Predicting motor development for cerebral palsy

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					                                                                                                 SPECIAL FEATURE ON RESEARCH


                        PREDICTING
                                  MOTOR DEVELOPMENT FOR CEREBRAL PALSY

by Hélèna Katz


When parents are told that their child           child’s age and GMFCS level can be used          allow us to see when the child will reach a
has cerebral palsy, they usually want            to predict his/her prognosis for gross motor     plateau and when most have reached their
to know how severe the condition is              development.                                     potential. This means therapists can set reha-
and whether their child will ever be                Dr. Louise Koclas, a paediatrician in the     bilitation therapy objectives in a clearer and
able to walk. These questions have               neonatology clinic at the Montreal Child-        more targeted way,” she says.
generally been difficult to answer               ren’s Hospital, heads a team that works              She would like to see some long-term
because there has been no reliable               with children who have cerebral palsy.           research explore these children’s future
way to classify the severity of cerebral         “Using the GMFCS makes it easier for thera-      into adolescence. “If a child reaches his/her
palsy, nor has long-term information             pists to assess each child’s potential and       motor objectives early,what is his/her poten-
on which to base opinions been                   explain the prognosis to parents.The curves      tial with respect to adolescence? Do they
available.                                                                                                       maintain or improve?” she
                                                                                                                 wonders. Dr. Koclas would
                                                                                                                 also be interested to learn


A
         team of researchers wanted to                                                                           about the impact of new
         describe the gross motor develop-                                                                       therapies, such as the use of
         ment of children with varying                                                                           botox, on the children’s mo-
degrees of cerebral palsy.They hoped that                                                                        tor skill development and the
following the same children for a period of                                                                      use of the GMFCS.
up to four years would allow them to find
patterns on which to base predictions for                                                                         Ref.: Rosenbaum PL, Walter SD,
parents.                                                                                                          Hanna SE, Palisano RJ, Russell DJ,
    This study included 657 children                                                                              Raina P, Wood E, Bartlett DJ, Galup-
between the ages of 1 and 13. The extent                                                                          pi BE. Prognosis for Gross Motor Func-
of their cerebral palsy varied;it was assessed                                                                    tion in Cerebral Palsy: Creation of
using the Gross Motor Function Classifi-                                                                          Motor Development Curves. JAMA -
cation System (GMFCS).This classifies child-                                                                      Journal of the American Medical Associ-
ren into five levels, depending on their                                                                          ation 2002:288(11);1357-1363.
gross motor activity and which of four age
groups they fall into.
    Each child’s motor function was also
assessed with the Gross Motor Function
Measure (GMFM), a widely used tool with
a scale of 0 to 100 that was developed for
children with cerebral palsy or Down syn-
drome. It evaluates change in the gross
motor function of children diagnosed with
cerebral palsy, using activities that a typic-
al five-year-old could accomplish.
    Children under the age of six were
assessed every six months while older                            “Using the GMFCS makes it easier for therapists
children were evaluated every 9 to 12
months. As expected, there was a system-
                                                                 to assess each child’s potential and explain the
atic and significant change in motor func-                       prognosis to parents”
tion over time, related to the severity of
the children’s cerebral palsy.Therefore, the
VOLUME 2, No. 3-NOVEMBER 2003                                          BULLETIN OF THE CENTRE OF EXCELLENCE FOR EARLY CHILDHOOD DEVELOPMENT - PAGE 9