The Effects of Associated Impairments on Severity of Cerebral Palsy: Insights from a Single-Center

Cemil Özal; Kübra Seyhan Bıyık; Özge Çankaya; Kıvanç Delioğlu; Sefa Üneş; Merve Tunçdemir; Fulya İpek Erdem; Mintaze Kerem Günel

doi:10.38079/igusabder.1533362

Research Article

The Effects of Associated Impairments on Severity of Cerebral Palsy: Insights from a Single-Center

Year 2025, Issue: 25, 196 - 207, 29.04.2025

Cemil Özal , Kübra Seyhan Bıyık , Özge Çankaya , Kıvanç Delioğlu , Sefa Üneş , Merve Tunçdemir , Fulya İpek Erdem , Mintaze Kerem Günel

https://doi.org/10.38079/igusabder.1533362

Abstract

Aim: The aim of the study was to describe the distribution of the impairment index across Cerebral Palsy (CP) subtypes and Gross Motor Function Classification System (GMFCS) levels and investigate the relationship between CP subtypes, birth weight, gestational age, and the impairment index.
Method: This retrospective study was conducted with 423 children with CP aged between 0-18 years. Data were gathered from the medical records of children. Birth weight and week, functional classification levels, intellectual impairment, presence of vision, hearing problems, epilepsy recorded. All children were classified according to the GMFCS, Manual Abilities Classification System (MACS), Communication Function Classification System (CFCS), Eating and Drinking Abilities Classification System (EDACS), and CP subtypes. Participants were categorized according to Impairment Index (II) that consist of gross motor, intellectual, vision and hearing impairments and epilepsy. Multivariate backward modelling linear regression model was used to explain relations between impairment index and functional classification systems, birth weight and birth week.
Results: Amongst the 423 children (mean age 6.38±4.57 years) analyzed, 130 (30.7) of the children had low impairment, 159 (31.7%) of them had moderate impairment, and 134 (31.7%) of them had high impairment according to the II. In unilateral spastic type CP, 61.5% had a low impairment index (p<0.05), in bilateral spastic CP, 44.2% of children had a moderate impairment index (p<0.05), in dyskinetic CP 67.9% of children had a high impairment index (p<0.05). In ataxic type there were not any difference significantly between impairment index levels (p=0.06). As a result of regression analysis gross motor function level (Beta=0.85, p<0.01) and birth weight (Beta=-0.05, p=0.04) were predictors of the Impairment Index, and explained 73% of the variance.
Conclusion: Nearly one third of the children had high II; birth weight and gross motor functional level are the predictors of II. These results can help improve rehabilitation and social services.

Keywords

Cerebral palsy, physiotherapy, impairment, ICF

Ethical Statement

Ethical approval gathered from Hacettepe University, Non-invasive Clinical Researches Ethical Committee (Number: GO 20/356; Date: 17.04.2020).

