Abstract
The aim of this study was to investigate the relationship among functional classification systems, the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy (CP). One hundred and eighty-five children with spastic CP (101 males, 84 females), 65 (35.1%) diparetic, 60 (32.4%) quadriparetic, and 60 (32.4%) hemiparetic children, ranging from 4 to 15 years of age with a median age of 7 years, were included in the study. The children were classified according to the GMFCS for their motor function and according to the MACS for the functioning of their hands when handling objects in daily activities. The functional status and performance were assessed by using the Functional Independence Measure of Children (WeeFIM). A good correlation between the GMFCS and MACS was found in all children (r = 0.735, p < 0.01). There was also a correlation between the GMFCS and WeeFIM subscales according to subtypes and all parameters were correlated at the level of p < 0.01, the same as the MACS. There was no difference in the MACS scores among the age groups of 4–7, 8–11, and 12–15 years (p > 0.05). The use of both the GMFCS and MACS in practice and in research areas will provide an easy, practical, and simple classification of the functional status of children with CP. The adaptation of both of these scales and WeeFIM and using these scales together give the opportunity for a detailed analysis of the functional level of children with spastic CP and reflect the differences between clinical types of CP.
Similar content being viewed by others
References
Altman DG (1991) Practical statistics for medical research. Chapman and Hall, London
Aneja S (2004) Evaluation of a child with cerebral palsy. Indian J Pediatr 71:627–634
Arner M, Eliasson AC, Rösblad B, Rosenbaum PL, Beckung E, Krumlinde-Sundholm L (2008) Manual Ability Classification System for children with cerebral palsy. Home page at: http://www.macs.nu
Bax M, Goldstein M, Rosenbaum PL, Leviton A, Paneth N, Dan B, Jacobsson B, Damiano DL; Executive Committee for the Definition of Cerebral Palsy (2005) Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 47:571–576
Beckung E, Hagberg G (2002) Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Dev Med Child Neurol 44:309–316
Carnahan KD, Arner M, Hägglund G (2007) Association between gross motor function (GMFCS) and manual ability (MACS) in children with cerebral palsy. A population-based study of 359 children. BMC Musculoskelet Disord 8:50
Colver A; SPARCLE Group (2006) Study protocol: SPARCLE—a multi-centre European study of the relationship of environment to participation and quality of life in children with cerebral palsy. BMC Public Health 6:105
Damiano DL, Abel MF, Romness M, Oeffinger DJ, Tylkowski CM, Gorton GE 3rd, Bagley AM, Nicholson DE, Barnes D, Calmes J, Kryscio R, Rogers S (2006) Comparing functional profiles of children with hemiplegic and diplegic cerebral palsy in GMFCS Levels I and II: are separate classifications needed? Dev Med Child Neurol 48:797–803
Eliasson AC, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Öhrvall A-M, Rosenbaum PL (2006) The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol 48:549–554
Eliasson AC, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Öhrvall A-M, Rosenbaum PL; MACS Group (2007) Using the MACS to facilitate communication about manual abilities of children with cerebral palsy. Dev Med Child Neurol 49:156–157
Gorter JW, Rosenbaum PL, Hanna SE, Palisano RJ, Bartlett DJ, Russell DJ, Walter SD, Raina P, Galuppi BE, Wood E (2004) Limb distribution, motor impairment, and functional classification of cerebral palsy. Dev Med Child Neurol 46:461–467
Hagberg B, Hagberg G, Olow I (1975) The changing panorama of cerebral palsy in Sweden 1954–1970. I. Analysis of the general changes. Acta Paediatr Scand 64:187–192
Kwolek A, Majka M, Pabis M (2001) The rehabilitation of children with cerebral palsy: problems and current trends. Ortop Traumatol Rehabil 3:499–507
Mayston MJ (2001) People with cerebral palsy: effects of and perspectives for therapy. Neural Plast 8:51–69
Mayston MJ (2001) The Bobath concept today. Synapse, Spring edition, pp 32–34
Morris C, Bartlett D (2004) Gross Motor Function Classification System: impact and utility. Dev Med Child Neurol 46:60–65
