Classification systems for CP - Traditional

Traditional classifications of CP involved three basic considerations:

  • One: The parts of the body involved (often called ‘topography’), and the extent of their involvement:

    – One side of the body, arm and leg = ‘hemi-syndrome’

    – Legs more affected that arms = ‘diplegia’

    – Whole-body involvement = quadriplegia (from Latin!) or tetraplegia (from Greek!)

    – There may sometimes (but rarely) be a single limb involved (‘monoplegia’), or three limbs (‘triplegia’)

    The challenge with these terms is that they are not well defined, and people often focus on different aspects of function, so these terms, while well known around the world, are not as exact as we would like.

  • Two: The kind of motor function challenge, with these terms commonly used:

    – ‘spastic’ refers to over-reactive muscles that too easily become extended with effort (‘stiff’)

    – ‘dystonia/dystonic’ refers to abnormal tonicity of muscles associated with prolonged repetitive muscle contractions that may cause twisting or jerking movements of the body, or some parts of the body

    – ‘athetosis/athetoid’ refers to repetitive involuntary, slow, sinuous, writhing movements

    – ‘mixed’ simply refers to the reality than many people with CP have more than one of these descriptive motor function impairments

    The challenges with these terms is that (i) they can be difficult to discriminate from one another; (ii) they may co-exist in the same person; and (iii) while they often are more specific to one ‘cause’ of CP than another, none is diagnostic.

    We formulate a ‘to be’ process, eliminating operational inefficiencies and planning for risk mitigation. Next, we re-design the organizational structure, defining and mapping the skills matrix. The feasibility of implementing the new process is discussed with stakeholders.

  • Three: The ‘severity’ of motor function impairment has traditionally been referred to as:

    – ‘mild’

    – ‘moderate’

    – ‘severe’

    The challenges here include: (i) these terms are value judgments and are negative; (ii) they have never been defined and used in a consistent way; (iii) hence they are not used ‘reliably’; and (iiv) the degree of functional impairment may change with time.

Classification systems for CP - New

TODAY, we use several purpose-designed functional classification systems, created using principles of measurement science, that in each case provide ‘word pictures’ of five mutually distinct graded ‘levels’ of function, and focus on what people can do rather than on what they cannot. Note that these are NOT assessment tools, nor are they designed to measure change in functioning over time.

  • Gross Motor Function Classification System (GMFCS) looks at whole-body posture and movement in several age bands. There is good evidence that the GMFCS is reliable (people use it consistently), valid (the levels are meaningfully distinct from one another, and predictive of later motor function.
  • The Manual Abilities Classification System (MACS) (and the preschool ‘mini-MACS’) is an analogue of the GMFCS, and looks at functional achievement with manual activities rather than at the details of hand function.
  • The Communication Function Classification System (CFCS) was developed with people with CP, and looks at their abilities to both receive and send communicative messages.

An overview of these systems is provided in: Rosenbaum PL, Eliasson A-C, Hidecker MJC, Palisano RJ (2014). Classification in Childhood Disability: Focusing on Function in the 21st Century. J Ped Neurol Volume 29(8):1036-1045 (published online 7 May 2014DOI: 10.1177/0883073814533008)