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2 Methods of Classification2.1 Severity2.2 Topographical Distribution2.3 Muscle Tone2.4 Functional Classification of Cerebral Palsy
The information on this page has developed for you from the expert work of Roelie Wolting alongside the Enablement Cerebral Palsy Project and Handicap International Group.
Cerebral Palsy is caused by an injury to the brain or by abnormal brain development. Although the injury is neurological in nature, it produces affects to the body that impair movement, coordination, balance and posture. There are various types of Cerebral Palsy. There are 3 major types of Cerebral Palsy: Spastic (70-80%), Dyskinetic (10-20%) and Ataxic (5-10%); or a combination of the three can occur.Some children develop further disorders such as seizure, mental impairments and suffer from other problems such as difficulty learning to chew, swallow and talk, difficulty communicating, Poor eyesight and hearing difficulties, perception, growth problems, dental problems, constipation, sleep problems, slow learning, challenging behaviour.
The specific needs of this heterogeneous group vary widely. Every child is unique with varying degrees of impairment. Classification is important in understanding the individual child’s impairment, and for coordinating the management of care but treatment must be adapted to each individual child”s needs. Professionals who specialize in treatment of cerebral palsy approach the condition from a number of different vantage points.For these reasons, many cerebral palsy classification systems are used today. Over the last 150 years, the definition of Cerebral Palsy has evolved and changed as new medical discoveries contributed to growing knowledge of the condition. Although a myriad of classifications, used differently and for many purposes, exists today, those involved in Cerebral Palsy research are working towards a universally accepted classification system.
Classification of Cerebral Palsy is important, as this enables realistic expectations and can play an important role in influencing treatment. There are many ways of classifying Cerebral Palsy and tools available to be able to do this.
Methods of Classification
Cerebral Palsy is often classified by severity level as Mild, Moderate, Severe. These are broad generalizations that lack a specific set of criteria. Even when doctors agree on the level of severity, the classification provides little specific information, especially when compared to other means of Classification. Still, this method is common and offers a simple method of communicating the scope of impairment, which can be useful when accuracy is not necessary.
Mild Cerebral Palsy means a child can move without assistance; his or her daily activities are not limited.
Moderate Cerebral Palsy means a child will need braces, medications, and adaptive technology to accomplish daily activities.
Severe Cerebral Palsy means a child will require a wheelchair and will have significant challenges in accomplishing daily activities and will need important support.
Topographical classification describes body parts affected. The words are a combination of phrases combined for one single meaning. When used with Motor Function Classification, it provides a description of how and where a child is affected by Cerebral Palsy. This is useful in ascertaining treatment protocols.
Term at the heart of this classification method;
Plegia/Plegic – Means Paralyzed
The prefix and root word are combined to yield the topographical classifications commonly used in practice today;
Means only one limb is affected. It is believed this may be a form of hemiplegia/hemiparesis where one limb is significantly impaired.
Usually indicates the legs are affected more than the arms; primarily affects the lower body.
Indicates the arm and leg on one side of the body is affected.
Indicates three limbs are affected. This could be both arms and a leg, or both legs and an arm. Or, it could refer to one upper and one lower extremity and the face.
Indicates all four limbs are involved, but one side of the body is more affected than the other.
Means that all four limbs are involved.
Many motor function terms describe Cerebral Palsy’s effect on muscle tone and how muscles work together. Proper muscle tone when bending an arm requires the biceps to contract and the triceps to relax. When muscle tone is impaired, muscles do not work properly together and can even work in opposition to one another.Two terms used to describe Muscle Tone are hypertonia and hypotonia.
Increased muscle tone, often resulting in very stiff limbs. Hypertonia is associated with spastic cerebral palsy.
Decreased muscle tone, often resulting in loose, floppy limbs. Hypotonia is associated with non-spastic cerebral palsy.
Functional Classification of Cerebral Palsy
The functional abilities of children with Cerebral Palsy vary immensely in the domains of cognition, self-care, mobility and social aspects. However, the classification of gross motor function in children with Cerebral Palsy has proven to be successful.
The Gross Motor Function Classification System (GMFCS) was the first Classification system developed for children with cerebral palsy, first published in 1997 and revised and expanded in 2007. The GMFCS was developed by CanChild Centre for Childhood Disability Research (Canada).
After the GMFCS the Manual Ability Classification System (MAC) was developed and published in 2010. The members of this group have different competencies and professions, they are located in different universities in Sweden. The team collaborates with CanChild, Centre for Childhood Disability Research.
In 2011 the Communication Function Classification System (CFCS) was published, also developed by a team of professionals at University of Central Arkansas (US). They have all 5 levels in functioning.
Only the GMFCS has different descriptions for 5 different ages: the first before the age of 2 and the last one for age 12-18. During their life it is expected that children will stay at the same level and the GMFCS describes what gross motor functions the child will be able to learn during life at different ages. The Gross Motor Functional Classification Scale (GMFCS), first devised in 1997, has been universally implemented as the common language between health professionals to communicate the gross motor ability of children with Cerebral Palsy.<1>