Gross Motor Development by Age and Functional Level in Children with Cerebral Palsy from 6 Months to 17 Years-A
Reidun Birgitta Jahnsen1,2, Harald Weedon-Fekjar3, Gerd Myklebust1
1Norwegian Quality and Surveillance Registry of Cerebral Palsy, Oslo University Hospital, 0424 Oslo, Norway.
Insights
Norwegian children with cerebral palsy show motor development similar to Canadian peers. The Gross Motor Function Measure (GMFM-66) reference curves are valid for both populations, with Norwegian data available from an earlier age.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a complex, lifelong disability resulting from immature brain injury.
- Assessing interventions for children with CP necessitates validated and reliable outcome measures.
- Motor development curves and reference percentiles, such as those from the Gross Motor Function Measure (GMFM-66), are crucial for tracking and evaluating gross motor skill changes.
Purpose of the Study:
- To establish motor development curves and reference percentiles using Norwegian data for children aged 2-21 years.
- To compare these Norwegian curves with existing Canadian reference data.
- To assess the applicability of current GMFM-66 reference curves in a Norwegian context.
Main Methods:
- Utilized prospective, population-based cohort data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP).
- Included 1206 children with 3612 GMFM-66 tests administered between 0.5 and 17.3 years of age.
- Employed generalized additive regression models (GAMLSS) to estimate median development by Gross Motor Function Classification System (GMFCS) levels, adjusting for repeated measurements.
Main Results:
- Norwegian motor development curves for GMFCS levels I-IV show an increase up to age 7, followed by a plateau.
- GMFCS level V curves in Norway remain relatively flat.
- Both the Norwegian motor development curves and GMFM-66 percentiles closely resemble their Canadian counterparts.
Conclusions:
- The established Canadian reference curves for GMFM-66 are applicable and valid for use in Norway.
- These curves are suitable for both clinical practice and research purposes in Norway.
- Norwegian reference percentiles derived from this study can be utilized from an earlier age compared to existing Canadian data.
Abstract:
Background: Cerebral palsy is a complex lifespan disability caused by a lesion to the immature brain. Evaluation of interventions for children with cerebral palsy requires valid and reliable outcome measures. Motor development curves and reference percentiles for The Gross Motor Function Measure (GMFM-66) are valuable tools for following, predicting, comparing, and evaluating changes in gross motor skills. The aims of this study were to create motor development curves with reference percentiles based on Norwegian data and compare them with published counterparts for Canadian children aged 2-21 years. Method: Prospective population-based cohort data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) for 1206 children with 3612 GMFM-66 tests between 0.5 and 17.3 years of age. Median development by Gross Motor Function Classification System (GMFCS) levels was estimated using a generalized additive regression model with smoothed parameters for location, scale, and shape (based on the R GAMLSS library). To adjust for repeated individual measurements, we report the median curve of 100 random samples with only one observation per observed child. Results: The Norwegian motor development curves for GMFCS levels I-IV increase up to 7 years of age before flattening off, while GMFCS level V curves are relatively flat. Overall, both motor development curves and GMFM-66 percentiles are very similar to Canadian counterparts. Conclusions: The existing Canadian reference curves are valid also for Norway, working well for both clinical and research applications. However, Norwegian percentiles can be used from an earlier age.
