Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands.
Dev Med Child Neurol. 2013 Apr;55(4):378-84. doi: 10.1111/dmcn.12083. Epub 2013 Jan 29.
The aim of this study was to describe patterns for gross motor development by level of severity in a Dutch population of individuals with cerebral palsy (CP).
This longitudinal study included 423 individuals (260 males, 163 females) with CP. The mean age at baseline was 9 years 6 months (SD 6y 2mo, range 1-22y). The level of severity of CP among participants, according to the Gross Motor Function Classification System (GMFCS), was 50% level I, 13% level II, 14% level III, 13% level IV, and 10% level V. Participants had been assessed up to four times with the Gross Motor Function Measure (GMFM-66) at 1- or 2-year intervals between 2002 and 2009. Data were analysed using non-linear mixed effects modelling. For each GMFCS level, patterns were created by contrasting a stable limit model (SLM) with a peak and decline model (PDM), followed by estimating limits and rates of gross motor development.
The SLM showed a better fit for all GMFCS levels than the PDM. Within the SLM, significant differences between GMFCS levels were found for both the limits (higher values for lower GMFCS levels) and the rates (higher values for GMFCS levels I-II vs level IV and for GMFCS levels I-IV vs level V) of gross motor development.
The results validate the existence of five distinct patterns for gross motor development by level of severity of CP.
本研究旨在描述荷兰脑瘫（CP）人群中按严重程度分级的粗大运动发育模式。
本纵向研究纳入了 423 名 CP 患者（260 名男性，163 名女性）。基线时的平均年龄为 9 岁 6 个月（SD 6y 2mo，范围 1-22y）。根据粗大运动功能分类系统（GMFCS），参与者的 CP 严重程度水平为 50%为 I 级，13%为 II 级，14%为 III 级，13%为 IV 级，10%为 V 级。参与者在 2002 年至 2009 年间，每隔 1 或 2 年，使用粗大运动功能测量量表（GMFM-66）进行了 4 次评估。使用非线性混合效应模型进行数据分析。对于每个 GMFCS 水平，通过对比稳定极限模型（SLM）和峰值及下降模型（PDM）来创建模式，然后估计粗大运动发育的极限和速度。
与 PDM 相比，SLM 对所有 GMFCS 水平都有更好的拟合度。在 SLM 内，GMFCS 水平之间在极限（较低 GMFCS 水平的数值较高）和速度（GMFCS 水平 I-II 与 IV 以及 I-IV 与 V 之间的数值较高）方面均存在显著差异。
结果验证了 CP 严重程度分级的粗大运动发育存在五种不同的模式。