References

1. Rosenbaum P, Paneth N, Leviton A, et al. A report: The definition and classification of cerebral palsy April 2006. Dev Med Child Neurol. 2007;109(suppl 109):8-14. doi: 10.1111/j.1469-8749.2007.00201.x.
2. Monbaliu E, De La Peña MG, Ortibus E, et al. Functional outcomes in children and young people with dyskinetic cerebral palsy. Dev Med Child Neurol. 2017;59(6):634-40. doi: 10.1111/dmcn.13406.
3. Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: A clinical overview. Transl Pediatr. 2020;9(Suppl 1):125-135. doi: 10.21037/tp.2020.01.01.
4. Jonsson U, Eek MN, Sunnerhagen KS, Himmelmann, K. Cerebral palsy prevalence, subtypes, and associated impairments: A population‐based comparison study of adults and children. Dev Med Child Neurol. 2019;61(10):1162-1167. doi: 10.1111/dmcn.14229.
5. Leonardi M, Lee H, Kostanjsek N, et al. 20 years of ICF-international classification of functioning, disability and health: Uses and applications around the world. Int J Environ Res Public Health. 2022;19(18):11321. doi: 10.3390/ijerph191811321.
6. Horber V, Fares A, Platt MJ, et al. Severity of cerebral palsy—the impact of associated impairments. Neuropediatrics. 2020;51(02):120-128. doi: 10.1055/s-0040-1701669.
7. Rameshan S, Buch PM. Prevalence of comorbidities and their relationship to functional status of children with cerebral palsy. Indian Journal of Child Health. 2019;6(7):383-387. doi: 10.32677/IJCH.2019.v06.i07.013.
8. Paulson A, Vargus-Adams J. Overview of four functional classification systems commonly used in cerebral palsy. Children. 2017;4(4):30. doi: 10.3390/children4040030.
9. El Ö, Baydar M, Berk H, et al. Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disabil Rehabil. 2012;34(12):1030-3. doi: 10.3109/09638288.2011.632466.
10. Akpinar P, Tezel CG, Eliasson AC, Icagasioglu A. Reliability and cross-cultural validation of the Turkish version of Manual Ability Classification System (MACS) for children with cerebral palsy. Disabil Rehabil. 2010;32(23):1910-6. doi: 10.3109/09638281003763796.
11. Mutlu A, Kara ÖK, Livanelioğlu A, et al. Agreement between parents and clinicians on the communication function levels and relationship of classification systems of children with cerebral palsy. Disabil Health J. 2018;11(2):281-6. doi: 10.1016/j. dhjo.2017.11.001.
12. Kerem Günel M, Ozal C, Seyhan Bıyık K, et al. The Turkish Version of the Eating and Drinking Ability Classification System: Intrarater reliability and the relationships with the other functional classification systems in children with cerebral palsy. Turk J Physiother Rehabil. 2020;31(3): 218-24. doi: 10.21653/tjpr.493150.
13. 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(4):214-23. doi: 10.1111/j.1469-8749.1997. tb07414.x.
14. Eliasson AC, Krumlinde-Sundholm L, Rösblad B, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: Scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549-54. doi: 10.1111/j.1469-8749.2006.tb01313.x.
15. Sellers D, Mandy A, Pennington L, Hankins M, Morris C. Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Dev Med Child Neurol. 2014;56(3):245-51. doi: 10.1111/dmcn.12352.
16. Hidecker MJC, Paneth N, Rosenbaum PL, et al. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol. 2011;53(8):704- 10. doi: 10.1111/j.1469-8749.2011.03996.x.
17. Christine C, Dolk H, Platt MJ, Colver A, Prasauskiene A, KrägelohMann I; SCPE Collaborative Group. Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy. Dev Med Child Neurol. 2007;109(49):35–38 doi: 10.1111/j.1469-8749.2007.tb12626.x.
18. Gabis LV, Tsubary NM, Leon O, et al. Assessment of abilities and comorbidities in children with cerebral palsy. Journal of Child Neurology. 2015;12:1640-1645 doi: 10.1177/088307381557.
19. Pashmdarfard M, Richards LG, Amini, M. Factors affecting participation of children with cerebral palsy in meaningful activities: Systematic review. Occupational Therapy in Health Care. 2021;35(4):442-479. doi: 10.1080/07380577.2021.1938339.
20. Alghamdi MS, Chiarello LA, Palisano RJ, McCoy SW. Understanding participation of children with cerebral palsy in family and recreational activities. Research in Developmental Disabilities. 2017;69(1):96–104. doi: 10.1016/ j.ridd.2017.07.006.
21. Dang VM, Colver A, Dickinson HO, et al. Predictors of participation of adolescents with cerebral palsy: A European multi-centre longitudinal study. Research in Developmental Disabilities. 2015;36, 551–564. doi: 10.1016/j. ridd.2014.10.043.
22. McManus V, Corcoran P, Perry IJ. Participation in everyday activities and quality of life in pre-teenage children living with cerebral palsy in South West Ireland. BMC Pediatrics. 2008;8(1):10. doi: 10.1186/1471-2431-8-50.
23. Colver A, Thyen U, Arnaud C, et al. Association between participation in life situations of children with cerebral palsy and their physical, social, and attitudinal environment: A cross-sectional multicenter European study. Archives of Physical Medicine and Rehabilitation. 2012;93(12):2154–2164. doi: 10.1016/j.apmr.2012.07.011.
24. Duke RE, Torty C, Okorie U, et al. Pattern of comorbidities in school-aged children with cerebral palsy in Cross River State, Nigeria. BMC Pediatrics. 2021;21:1-8. doi: 10.1186/s12887-021-02637-9.
25. Burgess A, Boyd RN, Chatfield MD, Ziviani J, Sakzewski L. Self‐care performance in children with cerebral palsy: A longitudinal study. Dev Med Child Neurol. 2020;62(9):1061-1067. doi: 10.1111/dmcn.14561.
26. Crotti M, Ortibus E, Itzhak NB, et al. The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy. Research in Developmental Disabilities. 2024;152:104792. doi: 10.21203/rs.3.rs-4045564/v1.
27. Van Gorp ME, Roebroeck M, Van Eck M, et al. Childhood factors predict participation of young adults with cerebral palsy in domestic life and interpersonal relationships: A prospective cohort study. Disability and Rehabilitation. 2020;42(22):3162-3171. doi: 10.1080/09638288.2019.1585971.
28. Burç E, Özal C, Kerem Gunel M. The relationship among the functional levels, dyskinetic movements and participation in children with dyskinetic cerebral palsy. Neurology Asia. 2024;29(2). doi: 10.54029/2024kmn.
29. Reid SM, Meehan EM, Reddihough DS, Harvey AR. Dyskinetic vs spastic cerebral palsy: A cross sectional study comparing functional profiles, comorbidities, and brain imaging patterns. J Child Neurol. 2018;33(9):593-600. doi: 10.1177/0883073818776175.
30. Esih K, Trunk T, Osredkar D, et al. The impact of birthweight on the development of cerebral palsy: A population-based matched case-control study. Early Human Development. 2022;165:105533 doi: 10.1016/j.earlhumdev.2021.105533.
31. Delacy M, Reid SM on behalf of the Australian Cerebral Palsy Register Group. Profile of associated impairments at age 5 years in Australia be cerebral palsy subtype and Gross Motor Function Classification System level for birth years 1996–2005. Dev Med Child Neurol. 2016;58:50–56. doi: 10.1111/dmcn.13012.

