Development of an adolescent age band of the Gross Motor Function Classification System

Chercheurs: Robert Palisano(a,b), PT, ScD, Peter Rosenbaum(a) MD, PhD, Doreen Bartlett (a,c), PT, PhD.
(a) CanChild Centre, McMaster University, Hamilton, On, Canada
(b) Drexel University, Philadelphia, PA, USA
(c) University of Western Ontario, London, ON, Canada

Objective:
The Gross Motor Function Classification System (GMFCS) for cerebral palsy is validated for children < 12 years old of age. Extension of the GMFCS through adolescence should have utility for assessment of health care services and community resources for adolescents and young adults with cerebral palsy. An iterative process involving analysis of data and expert consensus is being used to create and validate an adolescent age band. The purpose of this study was to create a prototype for the adolescent age band through analysis of data from Year One of a longitudinal study of mobility and self-care of adolescents with cerebral palsy.

Methods:
The subjects were 229 adolescents with cerebral palsy, 11-18 years of age. Subjects were selected from a population-based sample of children with cerebral palsy in Ontario, Canada who had participated in a study of gross motor development. Subjects were grouped based on GMFCS levels from the previous study. The distribution of scores for items on the Gross Motor Function Measure, the Activities Scale for Kids, and self-reported methods of preferred mobility at home, school, outdoors, and in the community were analyzed to generate descriptions for an adolescent age band.

Results:
Adolescents previously classified in level I continue to walk in all settings but may have difficulty balancing when moving in confined spaces or carrying objects. Among adolescents previously classified in level II, some have fewer limitations in walking while others require assistance of a person or a mobility device, or use wheeled mobility outdoors and in the community. Adolescents previously classified in level III vary in methods of mobility. At home, most adolescents walk (with or without support of a person or mobility device). At school, adolescents may walk with a mobility device or use wheeled mobility (self-propel, powered, transported). Among adolescents previously classified in level IV, most use some form of wheeled mobility in all settings. At home, many adolescents walk with support or use floor mobility. Adolescents previously classified in level V are mostly transported in wheelchair in all settings.

Conclusions:
Changes in mobility between childhood and adolescence occurred most often in adolescents previously classified in levels II and III especially when outdoors and in the community. The changes may partly reflect choices based on the physical and social environment. The findings require confirmation from Year 2 and 3 assessments.