Multidisciplinary rehabilitation for patients with cerebral palsy: improving long-term care

Figures & data

Table 1 Classifications of CP based on type of tonus and distribution of impairments

Type of tonus approach	Topographical approach
Spastic	Monoplegia	Unilateral
Ataxic	Hemiplegia	Bilateral
Dyskinetic	Diplegia
Dystonic	Triplegia
Choreoathetotic	Quadriplegia

Abbreviation: CP, cerebral palsy.

Table 2 Functional classifications for cerebral palsy

	Level I	Level II	Level III	Level IV	Level V
GMFCS	Can walk without limitations	Walk with limitations	Walk with assistive mobility device	Walking ability severely limited even with assistive devices. Use of power wheelchair	Transported by manual wheelchair
MACS	Handles objects easily and successfully	Handles most objects, but with somewhat reduced quality and/or speed of achievement	Handles objects with difficulty; needs help to prepare and/or modify activities	Handles a limited selection of easily managed objects in adapted situations	Does not handle objects and has severely limited ability to perform even simple actions
CFCS	Effective sender and receiver with unfamiliar and familiar partners	Effective but slower-paced sender and/or receiver with unfamiliar and familiar partners	Effective sender and receiver with familiar partners	Sometimes effective sender and receiver with familiar partners	Seldom effective sender and receiver even with familiar partners
EDACS	Eats and drinks safely and efficiently	Eats and drinks safely, but with some limitations to efficiency	Eats and drinks with some limitations to safety; there may be limitations to efficiency	Eats and drinks with significant limitations to safety	Unable to eat or drink safely – tube feeding may be considered to provide nutrition

Note: Copyright ©2014. Elsevier Ltd. Adapted from Compagnone E, Maniglio J, Camposeo S, et al. 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). Res Dev Disabil. 2014;35(11):2651–657.¹⁹

Abbreviations: CFCS, Communication Function Classification System; EDACS, Eating and Drinking Ability Classification System; GMFCS, Gross Motor Function Classification System-Expanded and Revised; MACS, Manual Abilities Classification System.

Table 3 Interventions for cerebral palsy

Rehabilitative interventions	Bimanual therapy Constraint-induced movement therapy Goal-directed training Occupational therapy Home programs for improving motor activity performance and/or self-care Robotic rehabilitation (for arm and leg training) Virtual reality rehabilitation
Spasticity management	Baclofen (oral format or intrathecal baclofen) BoNT Diazepam Selective dorsal rhizotomy Orthopedic surgery Single-event multilevel surgery Hip surveillance for maintaining hip joint integrity Orthoses and casting
Other movement disorders management:dystonia	Anticholinergic medications (eg, trihexiphenidyl), tetrabenazine, benzodiazepines (eg, diazepam), and baclofen DBS
Cognitive behavior and social skills interventions	Behavior therapy and coaching; cognitive behavior therapy Communication training (alternative and augmentative communication) Parent training Counseling
Comorbidities interventions	Management of epilepsy (antiepileptic drugs, VNS) Nutritional management, reflux management, swallowing safety, and drooling (eg, dysphagia management, fundoplication, percutaneous endoscopic gastrostomy/jejunostomy) Pain management Bone health management (bisphosphonate medication, vitamin D) Management of bladder dysfunction (urinary retention and incontinence) and bowel dysfunction (constipation and soiling) Management of respiratory complications Management of visual and hearing impairment
Environmental interventions	Assistive technology and assistive devices (eg, wheelchairs, robotics, and communication devices), ECS, and HAS

Abbreviations: BoNT, botulinum toxin; DBS, deep brain stimulation; ECS, environmental control systems; HAS, home automation systems; VNS, vagus nerve stimulation.

Figure 1 Multi-inter-transdisciplinary approach for cerebral palsy.

Abbreviations: ICF, International Classification of Functioning, Disability, and Health; ICF-CY, ICF Children and Youth Version.

Figure 2 Guidance for planning interventions.

CompagnoneEManiglioJCamposeoSFunctional 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)Res Dev Disabil201435112651265725062096

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