Serebral Palside Eşlik Eden Bozuklukların Serebral Palsi Şiddetine Etkisi: Tek Merkez Bulguları

Year 2025, Issue: 25, 196 - 207, 29.04.2025

Cemil Özal , Kübra Seyhan Bıyık , Özge Çankaya , Kıvanç Delioğlu , Sefa Üneş , Merve Tunçdemir , Fulya İpek Erdem , Mintaze Kerem Günel

https://doi.org/10.38079/igusabder.1533362

Abstract

Amaç: Çalışmanın amacı, Serebral Palsi (SP) alt tipleri ve Kaba Motor Fonksiyon Sınıflandırma Sistemi (GMFCS) seviyeleri arasında Bozukluk İndeksi (Bİ) dağılımını tanımlamak ve Bİ, SP alt tipleri, doğum ağırlığı ve doğum haftası arasındaki ilişkiyi incelemektir.
Yöntem: Bu retrospektif çalışma 0-18 yaş aralığında 423 SP'li çocukla yürütüldü. Veriler çocukların tıbbi kayıtlarından toplandı. Doğum ağırlığı ve haftası, fonksiyonel sınıflandırma seviyeleri, bilişsel bozukluk, görme, işitme sorunları, epilepsi varlığı kaydedildi. Tüm çocuklar GMFCS, El Becerileri Sınıflandırma Sistemi (MACS), Yeme ve İçme Becerileri Sınıflandırma Sistemi (EDACS), İletişim Fonksiyonu Sınıflandırma Sistemi (CFCS) ve SP alt tiplerine göre sınıflandırıldı. Katılımcılar, kaba motor, bilişsel, görme ve işitme bozuklukları ile epilepsiden oluşan Bİ'ye göre kategorize edildi. Bİ ile fonksiyonel sınıflandırma sistemleri, doğum ağırlığı ve doğum haftası arasındaki ilişkileri açıklamak multivariat doğrusal regresyon modeli kullanıldı.
Bulgular: Analiz edilen 423 çocuktan (ortalama yaş 6,38±4,57 yıl) Bİ’ye göre 130'unda (%30,7) düşük düzeyde bozukluk, 159'unda (%31,7) orta düzeyde bozukluk ve 134'ünde (%31,7) yüksek düzeyde bozukluk saptandı. Unilateral spastik SP'li çocukların %61,5'inde düşük düzeyde Bİ (p<0,05), bilateral spastik SP'li çocukların %44,2'sinde orta düzeyde Bİ (p<0,05), diskinetik SP'li çocukların %67,9'unda yüksek düzeyde Bİ p<0,05) saptandı. Ataksik tipte ise Bİ düzeyleri arasında anlamlı bir fark yoktu (p=0,06). Regresyon analizi sonucunda kaba motor fonksiyon düzeyi (Beta=0,85; p<0,01) ve doğum ağırlığının (Beta=-0,05; p=0,04) Bİ’nin yordayıcıları olduğu ve varyansın %73'ünü açıkladığı görüldü.
Sonuç: Çocukların yaklaşık üçte biri yüksek Bİ’ye sahipti; doğum ağırlığı ve kaba motor fonksiyonel seviyesi Bİ’nin prediktörleridir. Bu sonuçlar, SP’de rehabilitasyona yönelik yaklaşımların geliştirilmesine ve sosyal hizmetlerin iyileştirilmesine yardımcı olabilir.

