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Association between gross motor function (GMFCS) and manual ability (MACS) in children with cerebral palsy. A
Katharina Delhusen Carnahan1, Marianne Arner, Gunnar Hägglund
1Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden. katharina.delhusen-carnahan@skane.se
Insights
Gross motor function and manual ability in children with Cerebral Palsy (CP) are often different. The Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) help describe these differences in CP subgroups.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral Palsy (CP) affects motor function in children.
- The Gross Motor Function Classification System (GMFCS) assesses gross motor skills.
- The Manual Ability Classification System (MACS) evaluates manual abilities.
Purpose of the Study:
- To determine the association between gross motor function and manual ability in children with CP.
- To analyze these associations across different CP diagnostic subtypes.
Main Methods:
- A population-based study included 365 children with CP (born 1992-2001) in southern Sweden.
- Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels were assessed.
- CP diagnosis and subtype were confirmed by a neuropaediatrician.
Main Results:
- A weak overall correlation was found between GMFCS and MACS.
- Significant discrepancies were observed in spastic hemiplegia (lower manual ability) and spastic diplegia (lower gross motor function).
- Children with dyskinetic CP showed significant limitations in both domains without discrepancy.
Conclusions:
- Gross motor function and manual ability are frequently discrepant in children with CP.
- The GMFCS and MACS are valuable tools for a comprehensive clinical assessment.
- These classification systems aid in population-based studies and clinical practice for CP.
Background:
The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP). The Manual Ability Classification System (MACS) was developed recently as a corresponding classification of manual ability. 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.
Methods:
365 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. GMFCS was evaluated by the child's physiotherapist and MACS by the occupational therapist. CP diagnosis and subtype were determined by the neuropaediatrician at or after the age of four.
Results:
GMFCS levels were available in all 365 children, MACS levels in 359 (98%). There was a poor overall correlation between gross motor function and manual ability. However, different associations between gross motor function and manual ability were found in the different diagnostic subtypes. Children with spastic hemiplegia generally had a lower level of manual ability than gross motor function (p < 0.001). The reverse association was generally found in children with spastic diplegia (p < 0.001). Children with dyskinetic CP had large limitations in both gross motor function and manual ability, with no significant discrepancy between GMFCS and MACS levels.
Conclusion:
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. To give a complete clinical picture when evaluating these children, both aspects have to be described. 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.
