Cerbral palsy

Spectrum of Gross Motor Function in Extremely Low Birth Weight Children With Cerebral Palsy at 18 Months of Age Betty R. Vohr, Michael E. Msall, Dee Wilson, Linda L. Wright, Scott McDonald and W. Kenneth Poole Pediatrics 2005;116;123-129 DOI: 10.1542/peds.2004-1810

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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2005 by the American Academy of Pediatrics.All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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Spectrum of Gross Motor Function in Extremely Low Birth Weight Children With Cerebral Palsy at 18 Months of Age
Betty R. Vohr, MD*; Michael E. Msall, MD‡; Dee Wilson, MD§; Linda L. Wright, MD ; Scott McDonald, BS¶; and W. Kenneth Poole, PhD¶
ABSTRACT. Objective. Thepurpose of this study was to evaluate the relationship between cerebral palsy (CP) diagnoses as measured by the topographic distribution of the tone abnormality with level of function on the Gross Motor Function Classification System (GMFCS) and developmental performance on the Bayley Scales of Infant Development II (BSID-II). It was hypothesized that (1) the greater the number of limbs involved,the higher the GMFCS and the lower the BSID-II Motor Scores and (2) there would be a spectrum of function and skill achievement on the GMFCS and BSID-II Motor Scores for children in each of the CP categories. Methods. A multicenter, longitudinal cohort study was conducted of 1860 extremely low birth weight (ELBW) infants who were born between August 1, 1995 and February 1, 1998, and evaluated at18 to 22 months’ corrected age. Children were categorized into impairment groups on the basis of the typography of neurologic findings: spastic quadriplegia, triplegia, diplegia, hemiplegia, monoplegia, hypotonic and/or athetotic CP, other abnormal neurologic findings, and normal. The neurologic category then was compared with GMFCS level and BSID-II Motor Scores. Results. A total of 282 (15.2%)of the 1860 children evaluated had CP. Children with more limbs involved had more abnormal GMFCS levels and lower BSID-II scores, reflecting more severe functional limitations. However, for each CP diagnostic category, there was a spectrum of gross motor functional levels and BSID-II scores. Although more than 1 (26.6%) in 4 of the children with CP had moderate to severe gross motor functionalimpairment, 1 (27.6%) in 4 had motor functional skills that allowed for ambulation. Conclusions. Given the range of gross motor skill outcomes for specific types of CP, the GMFCS is a better indicator of gross motor functional impairment than the traditional categorization of CP that specifies the number of limbs with neurologic impairment. The neurodevelopmental assessment of young children isoptimized by combining a standard neurologic examination with measures of gross and fine motor function (GMFCS and
From the *Women and Infants Hospital, Providence, Rhode Island; ‡University of Chicago Comer Children’s and La Rabida Children’s Hospitals, Chicago, Illinois; §Rainbow Babies and Children’s Hospital, Cleveland, Ohio; National Institute of Child Health and Human Development, Bethesda,Maryland; and ¶RTI International, Research Triangle Park, North Carolina. Accepted for publication Nov 16, 2004. doi:10.1542/peds.2004-1810 This work was presented in part at the annual meeting of the Society for Pediatric Research; May 1–5, 2000; Boston, MA. No conflict of interest declared. Reprint requests to (B.R.V.) Women and Infants Hospital, 101 Dudley St, Providence, RI 02905. E-mail: betty...