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Stability of motor impairment in children with cerebral palsy
Michael I Shevell1, Annette Majnemer, Chantal Poulin
1Neurology/Neurosurgery and Pediatrics, McGill University, Montreal, Quebec, Canada. michael.shevell@muhc.mcgill.ca
Insights
Cerebral palsy (CP) classification remained stable for most children, though a notable minority experienced changes. Early non-spastic or quadriparetic classifications may predict subtype alterations in cerebral palsy.
Area of Science:
- Neurology
- Pediatrics
- Developmental Pediatrics
Background:
- Cerebral palsy (CP) is described by motor impairment quality and topographical patterns.
- Understanding CP classification stability is crucial for tracking development and intervention effectiveness.
Purpose of the Study:
- To compare initial and follow-up classifications of cerebral palsy in school-aged children.
- To identify predictors of CP subtype change over time.
Main Methods:
- A cohort of 93 children with CP were assessed initially and reassessed approximately 6.5 years later.
- Classifications included the Gross Motor Function Classification System (GMFCS) and CP subtype.
- Statistical analysis identified significant predictors of subtype change.
Main Results:
- Ninety-two percent of children remained classified with CP at follow-up.
- CP subtype remained constant in 72% of participants.
- Original classification as non-spastic or non-spastic quadriparetic CP predicted subtype change.
Conclusions:
- CP subtype classification is generally stable but changes occur in a significant minority of children.
- These changes may be influenced by intrinsic and extrinsic factors.
- Monitoring intervention effects in CP may be complicated by potential classification changes.
Abstract:
Classification of the quality and topographical pattern of motor impairment is used to describe cerebral palsy (CP). As an adjunct to a study characterizing the quality of life and participation of school-age children with C P, initial and follow-up classification of CP were compared. A cohort of 93 children (58 males, 35 females) were initially assessed at a mean age of 2 years 6 months (SD 2y 2mo) and re-assessed at 9 years 4 months (SD 2y 2mo) with a mean interval of 6 years 6 months (SD 2y 4mo) between assessments. Sixty children had Gross Motor Function Classification System levels I-III. All but one of the children were still classified has having CP at follow-up. Type of CP documented remained constant in 67 children (72%; 95% confidence interval 62-80). Clinical factors that were statistically significant (p<0.05) as possible predictors of CP subtype change were original classification of a non-spastic subtype or a non-spastic quadriparetic subtype. Change in CP subtype occurs in an appreciable minority of children with CP, which is likely to reflect a combination of intrinsic and extrinsic influences. Such change may challenge efforts to monitor the effects of interventions in this population.