Keywords

Serebral palsi, fizyoterapi, bozukluk, ICF

References

1. Rosenbaum P, Paneth N, Leviton A, et al. A report: The definition and classification of cerebral palsy April 2006. Dev Med Child Neurol. 2007;109(suppl 109):8-14. doi: 10.1111/j.1469-8749.2007.00201.x.
2. Monbaliu E, De La Peña MG, Ortibus E, et al. Functional outcomes in children and young people with dyskinetic cerebral palsy. Dev Med Child Neurol. 2017;59(6):634-40. doi: 10.1111/dmcn.13406.
3. Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: A clinical overview. Transl Pediatr. 2020;9(Suppl 1):125-135. doi: 10.21037/tp.2020.01.01.
4. Jonsson U, Eek MN, Sunnerhagen KS, Himmelmann, K. Cerebral palsy prevalence, subtypes, and associated impairments: A population‐based comparison study of adults and children. Dev Med Child Neurol. 2019;61(10):1162-1167. doi: 10.1111/dmcn.14229.
5. Leonardi M, Lee H, Kostanjsek N, et al. 20 years of ICF-international classification of functioning, disability and health: Uses and applications around the world. Int J Environ Res Public Health. 2022;19(18):11321. doi: 10.3390/ijerph191811321.
6. Horber V, Fares A, Platt MJ, et al. Severity of cerebral palsy—the impact of associated impairments. Neuropediatrics. 2020;51(02):120-128. doi: 10.1055/s-0040-1701669.
7. Rameshan S, Buch PM. Prevalence of comorbidities and their relationship to functional status of children with cerebral palsy. Indian Journal of Child Health. 2019;6(7):383-387. doi: 10.32677/IJCH.2019.v06.i07.013.
8. Paulson A, Vargus-Adams J. Overview of four functional classification systems commonly used in cerebral palsy. Children. 2017;4(4):30. doi: 10.3390/children4040030.
9. El Ö, Baydar M, Berk H, et al. Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disabil Rehabil. 2012;34(12):1030-3. doi: 10.3109/09638288.2011.632466.
10. Akpinar P, Tezel CG, Eliasson AC, Icagasioglu A. Reliability and cross-cultural validation of the Turkish version of Manual Ability Classification System (MACS) for children with cerebral palsy. Disabil Rehabil. 2010;32(23):1910-6. doi: 10.3109/09638281003763796.
11. Mutlu A, Kara ÖK, Livanelioğlu A, et al. Agreement between parents and clinicians on the communication function levels and relationship of classification systems of children with cerebral palsy. Disabil Health J. 2018;11(2):281-6. doi: 10.1016/j. dhjo.2017.11.001.
12. Kerem Günel M, Ozal C, Seyhan Bıyık K, et al. The Turkish Version of the Eating and Drinking Ability Classification System: Intrarater reliability and the relationships with the other functional classification systems in children with cerebral palsy. Turk J Physiother Rehabil. 2020;31(3): 218-24. doi: 10.21653/tjpr.493150.
13. 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(4):214-23. doi: 10.1111/j.1469-8749.1997. tb07414.x.
14. Eliasson AC, Krumlinde-Sundholm L, Rösblad B, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: Scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549-54. doi: 10.1111/j.1469-8749.2006.tb01313.x.
15. Sellers D, Mandy A, Pennington L, Hankins M, Morris C. Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Dev Med Child Neurol. 2014;56(3):245-51. doi: 10.1111/dmcn.12352.
16. Hidecker MJC, Paneth N, Rosenbaum PL, et al. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol. 2011;53(8):704- 10. doi: 10.1111/j.1469-8749.2011.03996.x.
17. Christine C, Dolk H, Platt MJ, Colver A, Prasauskiene A, KrägelohMann I; SCPE Collaborative Group. Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy. Dev Med Child Neurol. 2007;109(49):35–38 doi: 10.1111/j.1469-8749.2007.tb12626.x.
18. Gabis LV, Tsubary NM, Leon O, et al. Assessment of abilities and comorbidities in children with cerebral palsy. Journal of Child Neurology. 2015;12:1640-1645 doi: 10.1177/088307381557.
19. Pashmdarfard M, Richards LG, Amini, M. Factors affecting participation of children with cerebral palsy in meaningful activities: Systematic review. Occupational Therapy in Health Care. 2021;35(4):442-479. doi: 10.1080/07380577.2021.1938339.
