Classification systems for children and adolescents with cerebral palsy: their use in clinical practice
DOI:
https://doi.org/10.31053/1853.0605.v77.n3.28347Keywords:
cerebral palsy, child, classificationAbstract
Introduction: Classification systems are internationally used tools to characterize the functions of children and young people with cerebral palsy (CP), for clinical and research use. The aim of this study was to characterize the different classification systems available and describe the usefulness of each of the classifications, describing their use in clinical practice.
Methods: an exhaustive bibliographic revision was performed using the Cochrane Database, MEDLINE, LILACS y Google Scholar databases. The search period was from 1997 to 2019 using key words. Classification systems were included that focused on functions and body structures, considered the International Classification of Functioning, Disability and Health, were validated and in English and Spanish. The quality of the works was assessed according to the AGREE reporting checklist.
Results: Six classification systems were found for children with CP regarding their functions and body structures. Each of the systems focuses on a specific function or skill, which are: gross motor function, manual skills, communication functions, eating and drinking skills, MRIs, and visual functions.
Main conclusion: All systems have been validated, standardized and used internationally. They serve to more fully describe the functional levels and body structure of children with CP both at the clinical, population and research levels.
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References
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15. Eliasson A, Ullenhag A, Wahlstr U. Mini-MACS : development of the Manual Ability Classification System for children younger than 4 years of age with signs of cerebral palsy. Dev Med Child Neurol. 2016:1-7. doi:10.1111/dmcn.13162
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19. Beckung E, Hagberg G. Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Dev Med Child Neurol. 2002;44(5):309-316. doi:10.1017/S0012162201002134
20. Elvrum AKG, Beckung E, Sæther R, Lydersen S, Vik T, Himmelmann K. Bimanual Capacity of Children With Cerebral Palsy: Intra- and Interrater Reliability of a Revised Edition of the Bimanual Fine Motor Function Classification. Phys Occup Ther Pediatr. 2017;37(3):239-251. doi:10.1080/01942638.2016.1185507
21. Lydersen S, Vik T, Beckung E, Ohrvall A. Bimanual Fine Motor Function ( BFMF ) Classification in Children with Cerebral Palsy : Aspects of Construct and Content Validity. Phys Occup Ther Pediatr. 2014;(March):1-16. doi:10.3109/01942638.2014.975314
22. Barty E, Caynes K, Johnston LM. Development and reliability of the Functional Communication Classification System for children with cerebral palsy. Dev Med Child Neurol. 2016:1-6. doi:10.1111/dmcn.13124
23. Jo M, Hidecker C, Paneth N, et al. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol. 2011;53:704–710. doi:10.1111/j.1469-8749.2011.03996.x
24. Soleymani Z, Joveini G, Reza A. Pediatric Neurology The Communication Function Classi fi cation System : Cultural Adaptation , Validity , and Reliability of the Farsi Version for Patients With Cerebral Palsy. Pediatr Neurol. 2015;52(3):333-337. doi:10.1016/j.pediatrneurol.2014.10.026
25. Willem JAN, Mary G, Cooley JO, Jeroen HR. Reliability of the Dutch-language version of the Communication Function Classification System and its association with language comprehension and method of communication. Dev Med Child Neurol. 2016;58:180-188. doi:10.1111/dmcn.12839
26. Sussex Community NHS. Sistema de Clasificación de Las Habilidades Para Comer y Beber. Version en español; 2014. Disponible en: https://ad.uib.es/estudis1819/pluginfile.php/301643/mod_resource/content/1/edacs-classificationsystem-spanish.pdf.
