A classification of bimanual fine function (BFMF) was described by Beckung et al in 2002. ĭescribing upper limb function in CP has been a more challenging task. According to the designers of the GMFCS, most children will remain at the same level from age 2 to 12 years, which makes it possible to try to predict gross motor development. The GMFCS has been internationally accepted and is widely used. The GMFCS has proved to be a valid and reliable tool and has been reported to remain relatively stable over time. It is an age-related five-level system in which level I represents the least limitation and level V the most (Table I). The GMFCS was developed to describe gross motor function in children with CP and has its focus on self-initiated movements, in particular sitting and walking. The SC subtypes spastic tetraplegia and diplegia are thus not separated, instead children are described according to functional level in lower and upper extremities, cognitive development, visual function, hearing, epilepsy etc. In the SCPE classification, spastic CP is divided only into bilateral and unilateral (hemiplegia). The Swedish classification (SC) of clinical CP subtypes has been accepted and used internationally, but recently the Surveillance of Cerebral Palsy in Europe (SCPE) group proposed a new classification of CP subtypes. Associated cognitive, visual and other impairments are common and the proposed new definition of CP puts more focus on the activity restrictions and disability. It has been defined as a group of motor impairment syndromes secondary to a defect or lesion of the immature brain, and children with CP display a variety of functional limitations of varying severity. The GMFCS and the MACS seem to work well in this context and seem very useful in population-based studies, in health care registers for children with CP, and in clinical practice.Ĭerebral Palsy (CP) is the commonest cause of physical disability in early childhood. To give a complete clinical picture when evaluating these children, both aspects have to be described.
MANUAL ABILITIES CLASSIFICATION SYSTEM MANUAL
Gross motor function and manual ability are often discrepant in children with CP, and the patterns seem to vary across the different subgroups based on the predominant neurological findings. Children with dyskinetic CP had large limitations in both gross motor function and manual ability, with no significant discrepancy between GMFCS and MACS levels. The reverse association was generally found in children with spastic diplegia (p < 0.001). Children with spastic hemiplegia generally had a lower level of manual ability than gross motor function (p < 0.001). However, different associations between gross motor function and manual ability were found in the different diagnostic subtypes. There was a poor overall correlation between gross motor function and manual ability. GMFCS levels were available in all 365 children, MACS levels in 359 (98%). CP diagnosis and subtype were determined by the neuropaediatrician at or after the age of four. GMFCS was evaluated by the child's physiotherapist and MACS by the occupational therapist. Methodsģ65 children, born 1992 to 2001, who were registered in a population-based health care programme (CPUP) for children with CP living in the south of Sweden were included in the study. The aim of this study was to describe the association between gross motor function and manual ability in a total population of children with cerebral palsy.
The Manual Ability Classification System (MACS) was developed recently as a corresponding classification of manual ability. The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP).
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