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Comparing functional profiles of children with hemiplegic and diplegic cerebral palsy in GMFCS Levels I and II: are separate classifications needed?

Published online by Cambridge University Press:  18 September 2006

Diane Damiano
Affiliation:
Washington University, St Louis, Missouri, USA.
Mark Abel
Affiliation:
University of Virginia, Charlottesville, Virginia, USA.
Mark Romness
Affiliation:
University of Virginia, Charlottesville, Virginia, USA.
Donna Oeffinger
Affiliation:
Shriners Hospitals for Children (SHC) Lexington, Kentucky, USA.
Chester Tylkowski
Affiliation:
Shriners Hospitals for Children (SHC) Lexington, Kentucky, USA.
George Gorton
Affiliation:
SHC Springfield, Massachusetts, USA.
Anita Bagley
Affiliation:
SHC Sacramento, California, USA.
Diane Nicholson
Affiliation:
SHC Salt Lake City, Utah, USA.
Douglas Barnes
Affiliation:
SHC Houston, Texas, USA.
Janine Calmes
Affiliation:
SHC Houston, Texas, USA.
Richard Kryscio
Affiliation:
University of Kentucky, USA.
Sarah Rogers
Affiliation:
Shriners Hospitals for Children (SHC) Lexington, Kentucky, USA.
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Abstract

The goal was to compare children with hemiplegia with those with diplegia within Gross Motor Functional Classification System (GMFCS) levels using multiple validated outcome tools. Specifically, we proposed that children with hemiplegia would have better gait and gross motor function within levels while upper extremity function would be poorer. Data were collected on 422 ambulatory children with cerebral palsy: 261 with diplegia and 161 with hemiplegia, across seven centers. Those with hemiplegia in each level performed significantly and consistently better on gait or lower extremity function and poorer on upper extremity and school function than those with diplegia. In GMFCS Level II, the group with hemiplegia walked faster (p=0.017), scored 6.6 points higher on Dimension E of the Gross Motor Function Measure (p=0.017), 6.7 points lower on Upper Extremity subscale of the Pediatric Outcomes Data Collection Instrument, and 9.1 points lower on WeeFIM self-care (p=0.002). Basing motor prognosis on GMFCS level alone may underestimate lower extremity skills of children with hemiplegia, and overestimate those of children with diplegia.

Type
Original Articles
Copyright
2006 Mac Keith Press

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