Related Experiment Video
Updated: May 17, 2026
Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy
Published on: August 9, 2024
Stability of the Gross Motor Function Classification System after single-event multilevel surgery in children with
Erich Rutz1, Oren Tirosh, Pam Thomason
1Murdoch Childrens Research Institute, The Royal Children's Hospital, Victoria, Australia. erich_rutz@hotmail.com
Insights
The Gross Motor Function Classification System (GMFCS) remained stable in most children with cerebral palsy (CP) after surgery. This finding is crucial for setting realistic goals and counseling families regarding CP treatment outcomes.
Area of Science:
- Orthopaedic Surgery
- Pediatric Rehabilitation
- Cerebral Palsy Research
Background:
- Conflicting reports exist regarding the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) post-orthopaedic surgery.
- The GMFCS is a key tool for classifying motor function in children with CP.
Purpose of the Study:
- To investigate the stability of the GMFCS in children with bilateral spastic CP following single-event multilevel surgery.
- To utilize the Gait Profile Score (GPS) as the primary outcome measure to assess surgical outcomes.
Main Methods:
- Retrospective cohort study of 107 children (GMFCS level II or III) with bilateral spastic CP.
- Data collected from surgeries performed between 1997 and 2008 at a single tertiary institution.
- Gait Profile Score (GPS) was the primary outcome; GMFCS levels were assessed pre- and post-intervention.
Main Results:
- A mean improvement of 28% in the Gait Profile Score (GPS) was observed, indicating partial correction of gait dysfunction.
- The GMFCS remained stable in 95% of children; 5% improved by one level.
- The improvement in GPS exceeded the minimal clinically important difference by three times.
Conclusions:
- The Gross Motor Function Classification System (GMFCS) demonstrates stability in the majority of children with bilateral spastic CP post-single-event multilevel surgery.
- Statistically and clinically significant improvements in gait dysfunction and functional mobility were noted.
- Findings are vital for realistic goal-setting and family counseling in pediatric cerebral palsy management.
Aim:
There are conflicting reports about the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) after orthopaedic surgery. We studied the stability of the GMFCS in children with bilateral spastic CP after single-event multilevel surgery, using the Gait Profile Score (GPS) as the primary outcome measure.
Method:
This was a retrospective cohort study of 107 children (46 females, 61 males) with bilateral spastic CP, classified as GMFCS level II or III, who underwent surgery at a single tertiary institution between 1997 and 2008. The mean age at surgery was 10 years 7 months (SD 2 y 8 mo). The primary outcome measure was the GPS. Changes in GMFCS level were studied at multiple time points before and after intervention.
Results:
Gait dysfunction was partially corrected, with a mean improvement of 28% in the GPS. The GMFCS remained stable and unchanged in 95% of children and improved by one level in 5% of children. The improvement in GPS was three times the minimal clinically important difference. The mean age at final postoperative GPS assessment was 11 years 10 months (SD 2 y 10 mo) and at final GMFCS assessment was 15 years 7 months (SD 3 y 9 mo).
Interpretation:
Stability of the GMFCS was confirmed in the majority of children with bilateral spastic CP after single-event multilevel surgery, despite statistically and clinically significant improvements in gait dysfunction and functional mobility. This information is important in realistic goal-setting and in counselling families.
