Classification of Cerebral Palsy: Clinical Physiotherapist’s Perspective
Keywords:
cerebral palsy, Gross Motor Function Classification System, physiotherapy, Gross Motor Function Measure, Minimal Clinically Important DifferenceAbstract
Cerebral Palsy (CP) is a common childhood-onset physical disability that results from abnormal development of the brain which occurs during pregnancy or early childhood. CP results in changes to physical, sensory, and cognitive behavior and also communication which depends on severity, type of CP or GMFCS level. There are three main classifications for CP namely 1) Traditional classification 2) Modified traditional classification and 3) Gross Motor Function Classification System (GMFCS). These classifications help physiotherapists to set demands, goals, and therapeutic interventions for individual patient. GMFCS has been correlated with Gross Motor Function Measure (GMFM) that is a measurement of changes in gross motor function performance after therapeutic interventions. This measurement has been widely used in research and in clinical as outcome measurement to measure functional abilities of CP. A Minimal Clinically Important Difference (MCID) is important in clinical practice because it shows the smallest change in an outcome of treatment. The roles of physiotherapist are to promote, prevent, treatment and rehabilitation of patients’ physical., psychological and social wellbeing. Aim of physiotherapy is to solve problems by improving functional abilities and movement skills by focusing on physical and emotional needs of children. Therefore, this review will provide perspective of classifications for CP, GMFM and MCID of GMFM that may help physiotherapists to create suitable approach and management in individual patient with CP.
References
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Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A., Paneth, N., Dan, B., … Damiano, D. (2005). Proposed definition and classification of cerebral palsy. Developmental Medicine & Child Neurology, 47(08), pp. 571-576.
Bobath, K., & Bobath, B. (1984). The neurodevelopmental treatment. In. D. Scrutton Ed., Management of the motor disorders of children with cerebral palsy (pp. 6-18). Philadelphia: JB Lippincott.
Bodkin, A. W., Robinson, C., & Perales, F. P. (2003). Reliability and validity of the Gross Motor Function Classification System for cerebral palsy. Pediatric Physical Therapy, 15(4), pp. 247-252.
Brunton, L. K., & Bartlett, D. J. (2010). Description of exercise participation of adolescents with cerebral palsy across a 4-year period. Pediatric Physical Therapy, 22(2), pp. 180- 187.
Campbell, S. K., Vander Linden, D. W., & Palisano, R. (2006). Physical therapy for children. St. Louis, MO: Elsevier Saunders.
Cans, C. (2000). Surveillance of cerebral palsy in Europe: A collaboration of cerebral palsy surveys and registers. Developmental Medicine & Child Neurology, 42(12), pp. 816-824.
Carnahan, D. K., Arner, M., & Hägglund, G. (2007). Association between Gross Motor Function (GMFCS) and Manual Ability (MACS) in children with cerebral palsy. A population-based study of 359 children. BMC Musculoskeletal Disorders, 8(1), p. 1.
Copay, A. G., Subach, B. R., Glassman, S. D.,Polly, D. W., & Schuler, T. C. (2007). Understanding the minimum clinically important difference: A review of concepts and methods. The Spine Journal, 7(5), pp. 541-546.
Eek, M. N., & Beckung, E. (2008). Walking ability is related to muscle strength in children with cerebral palsy. Gait & Posture, 28(3), pp. 366-371.
Eunson, P. (2012). Aetiology and epidemiology of cerebral palsy. Paediatrics and Child Health, 22(9), pp. 361-366.
Flett, P. J. (2003). Rehabilitation of spasticity and related problems in childhood cerebral palsy. Journal of Paediatrics and Child Health, 39(1), pp. 6-14.
Fowler, E. G. (2010). Concepts in spasticity and selective motor control in children with spastic cerebral palsy. Technology and Disability, 22(4), pp. 207-214.
Gorter, J. W., Rosenbaum, P. L., Hanna, S. E., Palisano, R. J., Bartlett, D. J., Russell, D. J., … Wood, E. (2004). Limb distribution, motor impairment, and functional classification of cerebral palsy. Developmental Medicine & Child Neurology, 46(07), pp. 461-467.
Hur, J. (1995). Review of research on therapeutic interventions for children with cerebral palsy. Acta Neurologica Scandinavica, 91(6), pp. 423-432.
Jaeschke, R., Singer, J., & Guyatt, G. H. (1989). Measurement of health status: Ascertaining the minimal clinically important difference. Controlled Clinical Trials, 10(4), pp. 407-415.
Knox, V., & Evans, A. L. (2002). Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: A preliminary study. Developmental Medicine & Child Neurology, 44(7), pp. 447-460.
