AN ICF CORE SET BASED INVESTIGATION OF THE EFFECTS OF GROSS MOTOR FUNCTIONS ON HEALTH IN CHILDREN WITH CEREBRAL PALSY

Abstract

Purpose: The Gross Motor Function Measure (GMFM) is commonly used to assess gross motor functions in children with cerebral palsy (CP). Our aim was to investigate the relationship between gross motor function and health status in children with CP based on clinical types and functional levels. Methods: This cross-sectional study included 75 children with CP (mean age ± SD 7.59 ±3.86 years). The 66-item Gross Motor Function Measure (GMFM-66) was used to measure the gross motor functions of children. The International Classification of Functioning, Disability and Health (ICF) CP Core Set was used to assess the general health status of children including body functions and structures, activity and participation, and environmental factors for obtaining a holistic framework. Results: Of the children, 61 (81.3%) were spastic and 14 (18.7%) were dyskinetic. Children were divided into 3 groups based on the Gross Motor Function Classification System (GMFCS) level as mild (levels 1-2, n=28), moderate (level 3, n=16), and severe (levels 4-5, n=31). The GMFM-66 had moderate to strong correlations with body functions and structures (r=-0.811, p<0.001) and activity and participation (r=-0.862, p<0.001) domains of the ICF in severely affected children with CP although it had no strong correlation in any of the ICF domains in mildly or moderately affected children. Conclusion: Although gross motor functions may reflect the health status holistically in severely affected children with CP, it seems not sufficient to reflect the health status in mildly or moderately affected children with CP.

Keywords

• Cerebral palsy
• Gross motor function
• Health status
• ICF

SEREBRAL PALSİLİ ÇOCUKLARDA KABA MOTOR FONKSİYONLARIN SAĞLIK ÜZERİNE ETKİLERİNİN ICF ÇEKİRDEK SETİ TEMEL ALINARAK ARAŞTIRILMASI

Öz

Amaç: Kaba Motor Fonksiyon Ölçümü (GMFM), serebral palsili (SP) çocuklarda kaba motor fonksiyonların değerlendirilmesinde yaygın olarak kullanılmaktadır. Amacımız SP'li çocuklarda klinik tipe ve fonksiyonel seviyelere göre kaba motor fonksiyon ile sağlık durumu arasındaki ilişkiyi araştırmaktı. Yöntem: Bu kesitsel çalışmaya SP'li 75 çocuk (ortalama±standart sapma yaş 7,59±3,86 yıl) dahil edildi. Çocukların kaba motor fonksiyonlarını ölçmek için 66 maddelik Kaba Motor Fonksiyon Ölçeği (GMFM-66) kullanıldı. Bütünsel bir çerçeve elde etmek amacıyla vücut yapı ve fonksiyonları, aktivite ve katılım düzeyi ve çevresel faktörler de dahil olmak üzere çocukların genel sağlık durumunu değerlendirmek için Uluslararası İşlevsellik, Engellilik ve Sağlık Sınıflandırması (ICF) SP Çekirdek Seti kullanıldı. Sonuçlar: Çocukların 61'i (%81,3) spastik, 14'ü (%18,7) diskinetikti. Çocuklar Kaba Motor Fonksiyon Sınıflandırması (GMFCS) düzeyine göre hafif (seviye 1-2, n=28), orta (seviye 3, n=16) ve şiddetli (seviye 4-5, n=31) olmak üzere 3 gruba ayrıldı.GMFM-66 ağır etkilenimli SP’li çocuklarda ICF’in vücut yapı ve fonksiyonları (r=-0,811, p<0,001) ve aktivite ve katılım seviyesi (r=-0,862, p<0,001) ile orta-güçlü ilişkiye sahipken, hafif veya orta şiddetli etkilenimi olan SP’li çocuklarda ICF’in hiçbir alanı ile güçlü ilişkisi bulunmadı. Tartışma: Kaba motor fonksiyonlar, ağır etkilenmiş SP'li çocuklarda sağlık durumunu bütünsel olarak yansıtabilse de, hafif veya orta derecede etkilenmiş SP'li çocuklarda sağlık durumunu yansıtmada yeterli görünmemektedir.

Anahtar Kelimeler

• Serebral palsi
• Kaba motor fonksiyonlar
• Sağlık durumu
• ICF

References

1. 1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14.
2. 2. McIntyre S, Goldsmith S, Webb A, Ehlinger V, Hollung SJ, McConnell K, et al. Global prevalence of cerebral palsy: A systematic analysis. Dev Med Child Neurol. 2022;64(12):1494-1506.
3. 3. Pashmdarfard M, Richards LG, Amini M. Factors affecting participation of children with cerebral palsy in meaningful activities: systematic review. Occup Ther Health Care. 2021;35(4):442-479.
4. 4. Imms C, Adair B. Participation trajectories: impact of school transitions on children and adolescents with cerebral palsy. Dev Med Child Neurol. 2017;59(2):174-182.
5. 5. Tavares Netto AR, Wiesiolek CC, Brito PM, Rocha GAd, Tavares RMF, Lambertz KMF. Functionality, school participation and quality of life of schoolchildren with cerebral palsy. Fisioterapia em Movimento. 2020;33.
6. 6. Schmidt AK, van Gorp M, van Wely L, Ketelaar M, Hilberink SR, Roebroeck ME, et al. Autonomy in participation in cerebral palsy from childhood to adulthood. Dev Med Child Neurol. 2020;62(3):363-371.
7. 7. Zeidan J, Joseph L, Camden C, Shevell M, Oskoui M, Lamotte P, et al. Look around me: environmental and socio-economic factors related to community participation for children with cerebral palsy in Québec. Phys Occup Ther Pediatr. 2021;41(4):429-446.
8. 8. Organization WH. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY: World Health Organization; 2007.

