Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy

Abstract

In a representative series of 176 children with cerebral palsy (CP), aged 5 to 8 years, associations were studied between additional neuroimpairments, activity limitations, and participation restrictions in the domains of mobility, education, and social relations as proposed in the International Classification of Functioning Disability and Health (ICF). Learning disability occurred in 40%, epilepsy in 35%, visual impairment in 20%, and infantile hydrocephalus in 9% of the children. Additional neuroimpairments were most frequently seen in children with tetraplegia and dystonic CP and in those with antecedents of brain malformations or severe perinatal compromise. Activity limitations were studied with the Gross Motor Function Classification System (GMFCS) and a system for grading bimanual fine motor function (BFMF) was developed. There was a strong correlation of 0.74 between the GMFCS and BFMF (p<0.001). Learning disability, activity limitations, and participation restrictions were all clinically strongly associated with each other (p<0.001). Restriction in mobility was best predicted by the GMFCS, learning disability, and the BFMF; in education by learning disability and the GFMCS; and in social relations by learning disability, the GMFCS, and BFMF. Motor function and learning disability were important predictors for participation restrictions in children with CP. The ICF has the capacity to be a model to help plan interventions for specific functional goals and to ascertain the child's participation in society.

Development of The Viking Speech Scale to classify the speech of children with cerebral palsy

“…Unlike other classification systems (Beckung & Hagberg, 2002;Eliasson et al, 2006;Hidecker et al, 2011;Palisano et al, 1997), the Viking Speech Scale contains four levels. The scale's levels were determined by the need to create meaningful categories for epidemiological surveillance.…”

“…Extensive, clinical assessments are rarely practicable for surveillance purposes because of the time taken for completion and variation in personnel reporting data. Easy to use scales have been developed to describe the gross motor performance (Palisano et al, 1997) and manual performance (Beckung & Hagberg, 2002;Eliasson et al, 2006) of children with cerebral palsy and are now used across surveillance registers rather than detailed clinical assessments such as the Gross Motor Function Measure (Russell et al, 1993) or the ABILHAND-Kids (Arnould, Penta, Renders, & Thonnard, 2004). The use of common, consistent measures by registers has enabled the comparison of prevalence rates by severity of impairment across time and regions (Arneson et al, 2009;Platt et al, 2007;SCPE, 2002).…”

“…Following usual practice in SCPE surveillance, IQ was classified by paediatricians from clinical observations and medical notes using a three point scale: 41 (29.54%) children were classified as having an IQ of less than 50; 25 (18.0%) had IQ 50-69; 56 (40.3%) had IQ above 70 and the IQ of 17 (12.25%) was unknown. Gross motor function was classified using the Gross Motor Function Classification System (GMFCS) (Palisano et al, 1997), upper limb function was classified using the Manual Ability Classification System (MACS) (Eliasson et al, 2006) and the Bimanual Fine Motor Function scale (BFMF) (Beckung & Hagberg, 2002) (Table 1). Vision was classified using a three point scale: 67 (48.2%) had no visual impairment; 52 (37.4%) had impairment but not severe; 16 (11.5%) had severe impairment and the visual function of four (2.9%) children was unknown.…”

Predicting additional care in young children with neurodevelopmental disability: a systematic literature review

“…The Functional Independence Measure for children (WeeFIM) measures a child's performance (by observation or parent report) of essential tasks in the domains of self-care, mobility, and cognition. Additional care is measured as the amount of assistance needed to perform each task, and is rated on a 7-point ordinal scale (1)(2)(3)(4)(5)(6)(7). A score of 7 indicates independence: no help (personal help, modifications, devices, or aids) needed with regard to safety and time required to perform the task.…”

“…[1][2][3][4][5][6] Despite medical treatment and habilitation, these impairments may lead to limitations in the capacities of the child. According to the International Classification of Functioning, Disability and Health (ICF), 5 capacities describe the individual's ability to execute a task or an action.…”