Different Scales for

Children with Cerebral

Palsy
Dr. Amit Baruaa (PT)
B.P.T., M.P.T.(SVNIRTAR), MIAP, MIACP
Certified sensory integration(SI) therapist from university of California
C/NDT,( Boston university USA)
Certified Oral placement therapist(OPT)
Certified Autism movement therapy(AMT) practitioner .
Certified in Halliwick therapy for special needs children.
 ICF
INTERNATIONAL CLASSIFICATION
OF FUNCTIONING, DISABILITY AND
HEALTH
 INTRODUCTION
• ICF is a framework that organizes, labels, and categorizes biological and
social perspectives of health and disability.

• ICF integrates the major model of disability, it recognizes the role of

environmental factors in the creation of disability, as well as the relevance
of associated health conditions and their effects.

• The ICF was approved for use by World health Assembly in 2001, after
extensive testing across the World involving people with disabilities, a
companion classification for children and youth(ICF-CY) was published
in2007.
 AIMS OF ICF
• ICF is a multipurpose classification designed to serve various disciplines
and different sectors-
 To provide a scientific basis for understanding and studying health and
health related states, outcomes and determinants.
 To establish a common language for describing health and health related
states in order to improve communication between different users such as
health workers, researchers, policy makers, and the public including people
with disability.
 To permit comparison of data across countries.
 To provide a systematic coding scheme for health information systems.
 Application of ICF
• ICF has been use for various purposes
 As a statistical tool-in the collection and recording the data

 As a research tool- to measure outcomes

 As a clinical tool-in needs of assessments, matching treatments with

specific conditions.

 As a social policy tool

 As an educational tool
ICF MODEL
 Activities and activity limitations
• Activities describes an individual’s functioning as a whole function.
• Activity is a person’s positive performance of the task.
• This domain does however still include contextual factors in the
description of task, like performing a task in one setting a can be different
at another setting.
• For example- a person can feed himself at home but feeding at restaurant
with group may not be feasible.
• Outcome measures for both the adults and children are being designed to
specifically examine a client’s abilities to perform functional activities.
• Activity limitations are difficulties an individual may have in executing
activities.
 Participation and participation restriction
• Participation reflects a person’s functional involvement in a life situation in
any point in the life span.
• Participation restriction on other hand reflect problems that an individual
may encounter in those same real life situations no matter what the cause.
• Participation includes how the person functions in multiple environments
and therefore considers all the contextual factors.
• Participation usually involves other people and its based on person’s value
systems or goals.
• 5. domestic life, housework, assisting others.
• 6. interpersonal relationship –basic and complex interactions relating with
strangers, formal relationships.
• 7.major life areas- formal and informal education, employment, economic
self sufficiency.
• 8. community, social and civic life- recreation and leisure, religions,
spirituality, political life.
 Contextual factors
• Contextual factors represents the complete background of an individual’s life and living, they
include environmental and personal factors
• Contextual factors can be identified as either facilitators or barriers according to the impact on
individual’s life
Environmental factors Personal factors

Environmental factors are Personal factors are the

those features of physical,
social, and attitudinal world
that create the backdrop of an
individual’s life.
It includes culture, climate,
formal and informal social
structures, work settings etc
background of an individual’s
life and living.
These factors includes gender,
race, age, fitness, lifestyle,
habits, social background,
education etc.
 GMFCS
• The Gross Motor Function Classification System for
cerebral palsy is based on self-initiated movement
with particular emphasis on sitting (truncal control)
and walking.
• Distinctions between levels of motor function are
based on functional limitations, the need for
assistive technology, including mobility devices (such
as walkers, crutches, and canes) and wheeled
mobility, and to much lesser extent quality of
movement.
• The focus is on determining which level best
represents the child’s present abilities and
limitations in motor function. Emphasis is on
the child’s usual performance in home, school,
and community settings.
 GENERAL HEADINGS FOR EACH LEVEL
GMFCS

LEVEL
ACTIVITY

LEVEL I Walks without Limitations

LEVEL II Walks with Limitations

LEVEL III Walks Using a Hand-Held Mobility Device

LEVEL IV Self-Mobility with Limitations; May Use Powered Mobility

LEVEL V Transported in a Manual Wheelchair

Manual Ability Classification
System
• The MACS is intended to apply to children of all ages and, therefore,
does not include age bands.

• Raters are instructed to consider the child's performance doing age-

appropriate tasks and using age-appropriate objects. The MACS has
been demonstrated to be both reliable and valid.

• Eliasson and colleagues demonstrated excellent reliability of MACS

among children aged 4 to 18 years.
I. Handles II. Handles III. Handles IV. Handles a V. Does not
objects easily most objects objects with limited handle objects
and but with some difficulty; selection of and has
successfully. At what reduced needs help to easily managed severely limited
most, the both quality and/or prepare and/or objects in ability to
hands speed of modify adapted perform even
achievement. activities. situations simple actions.
 CFCS
• The purpose of the CFCS is to classify the
everyday communication performance of an
individual with cerebral palsy into one of five
levels.
• The CFCS focuses on activity and participation
levels as described in the World Health
Organization’s (WHO) International
Classification of Functioning, Disability, and
Health (ICF).
• Communication occurs when a sender
transmits a message and a receiver
understands the message.
• Distinctions between the levels are based on
the performance of sender and receiver roles,
the pace of communication, and the type of
conversational partner.
Communication Function Classification System for Individual with Cerebral
Palsy

Effective Effective but Effective Inconsistent Seldom

Sender and slower paced Sender and Sender and/or Effective
Receiver with Sender and/or Receiver with Receiver with Sender and
unfamiliar and Receiver with familiar familiar Receiver even
familiar unfamiliar partners. partners. with familiar
partners. and/or partners.
familiar
partners.
Thank you