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Stability of the gross motor function classification system in children with cerebral palsy in the two to four year age band

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JOURNAL OF PEDIATRIC REHABILITATION MEDICINE 2023年第2期16卷 321-329页

作者： Wizinsky, Amanda M. Donawerth, Molly Badgley, Megan Hemphill-Morytko, Brooke Laughlin, Emily Rogan, Marie Cincinnati Childrens Hosp Med Ctr Perlman Ctr Cincinnati OH USA Xavier Univ Cincinnati OH USA

PURPOSE: This study aimed to investigate the stability of the gross motor function classification system (GMFCS) in children with cerebral palsy (CP) in the two to four year age band, the frequency at which children were reclassified, and trends of reclassification to higher or lower ability. METHODS: This retrospective study included 164 children with CP between 24 to 48 months old with two or more GMFCS ratings at least 12 months apart between their second and fourth birthdays. GMFCS ratings were captured closest to 24, 36, and 48 months. Stability and reclassification trends were analyzed using inferential statistics. Frequency of reclassification, age at ratings, duration between ratings, and corresponding change rate were analyzed using descriptive statistics. RESULTS: When comparing ratings closest to second and fourth birthdays, a linear weighted kappa of 0.726 was found. Of the total population, 46.95% changed GMFCS levels at any time between two to four years of age, the majority of which were reclassified to a higher level of ability. CONCLUSION: Findings suggest the GMFCS is less stable in the two to four year age band compared to older age bands. Due to the importance of providing accurate guidance for caregivers and high rate of reclassification, it is recommended GMFCS levels be reassessed every six months during this period of time.

关键词： Cerebral palsy gross motor function classification system two to four year age band

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Introduction of the gross motor function classification system in Venezuela - a model for knowledge dissemination

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BMC PEDIATRICS 2015年第1期15卷 111-111页

作者： Lowing, Kristina Arredondo, Ynes C. Tedroff, Marika Tedroff, Kristina Karolinska Inst Karolinska Univ Hosp Dept Womens & Childrens Hlth SE-17176 Stockholm Sweden Child Rehabil Ctr Mundo Sonrisas Alta Vista Puerto Ordaz 8050 Venezuela

Background: A current worldwide common goal is to optimize the health and well-being of children with cerebral palsy (CP). In order to reach that goal, for this heterogeneous group, a common language and classification systems are required to predict development and offer evidence based interventions. In most countries in Africa, South America, Asia and Eastern Europe the classification systems for CP are unfamiliar and rarely used. Education and implementation are required. The specific aims of this study were to examine a model in order to introduce the gross motor function classification system (GMFCS-E&R) in Venezuela, and to examine the validity and the reliability. Methods: Children with CP, registered at a National child rehabilitation centre in Venezuela, were invited to participate. The Spanish version of GMFCS-E&R was used. The Wilson mobility scale was translated and used to examine the concurrent validity. A structured questionnaire, comprising aspects of mobility and gross motor function, was constructed. In addition, each child was filmed. A paediatrician in Venezuela received supervised self-education in GMFCS-E&R and the Wilson mobility scale. A Swedish student was educated in GMFCS-E&R and the Wilson mobility scale prior to visiting Venezuela. In Venezuela, all children were classified and scored by the paediatrician and student independently. An experienced paediatric physiotherapist (PT) in Sweden made independent GMFCS-E&R classifications and Wilson mobility scale scorings, accomplished through merging data from the structured questionnaire with observations of the films. Descriptive statistics were used and reliability was presented with weighted Kappa (Kw). Spearman's correlation coefficient was calculated to explore the concurrent validity between GMFCS-E&R and Wilson mobility scale. Results: Eighty-eight children (56 boys), mean age 10 years (3-18), with CP participated. The inter-rater reliability of GMFCS-E&R between;the paediatrician and t

关键词： Cerebral Palsy Structure Questionnaire Concurrent Validity Assistive Device gross motor function classification system

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Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system

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DISABILITY AND REHABILITATION 2012年第12期34卷 1030-1033页

