Classification of Cerebral Palsy

 Introduction

Classification of Cerebral Palsy is important, as this enables realistic expectations and can play an important role in influencing treatment. There are many tools available to be able to do this. Some of the most poular ones are explained below:

• The Gross Motor Function Classification System
• Communication Function Classification System 
• Manual Ability Classification System

The Gross Motor Function Classification System (GMFCS) was the first Classification system developed for children with cerebral palsy, first published in 1997 and revised and expanded in 2007. The GMFCS was developed by CanChild Centre for Childhood Disability Research (Canada). After the GMFCS the Manual Ability Classification System (MAC) was developed and published in 2010. The members of this group have different competencies and professions, they are located in different universities in Sweden. The team collaborates with CanChild, Centre for Childhood Disability Research. In 2011 the Communication Function Classification System (CFCS) was published, also developed by a team of professionals at University of Central Arkansas (US). They all have 5 levels in functioning. Only the GMFCS has different descriptions for 5 different ages: the first before the age of 2 and the last one for age 12-18. During their life it is expected that children will stay at the same level, and the GMFCS describes what gross motor functions the child will be able to learn during life at different ages.

MACS can be used for children of different ages (4-18 years), but the interpretation of the levels needs to be related to the age of the child. Obviously, children handle different objects at age four years, compared to adolescent age. The same point concerns independence, as a young child needs more help and supervision than an older child but their handling of objects is the primary focus of MACS. To date the stability of the classification over time has not been investigated , but our belief is that most children will stay at the same level.

The Communication Function Classification System (CFCS) provides a valid and reliable classification of communication performance and activity limitations that can be used for research and clinical purposes. The CFCS does not rate the person’s potential for improvement

The classifications can be done together with parents or by parents. So, it is not a classification system to be used only be professionals. Using the three different classification systems will help you and the parents to look at different developmental areas of the child and to develop goals and interventions (and when these are needed) for three different areas. It will provide a basis for discussion what the child can do and where to work on. Below each classification system is explained in a little more detailed.

GMFCS

The original version, the GMFCS, The Gross Motor Function Classification System, was developed in 1997; as of 2007, the expanded and revised version (GMFCS – E&R) further includes an age band for youth 12 to 18 years. The 2007 version will be used in this module.

The GMFCS has 5 classification levels for 5 different age groups:

• Before 2 years
• Between 2 and 4 years
• Between 4 and 6 years
• Between 6 and 12 years
• Between 12 and 18 years

The Gross Motor Function Classification System is a 5 level classification system that describes the gross motor function of children and youth with cerebral palsy on the basis of their self-initiated movement with particular emphasis on sitting, walking, and wheeled mobility. The primary criterion has been that the distinctions between levels must be meaningful in daily life. Distinctions between levels are based on functional abilities, the need for assistive technology, including hand-held mobility devices (walkers, crutches, or canes) or wheeled mobility, and to a much lesser extent, quality of movement. The GMFCS emphasises the concepts inherent in the World Health Organisation's International Classification of Functioning, Disability and Health (ICF). We encourage users to be aware of the impact that environmental and personal factors may have on what children and youth are observed or reported to do. The descriptions for the 6 to 12 year and 12 to18 year age bands reflect the potential impact of environment factors (e.g., distances in school and community) and personal factors (e.g., energy demands and social preferences) on methods of mobility.

Here is a video with some examples of the different levels of the GMFCS

Use of the GMFCS

Therapists and physicians can reliably use the GMFCS with no training , simply by reading the criteria. When you are familiar with the GMFCS you can classify a child you know quite well in less than 5 minutes. If you are unfamiliar with a child (and therefore require an observation session) you may need 15-20 minutes. Most distinctions are fairly clear and decisions about which level most closely resembles the child’s current gross motor function can be made quite quickly. Sometimes (i.e., at certain ages), the distinctions between two adjacent levels are more subtle and require more careful deliberation. A classification can be made based on general familiarity with a child’s current gross motor abilities without necessitating an observation. Information about the child’s usual performance and limitations in gross motor function in home, school and community settings can be obtained by parent/caregiver interview or by review of recent (clinic) notes that describe gross motor function.

Here are some of the age specific assessment sheets that can be used by the family and the child to help assessment:

• Written instruction on use of GMFCS
• Ages 2-4 years
• Ages 4-6 years
• Ages 6-12 years
• Ages 12-18 parents' assessment
• Ages 12-18 self assessment