Frequência de comorbidades em crianças com paralisia cerebral de diferentes níveis de função motora grossa / Frequency of comorbidities in children with cerebral palsy of different levels of gross motor function

Introdução: A paralisia cerebral (PC) é uma desordem predominantemente motora, no entanto, pode estar associada a outras disfunções, que também impactam a funcionalidade das crianças. Objetivo: Documentar a frequência das comorbidades em crianças com PC nos diferentes níveis do Sistema de Classificação da Função Motora Grossa (GMFCS). Métodos: Estudo observacional, descritivo, de corte transversal. Foram coletados dados de 70 crianças com diagnóstico de PC, que recebiam tratamento fisioterapêutico em Belo Horizonte e na região metropolitana, por meio de entrevistas, e realizada análise descritiva e quantitativa. Resultados: As comorbidades mais frequentes foram as limitações do uso das mãos e dos braços, deficiências de continência urinária e fecal, deficiências da voz e da fala, deficiências de comportamento limitação para andar e epilepsia. Um número maior de comorbidades foi encontrado em crianças com maior comprometimento da função motora grossa. Conclusão: Profissionais da saúde devem observar com atenção a ocorrência das comorbidades na PC, proporcionando intervenções para preveni-las ou tratá-las, melhorando a funcionalidade desses indivíduos.

Introduction: Cerebral palsy (CP) is predominantly motor disorder, however, it may be associated with dysfunctions, which also impact the functionality of the children. Objective: To document the frequency of comorbidities in children with CP at different levels of the Gross Motor Function Classification System (GMFCS). Methods: Observational, descriptive, cross-sectional study. Data were collected from 70 children diagnosed with CP, who were receiving physical therapy treatment in Belo Horizonte and the metropolitan region, through interviews and descriptive and quantitative analysis were performed. Results: The most frequent comorbidities were limitations in the use of hands and arms, urinary and fecal continence deficiencies, voice and speech deficiencies, behavioral deficiencies, walking limitation and epilepsy. A greater number of comorbidities were found in children with greater impairment of gross motor function. Conclusion: Health professionals should pay attention to the occurrence of comorbidities in CP, providing interventions to prevent or treat them, improving the functionality of these individuals.

Gross Motor Function Classification System (GMFCS) For Children With Cerebral Palsy

Objectives: The objectives were to find out the sociodemographic characteristics, comorbidities, types of CP, level of GMFCS and to determine the association between GMFCS with age, gender, types of CP and topographic distribution among children with cerebral palsy. Methods and Materials: A retrospectives study was done in children with cerebral palsy. Total 384 participants were included in this study. The study setting was Paediatric Department, Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka, Bangladesh. The samples were collected through convenient sampling. The Chi-Square was used to find out the association between GMFCS with age, gender, types of CP and others. Results: Males were affected than female among all participants. The majority participants came from rural area. The children were more in 2 to 4-year age band in GMFCS. The majority participants (81%) had visual problem, 11% hearing and 31% had convulsion. The common levels were II and III. The age bands, topographic classification was associated with GMFCS (p<0.05) but gender and types of CP were not statistically associated (p>0.05). Conclusion: The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP).

Comparison of the clinical value of MRI classification system of deep gray matter injury in children with cerebral palsy / 西安交通大学学报(医学版)

Objective To investigate the reliability of MRI classification and clinical significance of deep gray matter injury(DGMI)in children with cerebral palsy(CP).Methods We made a retrospective assessment of 14 children with gross motor function classification system(GMFCS),manual ability classification system(MACS)and MRI classification system of deep gray matter injury.Based on T2WI,two radiologists worked independently and graded MRI pictures according to three-grading system and four-grading system.To evaluate the reliability of different grading systems,intra-observer and inter-observer agreements were tested by Kappa test.Spearman correlation analysis was performed to analyze the MRI classification system with GMFCS and MACS.Results The Kappa value of the intro-observer and inter-observe agreement of three-grading system was 0.873 and 0.873,respectively (P＜0.001).The Kappa value of the intro-observer and inter-observe agreement of four-grading system was 0.901 and 0.611(P＜0.001).Three-grading system had no significant correlation with GMFCS(r=0.053,P＞0.05)or MACS(r=0.128,P＞0.05).Four-grading system had a significant positive correlation with GMFCS(r=0.605, P＜0.05)and MACS(r=0.779,P＜0.05).Conclusion In the two grading systems,four-grading system is a more repeatable approach for detecting deep gray matter,gross motor function and manual function injuries in children with cerebral palsy.