作者： El, Ozlem Baydar, Meltem Berk, Haluk Peker, Ozlen Kosay, Can Demiral, Yucel Dokuz Eylul Univ Fac Med Dept Phys Med & Rehabil TR-35340 Izmir Turkey Dokuz Eylul Univ Fac Med Dept Orthopaed TR-35340 Izmir Turkey Dokuz Eylul Univ Fac Med Dept Publ Hlth TR-35340 Izmir Turkey

Purpose: Cerebral palsy (CP) is the most common disability in childhood. The gross motor function classification system (GMFCS) has become an important tool to assess motor function in CP patient. In 2007, the expanded and revised (E&R) version of GMFCS which includes age band for youth 12-18 years of age was developed. The aim of this study was to evaluate reliability of Turkish version of expanded and revised GMCS. Methods: We assessed interobserver reliability between two physical medicine and rehabilitation specialists in 136 children with CP and test-retest reliability within a subgroup of 48 patients. Percent agreement, intraclass correlation coefficient (ICC) and mu statistics were used to evaluate reliability. Result: The ICC between two physicians was 0.97 and the total agreement was 89%. This result indicates excellent agreement. The overall weighted mu was 0.86. High test-retest reliability was found (ICC: 0.94 95% confidence interval) and the total agreement was 75% for test-retest reliability. Conclusion: The Turkish version of the E&R GMFCS is shown to be reliable and valid for assessment of Turkish CP children.

关键词： Cerebral palsy gross motor function classification system reliability Turkey

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Physical and Psychosocial Consequences of Falls in Ambulatory Individuals With Cerebral Palsy by Age and gross motor function

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ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION 2025年第5期106卷 688-695页

作者： Esterley, Marissa Krach, Linda E. Pederson, Kari Wandersee, Nathan G. Tierney, Sandy Callen Boyer, Elizabeth R. Gillette Childrens Dept Res St Paul MN USA Gillette Childrens Dept Adult Phys Med & Rehabil Dept Rehabil Med St Paul MN USA Univ Minnesota Twin Cities Dept Rehabil Med Minneapolis MN USA Univ Minnesota Twin Cities Dept Orthoped Surg Minneapolis MN USA

Objective: To quantify physical and psychosocial impacts of falls by age and gross motor classification system (GMFCS) level in ambulatory individuals with cerebral palsy (CP). Design: Cross-sectional survey. Setting: Tertiary specialty hospital and online CP communities. Participants: Ambulatory individuals with CP (N=201 adults;18-76 years old) or the caregivers of minors (N=180;5-17 years old). Main Outcome Measure(s): Participants completed online surveys to report fall frequency, fall characteristics, injuries, concern about falling (Short Falls Efficacy Scale-International), activity avoidance due to concern about falling (Short Falls Efficacy Scale-International Avoidance Behavior), and psychosocial constructs related to perceived consequences of falling (Consequences of Falling-Damage to Identity subscale). Results: Most participants fell in the past 12 months (86%). Fall frequency in the past 12 months differed by age (P<.001) and GMFCS level (P=.021). Individuals aged 5-12 years or GMFCS level II reported the most falls. The percentage of participants who experienced a past serious fall-related injury (eg, head/face stitches, concussion, fractures) increased with age (P<.001), affecting 80% of >= 50-year olds. Falls often occurred in the forward direction, when wearing shoes, and during ambulation. Uneven surfaces and fatigue were notable causes. Concern about falling and associated activity avoidance scores differed by age and GMFCS level (all P<.01), both of which were highest for >= 50-year olds and GMFCS level III. Although psychosocial consequences of falls (eg, embarrassment, lost confidence) were elevated across all groups, they did not differ by age or GMFCS level (P=.130, P=.083). Nearly everyone (88%) wished they fell less. Conclusions: Falls are common for ambulatory children and adults with CP. Physical and psychosocial consequences of falls were frequent and impacted behavior. Differences observed by age and GMFCS level should be considered in

关键词： Accidental falls Anxiety Falls efficacy Postural balance CP cerebral palsy FES-I Falls Efficacy Scale-International FES-IAB Falls Efficacy Scale-International Avoidance Behavior GMFCS gross motor function classification system

