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Journal ArticleDOI

Development and reliability of a system to classify gross motor function in children with cerebral palsy

29 Sep 2008-Developmental Medicine & Child Neurology (Dev Med Child Neurol)-Vol. 39, Iss: 4, pp 214-223

TL;DR: A five‐level classification system analogous to the staging and grading systems used in medicine, which has application for clinical practice, research, teaching, and administration is developed.
Abstract: To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (kappa) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.
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Journal ArticleDOI
TL;DR: Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, health officials, families and the public and would provide a common language for improved communication.
Abstract: For a variety of reasons, the definition and the classification of cerebral palsy (CP) need to be reconsidered. Modern brain imaging techniques have shed new light on the nature of the underlying brain injury and studies on the neurobiology of and pathology associated with brain development have further explored etiologic mechanisms. It is now recognized that assessing the extent of activity restriction is part of CP evaluation and that people without activity restriction should not be included in the CP rubric. Also, previous definitions have not given sufficient prominence to the non-motor neurodevelopmental disabilities of performance and behaviour that commonly accompany CP, nor to the progression of musculoskeletal difficulties that often occurs with advancing age. In order to explore this information, pertinent material was reviewed on July 11-13, 2004 at an international workshop in Bethesda, MD (USA) organized by an Executive Committee and participated in by selected leaders in the preclinical and clinical sciences. At the workshop, it was agreed that the concept 'cerebral palsy' should be retained. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, health officials, families and the public and would provide a common language for improved communication. Panels organized by the Executive Committee used this information and additional comments from the international community to generate a report on the Definition and Classification of Cerebral Palsy, April 2006. The Executive Committee presents this report with the intent of providing a common conceptualization of CP for use by a broad international audience.

3,505 citations


Journal ArticleDOI
TL;DR: Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic–ischemic encephalopathy and there was no increase in major disability among survivors.
Abstract: background Hypothermia is protective against brain injury after asphyxiation in animal models. However, the safety and effectiveness of hypothermia in term infants with encephalopathy is uncertain. methods We conducted a randomized trial of hypothermia in infants with a gestational age of at least 36 weeks who were admitted to the hospital at or before six hours of age with either severe acidosis or perinatal complications and resuscitation at birth and who had moderate or severe encephalopathy. Infants were randomly assigned to usual care (control group) or whole-body cooling to an esophageal temperature of 33.5°C for 72 hours, followed by slow rewarming (hypothermia group). Neurodevelopmental outcome was assessed at 18 to 22 months of age. The primary outcome was a combined end point of death or moderate or severe disability. results Of 239 eligible infants, 102 were assigned to the hypothermia group and 106 to the control group. Adverse events were similar in the two groups during the 72 hours of cooling. Primary outcome data were available for 205 infants. Death or moderate or severe disability occurred in 45 of 102 infants (44 percent) in the hypothermia group and 64 of 103 infants (62 percent) in the control group (risk ratio, 0.72; 95 percent confidence interval, 0.54 to 0.95; P=0.01). Twenty-four infants (24 percent) in the hypothermia group and 38 (37 percent) in the control group died (risk ratio, 0.68; 95 percent confidence interval, 0.44 to 1.05; P=0.08). There was no increase in major disability among survivors; the rate of cerebral palsy was 15 of 77 (19 percent) in the hypothermia group as compared with 19 of 64 (30 percent) in the control group (risk ratio, 0.68; 95 percent confidence interval, 0.38 to 1.22; P=0.20). conclusions Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic–ischemic encephalopathy.