Concordancia entre las escalas clínicas y los índices derivados del laboratorio de análisis del movimiento en el estudio de la marcha en niños con insuficiencia motora de origen central (IMOC) / Concordance between clinical scales and indexes derived from gait analysis studies of in children with cerebral palsy

Introducción La parálisis cerebral infantil (PC) se clasifica en términos de función según varias escalas: unas son clínicas, como el GMFCS (Gross Motor Function Classification System), FMS (Functional Mobility Scale) y el cuestionario de evaluación funcional FAQ, (Gillette Functional Assessment Walking Scale), y otras, realizadas en el laboratorio de movimiento, como el GDI (Gait Deviation Index) y el GPS (Gait Profile Score). El objetivo del estudio fue establecer la concordancia entre las escalas clínicas y las escalas derivadas del laboratorio de análisis de movimiento. Metodología Se incluyó a 104 niños entre 5 y 16 años con diagnóstico de PC. Se realizó un estudio transversal y retrospectivo en que se analizaron los datos de 3 escalas clínicas de movilidad funcional y un análisis en 3D de la marcha, realizado en el laboratorio de análisis de movimiento con un equipo SMART-D/BTS y dos plataformas de fuerza. Resultados Respecto a la concordancia entre las escalas evaluadas, encontramos que el valor más alto de kappa (0,416) se obtuvo al confrontar FAQ y FMS a 50 m, lo que demostró una concordancia moderada. El resto de valores de kappa al comparar las diferentes escalas fueron menores a 0,4. Al relacionar las escalas según el porcentaje de acuerdo, encontramos que el mayor fue entre FMS y GPS con el 62,5%, seguido del 60,5% entre FAQ y FMS. Discusión No siempre una correlación aceptable significa una alta concordancia para clasificar a los pacientes en el mismo nivel de compromiso. La baja concordancia entre la mayoría de las escalas indica que el análisis de la marcha en el niño con PC debe realizarse de manera complementaria y llevar a cabo una evaluación con escalas clínicas, de calidad de vida, de funcionalidad y con el laboratorio de análisis de movimiento. Nivel de evidencia clínica. Nivel II.

Background Cerebral Palsy (CP) in children can be classified in terms of function according to several scales, some clinics such as GMFCS (Gross Motor Function Classification System), FMS (functional mobility Scale), FAQ (Gillette Functional Assessment Walking Scale); and others carried out in gait analysis such as the GDI (Gait Deviation Index), GPS (Gait Profile Score). The aim of this study was to determine the concordance between the clinical and gait analysis scales. Methods 104 children between five and sixteen years old diagnosed with Cerebral palsy were included. A cross sectional and retrospective study analyzed data from three clinical scales of functional mobility and a 3D gait analysis were carried out in gait analysis laboratory, using a SMART-D/BTS equipment and two strength platforms. Results Regarding the concordance between the scales evaluated, we found that the highest value of kappa (0416), occurred when confronting FAQ and FMS at 50 m, showing a moderate concordance. The remaining values of Kappa when comparing the different scales were smaller than 0.4. While when comparing the scales according to the percentage of agreement we found that the highest percentage was 62.50% when comparing FMS against GPS, followed by 60.50% when comparing FAQ against FMS. Discussion Not always an acceptable correlation means a high agreement to classify patients at the same level of involvement. The low correlation between most of the scales indicates that the gait analysis in children with Cerebral Palsy should be performed in a complementary manner, performing an assessment with clinical scales, quality of life, and functionality and with instrumented motion analysis. Evidence level. II.

