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Stability of the Gross Motor Function Classification System in children with cerebral palsy in the two to four year
Amanda M Wizinsky1, Molly Donawerth1, Megan Badgley2
1Perlman Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
The Gross Motor Function Classification System (GMFCS) shows less stability in children with cerebral palsy (CP) aged two to four years. Frequent reassessments are recommended for accurate care planning.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) impacts motor function, necessitating reliable classification systems.
- The Gross Motor Function Classification System (GMFCS) is a key tool for assessing motor abilities in children with CP.
- Understanding GMFCS stability in early childhood is crucial for intervention planning.
Purpose of the Study:
- To evaluate the stability of the GMFCS in children with CP aged 2–4 years.
- To determine the frequency and direction of GMFCS reclassifications within this age group.
- To analyze trends in motor ability changes during early childhood.
Main Methods:
- Retrospective analysis of 164 children with CP with serial GMFCS ratings.
- GMFCS assessments were recorded near ages 24, 36, and 48 months.
- Statistical methods included linear weighted kappa and descriptive statistics to analyze stability and reclassification.
Main Results:
- A linear weighted kappa of 0.726 indicated moderate stability between ages 2 and 4 years.
- Nearly half (46.95%) of the children were reclassified to a different GMFCS level.
- The majority of reclassifications were to a higher (more able) GMFCS level.
Conclusions:
- The GMFCS demonstrates reduced stability in the 2–4 year age band compared to older children.
- The high rate of reclassification underscores the dynamic nature of motor development in early CP.
- Reassessing GMFCS levels every six months is recommended for this age group to ensure accurate guidance for caregivers.
Purpose:
This study aimed to investigate the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) in the two to four year age band, the frequency at which children were reclassified, and trends of reclassification to higher or lower ability.
Methods:
This retrospective study included 164 children with CP between 24 to 48 months old with two or more GMFCS ratings at least 12 months apart between their second and fourth birthdays. GMFCS ratings were captured closest to 24, 36, and 48 months. Stability and reclassification trends were analyzed using inferential statistics. Frequency of reclassification, age at ratings, duration between ratings, and corresponding change rate were analyzed using descriptive statistics.
Results:
When comparing ratings closest to second and fourth birthdays, a linear weighted kappa of 0.726 was found. Of the total population, 46.95% changed GMFCS levels at any time between two to four years of age, the majority of which were reclassified to a higher level of ability.
Conclusion:
Findings suggest the GMFCS is less stable in the two to four year age band compared to older age bands. Due to the importance of providing accurate guidance for caregivers and high rate of reclassification, it is recommended GMFCS levels be reassessed every six months during this period of time.