Lehmann, J. F., Price, R., deLateur, B. J., Hinderer, S. & Traynor, C. (1989). Spasticity: Quantitative measurement as a basis for assessing effectiveness of therapeutic intervention. Arch Phys Med Rehabil, 70(1), pp.6-15.
Levitt, S. (2013). Treatment of cerebral palsy and motor delay. Chicester: John Wiley & Sons.
Liptak, G. S. (2005). Complementary and alternative therapies for cerebral palsy. Mental Retardation and Developmental Disabilities Research Reviews, 11(2), pp. 156-163.
McCrum-Gardner, E. (2010). Sample size and power calculations made simple. International Journal of Therapy and Rehabilitation, 17(1), p.10.
Neale, A. V. (1955). Problems of cerebral palsy. Postgraduate Medical Journal, 31(357), pp. 356-359.
Nordmark, E., Hagglund, G., & Jarnlo, G. B. (1997). Reliability of the Gross Motor Function Measure in cerebral palsy. Scandinavian Journal of Rehabilitation Medicine, 29(1), pp. 25-28.
Oeffinger, D., Gorton, G., Bagley, A., Nicholson, D., Barnes, D., Calmes, J., Rogers, S. (2007).Outcome assessments in children with cerebral palsy, part I: Descriptive characteristics of GMFCS levels I to III. Developmental Medicine & Child Neurology, 49(3), pp. 172-180.
Pakula, A. T., Braun, K. V. N., & Yeargin-Allsopp, M. (2009). Cerebral palsy: classification and epidemiology. Physical Medicine and Rehabilitation Clinics of North America, 20(3), pp. 425-452.
Palisano, R. J., Cameron, D., Rosenbaum, P. L., Walter, S. D., & Russell, D. (2006). Stability of the Gross Motor Function Classification System. Developmental Medicine & Child Neurology, 48(06), pp. 424-428.
Palisano, R. J., Haley, S. M., & Brown, D. A. (1992). Goal attainment scaling as a measure of change in infants with motor delays. Physical Therapy, 72(6), pp. 432-437.
Palisano, R. J., Rosenbaum, P., Bartlett, D., & Livingston, M. H. (2008). Content validity of the Expanded and Revised Gross Motor Function Classification System. Developmental Medicine & Child Neurology, 50(10), pp. 744-750.
Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology, 39(4), pp. 214-223.
Palisano, R., Rosenbaum, P., Bartlett, D., & Livingston, M. (2007). Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R). Hamilton, ON: CanChild Centre for Childhood Disability Research, McMaster University.
Papavasiliou, A. S. (2009). Management of motor problems in cerebral palsy: A critical update for the clinician. European Journal of Paediatric Neurology, 13(5), pp. 387-396.
Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., … Jacobsson, B. (2007). A report: The definition and classification of cerebral palsy April 2006. Dev Med Child Neurol, 109 (Supplement), pp. 8-14.
Ross, S. A., & Engsberg, J. R. (2007). Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Archives of Physical Medicine and Rehabilitation, 88(9), pp. 1114-1120.
Russell, D. J., Rosenbaum, P. L., Avery, L. M., & Lane, M. (2002). Gross Motor Function Measure (GMFM-66 and GMFM-88) user’s manual. London, UK: Mac Keith Press.
Russell, D. J., Rosenbaum, P. L., Cadman, D. T., Gowland, C., Hardy, S., & Jarvis, S. (1989). The Gross Motor Function Measure: A means to evaluate the effects of physical therapy. Developmental Medicine & Child Neurology, 31(3), pp. 341-352.
Sterne, J. A., & Smith, G. D. (2001). Sifting the evidence-what’s wrong with significance tests? Physical Therapy, 81(8), pp. 1464-1469.
Stratford, P. W., Binkley, J. M., & Riddle, D. L. (1996). Health status measures: Strategies and analytic methods for assessing change scores. Physical Therapy, 76(10), pp. 1109- 1123.
Tecklin, J. S. (2015). Pediatric Physical Therapy. Baltimore, MD: Lippincott William & Wilkins.
Thompson, N., Stebbins, J., Seniorou, M., & Newham, D. (2011). Muscle strength and walking ability in diplegic cerebral palsy: Implications for assessment and management. Gait & Posture, 33(3), pp. 321-325.
Touyama, M., Touyama, J., Toyokawa, S. & Kobayashi, Y. (2016). Trends in the prevalence of cerebral palsy in children born between 1988 and 2007 in Okinawa, Japan. Brain and Development, 38(9), pp. 792-799.
Van den Broeck, C., De Cat, J., Molenaers, G., Franki, I., Himpens, E., Severijns, D., & Desloovere, K. (2010). The effect of individually defined physiotherapy in children with cerebral palsy (CP). European Journal of Paediatric Neurology, 14(6), pp. 519-525.
