title: Motor severity in children with cerebral palsy studied in a high-resource and low-resource country.
abstract: OBJECTIVE
  To compare the patterns of motor type and gross motor functional severity in preschool-aged children with cerebral palsy (CP) in Bangladesh and Australia.
  
  
  METHODS
  We used comparison of 2 prospective studies. A total of 300 children with CP were aged 18 to 36 months, 219 Australian children (mean age, 26.6 months; 141 males) recruited through tertiary and community services, and 81 clinic-attendees born in Bangladesh (mean age, 27.5 months; 50 males). All children had diagnosis confirmed by an Australian physician, and birth and developmental history collected on the Physician Checklist. All children were classified by the same raters between countries using the Gross Motor Function Classification System (GMFCS), and motor type and distribution.
  
  
  RESULTS
  There were more children from GMFCS I-II in the Australian sample (GMFCS I, P < .01; III, P < .01; V, P = .03). The patterns of motor type also differed significantly with more spasticity and less dyskinetic types in the Australian sample (spasticity, P < .01; dystonia, P < .01; athetosis, P < .01). Birth risk factors were more common in the Bangladesh sample, with risk factors of low Apgar scores (Australia, P < .01), lethargy/seizures (Australia, P = .01), and term birth (Bangladesh, P = .03) associated with poorer gross motor function. Cognitive impairments were significantly more common in the Bangladesh children (P < .01), and visual impairments more common in Australia (P < .01).
  
  
  CONCLUSIONS
  Patterns of functional severity, motor type, comorbidities, etiology, and environmental risk factors differed markedly between settings. Our results contribute to understanding the patterns of CP in low-resource settings, and may assist in optimizing service delivery and prioritizing appropriate early interventions for children with CP in these settings.
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine, Centre for the Rehabilitation of the Paralysed, Dhaka, Bangladesh; and katherine.benfer@uqconnect.edu.au.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Benfer
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jordan
authors.affiliation: Queensland Paediatric Rehabilitation Service, Royal Children's Hospital, Brisbane, Australia.
authors.forename: Sasaka
authors.initials: S
authors.lastname: Bandaranayake
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine.
authors.forename: Christine
authors.initials: C
authors.lastname: Finn
authors.affiliation: School of Population Health, and Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia;
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine.
authors.forename: Roslyn N
authors.initials: RN
authors.lastname: Boyd
mesh_terms: D001459:Bangladesh; D002547:Cerebral Palsy / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation; D002675:Child, Preschool; D015331:Cohort Studies; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004185:Disability Evaluation; D005260:Female; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007223:Infant; D008297:Male; D051346:Mobility Limitation; D010343:Patient Admission; D011446:Prospective Studies; D011793:Queensland; D012307:Risk Factors
keywords: cerebral palsy; gross motor severity; high-resource country; low-resource country; motor type