Morris C, Galuppi BE, Rosenbaum PL (2004) Reliability of family report for the Gross Motor Function Classification System. Dev Med Child Neurol 46:455–460
Morris C, Kurinczuk JJ, Fitzpatrick R, Rosenbaum PL (2006) Do the abilities of children with cerebral palsy explain their activities and participation? Dev Med Child Neurol 48:954–961
Msall ME, Rogers BT, Ripstein H, Lyon N, Wllczenski F (1997) Measurements of functional outcomes in children with cerebral palsy. Ment Retard Dev Disabil Res Rev 8:194–203
Oeffinger DJ, Tylkowski CM, Rayens MK, Davis RF, Gorton GE 3rd, D’Astous J, Nicholson DE, Damiano DL, Abel MF, Bagley AM, Luan J (2004) Gross Motor Function Classification System and outcome tools for assessing ambulatory cerebral palsy: a multicenter study. Dev Med Child Neurol 46:311–319
Ottenbacher KJ, Msall ME, Lyon NR, Duffy LC, Granger CV, Braun S (1997) Interrater agreement and stability of the Functional Independence Measure for Children (WeeFIM): use in children with developmental disabilities. Arch Phys Med Rehabil 78:1309–1315
Palisano R, Rosenbaum PL, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223
Penta M, Tesio L, Arnould C, Zancan A, Thonnard JL (2001) The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment. Stroke 32:1627–1634
Rosenbaum PL, Walter SD, Hanna SE, Palisano RJ, Russell DJ, Raina P, Wood E, Bartlett DJ, Galuppi BE (2002) Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA 288:1357–1363
Sanger TD, Chen D, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW; Taskforce on Childhood Motor Disorders (2006) Definition and classification of negative motor signs in childhood. Pediatrics 118:2159–2167
Sullivan E, Barnes D, Calmes J, Linton JL, Damiano DL, Oeffinger DJ, Abel MF, Bagley AM, Gorton GE 3rd, Nicholson DE, Rogers S, Tylkowski CM (2007) Relationships among functional outcome measures used for assessing children with ambulatory CP. Dev Med Child Neurol 49:338–344
World Health Organization (WHO) (2001) International classification of functioning, disability and health (ICF). WHO, Geneva. Home page at: http://www.who.int/classifications/icf/en/
Acknowledgments
The authors would like to thank Christin Elliason for the support during the revision of the manuscript and Dr. Levent Eker for helping with the data analyses. We also thank all of the participants of this study and their families.
Conflict of interest statement
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was presented as a poster presentation in 20th Annual Meeting, European Academy of Childhood Disability (EACD) in Zagreb, Crotia.
Appendices
Appendix 1
Estimated cognitive level of children with CP.
For the cognitive level, you can ask the parents some questions and report “estimated cognitive level”:
Cognitive description/IQ
Has your child had an assessment of IQ in the last year or so?
If yes, what was the result? ................................................
-
1.
Do you think your child learns as well as other children of a similar age?........................Yes/No
-
2.
Does your child play with and be friends with children of a similar age?....................Yes/No
If the answer is Yes to Questions 1 and 2, the IQ is probably >70. If not, consider the following questions:
-
3.
Does you child have severe difficulty with learning in all aspects of development? ................................. Yes/No
-
4.
Is your child’s ability to read and understand ideas like that of a much younger child, such as one more than half of their age? ......... Yes/No
If the answer is Yes to Questions 3 and 4, IQ is probably <50.
Otherwise the child probably falls into IQ 50–70, but this should be confirmed by expecting the answer Yes to the questions below:
-
5.
Do you think that your child needs much more help than other children to learn things like reading and understanding ideas?............................. Yes/No
-
6.
Does your child find it easier to make friends and play with younger children?.................. Yes/No
Appendix 2
Rights and permissions
About this article
Cite this article
Gunel, M.K., Mutlu, A., Tarsuslu, T. et al. Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy. Eur J Pediatr 168, 477–485 (2009). https://doi.org/10.1007/s00431-008-0775-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-008-0775-1