Functional classifications for cerebral palsy: Correlations between the gross motor function classification system (GMFCS), the manual ability classification system (MACS) and the communication function classification system (CFCS)

This study aimed to investigate a possible correlation between the gross motor function classification system-expanded and revised (GMFCS-E&R), the manual abilities classification system (MACS) and the communication function classification system (CFCS) functional levels in children with cerebral palsy (CP) by CP subtype. It was also geared to verify whether there is a correlation between these classification systems and intellectual functioning (IF) and parental socio-economic status (SES). A total of 87 children (47 males and 40 females, age range 4-18 years, mean age 8.9 +/- 4.2) were included in the study. A strong correlation was found between the three classifications: Level V of the GMFCS-E&R corresponds to Level V of the MACS (r(s) = 0.67, p = 0.001); the same relationship was found for the CFCS and the MACS (r(s) = 0.73, p < 0.001) and for the GMFCS-E&R and the CFCS (r(s) = 0.61, p = 0.001). The correlations between the IQ and the global functional disability profile were strong or moderate (GMFCS and IQ: r(s) = 0.66, p = 0.001; MACS and IQ: r(s) = 0.58, p = 0.001; CFCS and MACS: r(s) = 0.65, p = 0.001). The Kruskal-Wallis test was used to determine if there were differences between the GMFCS-E&R, the CFCS and the MACS by CP type. CP types showed different scores for the IQ level (Chi-square = 8.59, df = 2, p = 0.014), the GMFCS-E&R (Chi-square = 36.46, df = 2, p < 0.001), the CFCS (Chi-square = 12.87, df = 2, p = 0.002), and the MACS Level (Chi-square = 13.96, df = 2, p < 0.001) but no significant differences emerged for the SES (Chi-square = 1.19, df = 2, p = 0.554). This study shows how the three functional classifications (GMFCS-E&R, CFCS and MACS) complement each other to provide a better description of the functional profile of CP. The systematic evaluation of the IQ can provide useful information about a possible future outcome for every functional level. The SES does not appear to affect functional profiles. (C) 2014 Elsevier Ltd. All rights reserved.