy

Abstract

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.