Correlation between motor impairment and participation in children with cerebral palsy

Shraddha J. Diwan, Neelam K. Rathod, Hiral Ganatra, Neeta Vyas


Background: Children with chronic functional limitations have considerably more difficulties in the social and behavioral aspects of their lives than typical children. In CP, dysfunction of muscle control prevails, which can lead to spasticity or shifting muscle tone, to associated pathological postures, and to decreased range of joint motions. Activity limitations refer to difficulties in executing tasks or actions which focused on limitations in mobility, addressing walking, lifting and arm/hand use, and in self-care activities. Few studies are available which measure the participation and impairments. But there is also need to evaluate participation in relation to impairments. So, the purpose of the current study is to find out the co- relation between motor impairment and participation in children with cerebral palsy.

Methods: Convenient sample of 20 children with CP were selected according to selection criteria i.e. diagnosed case of CP with age 5 years or more and children with conditions like autism spectrum disorder, attention deficit hyperactive disorder, Down’s syndrome, spina bifida, metabolic disorders, and traumatic brain injuries were excluded. GMFCS and PEDI were taken in each of them. Statistical analysis was done.

Results: The result showed negative correlation between GMFCS level and different domains of PEDI: self-care, mobility and social function using spearman’s correlation with r: -0.77, -0.82, -0.78.

Conclusion: Children with lower level of GMFCS had higher participation while those with higher level of GMFCS had lower participation. So, participation is depends up on motor impairments. 


Cerebral palsy, Motor impairment, Participation, GMFCS level, PEDI

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Rosenbaum P, Paneth N, Leviton A , Goldstein M, Bax M. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol. 2006 Apr;49:8-14.

Heidi A, Tlona, Jutta S, Marjukka, Antti M. Effectiveness of physical therapy interventions for children with cerebral palsy: a systemic review. Biomed Cent Pediatr. 2008;8(14):1-10.

Kuben KCK, Leviton A. Cerebral palsy. N Eng J Med. 1994 Jan;20;330(3):188-95.

Bobath K, Bobath B. The facilitation of normal postural reactions and movements in the treatment of cerebral palsy. Physiother. 1967;50:246-9.

Hetzel BS. Iodine and neuropsychological development. J Nutr. 2000;130(Suppl 2):S493-5.

Stanley FJ. Cerebral palsies: epidemiology and causal pathways. In: Stanley FJ, Blair E, Alberman E, eds. Clinics in Developmental Medicine No. 151. London: MacKeith Press; 2000: 22-39.

Kennes J, Rosenbaum P, Hanna SE, Walter S, Russell D, Raina P et al. Health status of school-aged children with cerebral palsy: information from a population-based sample. Dev Med Child Neurol. 2002;44:240-7.

Cadman D, Boyle M, Szatmari P, Offord DR. Chronic illness, disability, and mental and social well-being: findings of the Ontario child health study. Pediatri. 1987;79:805-13.

McConachie H, Colver AF, Forsyth RJ, Jarvis SN, Parkinson KN. Participation of disabled children: how should it be characterised and measured? Disabil Rehabil. 2006;28:1157-64.

Coster W, Khetani MA. Measuring participation of children with disabilities: issues and challenges. Disabil Rehabil. 2007;30:639-48.

World Health Organization. The international classification of functioning, disability and health. In: WHO, eds. ICF. Geneva: WHO; 2001: 1-299.

Margaret J. Mayston. People with cerebral palsy: effects of and perspectives for therapy. Neural Plast. 2001;8(1-2):51-69.

Shevell MI, Dagenais L, Hall N. The relationship of cerebral palsy subtype and functional motor impairment: a population-based study. Dev Med Child Neurol. 2009 Nov;51(11):872-7.

World Health Organization. International classification of impairments, disabilities, and handicaps. In: WHO, eds. A Manual of Classification Relating to the Consequences of Disease. Geneva, Switzerland: WHO; 1980: 1-207.

Haley SM. Pediatric evaluation of disability inventory. In: Haley SM, Coster WJ, Ludlow LH, Haltiwanger JT, Andrellos PJ, eds. Development, Standardization, and Administration Manual. Boston, MA: New England Medical Center Inc. and PEDI Research Group; 1992.

Ostensjø S, Carlberg EB, Vollestad NK. Everyday functioning in young children with cerebral palsy: functional skills, caregiver assistance, and modifications of the environment. Dev Med Child Neurol. 2003;45:603-12.

Feldman AB, Haley SM, Coryell J. Concurrent and construct validity of the pediatric evaluation and disability inventory. Phys Ther. 1990;70:602-10.39.

Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214-23.

Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP,Raina EP, Galuppi BE. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther. 2000;10:974-85.

Smits DW, Gorter JW, Ketelaar M, Van Schie PE, Dallmeijer AJ, Lindeman E et al. Relationship between gross motor capacity and daily-life mobility in children with cerebral palsy. Dev Med Child Neurol. 2010;52:e60-6.

Holsbeeke L, Ketelaar M, Schoemaker MM, Gorter JW. Capacity, capability, and performance: different constructs or three of a kind? Arch Phys Med Rehabil. 2009;90:849-55.

Tieman BL, Palisano RJ, Gracely EJ, Rosenbaum PL. Gross motor capability and performance of mobility in children with cerebral palsy: a comparison across home, school, and outdoors/community settings. Phys Ther. 2004;84:419-29.

Hutton JL, Cooke T, Pharoah PO. Life expectancy in children with cerebral palsy. Br Med J. 1994;309:431-5.

Blair E, Watson L, Badawi N, Stanley FJ. Life expectancy of people with cerebral palsy born since 1956 in Western Australia. Brain Development 2001;23:150.

Lenski M, Paneth N, Shariff KB. Disability information improves the reliability of cerebral palsy classification. Dev Med Child Neurol. 2001;43:574-5.

Hagberg B, Hagberg G, Beckung E, Uvebrant P. Changing panorama of cerebral palsy in Sweden: VIII. Prevalence and origin in the birth year period 1991-1994. Acta Pediatr. 2001;90:1-7.

Beckung E, Hagberg G. Correlation between the ICIDH handicap code and gross motor function classification system in children with cerebral palsy. Dev Med Child Neurol. 2000;42:669-73.

Majnemer A., Shevell M., Law M., Birnbaum R., Chilingaryan G., Rosenbaum P., Poulin C. Participation and enjoyment of leisure activities in school aged children with cerebral palsy. Dev Med Child Neurol. 2008;50:751-8.

Margalit M. Leisure activities of cerebral palsied children. Israel J Psychiatr Rel Sci. 1981;18(3):209-14.

Michelsen SI, Flachs EM, Uldall P et al. Frequency of participation of 8–12-year-old children with cerebral palsy: a multi-centre cross-sectional European study. Euro J Paediatr Neurol. 2009;13:165-177.

Schenker R, Coster WJ, Parush S. Neuroimpairments, activity performance, and participation in children with cerebral palsy mainstreamed in elementary schools. Dev Med Child Neurol. 2005;47:808-14.

Stevenson RD, Conaway M, Chumlea WC et al. Growth and health in children with moderate to severe cerebral palsy. Pediatr. 2006;118(3):1010-8.

Kerr C, Parkes J, Stevenson M, Cosgrove A, McDowell B. Energy efficiency in gait, activity, participation and health status in children with cerebral palsy. Dev Med Child Neurol. 2008;50(3):204-10.

Morris C, Kurzinczuk J, Fitzpartick R, Rosenbaum PL. Do the abilities of children with cerebral palsy explain their activities and participation? Dev Med Child Neurol. 2006;48:954-61.