9. 9. Schiariti V, Mâsse LC. Relevant areas of functioning in children with cerebral palsy based on the international classification of functioning, disability and health coding system: a clinical perspective. J Child Neurol. 2015;30(2):216-222.
10. 10. Piscitelli D, Ferrarello F, Ugolini A, Verola S, Pellicciari L. Measurement properties of the Gross Motor Function Classification System, Gross Motor Function Classification System‐Expanded & Revised, Manual Ability Classification System, and Communication Function Classification System in cerebral palsy: a systematic review with meta‐analysis. Dev Med Child Neurol. 2021;63(11):1251-1261.
11. 11. Palisano RJ, Avery L, Gorter JW, Galuppi B, McCoy SW. Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System. Dev Med Child Neurol. 2018;60(10):1026-1032.
12. 12. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-223.
13. 13. Park E-Y. Stability of the gross motor function classification system in children with cerebral palsy for two years. BMC Neurol. 2020;20:1-7.
14. 14. Avery LM, Russell DJ, Rosenbaum PL. Criterion validity of the GMFM-66 item set and the GMFM-66 basal and ceiling approaches for estimating GMFM-66 scores. Dev Med Child Neurol. 2013;55(6):534-538.
15. 15. Russell DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palisano RJ. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther. 2000;80(9):873-885.
16. 16. Schiariti V, Selb M, Cieza A, O'Donnell M. International Classification of Functioning, Disability and Health Core Sets for children and youth with CP: contributions to clinical practice. Dev Med Child Neurol. 2015;57(2):203-204.
17. 17. Schiariti V, Selb M, Cieza A, O'Donnell M. International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy: a consensus meeting. Dev Med Child Neurol. 2015;57(2):149-158.
18. 18. Chan Y. Biostatistics 104: correlational analysis. Singapore Med J. 2003;44(12):614-619.
19. 19. Tofani M, Mustari M, Tiozzo E, Dall'Oglio I, Morelli D, Gawronski O, et al. The development of the International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY) Core Sets: a systematic review. Disabil Rehabil. 2022:1-10.
20. 20. Noten S, Troenosemito LAA, Limsakul C, Selb M, de Groot V, Konijnenbelt M, et al. Development of an ICF Core Set for adults with cerebral palsy: capturing their perspective on functioning. Dev Med Child Neurol. 2021;63(7):846-852.
21. 21. Goh YR, Choi JY, Kim SA, Park J, Park ES. Comparisons of severity classification systems for oropharyngeal dysfunction in children with cerebral palsy: Relations with other functional profiles. Res Dev Disabil. 2018;72:248-256.
22. 22. Unes S, Tuncdemir M, Ozal C, Cankaya O, Seyhan Biyik K, Delioglu K, et al. Relationship among four functional classification systems and parent interpredicted intelligence level in children with different clinical types of cerebral palsy. Dev Neurorehabil. 2022;25(6):410-416.
23. 23. Compagnone E, Maniglio J, Camposeo S, Vespino T, Losito L, De Rinaldis M, et al. Functional classifications for cerebral palsy: correlations between the gross motor function classification system (GMFCS), the manual ability classification system (MACS) and the communication function classification system (CFCS). Res Dev Disabil. 2014;35(11):2651-2657.
24. 24. Choi JY, Park J, Choi YS, Goh YR, Park ES. Functional Communication Profiles in Children with Cerebral Palsy in Relation to Gross Motor Function and Manual and Intellectual Ability. Yonsei Med J. 2018;59(5):677-685.
25. 25. Ko J, Kim M. Inter-rater Reliability of the K-GMFM-88 and the GMPM for Children with Cerebral Palsy. Ann Rehabil Med. 2012;36(2):233-239.
26. 26. Beckers LW, Bastiaenen CH. Application of the Gross Motor Function Measure-66 (GMFM-66) in Dutch clinical practice: a survey study. BMC Pediatr. 2015;15:146.
27. 27. Ferre-Fernández M, Murcia-González MA, Ríos-Díaz J. Intra-and Interrater Reliability of the Spanish Version of the Gross Motor Function Measure (GMFM-SP-88). Pediatr PhysTher. 2022;34(2):193-200.
28. 28. Almeida KM, Albuquerque KA, Ferreira ML, Aguiar SK, Mancini MC. Reliability of the Brazilian Portuguese version of the Gross Motor Function Measure in children with cerebral palsy. Braz J Phys Ther. 2016;20(1):73-80.
29. 29. Vila-Nova F, Dos Santos Cardoso de Sá C, Oliveira R, Cordovil R. Differences in Leisure Physical Activity Participation in Children with Typical Development and Cerebral Palsy. Dev Neurorehabil. 2021;24(3):180-186.
30. 30. Kostanjsek N, Rubinelli S, Escorpizo R, Cieza A, Kennedy C, Selb M, et al. Assessing the impact of health conditions using the ICF. Disabil Rehabil. 2011;33(15-16):1475-1482.