title: Comparing functional profiles of children with hemiplegic and diplegic cerebral palsy in GMFCS Levels I and II: Are separate classifications needed?
abstract: 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.
authors.affiliation: Department of Neurology, Washington University, St Louis, Missouri 63110, USA. damianod@neuro.wustl.edu
authors.forename: Diane
authors.initials: D
authors.lastname: Damiano
authors.forename: Mark
authors.initials: M
authors.lastname: Abel
authors.forename: Mark
authors.initials: M
authors.lastname: Romness
authors.forename: Donna
authors.initials: D
authors.lastname: Oeffinger
authors.forename: Chester
authors.initials: C
authors.lastname: Tylkowski
authors.forename: George
authors.initials: G
authors.lastname: Gorton
authors.forename: Anita
authors.initials: A
authors.lastname: Bagley
authors.forename: Diane
authors.initials: D
authors.lastname: Nicholson
authors.forename: Douglas
authors.initials: D
authors.lastname: Barnes
authors.forename: Janine
authors.initials: J
authors.lastname: Calmes
authors.forename: Richard
authors.initials: R
authors.lastname: Kryscio
authors.forename: Sarah
authors.initials: S
authors.lastname: Rogers
mesh_terms: 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