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Cerebral palsy: definition, assessment and rehabilitation
Carol L Richards1, Francine Malouin
1Department of Rehabilitation, Faculty of Medicine, Université Laval and Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, Canada.
Insights
Cerebral palsy (CP) classification and rehabilitation have advanced, focusing on function and quality of life. Early detection and outcome measures like the Gross Motor Function Measure (GMFM) improve CP assessment and intervention effectiveness.
Area of Science:
- Neurology
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a complex neurodevelopmental disorder affecting movement and posture due to early brain injury.
- CP presents with diverse motor impairments including spasticity, dyskinesia, and muscle weakness, impacting daily activities.
- Associated challenges can involve sensory, cognitive, communication, and behavioral deficits.
Purpose of the Study:
- To review the evolution of CP definition, classification, and rehabilitation approaches over the past 25 years.
- To highlight advancements in early detection and outcome measurement for CP.
- To discuss the shift towards a task-oriented approach in CP rehabilitation, emphasizing function and quality of life.
Main Methods:
- Review of diagnostic and assessment tools for CP, including General Movements Assessment and Test of Infant Motor Performance.
- Discussion of outcome measures such as the Gross Motor Function Measure (GMFM) for evaluating interventions.
- Examination of classification systems like the Gross Motor Classification System (GMCS) and Manual Ability Classification System (MACS).
Main Results:
- CP definition and classification have significantly evolved, improving diagnostic accuracy.
- Early detection methods and reliable outcome measures (e.g., GMFM) enable better tracking of progress and intervention efficacy.
- Standardized classification systems (GMCS, MACS) allow for consistent assessment of disability severity.
- The task-oriented approach in rehabilitation focuses on enhancing function, participation, and quality of life.
Conclusions:
- Modern CP management integrates advanced assessment tools and a functional, person-centered rehabilitation approach.
- There is increasing evidence supporting targeted interventions and a focus on social integration for individuals with CP throughout their lifespan.
- The evolution in CP care emphasizes maximizing potential and improving overall well-being for affected individuals.
Abstract:
Over the last 25 years the definition and classification of cerebral palsy (CP) have evolved, as well as the approach to rehabilitation. CP is a disorder of the development of movement and posture, causing activity limitations attributed to nonprogressive disturbances of the fetal or infant brain that may also affect sensation, perception, cognition, communication, and behavior. Motor control during reaching, grasping, and walking are disturbed by spasticity, dyskinesia, hyperreflexia, excessive coactivation of antagonist muscles, retained developmental reactions, and secondary musculoskeletal malformations, together with paresis and defective programing. Weakness and hypoextensibility of the muscles are due not only to inadequate recruitment of motor units, but also to changes in mechanical stresses and hormonal factors. Two methods, the General Movements Assessment and the Test of Infant Motor Performance, now permit the early detection of CP, while the development of valid and reliable outcome measures, particularly the Gross Motor Function Measure (GMFM), have made it possible to evaluate change over time and the effects of clinical interventions. The GMFM has further led to the development of predictive curves of motor function while the Gross Motor Classification System and the Manual Ability Classification System provide standardized means to classify the severity of the movement disability. With the emergence of the task-oriented approach, the focus of therapy in rehabilitation has shifted from eliminating deficits to enhancing function across all performance domains by emphasizing fitness, function, participation, and quality of life. There is growing evidence supporting selected interventions and interest for the therapy and social integration of adults with CP.
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