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Functional classification systems in Brazilian children with cerebral palsy: Reliability and associations between

Kennea Martins Almeida Ayupe1, Amanda Larissa Oliveira Lima2, Gabrielly Cristine de Alcântara Gomes1

  • 1School of Physical Therapy, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil.

Developmental Neurorehabilitation
|September 23, 2024
PubMed

Insights

Classification systems for children with Cerebral Palsy (CP) are reliable and interconnected. The Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) showed strong associations in Brazilian children.

Area of Science:

  • Pediatrics
  • Rehabilitation Medicine
  • Developmental Neuroscience

Background:

  • Cerebral palsy (CP) is a complex condition affecting movement and posture in children.
  • Standardized classification systems are crucial for understanding functional abilities and guiding interventions.
  • Existing systems include the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), Eating and Drinking Ability Classification System (EDACS), and Visual Function Classification System (VFCS).

Purpose of the Study:

  • To evaluate the inter-rater reliability of five classification systems in Brazilian children with CP.
  • To investigate the associations between the different classification levels.
  • To confirm the clinical utility of these tools in a specific population.

Main Methods:

  • 100 Brazilian children (3-17 years) with CP were classified by physical therapists using GMFCS, MACS, CFCS, EDACS, and VFCS.
  • Inter-rater reliability was assessed using the Intraclass Correlation Coefficient (ICC) on a subset of 60 participants by two independent examiners.
  • Spearman's correlation coefficients were used to analyze associations between classification levels.

Main Results:

  • Inter-rater reliability for all classification systems was found to be excellent to good (ICC 0.89-0.99).
  • Significant associations were observed between multiple classification systems, particularly GMFCS/MACS (r=0.81), GMFCS/CFCS (r=0.70), and MACS/CFCS (r=0.73).
  • Associations were also noted between GMFCS/VFCS, MACS/VFCS, CFCS/EDACS, CFCS/VFCS, and EDACS/VFCS (p < 0.05).

Conclusions:

  • The GMFCS, MACS, CFCS, EDACS, and VFCS demonstrate high inter-rater reliability in Brazilian children with CP.
  • These classification systems are significantly associated, indicating a degree of functional interdependence.
  • The findings support the reliable use and interconnectedness of these classification systems for assessing children with CP, especially GMFCS, MACS, and CFCS.

Keywords:
Cerebral palsycommunication function classification systemeating and drinking ability classification systemgross motor function classification systemmanual ability classification system

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