Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older

J.W. Gorter, M. Ketelaar, P. Rosenbaum, P.J.M. Helders, R. Palisano

Research output: Contribution to journalArticleAcademicpeer-review


The stability of the Gross Motor Function Classification System (GMFCS) over time is described in 77 infants (41 boys, 36 girls) with cerebral palsy (CP; mean age 19.4mo [SD 1.6 mo]; 27 unilateral spastic, 42 bilateral spastic, eight dyskinetic type) and in the same children at follow-up at age 2 to 4 years. The overall level of agreement over time (linear weighted kappa) was 0.70 (95% confidence interval [CI] 0.61-0.79). The overall percentage of children whose GMFCS level changed one or two levels was 42%, of which the majority were reclassified to a less functional level (McNemar's Chi(2) test p=0.11). The chance that children initially classified in the combination of GMFCS Levels I, II, and III would subsequently be classified in the same level in early childhood was 96% (positive predictive value [PPV] 0.96, 95% CI 0.85-0.99), whereas the PPV for the combination of Levels I and II was 0.88, 95% CI 0.70-0.96. These findings indicate that GMFCS classification in infants is less precise than classification over time in older children. In conclusion, children can be classified by the GMFCS early on, but there is a need for reclassification at age 2 or older as more clinical information becomes available.

Original languageEnglish
Pages (from-to)46-52
Number of pages7
JournalDevelopmental Medicine and Child Neurology
Issue number1
Publication statusPublished - Jan 2009


  • Activities of Daily Living
  • Age Factors
  • Cerebral Palsy
  • Child, Preschool
  • Dependent Ambulation
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Mathematical Computing
  • Mobility Limitation
  • Neurologic Examination
  • Reproducibility of Results
  • Software


Dive into the research topics of 'Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older'. Together they form a unique fingerprint.

Cite this