2,108 citations


Journal ArticleDOI
Martin Bax1, Murray Goldstein, Peter Rosenbaum, Alan Leviton2  +4 moreInstitutions (6)
TL;DR: A revised definition and classification of cerebral palsy is presented to meet the needs of clinicians, investigators, and health officials, and provide a common language for improved communication.
Abstract: Because of the availability of new knowledge about the neurobiology of developmental brain injury, information that epidemiology and modern brain imaging is providing, the availability of more precise measuring instruments of patient performance, and the increase in studies evaluating the efficacy of therapy for the consequences of injury, the need for reconsideration of the definition and classification of cerebral palsy (CP) has become evident. Pertinent material was reviewed at an international symposium participated in by selected leaders in the preclinical and clinical sciences. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, and health officials, and provide a common language for improved communication. With leadership and direction from an Executive Committee, panels utilized this information and have generated a revised Definition and Classification of Cerebral Palsy. The Executive Committee presents this revision and welcomes substantive comments about it.

2,045 citations


Journal ArticleDOI
19 Feb 2005-The Lancet
TL;DR: Induced head cooling is not protective in a mixed population of infants with neonatal encephalopathy, but it could safely improve survival without severe neurodevelopmental disability in infants with less severe aEEG changes.
Abstract: Summary Background Cerebral hypothermia can improve outcome of experimental perinatal hypoxia-ischaemia. We did a multicentre randomised controlled trial to find out if delayed head cooling can improve neurodevelopmental outcome in babies with neonatal encephalopathy. Methods 234 term infants with moderate to severe neonatal encephalopathy and abnormal amplitude integrated electroencephalography (aEEG) were randomly assigned to either head cooling for 72 h, within 6 h of birth, with rectal temperature maintained at 34–35°C (n=116), or conventional care (n=118). Primary outcome was death or severe disability at 18 months. Analysis was by intention to treat. We examined in two predefined subgroup analyses the effect of hypothermia in babies with the most severe aEEG changes before randomisation—ie, severe loss of background amplitude, and seizures—and those with less severe changes. Findings In 16 babies, follow-up data were not available. Thus in 218 infants (93%), 73/110 (66%) allocated conventional care and 59/108 (55%) assigned head cooling died or had severe disability at 18 months (odds ratio 0·61; 95% CI 0·34–1·09, p=0·1). After adjustment for the severity of aEEG changes with a logistic regression model, the odds ratio for hypothermia treatment was 0·57 (0·32–1·01, p=0·05). No difference was noted in the frequency of clinically important complications. Predefined subgroup analysis suggested that head cooling had no effect in infants with the most severe aEEG changes (n=46, 1·8; 0·49–6·4, p=0·51), but was beneficial in infants with less severe aEEG changes (n= 172, 0·42; 0·22–0·80, p=0·009). Interpretation These data suggest that although induced head cooling is not protective in a mixed population of infants with neonatal encephalopathy, it could safely improve survival without severe neurodevelopmental disability in infants with less severe aEEG changes.

1,794 citations


Journal ArticleDOI
TL;DR: Reliability was tested between pairs of therapists for 168 children between 4 and 18 years and between 25 parents and their children's therapists, demonstrating that MACS has good validity and reliability.
Abstract: The Manual Ability Classification System (MACS) has been developed to classify how children with cerebral palsy (CP) use their hands when handling objects in daily activities. The classification is designed to reflect the child's typical manual performance, not the child's maximal capacity. It classifies the collaborative use of both hands together. Validation was based on the experience within an expert group, a review of the literature, and thorough analysis of children across a spectrum of function. Discussions continued until consensus was reached, first about the constructs, then about the content of the five levels. Parents and therapists were interviewed about the content and the description of levels. Reliability was tested between pairs of therapists for 168 children (70 females, 98 males; with hemiplegia [n=52], diplegia [n=70], tetraplegia [n=19], ataxia [n=6], dyskinesia [n=19], and unspecified CP [n=2]) between 4 and 18 years and between 25 parents and their children's therapists. The results demonstrated that MACS has good validity and reliability. The intraclass correlation coefficient between therapists was 0.97 (95% confidence interval 0.96-0.98), and between parents and therapist was 0.96 (0.89-0.98), indicating excellent agreement.

