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Determinants of gross motor function of young children with cerebral palsy: a prospective cohort study
Journal article   Open access   Peer reviewed

Determinants of gross motor function of young children with cerebral palsy: a prospective cohort study

Doreen J Bartlett, Lisa A Chiarello, Sarah W Mccoy, Robert J Palisano, Lynn Jeffries, Alyssa L Fiss, Peter Rosenbaum and Piotr Wilk
Developmental medicine and child neurology, v 56(3)
Mar 2014
PMID: 24127787
url
https://doi.org/10.1111/dmcn.12317View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze) Open

Abstract

Aim The aim of this study was to test a model of determinants of gross motor function of young children with cerebral palsy (CP). Method Four hundred and twenty‐nine children with CP (242 males, 187 females; mean age 3y 2mo, SD 11mo) representing all levels of the Gross Motor Function Classification System (GMFCS) participated. Children in levels I to II and III to V were classified as Groups 1 and 2 respectively. Distribution of CP was quadriplegia, 44%; hemiplegia, 24%; diplegia, 23%; triplegia, 6%; and monoplegia, 2% (data not available for 1%). Impairment and motor function data were collected by reliable assessors; parents completed questionnaires on health conditions and adaptive behavior. Seven months later, parents were interviewed about family life and services received. One year after the study onset, motor function was re‐evaluated. Analysis involved structural equation modeling. Results The well‐fitting model explained 58% and 75% of the variance in motor function at study completion for Groups 1 and 2 respectively. Primary impairments (spasticity, quality of movement, postural stability, and distribution of involvement; β=0.52–0.68) and secondary impairments (strength, range of motion limitations, and reduced endurance; β=0.25–0.26) explained the most variance. Adaptive behavior was a significant determinant only for Group 2 (β=0.21) and participation in community programs was significant only in Group 1 (β=0.13). Interpretation Motor function is supported by optimizing body structures and function for all children and enhancing adaptive behavior for children with greater motor challenges. What this paper adds A higher proportion of gross motor function is explained for children in GMFCS levels III to V compared with children in levels I to II. Both primary and secondary impairments are significant determinants of gross motor function among children with CP. Adaptive behavior is a significant determinant of gross motor function for children in GMFCS levels III to V. Determinants amenable to change (postural stability, strength, and adaptive behavior) are reasonable areas for intervention.

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Clinical Neurology
Pediatrics
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