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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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Examining Reliability and Validity of the Jebsen-Taylor Hand Function Test Among Children With Cerebral Palsy

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PERCEPTUAL AND MOTOR SKILLS 2020年第4期127卷 684-697页

作者： Tofani, M. Castelli, E. Sabbadini, M. Berardi, A. Murgia, M. Servadio, A. Galeoto, G. Bambino Gesu Pediat Hosp Neurorehabil Unit Dept Neurosci & Neurorehabil Piazza St Onofrio 4 I-00185 Rome Italy Sapienza Univ Rome Rome Italy Sapienza Univ Rome Dept Anat Sci Histol Legal Med & Locomotor Appara Rome Italy Tor Vergata Hosp Dept Hlth Profess Rome Italy Sapienza Univ Rome Dept Publ Hlth & Infect Dis Rome Italy

manual dexterity has strongly predicted functional independence for daily life activities among children with cerebral palsy (CP). The Jebsen-Taylor Hand Function Test (JTHFT) is the most widely used assessment tool for exploring manual dexterity in the CP population, though no research has yet examined its psychometric properties for this use. This cross-sectional study explored the validity and internal consistency of the JTHFT in an Italian sample of inpatient and outpatient children with CP aged between 6-18 years (35 girls and 49 boys). We calculated internal consistency with Cronbach's alpha and tested validity against the manual ability classification system (MACS) using Pearson's correlation coefficient. To better understand how the JTHFT compares with different levels of the MACS, we performed dominant hand timing variability for each test item. Results showed excellent internal consistency with a Cronbach's alpha of .944 and .911, respectively, for nondominant and dominant hands. There was also a statistically significant positive linear Pearson's correlation coefficient between the JTHFT and the MACS (p < .01). We observed high variability in writing performance (Item 1 of the JTHFT) within this sample for each level of the MACS. This study confirms that the JTHFT is a valid assessment tool when used in children with CP aged 6-18 years.

关键词： cerebral palsy manual dexterity hand functions Jebsen-Taylor Hand Function Test manual ability classification system outcome assessment (healthcare) Italian

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Hand Preference and Cognitive, Motor, and Behavioral Functioning in 10-Year-Old Extremely Preterm Children

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JOURNAL OF PEDIATRICS 2018年 195卷 279-+页

作者： Burnett, Alice C. Anderson, Peter J. Joseph, Robert M. Allred, Elizabeth N. O'Shea, T. Michael Kuban, Karl C. K. Leviton, Alan Murdoch Childrens Res Inst Victorian Infant Brain Studies Melbourne Vic Australia Royal Womens Hosp Premature Infant Follow Program Melbourne Vic Australia Royal Childrens Hosp Neonatal Med Melbourne Vic Australia Univ Melbourne Dept Pediat Melbourne Vic Australia Monash Univ Sch Psychol Sci Melbourne Vic Australia Boston Univ Dept Anat & Neurobiol Boston MA 02215 USA Boston Childrens Hosp Dept Neurol Boston MA USA Harvard Med Sch Dept Neurol Boston MA USA Univ N Carolina Dept Pediat Chapel Hill NC USA Boston Univ Med Ctr Dept Pediat Div Pediat Neurol Boston MA 02215 USA

The association of hand preference (left, mixed, and right) with cognitive, academic, motor, and behavioral function was evaluated in 864 extremely preterm children at 10 years of age. Left-handed and right-handed children performed similarly but mixed-handed children had greater odds of functional deficits across domains than right-handed children.

关键词： ADHD Attention deficit hyperactivity disorder ASD Autism spectrum disorder MACS manual ability classification system NEPSY-II NEuroPSYchological Assessment-II

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Functional profiles of children with cerebral palsy in Jordan based on the association between gross motor function and manual ability

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BMC PEDIATRICS 2018年第1期18卷 276-276页

作者： Almasri, Nihad A. Saleh, Maysoun Abu-Dahab, Sana Malkawi, Somaya H. Nordmark, Eva Univ Jordan Sch Rehabil Sci Dept Physiotherapy Queen Rania Al Abdallah St Amman 11942 Jordan Univ Jordan Sch Rehabil Sci Dept Occupat Therapy Queen Rania Al Abdallah St Amman 11942 Jordan Lund Univ Fac Med PO 157 SE-22100 Lund Sweden

