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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.

Journal of Pediatric Rehabilitation Medicine
|April 3, 2023
PubMed

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.
Abstract

Keywords:
Cerebral palsygross motor function classification systemtwo to four year age band

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