The relationship between Segmental Assessment of Trunk Control and Gross Motor Function Classification System in children with cerebral palsy

AimTo determine the mechanistic relationship between segmental trunk control in the neutral vertical posture (NVP), assessed using the Segmental Assessment of Trunk Control (SATCo), and the Gross Motor Function Classification System (GMFCS); and hence to identify the means to enhance function in children with cerebral palsy (CP). MethodThis cross-sectional study included 101 children with CP (34 female, 10y(3y8m), 1.32(0.27)m, 33.4(18.4)kg) classified across GMFCS Levels I-V and tested with SATCo. Association and variation between GMFCS Levels and SATCo results were examined. ResultsSATCo results differed significantly (p<.05) between GMFCS Levels in static, active and reactive tests of trunk control. As neuro-ability increases through GMFCS Levels V-I, ability to control the head and trunk in NVP increases ({rho}(99)=-0.61 to -1,p<.0001) and variation in head and trunk control increases ({rho}(3)=-0.9 to -1,p<.05). InterpretationSATCo provides mechanistic insights supporting its use following GMFCS. In severe CP, NVP control is minimal across all children. In mild CP, large variation in results shows that SATCo discriminates between the use of full trunk control from compensatory strategies to achieve function. For each GMFCS Level, SATCo identifies the training required to improve trunk control in NVP, thus improving functional performance and reducing long-term risk of deformity. What this paper addsO_LISATCo results are related to GMFCS Levels, and complements GMFCS C_LIO_LISATCo provides the mechanistic explanation for what is observed in GMFCS C_LIO_LISATCo-GMFCS reveals if function is attained with trunk control or compensatory strategies C_LIO_LICompensatory strategies often used in mild CP are not captured by GMFCS C_LIO_LISATCo identifies the training required to improve function and reduce deformity risk C_LI Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=115 SRC="FIGDIR/small/26344472v2_ufig1.gif" ALT="Figure 1"> View larger version (19K): org.highwire.dtl.DTLVardef@3ba4f1org.highwire.dtl.DTLVardef@1c9ce70org.highwire.dtl.DTLVardef@101d01org.highwire.dtl.DTLVardef@1e04861_HPS_FORMAT_FIGEXP M_FIG C_FIG O_LIExample above: GMFCS Level I child leaning backwards when tested for lower thoracic NVP trunk control. Same child showing compensatory lordotic lumbar posture while standing. C_LIO_LISATCo can be used in combination with GMFCS to identify specific training targets to improve postural control, enhance function, and reduce deformity risk. C_LI