Investigation of differences between the representatives of the high-to moderate functional status according to upper limb functions and participation in children with congenital hemiplegic cerebral palsy: A cross-sectional study

Abstract

This study aimed to explore the acquisition of manual ability and participation performance in individuals with cerebral palsy (CP) in the context of classification systems. In other words, the aim was to determine whether the three representatives of functional status in individuals with CP differed according to manual ability and participation outcomes. Seventy-one individuals (mean 12.4 SD 2.3 years; 38 boys and 33 girls) diagnosed with CP were enrolled. The functional status of the study participants was defined using the Manual Ability Classification System (MACS), Gross Motor Function Classification System Expanded &Revised (GMFCS-E&R), and Communication Function Classification System (CFCS). Manual ability and participation outcomes were documented using the ABILHAND-Kids and Child and Adolescent Scales of Participation (CASP), respectively. Post-hoc tests demonstrated that individuals with high MACS and GMFCS-E&R levels had higher scores on the ABILHAND-Kids and CASP than those with low MACS and GMFCS-E&R levels (I>II>III, P<0.0001). Likewise, individuals in CFCS I scored better on both the ABILHAND-Kids and CASP than those in CFCS III (I>III, P<0.001). In contrast, ABILHAND-Kids and CASP scores were similar in individuals classified as CFCS I-II or CFCS II-III (P>0.05). Finally, multiple regression analyses revealed that MACS and GMFCS-E&R strongly predicted manual ability (MACS:65%; GMFCS-E&R: 23%) and participation outcomes (MACS: 46%-62%; GMFCS-E&R: 57%-68%). Knowledge from MACS and GMFCS-E&R can provide insight into the manual ability and participation outcomes of individuals with CP.