Background: Cerebral palsy (CP) is the most common cause of physical disability in childhood. A major challenge for delivering effective services for children with CP is the heterogeneity of the medical condition. Categorizing children into homogeneous groups based on functional profiles is expected to improve service planning. The aims of this study were to (1) to describe functional profiles of children with CP based on the Gross Motor Function classification system-Expanded & Revised (GMFCS-E & R) and the manual ability classification system (MACS);and (2) to examine associations and agreements between the GMFCS-E & R and the MACS for all participants then for subgroups based on subtypes of CP and chronological age of children. Methods: A convenience sample of 124 children with CP (mean age 4.5, SD 2.9 years, 56% male) participated in the study. Children were classified into the GMFCS-E & R and the MACS levels by research assistants based on parents input. Research assistants determined the subtypes of CP. Results: Thirty six percent of the participants were able to ambulate independently (GMFCS-E & R levels I-II) and 64% were able to handle objects independently (MACS levels I-II). The most common functional profile of children with CP in our study is the "manual abilities better than gross motor function". An overall strong correlation was found between the GMFCS-E & R and the MACS (r(s) = .73, p < .001), the correlations vary significantly based on subtypes of CP and chronological age of children. A very strong correlation was found in children with spastic quadriplegia (r(s) = .81, p < .001), moderate with spastic diplegia (r(s) = .64, p < .001), and weak with spastic hemiplegia (r(s) = .37, p < .001). Conclusions: The GMFCS-E & R and the MACS provide complementary but distinctive information related to mobility and manual abilities of children with CP. Subtypes of CP and chronological age differentiated functional profiles. Functional abilities of children w

关键词： Gross Motor Function classification system-Expanded &Revised manual ability classification system Cerebral palsy Children Functional profiles Jordan

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Functional Outcomes After Upper Extremity Surgery for Cerebral Palsy: Comparison of High and Low manual ability classification system Levels

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JOURNAL OF HAND SURGERY-AMERICAN VOLUME 2010年第2期35A卷 277-283页

作者： Gong, Hyun Sik Chung, Chin Youb Park, Moon Seok Shin, Hyung-Ik Chung, Moon Sang Baek, Goo Hyun Seoul Natl Univ Bundang Hosp Dept Orthopaed & Rehabil Songnam South Korea

Purpose The heterogeneity of cerebral palsy makes interpretation and prediction of outcome after upper extremity surgery difficult. We hypothesized that the outcome of upper extremity surgery for cerebral palsy is related to the manual ability classification system (MACS) level. Methods We reviewed 27 patients with a mean age of 22 years, who underwent upper extremity surgery for spastic cerebral palsy at a mean follow-up of 29 months. Patients were classified into 5 MACS levels using a standardized questionnaire completed by their primary caregivers. Preoperatively and at most recent follow-up visits, patients were assessed using the House scale and patient-reported functional outcomes on a 5-point scale. We compared the outcomes of patients with high (I-II, independence in daily activities) and low (III-V, dependence in daily activities) MACS levels. Results The overall mean House scale improved from 2.9 to 4.6 postoperatively (p<.001), dressing ability from 3.7 to 4.2 (p=.005), hygiene from 4.2 to 4.9 (p=.005), and appearance from 2.4 to 4.2 (p<.001). A total of 13 patients had a high MACS level (7 had I and 6 had II) and 14 had a low MACS level (8 had III, 6 had IV, and none had V). The high-MACS group had a greater improvement according to the House scale (p=.009) and the low-MACS group had a larger improvement in hygiene status (p=.043). There were no differences in the amount of improvement in dressing ability (p=.169) and appearance (p=.765). Overall satisfaction with surgery was higher for the high-MACS group (p=.038). Conclusions The high-MACS group had a greater improvement in rating according to the House scale and higher satisfaction than the low-MACS group after upper extremity surgery for cerebral palsy in our small number of patients. This study suggests that the MACS level can be used to predict upper extremity surgery outcomes for cerebral palsy. (J Hand Surg 2010;35A:277-283. Copyright (C) 2010 by the American Society for Surgery of the Hand. All

关键词： Cerebral palsy upper extremity surgery manual ability classification system outcome

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Reliability and cross-cultural validation of the Turkish version of manual ability classification system (MACS) for children with cerebral palsy

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DISability AND REHABILITATION 2010年第23期32卷 1910-1916页

作者： Akpinar, Pinar Tezel, Canan G. Eliasson, Ann-Christin Icagasioglu, Afitap Goztepe Educ & Res Hosp Dept Phys Med & Rehabil TR-34734 Istanbul Turkey Karolinska Inst Dept Woman & Child Hlth Stockholm Sweden