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Hospitalizations Following Complex Hip Surgery in Children with Intellectual Disability: A Self-Controlled Case Series Analysis

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JOURNAL OF PEDIATRICS 2025年 278卷 114435-114435页

作者： Anpalagan, Keerthi Jacoby, Peter Stannage, Katherine Leonard, Helen Langdon, Katherine Gibson, Noula Nagarajan, Lakshmi Wong, Kingsley Downs, Jenny Univ Western Australia Kids Res Inst Australia Ctr Child Hlth Res Perth Australia Perth Childrens Hosp Orthopaed Dept Perth Australia Perth Childrens Hosp Kids Rehab Perth Australia Perth Childrens Hosp Physiotherapy Dept Perth Australia UWA Perth Childrens Hosp Neurol Dept Perth Australia Curtin Univ Curtin Sch Allied Hlth Perth Australia

Objective To evaluate the associations between complex hip surgery and subsequent hospitalizations in children with intellectual disability, including a subset of children with cerebral palsy. Study design We conducted a retrospective cohort study using linked administrative, health, and disability data from Western Australia. Children born between 1983 and 2009 who underwent complex hip surgery by end 2014 were included (intellectual disability, n = 154;subset with cerebral palsy, n = 91). A self-controlled case series analysis using Poisson regression was used to estimate the age-adjusted associations of complex hip surgery on all- cause hospitalizations and when the principal diagnosis was lower respiratory tract infection or epilepsy, for periods following the individual's first major hip surgery, compared with the year before surgery. Results Age adjusted incidence of all-cause hospitalizations decreased after surgery (year 1: incidence rate ratio [IRR] 0.87 [95% CI, 0.74-1.02];year 6: IRR 0.57 [95% CI, 0.46-0.72]). The incidence of hospitalizations for lower respiratory tract infection increased (year 1: IRR, 1.03 [95% CI, 0.72-1.51];year 6: IRR 2.08 [95% CI, 1.18-3.68]). The incidence of hospitalizations for epilepsy decreased (year 1: IRR 0.93 [95% CI, 0.57, 1.54];year>6: IRR 0.72 [95% CI, 0.34-1.55]) after surgery. A similar pattern was observed for the subset of children with or without cerebral palsy. Conclusion Complex hip surgeries are associated with fewer hospitalizations overall but not respiratory hospitalizations for children with intellectual disability. Fewer hospitalizations suggest benefits for better musculoskeletal alignment. (J Pediatr 2025;278:114435).

关键词： data linkage intellectual disability database observational study cerebral palsy ACHI Australian classification of health intervention CP Cerebral palsy GMFCS gross motor function classification system ICD-10-AM International statistical classification of diseases and related health problems, tenth revision, Australian modification ICD-9-CM International classification of Disease, ninth revision ID Intellectual disability IDEA Intellectual Disability Exploring Answers IRR Incidence rate ratio LRTI Lower respiratory tract infection SCCS Self controlled case series WARDA Western Australian register of developmental anomalies

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Prediction of Neurodevelopmental Outcomes at 18 to 22 Months Using the Numerical Sarnat Score Compared with Modified Sarnat Staging in Infants with Moderate to Severe Hypoxic-Ischemic Encephalopathy

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JOURNAL OF PEDIATRICS 2025年 281卷 114522-114522页

作者： Natarajan, Girija McDonald, Scott A. Shankaran, Seetha Laptook, Abbot R. Bonifacio, Sonia Sewell, Elizabeth K. Chalak, Lina Cent Michigan Univ Discipline Pediat Mt Pleasant MI USA Wayne State Univ Dept Pediat Detroit MI USA RTI Int Dept Pediat Res Triangle Pk NC USA Brown Univ Dept Pediat Providence RI USA Stanford Univ Sch Med Dept Pediat Stanford CA USA Emory Univ Sch Med & Childrens Healthcare Atlanta Dept Pediat Div Neonatol Atlanta GA USA Univ Texas Southwestern Dept Pediat Div Neonatol Dallas TX USA Univ Texas Austin Austin TX USA Dell Childrens Hosp Austin TX USA