27. Sellers D, Mandy A, Pennington L, Hankins M, Morris C. Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Dev Med Child Neurol. 2014;56(3):245-251. doi:10.1111/dmcn.12352
28. Tschirren L, Bauer S, Hanser C, Marsico P, Sellers D, van Hedel HJA. The Eating and Drinking Ability Classification System: concurrent validity and reliability in children with cerebral palsy. Dev Med Child Neurol. 2018;60(6):611-617. doi:10.1111/dmcn.13751
29. Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. The Eating and Drinking Ability Classification System in a population-based sample of preschool children with cerebral palsy. Dev Med Child Neurol. 2017;59(6). doi:10.1111/dmcn.13403
30. Van Hulst K, Snik DAC, Jongerius PH, Sellers D, Erasmus CE, Geurts ACH. Reliability, construct validity and usability of the Eating and Drinking Ability Classification System (EDACS) among Dutch children with Cerebral Palsy. J Pediatr Rehabil Med. 2018;11(2):115-124. doi:10.3233/PRM-170515
31. Sellers D, Bryant E, Hunter A, Campbell V, Morris C. The Eating and Drinking Ability Classification System for cerebral palsy: A study of reliability and stability over time. J Pediatr Rehabil Med. 2019;12(2). doi:10.3233/PRM-180581
32. Goh Y ra, Choi JY, Kim SA, Park J, Park ES. Comparisons of severity classification systems for oropharyngeal dysfunction in children with cerebral palsy: Relations with other functional profiles. Res Dev Disabil. 2018;72. doi:10.1016/j.ridd.2017.12.002
33. Bell KL, Benfer KA, Ware RS, et al. Development and validation of a screening tool for feeding/swallowing difficulties and undernutrition in children with cerebral palsy. Dev Med Child Neurol. 2019:1-8. doi:10.1111/dmcn.14220
34. Ego A, Lidzba K, Brovedani P, et al. Visual-perceptual impairment in children with cerebral palsy: A systematic review. Dev Med Child Neurol. 2015;57(s2):46-51. doi:10.1111/dmcn.12687
35. Dufresne D, Dagenais L, Shevell MI. Spectrum of visual disorders in a population-based cerebral palsy cohort. Pediatr Neurol. 2014;50(4):324-328. doi:10.1016/j.pediatrneurol.2013.11.022
36. Baranello G, Signorini S, Tinelli F, et al. Visual Function Classification System for children with cerebral palsy: development and validation. Dev Med Child Neurol. 2019;62(1):104-110. doi:10.1111/dmcn.14270
37. Rosenbaum P. Visual Function Classification System for children with cerebral palsy: development of a new tool. Dev Med Child Neurol. 2019;62(1):14-14. doi:10.1111/dmcn.14279
38. Reid SM, Dagia CD, Ditchfield MR, Carlin JB, Reddihough DS. Population-based studies of brain imaging patterns in cerebral palsy. Dev Med Child Neurol. 2014;56(3):222-232. doi:10.1111/dmcn.12228
39. Krägeloh-Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Dev Med Child Neurol. 2007;49(2):144-151. doi:10.1111/j.1469-8749.2007.00144.x
40. Himmelmann K, Horber V, De La Cruz J, et al. MRI classification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations. Dev Med Child Neurol. 2017;59(1):57-64. doi:10.1111/dmcn.13166
41. Fiori S, Cioni G, Klingels K, et al. Reliability of a novel, semi-quantitative scale for classification of structural brain magnetic resonance imaging in children with cerebral palsy. Dev Med Child Neurol. 2014;56(9):839-845. doi:10.1111/dmcn.12457
42. Organización Mundial de la Salud. Clasificación Internacional Del Funcionamiento, de La Discapacidad y de La Salud: CIF.; 2001. doi:10.1097/01.pep.0000245823.21888.71
43. Compagnone E, Maniglio J, Camposeo S, et al. Functional classifications for cerebral palsy: Correlations between the gross motor function classification system (GMFCS), the manual ability classification system (MACS) and the communication function classification system (CFCS). Res Dev Disabil. 2014;35(11):2651-2657. doi:10.1016/j.ridd.2014.07.005
44. Schiariti V, Selb M, Cieza A, O’Donnell M. International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy: A consensus meeting. Dev Med Child Neurol. 2015;57(2):149-158. doi:10.1111/dmcn.12551
45. Khandaker G, Smithers-Sheedy H, Islam J, et al. Bangladesh Cerebral Palsy Register (BCPR): A pilot study to develop a national cerebral palsy (CP) register with surveillance of children for CP. BMC Neurol. 2015;15(1):173. doi:10.1186/s12883-015-0427-9
46. ACPR Group. Australian Cerebral Palsy Register Report, Birth Years 1995 -2012.; 2018. Disponible en: https://www.cpregister.com/pubs/pdf/ACPR-Report_Web_2018.pdf. Accessed December 18, 2018.
