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Classification of Cerebral Palsy Subtypes

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00072800
Recruitment Status : Completed
First Posted : November 11, 2003
Last Update Posted : March 4, 2008
Information provided by:
National Institutes of Health Clinical Center (CC)

Brief Summary:

This study, conducted at the National Institutes of Health and the Children's National Medical Center, will evaluate how well different physicians agree in how they classify cerebral palsy subtypes based on patient examination. Cerebral palsy is divided into several subtypes, according to the primary underlying muscle abnormality and its distribution and severity. Classification of these subtypes is important for conducting rehabilitation research studies on patients with the same type of abnormality. However, doctors do not always classify cerebral palsy types in the same way. This study will examine methods for improving agreement among doctors in their classification of cerebral palsy subtypes.

Children between 6 and 18 years of age with cerebral palsy who can voluntarily move their arms and legs may be eligible for this study. Participants will be examined by at least three doctors or therapists. The examinations take 30-60 minutes. For the examination, a doctor or therapist will do the following:

  • Observe the patient at rest
  • Gently move the patient's arms and legs and then have the patient move his or her arms and legs
  • Check the patient's reflexes
  • Observe the patient walking, if the patient is able to walk

Patients will be asked to remain in the clinic for up to 3 hours while researchers discuss the examination and may be asked to repeat part of the study examination.

Condition or disease
Cerebral Palsy

Detailed Description:
The movement and posture abnormalities that are characteristic of cerebral palsy are associated with underlying abnormalities of muscle tone, including dystonia, spasticity, and rigidity. The subtypes of cerebral palsy are defined according to the predominant muscle tone abnormality, its distribution and severity. There is widespread agreement that CP subtypes should be divided into the following groups. Spastic subtypes (hemiplegia: unilateral asymmetric spasticity; diplegia: bilateral symmetric spasticity, lower limbs more affected than upper limbs; quadriplegia: bilateral symmetric spasticity, upper and lower limbs affected equally), dystonic or athetotic type; and other miscellaneous types: hypotonic, mixed types, etc. These descriptive definitions are not useful when forming homogeneous cohorts of CP subtypes in rehabilitation research studies. Even when a preceding training session establishes precise criteria for each subtype based on these definitions and uses a "four limb" approach (defining the dominant muscle tone abnormality and its severity in each limb) the interobserver agreement in the classification of CP subtypes remains poor. This may be because there are no widely accepted definitions for the most common muscle tone abnormalities in cerebral palsy (spasticity, rigidity, dystonia) and examination methods vary widely. Recently, an interdisciplinary group of clinicians published a consensus document in which they set forth clear definitions for these disorders of muscle tone and recommendations on how to examine for them. Since the CP subtypes are defined according to the dominant muscle tone abnormality, we hypothesize that it may be possible to achieve acceptable interobserver agreement in the classification of the CP subtypes if these definitions and standard examination techniques are incorporated into the preceding training session with the other accepted elements. To test this hypothesis we will train clinicians from three different areas of expertise: child neurology, physiatry, physical therapy to classify subtypes of CP using accepted methods (establishing precise criteria for the subtypes and using a four limb approach) and will also train them to identify muscle tone abnormalities using the definitions and standard examination techniques in the consensus document. Following this training, we will ask the same clinicians to classify subtypes of cerebral palsy in a group of CP children. We will then measure interobserver agreement for the classification of CP using the kappa statistic. Achieving acceptable interobserver agreement in the classification of CP subtypes may facilitate the formation of homogeneous cohorts in research studies.

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Study Type : Observational
Enrollment : 115 participants
Official Title: Classification of Cerebral Palsy Subtypes
Study Start Date : November 2003
Study Completion Date : August 2005

Resource links provided by the National Library of Medicine

Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No


  1. Children 6 to 18 years of age
  2. Children must be previously diagnosed with cerebral palsy
  3. Children born at any gestational age will be eligible.
  4. Lesions must be pre-, peri- or post-natal and acquired before 2 years of age
  5. Lesions must be non-progressive
  6. Patients must be able to voluntarily move their upper and lower limbs


  1. Any subject who is pregnant
  2. Children with an underlying known genetic or chromosomal disorder
  3. Children with clearly identified familial or non-familial syndromes (without known chromosomal or genetic defect)
  4. Cerebral lesions acquired after 2 years of age
  5. Patients with progressive or neurodegenerative disorders
  6. Patients with spinal disorders in the absence of cerebral lesions
  7. Patients with sickle cell disease
  8. Patients with cerebral lesions caused by emboli associated with congenital cardiac lesions
  9. Patients with severe cognitive deficits who cannot follow simple verbal commands
  10. Patients incapable of voluntary movement of either upper or lower limbs due to contractures.
  11. Patients with prior rhizotomy
  12. Patients with prior orthopedic (bone or soft tissue) surgery or serial casting
  13. Patients with severe postural abnormalities who cannot maintain supported sitting.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00072800

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United States, Maryland
National Institute of Neurological Disorders and Stroke (NINDS)
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)

Layout table for additonal information Identifier: NCT00072800    
Other Study ID Numbers: 040034
First Posted: November 11, 2003    Key Record Dates
Last Update Posted: March 4, 2008
Last Verified: August 2005
Keywords provided by National Institutes of Health Clinical Center (CC):
Muscle Tone Abnormality
Cerebral Palsy
Additional relevant MeSH terms:
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Cerebral Palsy
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Brain Damage, Chronic
Brain Diseases
Central Nervous System Diseases