Neurological Sciences

, Volume 40, Issue 12, pp 2493–2500 | Cite as

Examining mobility, independence, motor function, participation, and parental stress in a school-aged Turkish cerebral palsy population: a cross-sectional study

  • İpek Alemdaroğlu-GürbüzEmail author
  • Arzu Burcu Karakuş
Original Article



This study aimed to describe a school-aged Turkish cerebral palsy (CP) population in terms of gross motor function, mobility, independence, and participation, and to investigate parental stress.


Mobility (Functional Mobility Scale (FMS)), independence (Barthel Index (BI)), motor function (Gross Motor Function Measurement (GMFM)), functional classification (Gross Motor Function Classification System (GMFCS)), participation (Pediatric Outcome Data Collection Instrument (PODCI)), and parents’ stress (Parental Stress Scale (PSS)) of 100 school-aged children with CP aged 5–15 years old were evaluated. School-related difficulties and restrictions were also questioned.


Of the 100 children with GMFCS levels I–V, almost half had independent mobility on level or all surfaces according to the FMS, with a relatively high GMFM score (72.8%), and above average BI (12 from 20), and PODCI Global Functioning (62.8%) scores. Strong-to-very strong correlations were determined between all test batteries. A mean score of 42.3 ± 9.92 out of 90 was obtained for parental stress with a weak correlation to the GMFCS and the child’s mobility distance according to family (p < 0.05).


Turkish school-aged children with CP displayed functional abilities that are above average besides experiencing restrictions in the school environment. Parents’ view on the physical condition of the school varied depending on functional and mobility levels of their children.