Objective To examine the association of a numerical Sarnat score (NSS) and modified Sarnat staging among newborn infants with moderate/severe hypoxic-ischemic encephalopathy and their neurodevelopmental outcomes at 18-22 months. Study design This secondary analysis included participants with gestational age >= 36 weeks and moderate/severe hypoxic-ischemic encephalopathy (HIE) from the Induced Hypothermia and Optimizing Cooling trials. Early (<6 hours age) neurologic examinations were performed by trained examiners to categorize HIE severity by modified Sarnat staging. The NSS was calculated by summing abnormal scores (2 for moderate, 3 for severe) in the 6 examination categories. The primary outcome was death or moderate/severe disability. Statistical analysis included logistic regression, adjusting for center, trial, and cooling group, and linear regression for continuous scales. Results The cohort (n = 528) included infants with 71% moderate and 29% severe HIE (37% Induced Hypothermia and 63% Optimizing Cooling participants). Median (IQR) NSS of infants with moderate and severe HIE were 11 (9-13) and 16 (16-17), respectively. There were significant associations among NSS, NSS tertiles, and modified Sarnat staging and death or disability, but there were no differences found in their area-under-the-curve estimates. Similar to modified Sarnat staging, NSS showed significant associations with Bayley-III cognitive, language, and motor scores and Bayley-II mental and psychomotor developmental indices. Conclusion Among infants with moderate or severe HIE, the NSS did not improve the predictive accuracy for death or disability at 18-22 months of age, compared with modified Sarnat staging performed in the initial 6 hours after birth by trained examiners.

关键词： hypoxic-ischemic encephalopathy Sarnat staging disability EEG Electroencephalogram GMFCS gross motor function classification system HIE Hypoxic-ischemic encephalopathy IH Induced Hypothermia MDI Mental Developmental Index MRI Magnetic resonance imaging NICHD National Institute of Child Health and Human Development NRN Neonatal Research Network NSS Numerical Sarnat score OC Optimizing Cooling PDI Psychomotor Developmental Index RCT Randomized controlled trial SIBEN Score of the Iberoamerican Society of Neonatology TH Therapeutic hypothermia TSS Total Sarnat score

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Psychometric Evaluation of the Persian Version of the functional Mobility Scale: Assessing Validity and Reliability

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PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS 2024年第5期44卷 721-732页

作者： Sadeghian Afarani, Razieh Fatorehchy, Saeid Rassafiani, Mehdi Vahedi, Mohsen Azadi, Hamidreza Akbarfahimi, Nazila Univ Social Welf & Rehabil Sci Fac Rehabil Sci Dept Occupat Therapy Tehran Iran Charles Sturt Univ Sch Allied Hlth Exercise & Sports Sci Bathurst Australia Univ Social Welf & Rehabil Sci Psychosis Res Ctr Dept Biostat & Epidemiol Tehran Iran Isfahan Univ Med Sci Dept Occupat Therapy Esfahan Iran Univ Social Welf & Rehabil Sci Rofeideh Rehabil Hosp Sch Rehabil Sci Dept Occupat Therapy Tehran Iran

AimThis study aimed to assess the content, concurrent validity, test-retest, and intra-rater reliability of the Persian version of the functional Mobility Scale (FMS) for evaluating functional mobility in children and adolescents with cerebral palsy (CP).MethodsFollowing international standards for measurement translation, we developed a Persian version of the FMS. A total of 160 participants took part in this study. Concurrent validity was assessed using Spearman's coefficient to correlate with the gross motor function classification system (GMFCS). Test-retest (n = 30) and intra-rater (n = 30) reliability of the FMS were also examined by Cohen's weighted kappa *** validity ranged from -0.912 to -0.941 for children and -0.912 to -0.936 for adolescents. Test-retest ranged from 0.902 to 1. Intra-rater ranged from 0.933 to *** Persian version of the FMS demonstrates very strong validity and almost perfect reliability for assessing and classifying functional mobility in children and adolescents with CP. These findings suggest that this tool could be a useful addition to clinical practice and research for the Persian-speaking population.