47. Camacho-Salas a. Infantile cerebral palsy: the importance of population registers. Rev Neurol. 2008;47 Suppl 1(Supl 1):S15-S20. doi:rn2008345 [pii]
2. Surveillance of Cerebral Palsy in Europe. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol. 2000;42(12):816-824. doi:10.1111/j.1469-8749.2000.tb00695.x
3. Rosenbaum P, Eliasson A-C, Hidecker MJC, Palisano RJ. Classification in Childhood Disability: Focusing on Function in the 21st Century. J Child Neurol. 2014;29(May). doi:10.1177/0883073814533008
4. The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines | The EQUATOR Network. https://www.equator-network.org/reporting-guidelines/the-agree-reporting-checklist-a-tool-to-improve-reporting-of-clinical-practice-guidelines/. Accessed April 8, 2020.
5. McDowell BC, Kerr C, Parkes J. Interobserver agreement of the Gross Motor Function Classification System in an ambulant population of children with cerebral palsy. Dev Med Child Neurol. 2007;49(7):528-533. doi:10.1111/j.1469-8749.2007.00528.x
6. Wood E, Rosenbaum P. The gross motor function classification system for cerebral palsy: A study of reliability and stability over time. Dev Med Child Neurol. 2000;42(5):292-296. doi:10.1017/S0012162200000529
7. Sellier E, Horber V, Krägeloh-Mann I, De La Cruz J, Cans C. Interrater reliability study of cerebral palsy diagnosis, neurological subtype, and gross motor function. Dev Med Child Neurol. 2012;54(9):815-821. doi:10.1111/j.1469-8749.2012.04359.x
8. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-223. doi:10.1111/j.1469-8749.1997.tb07414.x
9. Palisano RR, Rosenbaum P, Bartlett D, Livingstone M, Walter S, Russell D. Gross Motor Function Clasification System. Extendida y Revisada. Child A Glob J Child Res. 2007;39:214-233.
10. McIntyre S, Morgan C, Walker K, Novak I. Cerebral palsy-Don’t delay. Dev Disabil Res Rev. 2011;17(2):114-129. doi:10.1002/ddrr.1106
11. Morris C, Galuppi BE, Rosenbaum PL. Reliability of family report for the Gross Motor Function Classification System. Dev Med Child Neurol. 2004;46(7):455-460. doi:10.1017/S0012162204000751
12. Mccormick A. The Gross Motor Function Classification System: 20 years on. Dev Med Child Neurol. 2017:13385. doi:10.1111/dmcn.13397
13. Rosenbaum P, Livingston M, Palisano R, Galuppi B, Russell D. Quality of life and health-related quality of life of adolescents with cerebral palsy. Dev Med Child Neurol. 2007;49(7):516-521. doi:10.1111/j.1469-8749.2007.00516.x
14. Alriksson-Schmidt A, Nordmark E, Czuba T, Westbom L. Stability of the Gross Motor Function Classification System in children and adolescents with cerebral palsy: a retrospective cohort registry study. Dev Med Child Neurol. 2017;59(6):641-646. doi:10.1111/dmcn.13385
15. Eliasson A, Ullenhag A, Wahlstr U. Mini-MACS : development of the Manual Ability Classification System for children younger than 4 years of age with signs of cerebral palsy. Dev Med Child Neurol. 2016:1-7. doi:10.1111/dmcn.13162
16. Jeevanantham D, Dyszuk E, Bartlett D. The Manual Ability Classification System : A Scoping Review. Pediatr Phys Ther. 2015. doi:10.1097/PEP.0000000000000151
17. Paulson A, Vargus-adams J. Overview of Four Functional Classification Systems Commonly Used in Cerebral Palsy. Children. 2017;4(4):30. doi:10.3390/children4040030
18. Silva DBR, Funayama CAR, Pfeifer LI. Manual Ability Classification System ( MACS ): reliability between therapists and parents in Brazil. Brazilian J Phys Ther. 2015;19(1):26-33.