Vendaje neuromuscular en músculo tibial anterior durante la marcha en niños con parálisis cerebral tipo hemiparesia espástica: estudio de casos / Kinesiotape in tibialis anterior muscle during gait in children with spastic hemiparetic cerebral palsy: case reports

Introduction: Kinesiotape (Kt) is a therapeutic technique producing somatosensory stimulation when placed on the skin, and has shown improvement in dynamic activities in neuropediatric field; however, there are limited studies on its effect during gait. Objective: To assess the effect of KT in children with spastic hemiparetic cerebral palsy (CP) during gait, when applied on tibialis anterior muscle of the affected side. Method: Study carried out with 9 children with spastic hemiparetic cerebral palsy and Gross Motor Function Classification System (GMFCS) I & II, between 4 and 10 years old, male and female, at Instituto teletón Antofagasta. Gait was recorded in video in 3 instances: before Kt, immediately after application of Kt, and 5 days post application. Recordings were assessed using the Edinburgh Visual Gait Score (EVGS) and range of motion (RoM) of the ankle during gait. Results: None of the subjects showed significant improvement in RoM of the ankle during gait or in the EVGS. Conclusion: Kt did not change ROM of the ankle during gait in the studied cases, nor as an immediate effect or 5 days after application. only 2 out of 9 children showed a 1 point improvement during the swing phase during EVGS. It is suggested to consider other exclusion criteria and extend the duration of Kt therapy.

El vendaje neuromuscular (VN) es una herramienta terapéutica que estimula el nivel somatosensitivo al ubicarlo sobre la piel, que ha demostrado mejoras en actividades dinámicas en el ámbito neuroinfantil; sin embargo, existen escasos estudios sobre su efecto durante la marcha. Objetivo: Evaluar el efecto del VN sobre la marcha de niños con parálisis cerebral (PC) hemiparética espástica, aplicado en músculo tibial anterior del lado afectado. Método: Estudio de 9 niños con PC y Gross Motor Function Classification System (GMFCS) I y II tipo hemiparesia espástica entre 4 y 10 años de edad, de ambos sexos en el Instituto Teletón Antofagasta. Se filmó marcha en 3 instancias: antes del VN, inmediato con VN y a los 5 días post aplicación. Las grabaciones fueron valoradas con la Edinburgh Visual Gait Score (EVGS) y rango de movimiento (RoM) de tobillo durante la marcha. Resultados: Ninguno de los 9 niños presentó mejoría significativa en su ROM del tobillo durante la marcha ni en la EVGS. Conclusión: El vendaje neuromuscular no produjo cambios del RoM del tobillo durante la marcha en los casos presentados, ni como efecto inmediato ni a los 5 días post aplicación. Sólo 2 de 9 mejoraron en 1 punto durante la fase de balanceo en la EVGS. Se sugiere considerar otros criterios de exclusión y ampliar el tiempo de aplicación del VN.

Perioperative Complications of Orthopedic Surgery for Lower Extremity in Patients with Cerebral Palsy

Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.

Análisis comparativo de puntajes GMFM-66 según sistema de clasificación de la función motora gruesa GMFFCS en Instituto Teletón Santiago 2006-2010 / Comparative analysis of GMFM-66 scores and GMFCS in Teletón Santiago Institute, 2006-2010

Introduction: The gross Motor Measure (GMFM), and two validated scales that measure gross motor developmental changes in children with cerebral palsy (CP), and are utilized to quantify therapeutic intervention results. Objetive: To analyze gross motor function scores (GMFM-66), across condiction severity levels (GMFCS), considering age, type, and CP topographical distribution, at Santiago's Teletón Institute, from 2006 to 2010. Comparison of results with that obtained in the literature, and evaluate the eventual prognostic value of both scales. Methodology: A descriptive retrospective review study of a GMFM database was conducted. A total of 397 children with CP met the inclusion criteria. GMFM-66 scores and GMFCS levels were associated according to the selected variables, and were compared to the literature. Results: 63.2 percent of the children are under 6 years of age. Hemiplegic and diplegic patients concentrate 76.6 percent of cases. According to type, 84.9 percent of patients with spastic CP. Independently from the analyzed variable, the mediam values of GMFM-66 decrease two to four time as the severity of the pathology increases from level I to level IV. Quadriplegic children are distributed among levels III and IV. No hemiplegic patients were found at level V. Compared to other studies, no significant differences were found in GMFM-66 scores across GMFCS levels. Visually, the score diagram by GMFCS levels and age is similar to Rosenbaum's. Conclusion: GMFM-66 score distribution across GMFCS levels turns out as described in the literature, however caution is suggested if used as a predictive value for individual cases.

