A comparison of functioning, activity, and participation in school-aged children with cerebral palsy using the manual ability classification system

Impairments, activity limitations, and participation restrictions of the international classification of functioning, disability, and health model in children with ambulatory cerebral palsy

Objectives:

To examine the impairments, activity limitations, and participation restrictions in children with spastic unilateral and bilateral cerebral palsy (CP). We investigated the relationship between these factors according to the international classification of functioning, disability, and health (ICF) model.

Methods:

This prospective cross sectional study included 60 children aged between 4-18 years with spastic CP (30 unilateral, 30 bilateral involvement) classified as Levels I and II on the gross motor function classification system. Children had been referred to the Pediatric Rehabilitation Unit in the Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey between March 2014 and March 2015. The Physician Rating scale was used to assess body functions and structures. The Gillette Functional Assessment Questionnaire 22-item skill set, Pediatric Functional Independence Measure, and Pediatric Outcomes Data Collection Instrument were used to assess activity and participation levels.

Results:

There was a significant positive correlation between impairments and activity limitations (r=0.558; p=0.000), as well as between activity limitations and participation restrictions (r=0.354, p=0.005).

Conclusion:

These results show that activity limitations in children with unilateral and bilateral ambulatory CP may be related to their impairments and participation restrictions, although the sample size of our study is not large enough for generalizations. Overall, our study highlights the need for up-to-date, practical evaluation methods according to the ICF model.

Evaluating the Discriminant Validity of the Pediatric Evaluation of Disability Inventory: Computer Adaptive Test in Children With Cerebral Palsy

BACKGROUND

The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) is a new clinical assessment for children and youth from birth through 20 years of age.

OBJECTIVE

To determine the discriminant validity of the PEDI-CAT according to the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) in children with cerebral palsy (CP).

DESIGN

A prospective convenience cross-sectional sample of 101 school-age children with CP was stratified by GMFCS level.

METHODS

Participants were excluded if they underwent recent surgery (<6 months). Receiver operating characteristics curve analysis was used to quantify the discriminant validity of the PEDI-CAT domains to distinguish the level of independence in fine and gross motor function. General linear modeling was used to assess discriminant ability across all GMFCS and MACS levels.

RESULTS

Mean age was 11 years, 11 months (SD 3.7). Mobility and Daily Activities domains exhibited excellent discriminant validity distinguishing between ambulatory and nonambulatory participants [area under the curve (AUC) = 0.98 and 0.97, respectively] and the Daily Activities domain exhibited excellent discriminant validity distinguishing between independent and dependent hand function (AUC = 0.93). All PEDI-CAT domains were able to discriminate between ambulatory (GMFCS levels I-III) or nonambulatory (GMFCS levels IV-V) as well as manually independent (MACS levels I-II) or manually dependent functional levels (MACS levels III-V) ( P < .001).

LIMITATIONS

Our convenience cross-sectional sample included school-age children with primarily Caucasian, middle-income parents and may not be representative of other cultural, socioeconomic backgrounds. Not all participants had a MACS level assigned, however, no differences were found in PEDI-CAT scores between those with and without MACS scores.

CONCLUSIONS

These results demonstrate that the PEDI-CAT is a valid outcome instrument for measuring functional abilities in children with CP, able to differentiate across fine and gross motor functional levels.

Effects of hippotherapy on body functions, activities and participation in children with cerebral palsy based on ICF-CY assessments

PURPOSE

To evaluate the effects of hippotherapy on body functions, activities, and participation in children with CP of various functional levels by using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) checklist.

METHODS

Fourteen children with cerebral palsy (CP) (3-8 years of age) were recruited for a 36-week study composed of baseline, intervention, and withdrawal phases (12 weeks for each phase, ABA design). Hippotherapy was implemented for 30 min once weekly for 12 consecutive weeks during the intervention phase. Body Functions (b) and Activities and Participation (d) components of the ICF-CY checklist were used as outcome measures at the initial interview and at the end of each phase.

RESULTS

Over the 12 weeks of hippotherapy, significant improvements in ICF-CY qualifiers were found in neuromusculoskeletal and movement-related functions (b7), mobility (d4) and major life areas (d8) and, in particular, mobility of joint functions (b710), muscle tone functions (b735), involuntary movement reaction functions (b755), involuntary movement functions (b765), and play (d811) (all p < 0.05) when compared with baseline.

CONCLUSION

This study demonstrated the beneficial effects of hippotherapy on body functions, activities, and participation in children with CP. Implications for Rehabilitation ICF-CY provides a comprehensive overview of functioning and disability and constitutes a universal language for identifying the benefits of hippotherapy in areas of functioning and disability in children with CP. In children with CP, hippotherapy encourages a more complementary approach that extends beyond their impairments and limitations in body functions, activities, and participation. The effect of hippotherapy was distinct from GMFCS levels and the majority of improvements were present in children with GMFCS levels I-III.

Clinical usefulness of Adeli suit therapy for improving gait function in children with spastic cerebral palsy: a case study

[Purpose] The purpose of this study was to determine the effects of Adeli suit therapy (AST) on gross motor function and gait function in children with cerebral palsy. [Subjects and Methods] Two participants with spastic cerebral palsy were recruited to undergo AST. AST was applied in 60-minute sessions, five times per week, with 20 sessions total over 4 weeks. Assessments of gross motor function, spatiotemporal parameters, and functional ambulation performance for gait were conducted. [Results] Gross motor function, cadence, and functional ambulation performance improved after the intervention in both cases. [Conclusion] Although additional follow-up studies are required, the results demonstrated improved gross motor function and functional ambulation performance in the children with cerebral palsy. These findings suggest a variety of applications for conservative therapeutic methods that require future clinical trials in children with cerebral palsy.

An investigation of the factors affecting handwriting articulation of school aged children with cerebral palsy based on the international classification of functioning, disability and health

[Purpose] This study was designed to identify factors influencing handwriting articulation based on the international classification of functioning, disability and health (ICF) and to recommend effective evaluation and intervention strategies to improve the handwriting of children with cerebral palsy. [Subjects] The subjects were 96 elementary school children with cerebral palsy and the study was conducted from 04/07/2011 to 29/08/2011. [Methods] Factors related to handwriting articulation were investigated based on the ICF model. [Results] Wrist lateral deviation, upper-extremity speed of body function and education of personal factor were significantly associated with handwriting articulation. [Conclusion] Efforts to manage and improve the handwriting articulation of children with cerebral palsy should focus on wrist lateral deviation, upper-extremity speed, and education.

Relationship between activity limitations and participation restriction in school-aged children with cerebral palsy

[Purpose] This study investigated the relationship between activity limitation and participation restriction in school-aged children with cerebral palsy. [Subjects and Methods] Data were collected from 109 children with cerebral palsy aged 6–12 years. Activity limitations were assessed by using functional classification systems including the Korean-Gross Motor Function Classification System, the Korean-Manual Ability Classification System, and the Korean-Communication Function Classification System. Participation restriction was measured using the Korean-Frequency of Participation Questionnaire. Physical or occupational therapists and parents collected the data. [Results] All levels of the functional classification systems were significantly negatively correlated with Korean-Frequency of Participation Questionnaire ratings (r= −0.382 to −0.477). The Korean-Frequency of Participation Questionnaire ratings differed significantly with respect to the functional classification systems; in particular, the differences in the ratings of levels I and V were significant. The Korean-Communication Function Classification System and Korean-Gross Motor Function Classification System were significant predictors of participation, explaining 26.5% of the variance. [Conclusion] Intervention programs are required to promote communication skills and gross motor ability in order to improve the participation of children with cerebral palsy.