19. Beckung E, Hagberg G. Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Dev Med Child Neurol. 2002;44(5):309-316. doi:10.1017/S0012162201002134
20. Elvrum AKG, Beckung E, Sæther R, Lydersen S, Vik T, Himmelmann K. Bimanual Capacity of Children With Cerebral Palsy: Intra- and Interrater Reliability of a Revised Edition of the Bimanual Fine Motor Function Classification. Phys Occup Ther Pediatr. 2017;37(3):239-251. doi:10.1080/01942638.2016.1185507
21. Lydersen S, Vik T, Beckung E, Ohrvall A. Bimanual Fine Motor Function ( BFMF ) Classification in Children with Cerebral Palsy : Aspects of Construct and Content Validity. Phys Occup Ther Pediatr. 2014;(March):1-16. doi:10.3109/01942638.2014.975314
22. Barty E, Caynes K, Johnston LM. Development and reliability of the Functional Communication Classification System for children with cerebral palsy. Dev Med Child Neurol. 2016:1-6. doi:10.1111/dmcn.13124
23. Jo M, Hidecker C, Paneth N, et al. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol. 2011;53:704–710. doi:10.1111/j.1469-8749.2011.03996.x
24. Soleymani Z, Joveini G, Reza A. Pediatric Neurology The Communication Function Classi fi cation System : Cultural Adaptation , Validity , and Reliability of the Farsi Version for Patients With Cerebral Palsy. Pediatr Neurol. 2015;52(3):333-337. doi:10.1016/j.pediatrneurol.2014.10.026
25. Willem JAN, Mary G, Cooley JO, Jeroen HR. Reliability of the Dutch-language version of the Communication Function Classification System and its association with language comprehension and method of communication. Dev Med Child Neurol. 2016;58:180-188. doi:10.1111/dmcn.12839
26. Sussex Community NHS. Sistema de Clasificación de Las Habilidades Para Comer y Beber. Version en español; 2014. Disponible en: https://ad.uib.es/estudis1819/pluginfile.php/301643/mod_resource/content/1/edacs-classificationsystem-spanish.pdf.
27. Sellers D, Mandy A, Pennington L, Hankins M, Morris C. Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Dev Med Child Neurol. 2014;56(3):245-251. doi:10.1111/dmcn.12352
28. Tschirren L, Bauer S, Hanser C, Marsico P, Sellers D, van Hedel HJA. The Eating and Drinking Ability Classification System: concurrent validity and reliability in children with cerebral palsy. Dev Med Child Neurol. 2018;60(6):611-617. doi:10.1111/dmcn.13751
29. Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. The Eating and Drinking Ability Classification System in a population-based sample of preschool children with cerebral palsy. Dev Med Child Neurol. 2017;59(6). doi:10.1111/dmcn.13403
30. Van Hulst K, Snik DAC, Jongerius PH, Sellers D, Erasmus CE, Geurts ACH. Reliability, construct validity and usability of the Eating and Drinking Ability Classification System (EDACS) among Dutch children with Cerebral Palsy. J Pediatr Rehabil Med. 2018;11(2):115-124. doi:10.3233/PRM-170515
31. Sellers D, Bryant E, Hunter A, Campbell V, Morris C. The Eating and Drinking Ability Classification System for cerebral palsy: A study of reliability and stability over time. J Pediatr Rehabil Med. 2019;12(2). doi:10.3233/PRM-180581
32. Goh Y ra, Choi JY, Kim SA, Park J, Park ES. Comparisons of severity classification systems for oropharyngeal dysfunction in children with cerebral palsy: Relations with other functional profiles. Res Dev Disabil. 2018;72. doi:10.1016/j.ridd.2017.12.002
33. Bell KL, Benfer KA, Ware RS, et al. Development and validation of a screening tool for feeding/swallowing difficulties and undernutrition in children with cerebral palsy. Dev Med Child Neurol. 2019:1-8. doi:10.1111/dmcn.14220
