RESEARCH REPORT POSTER DISPLAY

DEVELOPMENT AND RELIABILITY OF A SYSTEM TO CLASSIFY HAND FUNCTION IN CHILDREN WITH CEREBRAL PALSY: MANUAL ABILITY CLASSIFICATION SYSTEM (MACS). Eliasson A¹, Krumlinde Sundholm L¹, Rösblad B², Beckung E³, Arner M⁴, Rosenbaum P⁵; ¹Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden. ²Department of Community Medicine and Rehabilitation, Physiotherapy, University of Umeå, Sweden. ³Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden. ⁴Hand Unit, Department of Orthopedics, Lund University Hospital, Sweden. ⁵CanChild Centre for Childhood Disability Research, McMaster University, Hamilton ON Canada

PURPOSE: To develop a system to classify how children with cerebral palsy use their hands when handling objects in daily activities. The classification is designed to reflect the child’s typical manual performance, not the child’s maximal capacity. MACS is not intended to explain the underlying reasons for limitations of performance or to classify types of cerebral palsy. MACS is analogous to the Gross Motor Function Classification System (GMFCS) and can be used for children and adolescents 4-18 years. RELEVANCE: No classification of hand function in children with cerebral palsy with a clear functional perspective has been available. MACS fills this gap and helps to broaden the perspective of CP beyond gross motor issues. PARTICIPANTS: 25 parents and 25 therapists were interviewed about the classification. 168 children/adolescents with cerebral palsy were classified independently by two therapists. Twenty-five children were tested independently by their parents and one therapist. METHODS: The validation was based on the experience within an expert group representing different professionals, review of the literature and also on thoroughly analysis of children with cerebral palsy, across a spectrum of different functional levels. Discussions continued until consensus occurred, first about the constructs, then at each level until these were clear and easily understood. The next step in the validation involved parents and therapists who were interviewed about the content and the description of levels. Thereafter reliability was tested between parents and therapists and between pairs of therapists. ANALYSIS: Textual analysis of the materials from the interviews of parents and therapists was performed separately and based on three sets of questions, and for each level of MACS. The remarks were analysed to understand if the distinction between levels were apparent or not. For analysis of interrater reliability Intra-Class Correlation Coefficient (ICC) was calculated. RESULTS: The MACS is a valid measure reflecting “the children’s manual ability when handling objects in daily activities”. The reliability between parents and therapist was 0.96 calculated by Intra-Class Correlation Coefficient (ICC) (95% confidence interval 0.89-0.98) indicating excellent agreement. The reliability between therapists was 0.97 (0.96-0.98). CONCLUSIONS: The Manual Ability Classification System is based upon self-initiated manual ability, with a particular emphasis on handling objects in daily activities. It is a valid and reliably classification for children and adolescents with cerebral palsy, between 4-18 years. Clinicians and parents seem to agree about meaningful differences between levels resulting in excellent inter-rater reliability. IMPLICATIONS: Physical therapy interventions for children with cerebral palsy have by tradition been focused on gross motor function. Instruments as MACS highlight the importance of including analysis of hand function in the planning of physical therapy interventions. KEYWORDS: Child, cerebral palsy, hand function, reliability. FUNDING ACKNOWLEDGEMENTS: This project was conducted in collaboration with collages in various places in Sweden and Melbourne, Australia with funding from Folke Bernadotte stiftelsen, Jerringfonden and the Swedish Research Council.

ETHICS COMMITTEE: the Etics Research Committee at the Karolinska Hospital, sweden and the state covernment, Victoria, Australia.