Lower Extremity Evaluation in Children With Diparetic Cerebral Palsy According to ICF Perspective

Cerebral palsy (CP); is the most common neurodevelopmental disorder seen in childhood, characterized by permanent motor dysfunctions that develop due to brain damage occurring before birth, during birth, or in early childhood.

The most common type is spastic type CP with a prevalence rate of 70-80%. Spastic type CP is divided into three groups as diparetic (38%), hemiparetic (39%) and quadriparetic (23%). In diparetic cerebral palsy (DCP); lower extremity involvement is more pronounced than upper extremity involvement. Typically; weakness in the trunk, postural and antigravity muscles, functional and/or structural asymmetry between both lower extremities are seen and this condition is closely related to impaired static and/or dynamic balance, decreased postural control, decreased functional performance, and low participation rate in activities.

The ICF (International Classification of Functioning, Disability, and Health) was developed by the World Health Organization in 2001 and is a comprehensive model that evaluates health status not only through the presence of diseases and disorders but also through various dimensions such as functionality, environmental, and personal factors. The ICF model includes five main components to evaluate an individual's functionality and disability: body structure and functions, activity, participation, environmental and personal factors. In recent years, functional abilities, including social participation, have increasingly become the focus of research in children with CP.

Study Overview

• Status: Completed
• Conditions: Cerebral Palsy; Diplegic Cerebral Palsy; Lower Extremity Paresis; Diparesis
• Intervention / Treatment: Other: Group1

Detailed Description

It's an observational study.

Purpose of the study: The increase in tone seen in the lower extremities in children with diparetic cerebral palsy (DCP) may adversely affect the activity and participation of children. Our study aim is to evaluate lower extremities in children with DCP according to ICF perspective.

A total of 30 cases, 15 females (50%) and 15 males (50%), aged between 3 and 13 years (mean: 5.8), who were admitted to the Pediatric Rehabilitation Department of Acıbadem Altunizade Hospital with the diagnosis of DCP between 2019 and 2022, were included in this cross-sectional study.

• What should the rehabilitation program for children with DCP include?
• What should we consider when evaluating children with DCP?

The lower extremity evaluations of these cases were made according to ICF. Modified Ashworth Scale (MAS) was used for body structure and functions, Gillette Functional Assessment Questionnaire (FAQ) was used for activity, and Pediatric Functional Independence Measure (WeeFIM) was used for participation

• Study Type: Observational
• Enrollment (Actual): 30

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey
    • Acıbadem Altunizade Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Children diagnosed with diparetic cerebral palsy between the ages of 3 and 13 were included.

Description

Inclusion Criteria:

• Between 3-13 years old,
• Diagnosis of diparetic cerebral palsy,
• Participants and/or parents willing to participate in the study voluntarily.

Exclusion Criteria:

• Having different types of CP such as dyskinetic, mixed, ataxic types other than spastic type,
• Having spastic quadriparetic or hemiparetic type CP,
• Having received Botulinum Toxin injections to the lower extremities within the last 6 months.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Lower extremity evaluation of children with DCP within the framework of ICF; 30 children with DCP were included. The lower extremity evaluations of these cases were made according to ICF. Modified Ashworth Scale (MAS) was used for body structure and functions, Gillette Functional Assessment Questionnaire (FAQ) was used for activity and Pediatric Functional Independence Measure (WeeFIM) was used for participation.

Other: Group1; 30 children with DCP were included. The lower extremity evaluations of these cases were made according to ICF. Modified Ashworth Scale (MAS) was used for body structure and functions, Gillette Functional Assessment Questionnaire (FAQ) was used for activity and Pediatric Functional Independence Measure (WeeFIM) was used for participation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Modified Ashworth Scale (MAS)	It is a 6-point scale used to describe the resistance of the muscle to passive movement and the ease with which the joint can be moved within the available range. It is frequently used in clinical settings. It is quite practical to evaluate and interpret.	baseline
Gillette Functional Walking Assessment Questionnaire (FAQ)	It is a measurement tool used to evaluate walking ability and functional mobility in children. This questionnaire was developed specifically to evaluate the walking functions of children with cerebral palsy and other neuromuscular disorders. Developed at Gillette Children's Hospital, this questionnaire aims to rate children's walking abilities in different environments. It scores children's walking skills on a scale of 1-10.	baseline
Pediatric Functional Independence Scale (WeeFIM)	The WeeFIM scale is a tool used to assess children's independence levels and functional abilities. It was developed to objectively assess children's independence levels and whether they need assistance with daily living activities. The scale consists of 6 main headings and 18 subheadings. These subheadings evaluate areas such as self-care (feeding, dressing, toilet use), sphincter control, transfers (e.g. bed, chair), movement (walking, wheelchair use), communication and social cognition (problem solving, memory). Scoring ranges from 1 to 7, with the highest score being 126. As the score increases, assistance decreases and independence increases.	baseline

Collaborators and Investigators

• Sponsor: Acıbadem Atunizade Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2002
• Primary Completion (Actual): January 31, 2022
• Study Completion (Actual): January 31, 2022

Study Registration Dates

• First Submitted: September 2, 2024
• First Submitted That Met QC Criteria: September 2, 2024
• First Posted (Actual): September 4, 2024

Study Record Updates

• Last Update Posted (Actual): September 4, 2024
• Last Update Submitted That Met QC Criteria: September 2, 2024
• Last Verified: September 1, 2024

More Information

Terms related to this study

• Keywords: Participation; Activity; Lower extremity; Diparetic Cerebral Palsy; International Classification of Function; Body structure and function
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Brain Damage, Chronic; Cerebral Palsy; Paralysis; Paresis
• Other Study ID Numbers: IlaydaS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be made available to other researchers.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No