34. Ego A, Lidzba K, Brovedani P, et al. Visual-perceptual impairment in children with cerebral palsy: A systematic review. Dev Med Child Neurol. 2015;57(s2):46-51. doi:10.1111/dmcn.12687
35. Dufresne D, Dagenais L, Shevell MI. Spectrum of visual disorders in a population-based cerebral palsy cohort. Pediatr Neurol. 2014;50(4):324-328. doi:10.1016/j.pediatrneurol.2013.11.022
36. Baranello G, Signorini S, Tinelli F, et al. Visual Function Classification System for children with cerebral palsy: development and validation. Dev Med Child Neurol. 2019;62(1):104-110. doi:10.1111/dmcn.14270
37. Rosenbaum P. Visual Function Classification System for children with cerebral palsy: development of a new tool. Dev Med Child Neurol. 2019;62(1):14-14. doi:10.1111/dmcn.14279
38. Reid SM, Dagia CD, Ditchfield MR, Carlin JB, Reddihough DS. Population-based studies of brain imaging patterns in cerebral palsy. Dev Med Child Neurol. 2014;56(3):222-232. doi:10.1111/dmcn.12228
39. Krägeloh-Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Dev Med Child Neurol. 2007;49(2):144-151. doi:10.1111/j.1469-8749.2007.00144.x
40. Himmelmann K, Horber V, De La Cruz J, et al. MRI classification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations. Dev Med Child Neurol. 2017;59(1):57-64. doi:10.1111/dmcn.13166
41. Fiori S, Cioni G, Klingels K, et al. Reliability of a novel, semi-quantitative scale for classification of structural brain magnetic resonance imaging in children with cerebral palsy. Dev Med Child Neurol. 2014;56(9):839-845. doi:10.1111/dmcn.12457
42. Organización Mundial de la Salud. Clasificación Internacional Del Funcionamiento, de La Discapacidad y de La Salud: CIF.; 2001. doi:10.1097/01.pep.0000245823.21888.71
43. Compagnone E, Maniglio J, Camposeo S, et al. Functional classifications for cerebral palsy: Correlations between the gross motor function classification system (GMFCS), the manual ability classification system (MACS) and the communication function classification system (CFCS). Res Dev Disabil. 2014;35(11):2651-2657. doi:10.1016/j.ridd.2014.07.005
44. Schiariti V, Selb M, Cieza A, O’Donnell M. International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy: A consensus meeting. Dev Med Child Neurol. 2015;57(2):149-158. doi:10.1111/dmcn.12551
45. Khandaker G, Smithers-Sheedy H, Islam J, et al. Bangladesh Cerebral Palsy Register (BCPR): A pilot study to develop a national cerebral palsy (CP) register with surveillance of children for CP. BMC Neurol. 2015;15(1):173. doi:10.1186/s12883-015-0427-9
46. ACPR Group. Australian Cerebral Palsy Register Report, Birth Years 1995 -2012.; 2018. Disponible en: https://www.cpregister.com/pubs/pdf/ACPR-Report_Web_2018.pdf. Accessed December 18, 2018.
47. Camacho-Salas a. Infantile cerebral palsy: the importance of population registers. Rev Neurol. 2008;47 Suppl 1(Supl 1):S15-S20. doi:rn2008345 [pii]
Published
2020-08-21
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1.
Ruiz Brunner M de las M, Escobar Zuluaga J, Cieri ME, Ayllón C, Cuestas E. Classification systems for children and adolescents with cerebral palsy: their use in clinical practice. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2020 Aug. 21 [cited 2024 Jul. 6];77(3):191-8. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/28347
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