Wang, H., & Yang, Y. H. (2006). Evaluating the responsiveness of 2 versions of the Gross Motor Function Measure for children with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 87(1), pp. 51-56.
Wood E1, & Rosenbaum P. (2000). The Gross Motor Function Classification System for cerebral palsy: A study of reliability and stability over time. Dev Med Child Neurol, 42(5): pp. 292-6.
Woollacott, M. H., & Shumway-Cook, A. (2005). Postural dysfunction during standing and walking in children with cerebral palsy: What are the underlying problems and what new therapies might improve balance? Neural Plasticity, 12(2-3), pp. 211-219.
Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A., Paneth, N., Dan, B., … Damiano, D. (2005). Proposed definition and classification of cerebral palsy. Developmental Medicine & Child Neurology, 47(08), pp. 571-576.
Bobath, K., & Bobath, B. (1984). The neurodevelopmental treatment. In. D. Scrutton Ed., Management of the motor disorders of children with cerebral palsy (pp. 6-18). Philadelphia: JB Lippincott.
Bodkin, A. W., Robinson, C., & Perales, F. P. (2003). Reliability and validity of the Gross Motor Function Classification System for cerebral palsy. Pediatric Physical Therapy, 15(4), pp. 247-252.
Brunton, L. K., & Bartlett, D. J. (2010). Description of exercise participation of adolescents with cerebral palsy across a 4-year period. Pediatric Physical Therapy, 22(2), pp. 180- 187.
Campbell, S. K., Vander Linden, D. W., & Palisano, R. (2006). Physical therapy for children. St. Louis, MO: Elsevier Saunders.
Cans, C. (2000). Surveillance of cerebral palsy in Europe: A collaboration of cerebral palsy surveys and registers. Developmental Medicine & Child Neurology, 42(12), pp. 816-824.
Carnahan, D. K., Arner, M., & Hägglund, G. (2007). Association between Gross Motor Function (GMFCS) and Manual Ability (MACS) in children with cerebral palsy. A population-based study of 359 children. BMC Musculoskeletal Disorders, 8(1), p. 1.
Copay, A. G., Subach, B. R., Glassman, S. D.,Polly, D. W., & Schuler, T. C. (2007). Understanding the minimum clinically important difference: A review of concepts and methods. The Spine Journal, 7(5), pp. 541-546.
Eek, M. N., & Beckung, E. (2008). Walking ability is related to muscle strength in children with cerebral palsy. Gait & Posture, 28(3), pp. 366-371.
Eunson, P. (2012). Aetiology and epidemiology of cerebral palsy. Paediatrics and Child Health, 22(9), pp. 361-366.
Flett, P. J. (2003). Rehabilitation of spasticity and related problems in childhood cerebral palsy. Journal of Paediatrics and Child Health, 39(1), pp. 6-14.
Fowler, E. G. (2010). Concepts in spasticity and selective motor control in children with spastic cerebral palsy. Technology and Disability, 22(4), pp. 207-214.
Gorter, J. W., Rosenbaum, P. L., Hanna, S. E., Palisano, R. J., Bartlett, D. J., Russell, D. J., … Wood, E. (2004). Limb distribution, motor impairment, and functional classification of cerebral palsy. Developmental Medicine & Child Neurology, 46(07), pp. 461-467.
Hur, J. (1995). Review of research on therapeutic interventions for children with cerebral palsy. Acta Neurologica Scandinavica, 91(6), pp. 423-432.
Jaeschke, R., Singer, J., & Guyatt, G. H. (1989). Measurement of health status: Ascertaining the minimal clinically important difference. Controlled Clinical Trials, 10(4), pp. 407-415.
Knox, V., & Evans, A. L. (2002). Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: A preliminary study. Developmental Medicine & Child Neurology, 44(7), pp. 447-460.
Lehmann, J. F., Price, R., deLateur, B. J., Hinderer, S. & Traynor, C. (1989). Spasticity: Quantitative measurement as a basis for assessing effectiveness of therapeutic intervention. Arch Phys Med Rehabil, 70(1), pp.6-15.
Levitt, S. (2013). Treatment of cerebral palsy and motor delay. Chicester: John Wiley & Sons.
Liptak, G. S. (2005). Complementary and alternative therapies for cerebral palsy. Mental Retardation and Developmental Disabilities Research Reviews, 11(2), pp. 156-163.
McCrum-Gardner, E. (2010). Sample size and power calculations made simple. International Journal of Therapy and Rehabilitation, 17(1), p.10.
Neale, A. V. (1955). Problems of cerebral palsy. Postgraduate Medical Journal, 31(357), pp. 356-359.
Nordmark, E., Hagglund, G., & Jarnlo, G. B. (1997). Reliability of the Gross Motor Function Measure in cerebral palsy. Scandinavian Journal of Rehabilitation Medicine, 29(1), pp. 25-28.