Purpose. To determine the reliability and cross-cultural validation of the Turkish translation of the manual ability classification system (MACS) for children with cerebral palsy (CP) and to investigate the relation to gross motor function and other comorbidities. Methods. After the forward and backward translation procedures, inter-rater and test-retest reliability was assessed between parents, physiotherapists and physicians using the intra-class correlation coefficient (ICC). Children (N = 118, 4 to 18 years, mean age 9 years 4 months;68 boys, 50 girls) with various types of CP were classified. Additional data on the Gross Motor Function classification system (GMFCS), intellectual delay, visual acuity, and epilepsy were collected. Results. The inter-rater reliability was high;the ICC ranged from 0.89 to 0.96 among different professionals and parents. Between two persons of the same profession it ranged from 0.97 to 0.98. For the test-retest reliability it ranged from 0.91 to 0.98. Total agreement between the GMFCS and the MACS occurred in only 45% of the children. The level of the MACS was found to correlate with the accompanying comorbidities, namely intellectual delay and epilepsy. Conclusion. The Turkish version of the MACS is found to be valid and reliable, and is suggested to be appropriate for the assessment of manual ability within the Turkish population.

关键词： Cerebral palsy children manual ability classification system

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Review of Therapeutic Interventions for the Upper Limb Classified by manual ability in Children with Cerebral Palsy

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SEMINARS IN PLASTIC SURGERY 2016年第1期30卷 14-23页

作者： Shierk, Angela Lake, Amy Haas, Tara Texas Scottish Rite Hosp Children Occupat Therapy Dallas TX 75219 USA Texas Childrens Hosp Phys Med & Rehabil Houston TX 77030 USA

The aim of this literature review was to assemble an inventory of intervention strategies utilized for children diagnosed with cerebral palsy (CP) based on the manual ability classification system (MACS). The purpose of the inventory is to guide physicians and therapists in intervention selection aimed at improving upper limb function in children with CP. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Database of systematic Reviews, ERIC (Educational Research Information Center), Google Scholar, OTSeeker (Occupational Therapy systematic Evaluation of Evidence), OVID (Ovid Technologies, Inc.), and PubMed. Inclusion criteria were whether the study (1) identified MACS levels of participants, and (2) addressed the effectiveness of intervention on upper limb function. Overall, 74 articles met the inclusion criteria. The summarized data identified 10 categories of intervention. The majority of participants across studies were MACS level II. The most frequently cited interventions were constraint-induced movement therapy (CIMT), bimanual training, and virtual reality and computer-based training. Multiple interventions demonstrated effectiveness for upper limb improvement at each MACS level. However, there is a need for additional research for interventions appropriate for MACS levels IV and V. To fully develop an intervention inventory based on manual ability, future studies need to report MACS levels of participants, particularly for splinting and therapy interventions used in combination with surgery.

关键词： cerebral palsy manual ability classification system therapy intervention surgical intervention upper limb

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Bimanual Fine Motor Function (BFMF) classification in Children with Cerebral Palsy: Aspects of Construct and Content Validity

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PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS 2016年第1期36卷 1-16页

作者： Elvrum, Ann-Kristin G. Andersen, Guro L. Himmelmann, Kate Beckung, Eva Ohrvall, Ann-Marie Lydersen, Stian Vik, Torstein St Olavs Univ Hosp Dept Clin Serv N-7006 Trondheim Norway Norwegian Univ Sci & Technol Fac Med Dept Lab Med Childrens & Womens Hlth N-7034 Trondheim Norway Vestfold Hosp Trust Cerebral Palsy Register Norway Tonsberg Norway Univ Gothenburg Sahlgrenska Acad Queen Silvia Childrens Hosp Dept PediatInst Clin Sci Gothenburg Sweden Univ Gothenburg Sahlgrenska Acad Inst Neurosci & Physiol Dept Physiotherapy Gothenburg Sweden Karolinska Inst Dept Womens & Childrens Hlth Stockholm Sweden Norwegian Univ Sci & Technol Fac Med Reg Ctr Child & Youth Mental Hlth & Child Welf N-7034 Trondheim Norway