1,594 citations


References
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Book
Joseph L. Fleiss1Institutions (1)
01 Jan 1981-
Abstract: Preface.Preface to the Second Edition.Preface to the First Edition.1. An Introduction to Applied Probability.2. Statistical Inference for a Single Proportion.3. Assessing Significance in a Fourfold Table.4. Determining Sample Sizes Needed to Detect a Difference Between Two Proportions.5. How to Randomize.6. Comparative Studies: Cross-Sectional, Naturalistic, or Multinomial Sampling.7. Comparative Studies: Prospective and Retrospective Sampling.8. Randomized Controlled Trials.9. The Comparison of Proportions from Several Independent Samples.10. Combining Evidence from Fourfold Tables.11. Logistic Regression.12. Poisson Regression.13. Analysis of Data from Matched Samples.14. Regression Models for Matched Samples.15. Analysis of Correlated Binary Data.16. Missing Data.17. Misclassification Errors: Effects, Control, and Adjustment.18. The Measurement of Interrater Agreement.19. The Standardization of Rates.Appendix A. Numerical Tables.Appendix B. The Basic Theory of Maximum Likelihood Estimation.Appendix C. Answers to Selected Problems.Author Index.Subject Index.

16,098 citations



Journal ArticleDOI
TL;DR: The Australian College of Paediatrics has shown the way by producing a balanced and thoughtful Discussion Document, and it is to be hoped that the Human Rights Commission will see fit to take this important matter further.
Abstract: awesome responsibility must make it as they feel the patient would wish it to be made. All physicians are charged to preserve life and to relieve suffering, but it must be pointed out that these two Hippocratic ethics are not always compatible. The Australian College of Paediatrics has shown the way by producing a balanced and thoughtful Discussion Document. It is to be hoped that the Human Rights Commission will see fit to take this important matter further. DOUGLAS COHEN, Division of Surgery, Royal Alexandra Hospital for Children, Sydney. 61

1,853 citations


Journal ArticleDOI
TL;DR: The characteristics of several major methods (Delphi, Nominal Group, and models developed by the National Institutes of Health and Glaser) are surveyed and guidelines for those who want to use the techniques are provided.
Abstract: Consensus methods are being used increasingly to solve problems in medicine and health. Their main purpose is to define levels of agreement on controversial subjects. Advocates suggest that, when properly employed, consensus strategies can create structured environments in which experts are given the best available information, allowing their solutions to problems to be more justifiable and credible than otherwise. This paper surveys the characteristics of several major methods (Delphi, Nominal Group, and models developed by the National Institutes of Health and Glaser) and provides guidelines for those who want to use the techniques. Among the concerns these guidelines address are selecting problems, choosing members for consensus panels, specifying acceptable levels of agreement, properly using empirical data, obtaining professional and political support, and disseminating results.

1,666 citations


Journal ArticleDOI
Dianne J Russell1, Peter Rosenbaum2, David Cadman1, Carolyn Gowland1  +2 moreInstitutions (2)
TL;DR: Correlations between scores for change on this measure and the judgments of change by parents, therapists and ‘blind’ evaluators supported the hypothesis that the instrument would be responsive to both negative and positive changes.
Abstract: This paper reports the results of a study to validate a measure of gross motor function in detecting change in the motor function of disabled children. Physiotherapists used this instrument to assess 111 patients with cerebral palsy, 25 with head injury and 34 non-disabled preschool children on two occasions, the second after an interval of four to six months. Parents and therapists independently rated the children's function within two weeks of each assessment, and a sample of paired assessments was videotaped for 'blind' evaluation by therapists. Correlations between scores for change on this measure and the judgments of change by parents, therapists and 'blind' evaluators supported the hypothesis that the instrument would be responsive to both negative and positive changes.

890 citations


Performance
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No. of citations received by the Paper in previous years
YearCitations
20221
2021408
2020350
2019335
2018300
2017342