What do the relationships between functional classification systems of children with cerebral palsy tell us?

The Interzonal Distribution of the Load on the Plantar Surface of the Foot During Walking in the Patients with Cerebral Palsy as an Objective Criterion of Functional Impairment Severity

Relevance. The main direction of rehabilitation of children with cerebral palsy is the preservation and enhancement of the existing level of support and locomotion, as well as compensation of its impairment through various methods of rehabilitation. For an adequate prescription and reliable assessment of these measures effectiveness, it is necessary to use objective indicators of functional impairment characteristic of cerebral palsy. The purpose of this study was to substantiate objective biomechanical indicators of functional impairment in children with cerebral palsy based on the analysis of the interzonal distribution of the load on the foot during walking, taking into account the level of global motor functions impairment. Materials and Methods. 47 children with cerebral palsy at the GMFCS levels of impairment 1 to 3 were examined. The control group consisted of 14 children without anatomical and functional signs of support and locomotion system impairment. Biomechanical examination was performed on the complex «DiaSled-M-Scan» with matrix plantar pressure meters in the form of insoles. The statistical analysis of the data was carried out by nonparametric methods using the SPSS for Widows software. Results. The analysis of the anatomical and functional impairment of 94 feet of the children with cerebral palsy and 28 feet of the control group revealed differences in the interzonal distribution of the load under the feet in six variables (p from 0.001 to 0.003). The most typical were: an increase in the toe-to-heel load ratio (on average by 80%), an increase in the load on the arch (by 49%), and a decrease in the medio-lateral load ratio on the toe (by 37%). For GMFCS 1 patients, a significant indicator of impairment was an increase in the partial load on the arch, for GMFCS 2 and 3 patients — a decrease in the load on the heel and an increase it under the toe. This leads to an increase in the toe-to-heel load ratio. Conclusion. It is advisable to use the revealed indicators of roll-over-the-foot impairment in the functional diagnosis of the condition and in assessing the effectiveness of rehabilitation of children with cerebral palsy.

The Impact of Manual Ability Level on Participation of Children with Cerebral Palsy in Life Areas: A Cross-Sectional Study

OBJECTIVES

Participation is a complex and context-dependent concept, which several factors can influence it. The aim of this study was assessing the relationship between the upper extremity function level of children with cerebral palsy (all type of cerebral palsy and severity) and their participation in different life areas.

MATERIALS & METHODS

This cross-sectional study assessed the relationship between the level of upper extremity function of cerebral palsy children and their participation in different life areas. Participants were 274 parents of children with cerebral palsy of the schools of children with special needs and occupational therapy clinics in Tehran, Iran in 2018. They completed the Manual Ability Classification System (MACS) to determine the level of upper extremity function of children with cerebral palsy and Children Participation Assessment Scale-Parent version (CPAS-P) (to determine the participation level of children with cerebral palsy) questionnaires separately.

RESULTS

The mean age of children was 8 yr and 8 months old (at least 6 yr and maximum 12 yr). The correlation between the level of upper extremity function and the overall score of each dimension of participation is significant (P<0.05) and moderate.

CONCLUSION

The upper extremity function of children with cerebral palsy has a moderate and significant relationship with the participation of children with cerebral palsy in different life areas and with different dimensions of participation especially parental satisfaction dimension. Therefore, there is a correlation between upper extremity function and participation in occupations, but this relationship is moderate and is not very strong.