20. Alghamdi MS, Chiarello LA, Palisano RJ, McCoy SW. Understanding participation of children with cerebral palsy in family and recreational activities. Research in Developmental Disabilities. 2017;69(1):96–104. doi: 10.1016/ j.ridd.2017.07.006.
21. Dang VM, Colver A, Dickinson HO, et al. Predictors of participation of adolescents with cerebral palsy: A European multi-centre longitudinal study. Research in Developmental Disabilities. 2015;36, 551–564. doi: 10.1016/j. ridd.2014.10.043.
22. McManus V, Corcoran P, Perry IJ. Participation in everyday activities and quality of life in pre-teenage children living with cerebral palsy in South West Ireland. BMC Pediatrics. 2008;8(1):10. doi: 10.1186/1471-2431-8-50.
23. Colver A, Thyen U, Arnaud C, et al. Association between participation in life situations of children with cerebral palsy and their physical, social, and attitudinal environment: A cross-sectional multicenter European study. Archives of Physical Medicine and Rehabilitation. 2012;93(12):2154–2164. doi: 10.1016/j.apmr.2012.07.011.
24. Duke RE, Torty C, Okorie U, et al. Pattern of comorbidities in school-aged children with cerebral palsy in Cross River State, Nigeria. BMC Pediatrics. 2021;21:1-8. doi: 10.1186/s12887-021-02637-9.
25. Burgess A, Boyd RN, Chatfield MD, Ziviani J, Sakzewski L. Self‐care performance in children with cerebral palsy: A longitudinal study. Dev Med Child Neurol. 2020;62(9):1061-1067. doi: 10.1111/dmcn.14561.
26. Crotti M, Ortibus E, Itzhak NB, et al. The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy. Research in Developmental Disabilities. 2024;152:104792. doi: 10.21203/rs.3.rs-4045564/v1.
27. Van Gorp ME, Roebroeck M, Van Eck M, et al. Childhood factors predict participation of young adults with cerebral palsy in domestic life and interpersonal relationships: A prospective cohort study. Disability and Rehabilitation. 2020;42(22):3162-3171. doi: 10.1080/09638288.2019.1585971.
28. Burç E, Özal C, Kerem Gunel M. The relationship among the functional levels, dyskinetic movements and participation in children with dyskinetic cerebral palsy. Neurology Asia. 2024;29(2). doi: 10.54029/2024kmn.
29. Reid SM, Meehan EM, Reddihough DS, Harvey AR. Dyskinetic vs spastic cerebral palsy: A cross sectional study comparing functional profiles, comorbidities, and brain imaging patterns. J Child Neurol. 2018;33(9):593-600. doi: 10.1177/0883073818776175.
30. Esih K, Trunk T, Osredkar D, et al. The impact of birthweight on the development of cerebral palsy: A population-based matched case-control study. Early Human Development. 2022;165:105533 doi: 10.1016/j.earlhumdev.2021.105533.
31. Delacy M, Reid SM on behalf of the Australian Cerebral Palsy Register Group. Profile of associated impairments at age 5 years in Australia be cerebral palsy subtype and Gross Motor Function Classification System level for birth years 1996–2005. Dev Med Child Neurol. 2016;58:50–56. doi: 10.1111/dmcn.13012.

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Details

Primary Language	English
Subjects	Physiotherapy
Journal Section	Articles
Authors	Cemil Özal 0000-0001-5692-3814 Kübra Seyhan Bıyık 0000-0001-7943-4255 Özge Çankaya 0000-0002-6639-217X Kıvanç Delioğlu 0000-0001-5898-3685 Sefa Üneş 0000-0002-0130-8440 Merve Tunçdemir 0000-0003-3453-6893 Fulya İpek Erdem 0000-0001-7606-042X Mintaze Kerem Günel 0000-0003-4942-5272
Early Pub Date	April 29, 2025
Publication Date	April 29, 2025
Submission Date	August 14, 2024
Acceptance Date	March 20, 2025
Published in Issue	Year 2025 Issue: 25

Cite

JAMA	Özal C, Seyhan Bıyık K, Çankaya Ö, Delioğlu K, Üneş S, Tunçdemir M, İpek Erdem F, Kerem Günel M. The Effects of Associated Impairments on Severity of Cerebral Palsy: Insights from a Single-Center. IGUSABDER. 2025;:196–207.

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