Introducción: Gross Motor Function Measure (GMFM) Y Gross Motor Function Classification System (GMFCS) son escalas validadas que miden cambios en el desarrollo motor grueso del niño con parálisis cerebral (PC); se utilizan para cuantificar resultados de las intervenciones terapéuticas. Objetivo: Analizar puntajes de función motora gruesa (GMFM-66) por nivel de severidad de la patología (GMFCS), según edad, tipo y distribución topográfica de PC del Instituto Teletón Santiago 2006-2010, comparar con resultados obtenidos en literatura y evaluar el eventual pronóstico de ambas escalas. Metodología: Estudio descriptivo, retrospectivo de revisión a base de datos del GMFM. Un total de 397 niños con PC cumplen con requisitos de inclusión. Se relacionan puntajes de GMFM-66 por niveles de GMFCS según variables consideradas y se compara con bibliografía. Resultados: 63,2 por ciento de los niños son menores de 6 años. Pacientes con diplejía y hemiplejía concentran 76,6 por ciento. Según tipo, el 84,9 por ciento son espásticos. Independientemente de la variable analizada, los valores de las medianas de GMFM-66 disminuye entre 2 y 4 veces a medida que aumenta la severidad de la patología de nivel I a V. Los niños con cuadriplejía se distribuyen de nivel III a V; no se observan diferencias significativas de puntajes GMFM-66 por niveles de GMFCS; visualmente, el diagrama de puntajes por nivel de GMFCS y edad sería similar a Rosenbaum. Conclusión: La distribución de puntajes obtenidos en GMFM-66 por nivel de GMFCS guarda relación con estudios descritos en la literatura, pero se sugiere cautela al usarlos como valor predictivo para los casos individuales.

Desempeño funcional y asociación entre función motora gruesa y habilidad manual en niños con parálisis cerebral del Hogar Clínica San Juan de Dios, Lima-Perú / Functional performance and association between gross motor function and manual skills in children with cerebral palsy from the Hogar Clínica San Juan de Dios, Lima-Perú

Introduction: Children with cerebral palsy (CP) are a heterogeneous and difficult group to classify, therefore, we recommend using a functional approach based on the gross motor function and manual dexterity. We propose a transversal and descriptive study to 1) classify a population of children with CP and to determine the degree of association between Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) and 2) establish the relationship of GMFCS with age, gender, topographic distribution, predominant motor disorder and gross motor function. Patients and Methods: We evaluated 122 children (1-12 years) according to GMFCS, in the subgroup (81/122) of children over 4 years, MACS was applied. The relationship between variables was evaluated using the association test x2, and the association between GMFCS-MACS using Kappa statics with p < 0.05. Results: According to GMFCS, the level V predominates in the different groups: 44.4 percent in < 2 years, 34.8 percent in 2-4 years, and 40 percent in 6-12 years. 88.5 percent of the hemiplegic had level I or II and 75 percent of the quadriplegics had level IV or V (p < 0.01). In regards of manual dexterity, 38.3 percent had MACS I or II. In only 6.1 percent (5/81) we observed GMFCS and MACS level I. There is a relationship between the two systems, but the degree of agreement was low (weighted Kappa = 0.40). Conclusion: The use of both systems helps to functionally characterize our patients and therefore to establish impact measures in the clinical practice, reinforcing the interventions to improve the activities and participation.

Introducción: Los niños con parálisis cerebral (PC) constituyen un grupo heterogéneo de difícil clasificación, por tanto, se recomienda emplear un enfoque funcional basado en la función motora gruesa y la habilidad manual. Se plantea un estudio descriptivo de corte transversal para 1) clasificar una población de niños con PC y determinar el grado de asociación entre los sistemas Gross Motor Function Clasification System (GMFCS) y Manual Ability Classification System (MACS) y, 2) establecer la relación de GMFCS con edad, género, distribución topográfica, trastorno motor predominante y función motora gruesa. Pacientes y Métodos: Se evaluaron 122 niños (1-12 años) según GMFCS; en subgrupo (81/122) de niños mayores de 4 años, se aplicó MACS. La relación entre las variables fue evaluada con prueba de asociación basada en x2 y, la asociación GMFCS-MACS mediante estadística Kappa con p < 0,05. Resultados: Según GMFCS, el nivel V predomina en los distintos grupos: 44,4 por ciento en < 2 años; 34,8 por ciento de 2-4 años y 40 por ciento en 6-12 años. 88,5 por ciento de los hemipléjicos tenían nivel I o II y el 75 por ciento de los cuadripléjicos nivel IV o V (p <0,01). Según habilidad manual 38,3 por ciento tuvieron MACS I o II. En sólo el 6,1 por ciento (5/81) se observó un GMFCS y MACS nivel I. Existe una relación entre ambos sistemas, pero el grado de concordancia fue bajo (Kappa ponderado =0,40). Conclusión: El uso de ambos sistemas permite caracterizar funcionalmente a nuestros pacientes para establecer medidas de impacto en la práctica clínica, reforzando las intervenciones que mejoren las actividades y la participación.

