Comparing functional profiles of children with hemiplegic and diplegic cerebral palsy in GMFCS Levels I and II: Are separate classifications needed?
The goal was to compare children with hemiplegia with those with diplegia within Gross Motor Functional Classification System (GMFCS) levels using multiple validated outcome tools. Specifically, we proposed that children with hemiplegia would have better gait and gross motor function within levels while upper extremity function would be poorer. Data were collected on 422 ambulatory children with cerebral palsy: 261 with diplegia and 161 with hemiplegia, across seven centers. Those with hemiplegia in each level performed significantly and consistently better on gait or lower extremity function and poorer on upper extremity and school function than those with diplegia. In GMFCS Level II, the group with hemiplegia walked faster (p = 0.017), scored 6.6 points higher on Dimension E of the Gross Motor Function Measure (p = 0.017), 6.7 points lower on Upper Extremity subscale of the Pediatric Outcomes Data Collection Instrument, and 9.1 points lower on WeeFIM self-care (p = 0.002). Basing motor prognosis on GMFCS level alone may underestimate lower extremity skills of children with hemiplegia, and overestimate those of children with diplegia.
Damiano
Diane
D
Department of Neurology, Washington University, St Louis, Missouri 63110, USA. damianod@neuro.wustl.edu
Abel
Mark
M
Romness
Mark
M
Oeffinger
Donna
D
Tylkowski
Chester
C
Gorton
George
G
Bagley
Anita
A
Nicholson
Diane
D
Barnes
Douglas
D
Calmes
Janine
J
Kryscio
Richard
R
Rogers
Sarah
S
D000293:Adolescent; D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D004522:Educational Status; D005121:Extremities / Q000502:physiology; D005260:Female; D005684:Gait / Q000502:physiology; D006429:Hemiplegia / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology*; D006763:Hospitals, Chronic Disease; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D012016:Reference Values; D015203:Reproducibility of Results; D012720:Severity of Illness Index