关键词： Cerebral palsy functional mobility scale gross motor function classification system measure reliability validity

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functional classification systems in Brazilian children with cerebral palsy: Reliability and associations between functional levels

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DEVELOPMENTAL NEUROREHABILITATION 2024年第7期27卷 243-250页

作者： Ayupe, Kennea Martins Almeida Lima, Amanda Larissa Oliveira Gomes, Gabrielly Cristine de Alcantara de Sousa, Deysiane Sobrinho Camargos, Ana Cristina Resende Chagas, Paula Silva de Carvalho Leite, Hercules Ribeiro Longo, Egmar de Toledo, Aline Martins Univ Brasilia Fac Ceilandia Sch Phys Therapy Bl ESQS 205 Brasilia DF Brazil Univ Brasilia Fac Ceilandia Grad Program Rehabil Sci Brasilia Brazil Univ Fed Minas Gerais Grad Program Rehabil Sci Belo Horizonte Brazil Univ Fed Juiz De Fora Sch Phys Therapy Grad Program Rehabil Sci & Phys & Funct Performanc Juiz De Fora Brazil Univ Fed Paraiba Grad Program Phys Therapy & Models Decis & Hlth Joao Pessoa Brazil

Children with Cerebral palsy (CP) present movement and posture disorders. The gross motor function classification system (GMFCS), Manual Ability classification system (MACS), Communication function classification system (CFCS), Eating and Drinking Ability classification system (EDACS), and Visual function classification system (VFCS) enhance the understanding of their performance. We verified inter-rater reliability and associations between the classification levels. Physical therapists classified 100 Brazilian children with CP (3-17 years) according to GMFCS, MACS, CFCS, EDACS, and VFCS. To evaluate inter-rater reliability (Intraclass Correlation Coefficient-ICC) two independent examiners concurrently assessed a subset of 60 participants. According to Spearman's correlation coefficients, there were associations between GMFCS/MACS (r = 0.81), GMFCS/CFCS (r = 0.70), MACS/CFCS (r = 0.73), GMFCS/VFCS (r = 0.61), MACS/VFCS (r = 0.61), CFCS/EDACS (r = 0.58), CFCS/VFCS (r = 0.50), and EDACS/VFCS (r = 0.45) (p < .05). The inter-rater reliability ranged from excellent (ICC = 0.93-0.99) to good (ICC = 0.89), p < .05. The classification systems are reliable, and the levels associated with each other in Brazilian children, especially the GMFCS, MACS, and CFCS.

关键词： Cerebral palsy communication function classification system eating and drinking ability classification system gross motor function classification system manual ability classification system

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Assessing Early Severity of Hypoxic-Ischemic Encephalopathy: The Role of Electroencephalogram Background in Addition to Sarnat Exam

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JOURNAL OF PEDIATRICS 2025年 277卷 114411-114411页

作者： Cornet, Marie-Coralie Numis, Adam L. Monsell, Sarah E. Chan, Natalie H. Gonzalez, Fernando F. Comstock, Bryan A. Juul, Sandra E. Wusthoff, Courtney J. Wu, Yvonne W. Glass, Hannah C. Univ Calif San Francisco Dept Pediat San Francisco CA 94143 USA Univ Calif San Francisco Dept Neurol San Francisco CA 94143 USA Univ Calif San Francisco Weill Inst Neurosci San Francisco CA 94143 USA Univ Washington Dept Biostat Seattle WA USA Univ Washington Sch Med Dept Pediat Seattle WA USA Stanford Univ Dept Neurol Palo Alto CA USA Univ Calif San Francisco Dept Epidemiol & Biostat San Francisco CA 94143 USA

