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Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy

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Abstract

The aim of this study was to investigate the relationship among functional classification systems, the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy (CP). One hundred and eighty-five children with spastic CP (101 males, 84 females), 65 (35.1%) diparetic, 60 (32.4%) quadriparetic, and 60 (32.4%) hemiparetic children, ranging from 4 to 15 years of age with a median age of 7 years, were included in the study. The children were classified according to the GMFCS for their motor function and according to the MACS for the functioning of their hands when handling objects in daily activities. The functional status and performance were assessed by using the Functional Independence Measure of Children (WeeFIM). A good correlation between the GMFCS and MACS was found in all children (r = 0.735, p < 0.01). There was also a correlation between the GMFCS and WeeFIM subscales according to subtypes and all parameters were correlated at the level of p < 0.01, the same as the MACS. There was no difference in the MACS scores among the age groups of 4–7, 8–11, and 12–15 years (p > 0.05). The use of both the GMFCS and MACS in practice and in research areas will provide an easy, practical, and simple classification of the functional status of children with CP. The adaptation of both of these scales and WeeFIM and using these scales together give the opportunity for a detailed analysis of the functional level of children with spastic CP and reflect the differences between clinical types of CP.

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Acknowledgments

The authors would like to thank Christin Elliason for the support during the revision of the manuscript and Dr. Levent Eker for helping with the data analyses. We also thank all of the participants of this study and their families.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Samanpazari, Ankara, Turkey

    Mintaze Kerem Gunel, Akmer Mutlu, Tulay Tarsuslu & Ayse Livanelioglu

Authors
  1. Mintaze Kerem Gunel
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  2. Akmer Mutlu
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  3. Tulay Tarsuslu
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  4. Ayse Livanelioglu
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Corresponding author

Correspondence to Mintaze Kerem Gunel.

Additional information

This study was presented as a poster presentation in 20th Annual Meeting, European Academy of Childhood Disability (EACD) in Zagreb, Crotia.

Appendices

Appendix 1

Estimated cognitive level of children with CP.

For the cognitive level, you can ask the parents some questions and report “estimated cognitive level”:

Cognitive description/IQ

Has your child had an assessment of IQ in the last year or so?

If yes, what was the result? ................................................

  1. 1.

    Do you think your child learns as well as other children of a similar age?........................Yes/No

  2. 2.

    Does your child play with and be friends with children of a similar age?....................Yes/No

If the answer is Yes to Questions 1 and 2, the IQ is probably >70. If not, consider the following questions:

  1. 3.

    Does you child have severe difficulty with learning in all aspects of development? ................................. Yes/No

  2. 4.

    Is your child’s ability to read and understand ideas like that of a much younger child, such as one more than half of their age? ......... Yes/No

If the answer is Yes to Questions 3 and 4, IQ is probably <50.

Otherwise the child probably falls into IQ 50–70, but this should be confirmed by expecting the answer Yes to the questions below:

  1. 5.

    Do you think that your child needs much more help than other children to learn things like reading and understanding ideas?............................. Yes/No

  2. 6.

    Does your child find it easier to make friends and play with younger children?.................. Yes/No

Appendix 2

Table 7 Summary of the criteria for the GMFCS and MACS
Full size table

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Gunel, M.K., Mutlu, A., Tarsuslu, T. et al. Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy. Eur J Pediatr 168, 477–485 (2009). https://doi.org/10.1007/s00431-008-0775-1

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  • DOI: https://doi.org/10.1007/s00431-008-0775-1

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