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Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older

Jan Willem Gorter1, Marjolijn Ketelaar, Peter Rosenbaum

  • 1CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada. gorter@mcmaster.ca

Developmental Medicine and Child Neurology
|November 21, 2008
PubMed

Insights

The Gross Motor Function Classification System (GMFCS) can classify infants with cerebral palsy (CP), but reclassification is needed by age 2 for greater accuracy. Early GMFCS levels may change as children develop.

Area of Science:

  • Pediatrics
  • Neurology
  • Rehabilitation Medicine

Background:

  • The Gross Motor Function Classification System (GMFCS) is widely used to categorize motor function in children with cerebral palsy (CP).
  • Understanding the stability of GMFCS classifications in early childhood is crucial for predicting long-term outcomes and guiding interventions.

Purpose of the Study:

  • To evaluate the stability of GMFCS classifications over time in infants diagnosed with cerebral palsy.
  • To determine the rate and direction of GMFCS level changes from infancy to early childhood.

Main Methods:

  • Longitudinal study of 77 infants with CP (mean age 19.4 months) assessed using GMFCS.
  • Follow-up assessments were conducted between ages 2 and 4 years.
  • Statistical analysis included linear weighted kappa for agreement and McNemar's test for changes.

Main Results:

  • Overall GMFCS agreement over time was 0.70 (95% CI 0.61-0.79).
  • 42% of children changed GMFCS levels by one or two grades, with a trend towards less functional levels.
  • High positive predictive values (PPV) were observed for maintaining Levels I-III (0.96) and Levels I-II (0.88).

Conclusions:

  • GMFCS classification in infants is less precise than in older children.
  • While early classification is possible, re-evaluation around age 2 or older is recommended as more clinical information emerges.
  • GMFCS provides a valuable framework for classifying motor function in CP, but its dynamic nature in early childhood necessitates periodic reassessment.

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