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• W2019189141 abstract "Cerebral palsy (CP) is the most common form of motor disability of childhood, with a prevalence of approximately 2.0 to more than 4.0 per 1000 live births or children of a defined age.1, 2 Much thought has recently gone into affirming and then redefining the condition known as CP.3 The classification of CP has traditionally relied upon a description of abnormalities in tone and/or the presence of abnormal movements with distribution (topography) of the affected motor areas. Topographical classification is only possible for the spastic subtypes. Terms such as spastic quadriplegia, spastic hemiplegia, and spastic diplegia are reflective of this classification system and are in common use clinically. Recognized risk factors are also sometimes associated with specific CP subtypes (such as a history of preterm birth or low birthweight in children who have spastic diplegia) although clinicians and researchers readily admit that the use of this terminology for describing subtypes is not very helpful in terms of prevention, etiology, treatment, or prognosis because there is no reliable method for distinguishing CP subtypes.4, 5 However, because of the need to establish reliability for epidemiological studies, there are methods being developed to improve reliability of the classification of subtypes.2, 3, 5 This improved reliability for research purposes may also help inform clinical practice. Reid et al.6 tackle the matter of what is known about the distribution of motor types of CP. They describe the distribution of predominant motor types in children found to have congenital CP at age 5 years (e.g. CP believed to be due to a brain abnormality occurring before 28 days of age) who were born in hospitals in Victoria, Australia from January 1 1970 through December 31 2003. Not surprisingly, and as has been previously reported,2, 4, 7 the most common form of CP was spastic (91%) with the proportion of children with ataxic and dyskinetic being much lower, at 5% and 4% respectively. The investigators also compared results from the Victorian CP Register (VCPR) with those from 28 other international population-based CP studies and found varying degrees of heterogeneity in the distribution of subtypes across registries. It was noted that within CP networks designed to follow a common protocol there was more agreement with regard to the proportions of identified motor types than within networks based on differing (and non-standardized) methods.2, 5 Another aim of the study was to examine the impact of the classification of mixed motor types on the proportional distribution of CP subtypes. The term ‘mixed CP’ is used when there is more than one subtype and one cannot be identified as dominant. There is a recent recommendation that the term ‘mixed CP’ not be used without elaboration of which subtypes are involved.3 Overall, the investigators nicely illustrate the range of findings reported from current CP registries, the wide variation in how mixed motor types are classified, and the impact on the overall distribution of subtypes. While the investigators also sought to answer the question of whether there were trends in the distribution of subtypes over time, they were unable to show any change. They stated that this may have been due to the use of different methodologies across studies. While informative, the paper by Reid et al. raises some interesting epidemiological questions about CP. First is the question of what is required to examine trends in CP. As the investigators point out, keeping the case ascertainment, data collection, and case classification methods, including the case definition constant is essential. However, this is rarely achieved. And, for the VCPR, as for many other registries, these factors were also not constant over time. Until we have data from systems with consistent and standardized methods, it is difficult for registries without such standardized methods to provide reliable trend data. A second related question is, given changes in registry methods and clinical practices over time, when is it appropriate to combine CP data over multiple study years? Given that methods were not stable covering the various time periods that the investigators included, they advise caution in the interpretation of their own trend data. Although it is desirable to have reliable data on CP subtypes, we are also aware of the numerous challenges with obtaining such data. Since training of examiners and developing novel classification schemes based on topography have not consistently led to greater reliability in describing CP subtypes,8 we are left wondering if there is any way to establish terminology and reliably describe CP subtypes. Given the movement toward a classification of functioning and less reliance on describing the underlying impairment,3, 4 we question the feasibility of striving for agreement on topographical classification (except as was done by Reid et al., for comparing changes over time). Greater reliability for clinical purposes has already been demonstrated using the Gross Motor Function Classification System and it has quickly been adopted as the measure of choice for classifying CP for research as well.4 One recommendation for future data collection might include having registries capture data using both old and new systems for a certain period of time in order to provide comparability between the classification systems. However, as Reid et al. note, widespread change in CP classification will not come quickly. And, until that time, we do need to document well our current practices." @default.
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• W2019189141 date "2010-12-17" @default.
• W2019189141 modified "2023-09-27" @default.
• W2019189141 title "Distribution of motor types in cerebral palsy: how do registry data compare?" @default.
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• W2019189141 doi "https://doi.org/10.1111/j.1469-8749.2010.03855.x" @default.
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