Objective To assess the relationship between the Sarnat exam, early electroencephalogram (EEG) background, and death or neurodevelopmental impairment (NDI) at age 2 years among neonates with moderate to severe hypoxic-ischemic encephalopathy treated with therapeutic hypothermia. (n = 463) or amplitude-integrated electroencephalogram (n = 15) reports available on the first day after birth were included in this cohort study. A Sarnat exam was performed between 1 and 6 hours after birth, and neonates were classified into 3 groups of increasing severity based on the number of severe features (none, 1-2, or 3+). EEG background continuity was extracted from reports and categorized as normal, excessively discontinuous, or severely abnormal. The primary outcome was severe NDI or death at age 2. Results Among 478 neonates with hypoxic-ischemic encephalopathy, EEG background continuity was normal in 186 (39%), excessively discontinuous in 171 (36%), and severely abnormal in 121 (25%). For each additional severe feature on the Sarnat exam, the risk of abnormal EEG background increased by 16% (relative risk 1.16 [95% CI 1.09-1.23]). Both the Sarnat exam and EEG background severity were associated with an increased risk of severe NDI or death. After adjusting for Sarnat exam severity, severe EEG background remained associated with severe NDI and death (relative risk 5.7 [95% CI 3.7-8.9]). Conclusions The early EEG background provides additional information beyond the Sarnat exam and could be an additional early marker when assessing the severity of HIE. (J Pediatr 2025;277:114411).

关键词： infant hypoxia-ischemia brain hypothermia induced electroencephalography brain injury neurodevelopment aEEG Amplitude-integrated electroencephalogram EEG Electroencephalogram GMFCS gross motor function classification system HEAL High-dose Erythropoietin for Asphyxia and Encephalopathy HIE Hypoxic-ischemic encephalopathy NDI Neurodevelopmental impairment NICHD National Institute of Child Health and Human Development RR Relative risk TH Therapeutic hypothermia

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Femoral neck-shaft angle changes based on the severity of neurologic impairment in children with cerebral palsy and spinal muscular atrophy

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JOURNAL OF CHILDRENS ORTHOPAEDICS 2024年第5期18卷 523-530页

作者： da Silva, Luiz Carlos Almeida Hori, Yusuke Kaymaz, Burak Rogers, Kenneth J. Trionfo, Arianna Bowen, James Richard Howard, Jason J. Shrader, Michael Wade Miller, Freeman Nemours Childrens Hlth Dept Orthopaed Wilmington DE USA

Introduction: The neck-shaft angle and head-shaft angle in children with varying levels of neurological disability were evaluated to define change over different ***: Children aged 1-12 years with spastic cerebral palsy, spinal muscular atrophy types 1 and 2, or typical development were reviewed to evaluate the neck-shaft angle and head-shaft angle. Patients were divided into five groups: gross motor function classification system levels I and II, gross motor function classification system level III, gross motor function classification system levels IV and V, spinal muscular atrophy types 1 and 2, and typical development. A linear mixed model was utilized to evaluate neck-shaft angle and head-shaft ***: Data from 196 children (mean age 4.8 +/- 4.5 years) were included. gross motor function classification system levels I and II: 22 children, 130 hip radiographs measured, neck-shaft angle 143.7 +/- 7.4, and head-shaft angle 160.0 +/- 7.1. gross motor function classification system level III: 8 children, 33 hips evaluated, neck-shaft angle 153.1 +/- 4.3, and head-shaft angle 163.4 +/- 4.2. gross motor function classification system levels IV and V: 30 children, 137 hip radiographs measured, neck-shaft angle 156.4 +/- 5.6, and head-shaft angle 167.9 +/- 6.8. Spinal muscular atrophy types 1 and 2: 32 children, 83 hip radiographs measured, neck-shaft angle 161.9 +/- 9.7, and head-shaft angle 173.4 +/- 7.4. Typical development: 104 children, 222 hip radiographs measured, neck-shaft angle 138.6 +/- 7.0, and head-shaft angle 156.4 +/- 5.9. There were significant statistical differences when comparing neck-shaft angle and head-shaft ***: As children grow, neck-shaft angle and head-shaft angle tend to decrease in typical development and gross motor function classification system levels I and II groups. However, in low-tone (spinal muscular atrophy types 1 and 2) and high-tone groups (gross motor function classification system levels IV and V), n

关键词： Cerebral palsy spinal muscular atrophy gross motor function classification system neck-shaft angle head-shaft angle proximal femoral guided growth linear mixed model

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