title: Association between gross motor function (GMFCS) and manual ability (MACS) in children with cerebral palsy. A population-based study of 359 children.
abstract: BACKGROUND
  The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP). The Manual Ability Classification System (MACS) was developed recently as a corresponding classification of manual ability. The aim of this study was to describe the association between gross motor function and manual ability in a total population of children with cerebral palsy.
  
  
  METHODS
  365 children, born 1992 to 2001, who were registered in a population-based health care programme (CPUP) for children with CP living in the south of Sweden were included in the study. GMFCS was evaluated by the child's physiotherapist and MACS by the occupational therapist. CP diagnosis and subtype were determined by the neuropaediatrician at or after the age of four.
  
  
  RESULTS
  GMFCS levels were available in all 365 children, MACS levels in 359 (98%). There was a poor overall correlation between gross motor function and manual ability. However, different associations between gross motor function and manual ability were found in the different diagnostic subtypes. Children with spastic hemiplegia generally had a lower level of manual ability than gross motor function (p < 0.001). The reverse association was generally found in children with spastic diplegia (p < 0.001). Children with dyskinetic CP had large limitations in both gross motor function and manual ability, with no significant discrepancy between GMFCS and MACS levels.
  
  
  CONCLUSIONS
  Gross motor function and manual ability are often discrepant in children with CP, and the patterns seem to vary across the different subgroups based on the predominant neurological findings. To give a complete clinical picture when evaluating these children, both aspects have to be described. The GMFCS and the MACS seem to work well in this context and seem very useful in population-based studies, in health care registers for children with CP, and in clinical practice.
authors.affiliation: Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden. katharina.delhusen-carnahan@skane.se
authors.forename: Katharina Delhusen
authors.initials: KD
authors.lastname: Carnahan
authors.forename: Marianne
authors.initials: M
authors.lastname: Arner
authors.forename: Gunnar
authors.initials: G
authors.lastname: Hägglund
mesh_terms: D002547:Cerebral Palsy / Q000145:classification* / Q000503:physiopathology* / Q000534:rehabilitation; D002648:Child; D004185:Disability Evaluation; D020820:Dyskinesias / Q000503:physiopathology; D006801:Humans; D009048:Motor Skills; D009068:Movement; D009128:Muscle Spasticity / Q000503:physiopathology; D012042:Registries; D012720:Severity of Illness Index; D013548:Sweden