The Bimanual Fine Motor Function (BFMF) is currently the principal classification of hand function recorded by the Surveillance of Cerebral Palsy in Europe (SCPE) register. The BFMF is used in a number of epidemiological studies, but has not yet been validated. Aims: To examine aspects of construct and content validity of the BFMF. Methods and Results: Construct validity of the BFMF was assessed by comparison with the manual ability classification system (MACS) using register-based data from 539 children born 1999-2003 (304 boys;4-12years). The high correlation with the MACS (Spearman's rho = 0.89, CI: 0.86-0.91, p<.001) supports construct validity of the BFMF. The content of the BFMF was appraised through literature review, and by using the ICF-CY as a framework to compare the BFMF and MACS. The items hold, grasp and manipulate were found to be relevant to describe increasingly advanced fine motor abilities in children with CP, but the description of the BFMF does not state whether it is a classification of fine motor capacity or performance. Conclusion: Our results suggest that the BFMF may provide complementary information to the MACS regarding fine motor function and actual use of the hands, particularly if used as a classification of fine motor capacity.

关键词： Bimanual fine motor function cerebral palsy classification fine motor manual ability classification system validity

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The Relationship Between manual ability and Ambulation in Adolescents with Cerebral Palsy

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PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS 2013年第2期33卷 243-252页

作者： Majnemer, Annette Shikako-Thomas, Keiko Shevell, Michael Poulin, Chantal Lach, Lucyna Law, Mary Schmitz, Norbert McGill Univ Sch Phys & Occupat Hlth Montreal PQ Canada McGill Univ Dept Pediat Montreal PQ H3A 2T5 Canada McGill Univ Dept Neurol & Neurosurg Montreal PQ Canada McGill Univ Dept Pediat Montreal Childrens Hosp Montreal PQ H3A 2T5 Canada McGill Univ Sch Social Work Montreal PQ Canada McMaster Univ Sch Rehabil Sci Hamilton ON Canada McGill Univ Dept Psychiat Inst Douglas Montreal PQ Canada

This study examined the relationship between gross motor function and manual ability in 120 adolescents with cerebral palsy (CP) (15.2, SD 2.1 years, 59.8% male). Adolescents were evaluated using the Gross Motor Function classification system (GMFCS) and the manual ability classification system (MACS). A neurologist classified CP subtype. Most adolescents were ambulatory with or without utilization of aids (GMFCS level I: 35.0%, II: 30.0%, III: 5.8%, IV: 10.8%, and V: 18.3%). MACS levels were I: 34.2%, II: 25.8%, III: 16.7%, IV: 7.5%, and V: 15.8%. Correlations between GMFCS and MACS were strong in youth with quadriplegia (r = .89, p < .001), moderate in individuals with diplegia (r = .58, p = .01), but weakly associated for adolescents with hemiplegia (r = .24, p = .23). The findings provide evidence for maintaining a clinical distinction between spastic quadriplegia and spastic diplegia. manual ability may not be congruent with mobility in adolescents with CP and should be specifically evaluated given its importance to daily life functioning.

关键词： Adolescents cerebral palsy gross motor function classification system manual ability classification system

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Agreement between parents and clinicians for the motor functional classification systems of children with cerebral palsy

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DISability AND REHABILITATION 2011年第11期33卷 927-932页

作者： Mutlu, Akmer Kara, Ozgun Kaya Gunel, Mintaze Kerem Karahan, Sevilay Livanelioglu, Ayse Hacettepe Univ Dept Physiotherapy & Rehabil Fac Hlth Sci Ankara Turkey

Purpose. This study aimed to evaluate whether parental ratings of expanded and revised Gross Motor Function classification system (GMFCS E&R) and manual ability classification system (MACS) had agreement with clinicians' ratings when classifying children with CP to these two well-known classifications of motor functioning and hereby to evaluate intertester reliability of the classification systems between clinicians and parents. Method. The process of study was designed to collect data from parents using the GMFCS E& R and MACS. The total participants consisted of 100 children with CP and their parents. The overall agreement between the parents and physiotherapist GMFCS and MACS scores was analysed using intraclass correlation coefficient (ICC). Results. The ICC value between parents and physiotherapist was 0.96 (95% confidence interval [CI] 0.95-0.97) for GMFCS and 0.96 (95% CI 0.94-0.97) for MACS and indicated excellent agreement. Conclusions. The excellent agreement between parents and clinicians indicated that parents and clinicians can talk in the same language for the motor functional classification systems of children with CP if careful administrations are provided.

关键词： Cerebral palsy parent Gross Motor Functional classification systems manual ability classification system

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