Oeffinger, D., Gorton, G., Bagley, A., Nicholson, D., Barnes, D., Calmes, J., Rogers, S. (2007).Outcome assessments in children with cerebral palsy, part I: Descriptive characteristics of GMFCS levels I to III. Developmental Medicine & Child Neurology, 49(3), pp. 172-180.
Pakula, A. T., Braun, K. V. N., & Yeargin-Allsopp, M. (2009). Cerebral palsy: classification and epidemiology. Physical Medicine and Rehabilitation Clinics of North America, 20(3), pp. 425-452.
Palisano, R. J., Cameron, D., Rosenbaum, P. L., Walter, S. D., & Russell, D. (2006). Stability of the Gross Motor Function Classification System. Developmental Medicine & Child Neurology, 48(06), pp. 424-428.
Palisano, R. J., Haley, S. M., & Brown, D. A. (1992). Goal attainment scaling as a measure of change in infants with motor delays. Physical Therapy, 72(6), pp. 432-437.
Palisano, R. J., Rosenbaum, P., Bartlett, D., & Livingston, M. H. (2008). Content validity of the Expanded and Revised Gross Motor Function Classification System. Developmental Medicine & Child Neurology, 50(10), pp. 744-750.
Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology, 39(4), pp. 214-223.
Palisano, R., Rosenbaum, P., Bartlett, D., & Livingston, M. (2007). Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R). Hamilton, ON: CanChild Centre for Childhood Disability Research, McMaster University.
Papavasiliou, A. S. (2009). Management of motor problems in cerebral palsy: A critical update for the clinician. European Journal of Paediatric Neurology, 13(5), pp. 387-396.
Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., … Jacobsson, B. (2007). A report: The definition and classification of cerebral palsy April 2006. Dev Med Child Neurol, 109 (Supplement), pp. 8-14.
Ross, S. A., & Engsberg, J. R. (2007). Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Archives of Physical Medicine and Rehabilitation, 88(9), pp. 1114-1120.
Russell, D. J., Rosenbaum, P. L., Avery, L. M., & Lane, M. (2002). Gross Motor Function Measure (GMFM-66 and GMFM-88) user’s manual. London, UK: Mac Keith Press.
Russell, D. J., Rosenbaum, P. L., Cadman, D. T., Gowland, C., Hardy, S., & Jarvis, S. (1989). The Gross Motor Function Measure: A means to evaluate the effects of physical therapy. Developmental Medicine & Child Neurology, 31(3), pp. 341-352.
Sterne, J. A., & Smith, G. D. (2001). Sifting the evidence-what’s wrong with significance tests? Physical Therapy, 81(8), pp. 1464-1469.
Stratford, P. W., Binkley, J. M., & Riddle, D. L. (1996). Health status measures: Strategies and analytic methods for assessing change scores. Physical Therapy, 76(10), pp. 1109- 1123.
Tecklin, J. S. (2015). Pediatric Physical Therapy. Baltimore, MD: Lippincott William & Wilkins.
Thompson, N., Stebbins, J., Seniorou, M., & Newham, D. (2011). Muscle strength and walking ability in diplegic cerebral palsy: Implications for assessment and management. Gait & Posture, 33(3), pp. 321-325.
Touyama, M., Touyama, J., Toyokawa, S. & Kobayashi, Y. (2016). Trends in the prevalence of cerebral palsy in children born between 1988 and 2007 in Okinawa, Japan. Brain and Development, 38(9), pp. 792-799.
Van den Broeck, C., De Cat, J., Molenaers, G., Franki, I., Himpens, E., Severijns, D., & Desloovere, K. (2010). The effect of individually defined physiotherapy in children with cerebral palsy (CP). European Journal of Paediatric Neurology, 14(6), pp. 519-525.
Wang, H., & Yang, Y. H. (2006). Evaluating the responsiveness of 2 versions of the Gross Motor Function Measure for children with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 87(1), pp. 51-56.
Wood E1, & Rosenbaum P. (2000). The Gross Motor Function Classification System for cerebral palsy: A study of reliability and stability over time. Dev Med Child Neurol, 42(5): pp. 292-6.
Woollacott, M. H., & Shumway-Cook, A. (2005). Postural dysfunction during standing and walking in children with cerebral palsy: What are the underlying problems and what new therapies might improve balance? Neural Plasticity, 12(2-3), pp. 211-219.
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2016-12-01
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Charoensuksiri, K., & Charoensuksiri, S. (2016). Classification of Cerebral Palsy: Clinical Physiotherapist’s Perspective. Journal of Health and Health Management, 3(3), 1–9. Retrieved from https://he01.tci-thaijo.org/index.php/slc/article/view/221777
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