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Updated: Aug 23, 2026
Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
Limb distribution, motor impairment, and functional classification of cerebral palsy
Jan Willem Gorter1, Peter L Rosenbaum, Steven E Hanna
1Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands.
Insights
The Gross Motor Function Classification System (GMFCS) effectively predicts mobility in children with cerebral palsy (CP). Limb distribution and motor impairment type offer limited additional prognostic value beyond GMFCS.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) classification systems are crucial for understanding functional abilities.
- The Gross Motor Function Classification System (GMFCS) is widely used to assess motor severity in CP.
- Limb distribution and motor impairment type are also considered in CP characterization.
Purpose of the Study:
- To investigate the association between GMFCS levels, limb distribution, and type of motor impairment in children with CP.
- To determine if limb distribution or motor impairment type provide additional prognostic value for mobility beyond GMFCS.
Main Methods:
- Utilized data from the Ontario Motor Growth study, a longitudinal cohort of 657 Canadian children with CP (aged 1-13 years).
- Analyzed relationships between GMFCS classifications and limb distribution/motor impairment type using statistical methods (Pearson's chi2, tau-b).
Main Results:
- A significant association was found between GMFCS and both limb distribution and motor impairment type (p<0.001).
- The correlation between limb distribution and GMFCS was low (tau-b=0.43).
- Limb distribution did not add significant prognostic value for mobility when GMFCS was considered.
Conclusions:
- GMFCS is a primary indicator of mobility in children with CP.
- While useful for clinical and epidemiological contexts, limb distribution and motor impairment type have limited prognostic value for mobility compared to GMFCS.
- GMFCS classification is superior for predicting mobility outcomes in pediatric cerebral palsy.
Abstract:
This study explored the relationships between the Gross Motor Function Classification System (GMFCS), limb distribution, and type of motor impairment. Data used were collected in the Ontario Motor Growth study, a longitudinal cohort study with a population-based sample of children with cerebral palsy (CP) in Canada (n=657; age 1 to 13 years at study onset). The majority (87.8%) of children with hemiplegia were classified as level I. Children with a bilateral syndrome were represented in all GMFCS levels, with most in levels III, IV, and V. Classifications by GMFCS and 'limb distribution' or by GMFCS and 'type of motor impairment' were statistically significantly associated (Pearson's chi2 p<0.001), though the correlation for limb distribution (two categories) by GMFCS was low (tau-b=0.43). An analysis of function (GMFCS) by impairment (limb distribution) indicates that the latter clinical characteristic does not add prognostic value over GMFCS. Although classification of CP by impairment level is useful for clinical and epidemiological purposes, the value of these subgroups as an indicator of mobility is limited in comparison with the classification of severity with the GMFCS.
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