The relationship of cerebral palsy subtype and functional motor impairment: a population-based study

Dev Med Child Neurol. 2009 Nov;51(11):872-7. doi: 10.1111/j.1469-8749.2009.03269.x. Epub 2009 Mar 11.


Aim: Traditionally, cerebral palsy (CP) had been classified according to the distribution and quality of motor impairment. A standardized functional classification of gross motor skills has recently been validated - the Gross Motor Function Classification System (GMFCS). The relationship between the neurological subtype of CP and GMFCS level remains undefined in CP.

Method: The Quebec Cerebral Palsy Registry (Registre de la paralysie cérébrale au Québec [REPACQ]) over a 4-year birth interval (1999-2002 inclusive) identified 301 children with CP. Information on both CP subtype and GMFCS level was available for 243 children (138 males, 105 females) with final data extraction at a mean age of 44 months (SD 14mo, range 24-79mo). Proportions of children with a particular CP subtype at GMFCS levels I to III versus levels IV to V were determined and compared.

Results: CP subtype versus GMFCS levels I to III or IV to V was distributed proportionally as follows: spastic diplegic, 51/52 (98%) versus 1/52 (2%); spastic quadriparetic, 20/85 (24%) versus 65/85 (76%); spastic hemiplegic, 76/77 (99%) versus 1/77 (1%); dyskinetic, 4/16 (25%) versus 12/16 (75%); other (triplegic or ataxic-hypotonic), 10/13 (77%) versus 3/13 (23%). These distributions (proportions) all yielded significant (p<0.001) Pearson chi(2) values.

Interpretation: Neurological subtype is a powerful predictor of functional status related to ambulation. This has implications for counseling families.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cerebral Palsy / classification*
  • Cerebral Palsy / epidemiology
  • Cerebral Palsy / physiopathology*
  • Child, Preschool
  • Cohort Studies
  • Female
  • Gait Disorders, Neurologic / epidemiology*
  • Humans
  • Male
  • Motor Activity / physiology*
  • Muscle Spasticity / classification
  • Muscle Spasticity / epidemiology
  • Muscle Spasticity / physiopathology
  • Paralysis / classification
  • Paralysis / epidemiology
  • Paralysis / physiopathology
  • Prevalence
  • Quebec / epidemiology
  • Registries
  • Severity of Illness Index