Description of children with cerebral palsy: steps for the future

Abstract

This commentary is on the original article by Hidecker et al. on pages 737-742 of this issue.Describing children with cerebral palsy (CP) has long been a challenge for both clinicians and researchers, from the neurological (spastic, dyskinetic, ataxic) to the topographical subtypes (unilateral or bilateral, upper and ⁄ or lower limbs), and to the description of the accompanying impairments. 1 More recently, several ordinal scales have been proposed related to the activity limitations of children with CP based on International Classification of Functioning, Disability and Health concepts. The study from Hidecker et al. presents the results for three scales: the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS).2 A clinical series of 222 children with CP were assessed, half of whom were born very preterm. Examples of the advantages of knowing each child's functional profile are given, as well as excellent demonstrations of how awareness of these children's needs might be increased and care improved when using information from these three scales. In addition, the reliability of describing groups of children with CP might also be improved. As CP is an umbrella term, with many different types, good reliability in describing subgroups of these children is useful for (1) clinical research trials conducted on CP subgroups, (2) longer-term evaluation of new therapies, and (3) epidemiological studies comparing data between registries or population-based surveys.The authors hypothesized that the three scales would not be strongly correlated. This weak correlation most probably results from combining different types of CP. For instance, the observed high correlation of GMFCS and MACS could have been expected in the group of children assigned to the quadriplegia type, with similar scores on the MACS and GMFCS. A lower correlation between MACS and GMFCS in the group labeled diplegic was observed and expected. The terms 'diplegia' and 'quadriplegia' raise questions because they differ in the number of limbs involved or predominantly involved, with this inaccuracy already mentioned several times.3 Controversy on this issue persists in the literature, 4 probably unnecessarily. At the individual level of a child with CP, all professionals will agree that more detailed knowledge than 'the child has a bilateral spastic CP subtype' is useful; but when used to describe a group of children with CP in clinical or epidemiological studies the reliability of the terms diplegia and quadriplegia are severely limited. The expertise of referral physicians in classifying the child by neurological ⁄ topographical subtype might differ greatly. Consequently, if the GMFCS and MACS were used as a proxy for lower and upper limbs involvement respectively, the reliability of a high GMFCS score and a low MACS score is likely to be much better than the reliability of the term diplegia. The GMFCS and MACS correlation results in the Hidecker et a...

The Greek Version of Mini-Manual Ability Classification System (Mini-MACS): Translation and Reliability Study

“…As was also demonstrated by similar studies [6][7]28], the study results indicated that there was a moderate to strong correlation between the Mini-MACS and GMFCS with the parent-and therapist-reported Mini-MACS scores. This slightly high correlation result, which most probably derives from the fact that children belonged to different types of CP [29], confirms and underlines the different construct that these two classification systems are built on and provide, fine versus gross motor function [6].…”