Performance of children with cerebral palsy in play & leisure activity assessed on gmfcs and macs

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Ajeet Kumar Saharan

Background: Cerebral palsy (CP) is a permanent, non-progressive neurological impairment resulting from a brain lesion, or lesions, that occur prior to, during or shortly after birth. Cerebral Palsy primarily affects body movement and muscle coordination. These Children are always deprived of love, attraction, and functional activity due to negligence and opportunity.
Objectives: of this study were to assess motor function and manual ability in children with cerebral palsy to measure their functional status on the basis of gross motor function classification system and Manual ability classification system.
Methods: The survey was mailed to 100 preteen children with CP, aged 8 to 13 years whose families were agreed to participate. Out of 100 mailed envelop few of rejected due to personal reason but 94 families voluntarily participated in survey. Later one family rejected participation due to misshaping with their child, and finally 93 left to continue. Participant were selected on the basis of following criteria if they are diagnosed CP, aged between 8 to 13 yr and able to understand and respond simple command. Participant were rejected if they were not matching the age criteria, having developmental disorder, movement disorder, profound CP, other neurological diseases and unable to understand, uncooperative child.
Procedure: First mailed the entire packet with detailed explanation with aim of the study. For each activity, they circled yes or no if they had participated in this play activity in the past year. Families were asked to classify their child’s movement ability using the Gross Motor Classification System (GMFCS) and manual ability using the Manual Ability Classification System (MACS) by circling the level that best represents their child’s manual ability and gross motor function.
Results: While assessing patterns of play participation of children with cerebral palsy: - Differences in the amount and type of play participation of children with CP among the 8 play categories of the PPP. To answer this, the 8 play categories were analyzed using the Friedman test, which showed an overall difference in mean ranks (p=0.000, 2= 382.485). Mean rank was then used to order the 8 play categories from highest to lowest. Participation was the lowest in Lessons and the highest in Indoor play activities. It was found that children participated in a wide range of activities, with a total mean score of 60.8 (SD = 23). Based on the GMFCS, there was a significant difference for the total play participation (p = 0.000, F = 6.876) in which play participation decreased in children from GMFCS level I (least limitations) to V (most limitations). For individual play categories, there were significant differences between levels in play participation in Sports, Outdoor, Summer, Winter, Indoor and Creative activities (p = .001, .000, .014, .025, .009, and .036 respectively. Table 4, shows play participation in lessons and social activities was almost similar for children at all levels of the GMFCS except for participants in Level V, which marked reduced participation. Based on the MACS, there was a significant difference in the total play participation (p = .000, F = 8.560). Play participation was the most at MACS level II and the least at MACS level V. Total play participation of children in MACS level I was less than those in level II. However, this difference was not significant. For individual play categories, significant differences were observed in participation in Sports, Outdoor, Summer, Indoor and Creative activities. Table 5 No significant differences in play participation of play categories were found in Winter, Lessons, and Social activities. Play participation scores did not present as clear a pattern, but reduced play participation by those at Level V on both scales was clearly evident.
Conclusions: Results suggest that there is no gender differences were found in the total play participation but higher rates in social, creative and play lessons among females and indoor activity is higher than outdoor.

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