When parents learn that their child has cerebral palsy (CP), they usually have one big question: “What does this mean for my child?” This question often does not a have simple answer. Cerebral palsy has a range of severity from mild to severe, and it can affect movement of different parts of the body with different physical limitations for everyday life. There are several classification systems that have been devised to help families and health care professionals define the level of ability of those with cerebral palsy.
What is Cerebral Palsy?
Cerebral palsy refers to a group of lifelong physical disabilities caused by damage to the brain during pregnancy, delivery, or shortly after birth. The word “cerebral” means something related to the brain, and the word “palsy” means a problem (weakness) with the muscles. According the Cerebral Palsy Alliance Research Foundation, 1 of every 323 babies born in the United States is diagnosed with cerebral palsy. They estimate that 18 million people worldwide have cerebral palsy, making it “the most common lifelong physical disability in the world.”
The Impact of Cerebral Palsy
Cerebral palsy affects our muscles in two main ways: paresis or plegia. Paresis refers to weakness, which means there is some ability to move the muscle. Plegia (or plegic) refers to paralysis, in which all voluntary movement is. It can affect any combination of our limbs, the right or left side of our bodies, or the top or bottom halves, or any combination thereof.
This weakness or paralysis can limit our ability to move and get around with or without mobility devices (gross motor function). It can affect or ability to handle or manipulate objects with our hands and fingers (manual ability). It can also impact our ability to speak. For some, there are even intellectual disabilities. Because there are so many varieties of ability and disability under the umbrella of cerebral palsy, there are multiple grading systems for the severity of the disorder.
CP & the Ability to Get Around: (GMFCS)
Created in 1997 by Dr. Robert Palisano and his team, the Gross Motor Function Classification System (GMFCS) is designed to help provide a clear description of the child’s motor function, as it pertains to sitting, standing, and walking, as well as what mobility devices (e.g., crutches, wheelchairs, etc.) might be needed. Below are the 5 levels of the GMFCS, but for more info, click here.
(From the Can Child website)
- Level I: Children walk at home, school, outdoors and in the community. They can climb stairs without the use of a railing. Children perform gross motor skills such as running and jumping, but speed, balance and coordination are limited.
- Level II: Children walk in most settings and climb stairs holding onto a railing. They may experience difficulty walking long distances and balancing on uneven terrain, inclines, in crowded areas or confined spaces. Children may walk with physical assistance, a handheld mobility device or used wheeled mobility over long distances. Children have only minimal ability to perform gross motor skills such as running and jumping.
- Level III: Children walk using a hand-held mobility device in most indoor settings. They may climb stairs holding onto a railing with supervision or assistance. Children use wheeled mobility when traveling long distances and may self-propel for shorter distances.
- Level IV: Children use methods of mobility that require physical assistance or powered mobility in most settings. They may walk for short distances at home with physical assistance or use powered mobility or a body support walker when positioned. At school, outdoors and in the community children are transported in a manual wheelchair or use powered mobility.
- Level V: Children are transported in a manual wheelchair in all settings. Children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements.
CP & the Ability to Use Hands: MACS
The Manual Ability Classification System MACS was developed to help families and healthcare providers describe how children with cerebral palsy are able to use their hands to handle objects in their daily activities. MACS was developed by a team of Swedish doctors in 2002. For more information on MACS, including videos of how to use it, click here.
(From the MACS.nu PDF)
- Level I: Handles objects easily and successfully.
- Level II: Handles most objects but with somewhat reduced quality and/or speed of achievement.
- Level III: Handles objects with difficulty; needs help to prepare and/or modify activities.
- Level IV: Handles a limited selection of easily managed objects in adapted situations.
- Level V: Does not handle objects and has severely limited ability to perform even simple actions.
CP & the Ability to Speak: CFCS
The Communication Function Classification System (CFCS) was developed to classify the ability to communicate for people with cerebral palsy. The initial development of the system was by Dr. Mary Jo Cooley Hidecker and her team in 2011. Originally designed for cerebral palsy, the CFCS is now used for any disability.
(From the CFCS.us website)
- Level I: A person independently and effectively alternates between being a sender and receiver of information with most people in most environments.
- Level II: A person independently alternates between being a sender and receiver with most people in most environments but the conversation may be slower.
- Level III: A person usually communicates effectively with familiar communication partners, but not unfamiliar partners, in most environments.
- Level IV: The person is not always consistent at communicating with familiar communication partners.
- Level V: A person is seldom able to communicate effectively even with familiar people.
The causes of cerebral palsy are varied as well, and they can be due to issues that are genetic or biological (therefore unavoidable) or due to complications or errors during delivery (preventable). If your child developed CP due to a medical error, our Baltimore birth injury attorneys can help you identify any and all liable parties and fight to recover the compensation you need to get your child the high-quality care they deserve. At Brown & Barron, LLC, we make it our mission to protect families’ rights against large hospitals and insurance companies.
We encourage you to contact us today at (410) 698-1717 to schedule a free consultation with our team.