Dysphagia in Cerebral Palsy and the Relationship between Levels of Gross Motor Function Classification System / 中国康复理论与实践

@#ObjectiveTo analyze the characteristics of dysphagia in children with cerebral palsy and explore the relation with the gross motor function classification.MethodsThe children with cerebral palsy in our rehabilitation center from June 2009 to June 2010 were assessed by Dysphagia Disorders Survey(DDS), Oral Motor Assessment and Gross Motor Function Classification System (GMFCS) to explore the relationship between the dysphagia disorders and different gross motor levels.ResultsOf all 105 children with cerebral palsy, 21.9% were mild dysphagia, and 34.3% were moderate to severe dysphagia, resulting in a prevalence of dysphagia of 56.2%. DDS and oral motor scores were changed by GMFCS levels. The correlation coefficient were 0.767 and -0.504 between DDS, oral motor scores and GMFCS, 0.55 and 0.27 between dysphagia, oral motor disorder and the gross motor functions, respectively(P<0.01).ConclusionDysphagia was positively related to severity of motor impairment. Children in GMFCS levels Ⅳ～Ⅴ almost with problems in the pharyngeal and esophageal phases, apparently on the DDS, should be referred for appropriate clinical evaluation of swallowing function.

Reliability Study of Gross Motor Function Classification System and Delphi Survey of Expert Opinion for Clinical Use of this System in Japan / The Japanese Journal of Rehabilitation Medicine

The purpose of this study was to examine the reliability of the Japanese version of the Gross Motor Function Classification System (GMFCS) and to determine expert opinions on clinical use of this system using a Delphi survey. The reliability study was performed with 334 children (191 boys, 143 girls) with cerebral palsy, ranging in age from 8 months to 12 years (mean, 5 years 7 months ; standard deviation, 3 years 1 month). A total of 181 assessors participated in the study. Two assessors classified each child's level of gross motor function independently using a revised version of the GMFCS (Japanese version 1.1). This revision of the GMFCS was based on the results of previous pilot studies performed in Japan. A questionnaire was used for the Delphi survey, and the rate of positive response was calculated from the answers of 20 assessors at each institute that conducted the reliability study. In the reliability study, overall kappa was 0.67, but specific kappas <0.40 were found at level III and IV in the 4.6 year age group. In the Delphi survey, the rate of positive responses was not ≥80% only for the description of level III among the five levels. These findings and structural analysis of descriptions for level III and IV according to the results reported by Rosenbaum and coworkers suggest that reliability of the GMFCS was partly lowered because of the level III description for the age of 4.6 years, which might be set at a relatively lower level than actual development.

Preliminary study of the Gross Motor Function Classification System(GMFCS) for children with cerebral palsy / 中国康复理论与实践

@#ObjectiveTo test the reliability of Gross Motor Function Classification System(GMFCS) among different raters.MethodsUsing the Chinese translation vision of the GMFCS,5 doctors(raters) determined the level of each cerebral palsy(CP) child(aged 0～12) independently.After finishing classification of all the 23 CP children's level,the reasons of disparities among raters were discussed and analyzed,and the supplementary classification sentences were formulated.ResultsThere was no statistic significant difference in classifications among 5 raters,the GMFCS levels were correlated well with mobility and self-care domain scores in comprehensive function assessment,and higher degree of agreement could be achieved by referring to the supplementary classification sentences while classifying.ConclusionFor classifying the level of gross motor function of CP children,Chinese translation vision of the GMFCS has high degree of reliability.