Cerebral palsy Mobility Participation School Motor function 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Bezmialem Vakıf University, Clinical Researches Ethical Committee, protocol number 10788) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Bax MCO, Flodmark O, Tydeman C (2007) From syndrome toward disease. Dev Med Child Neurol 49:39–41. CrossRefGoogle Scholar
  2. 2.
    Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Jacobsson B (2007) A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 109(suppl 109):8–14. Accessed 1 Nov 2018PubMedGoogle Scholar
  3. 3.
    Aisen ML, Kerkovich D, Mast J, Mulroy S, Wren TA, Kay RM, Rethlefsen SA (2011) Cerebral palsy: clinical care and neurological rehabilitation. Lancet Neurol 10(9):844–852. CrossRefPubMedGoogle Scholar
  4. 4.
    Tieman BL, Palisano RJ, Gracely EJ, Rosenbaum PL (2004) Gross motor capability and performance of mobility in children with cerebral palsy: a comparison across home, school, and outdoors/community settings. Phys Ther 84(5):419–429. CrossRefPubMedGoogle Scholar
  5. 5.
    Palisano RJ, Tieman BL, Walter SD, Bartlett DJ, Rosenbaum PL, Russell D, Hanna SE (2003) Effect of environmental setting on mobility methods of children with cerebral palsy. Dev Med Child Neurol 45(2):113–120. CrossRefPubMedGoogle Scholar
  6. 6.
    Tieman BL, Palisano RJ, Gracely EJ, Rosenbaum PL, Chiarello LA, O'neil ME (2004) Changes in mobility of children with cerebral palsy over time and across environmental settings. Phys Occup Ther Pediatr 24(1–2):109–128. CrossRefPubMedGoogle Scholar
  7. 7.
    Beckung E, Hagberg G (2002) Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Dev Med Child Neurol 44:309–316. CrossRefPubMedGoogle Scholar
  8. 8.
    Fauconnier J, Dickinson HO, Beckung E, Marcelli M, McManus V, Michelsen SI et al (2009) Participation in life situations of 8–12 year old children with cerebral palsy: cross sectional European study. Br Med J 338:b1458. CrossRefGoogle Scholar
  9. 9.
    Ramstad K, Jahnsen R, Skjeldal OH, Diseth TH (2012) Parent-reported participation in children with cerebral palsy: the contribution of recurrent musculoskeletal pain and child mental health problems. Dev Med Child Neurol 54:829–835. CrossRefPubMedGoogle Scholar
  10. 10.
    Majnemer A, Shevell M, Law M, Birnbaum R, Chilingaryan G, Rosenbaum P, Poulin C (2008) Participation and enjoyment of leisure activities in school-aged children with cerebral palsy. Dev Med Child Neurol 50:751–758. CrossRefPubMedGoogle Scholar
  11. 11.
    Goldstein M (2004) The treatment of cerebral palsy: what we know, what we don’t know. J Pediatr 145(2):S42–S46. CrossRefPubMedGoogle Scholar
  12. 12.
    Trivedi R, Gupta RK, Shah V, Tripathi M, Rathore RK, Kumar M, Narayana PA (2008) Treatment-induced plasticity in cerebral palsy: a diffusion tensor imaging study. Pediatr Neurol 39(5):341–349. CrossRefPubMedGoogle Scholar
  13. 13.
    Englander ZA, Sun J, Case L, Mikati MA, Kurtzberg J, Song AW (2015) Brain structural connectivity increases concurrent with functional improvement: evidence from diffusion tensor MRI in children with cerebral palsy during therapy. NeuroImage Clin 7:315–324. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Johnston MV (2009) Plasticity in the developing brain: implications for rehabilitation. Dev Disabil Res Rev 15(2):94–101. CrossRefPubMedGoogle Scholar
  15. 15.
    Chen R, Cohen LG, Hallett M (2002) Nervous system reorganization following injury. Neuroscience 111(4):761–773. CrossRefPubMedGoogle Scholar
  16. 16.
    Martin JH, Friel KM, Salimi I, Chakrabarty S (2007) Activity-and use-dependent plasticity of the developing corticospinal system. Neurosci Biobehav Rev 31(8):1125–1135. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39(4):214–223. CrossRefPubMedGoogle Scholar
  18. 18.
    Graham HK, Harvey A, Rodda J, Nattrass GR, Pirpiris M (2004) The functional mobility scale (FMS). J Pediatr Orthop 24(5):514–520. Accessed 1 Nov 2018CrossRefGoogle Scholar
  19. 19.
    Harvey A, Graham HK, Morris ME, Baker R, Wolfe R (2007) The functional mobility scale: ability to detect change following single event multilevel surgery. Dev Med Child Neurol 49(8):603–607. CrossRefPubMedGoogle Scholar
  20. 20.
    Russell DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palisano RJ (2000) Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther 80(9):873–885. CrossRefPubMedGoogle Scholar
  21. 21.
    Ko J, Kim M (2013) Reliability and responsiveness of the gross motor function measure-88 in children with cerebral palsy. Phys Ther 93(3):393–400. CrossRefPubMedGoogle Scholar
  22. 22.
    Collin C, Wade DT, Davies S, Horne V (1988) The Barthel ADL Index: a reliability study. Int Disabil Stud 10(2):61–63. CrossRefPubMedGoogle Scholar
  23. 23.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md State Med J 14:61–65. Accessed 1 Nov 2018PubMedGoogle Scholar
  24. 24.
    Wade DT, Collin C (1988) The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud 10(2):64–67. CrossRefPubMedGoogle Scholar
  25. 25.
    Shah S, Vanclay F, Cooper B (1989) Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 42(8):703–709. CrossRefPubMedGoogle Scholar
  26. 26.
    Daltroy LH, Liang MH, Fossel AH, Goldberg MJ (1998) The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. J Pediatr Orthop 18(5):561–571. Accessed 1 Nov 2018CrossRefGoogle Scholar
  27. 27.
    Dilbay NK, Günel MK, Aktan T (2013) Reliability and validity of Turkish version of pediatric outcome data collection instrument (PODCI) for people with cerebral palsy. Fiz Rehabil 24:118–126Google Scholar
  28. 28.
    Mutlu A, Büğüsan S, Kara ÖK (2017) Impairments, activity limitations, and participation restrictions of the international classification of functioning, disability, and health model in children with ambulatory cerebral palsy. Saudi Med J 38(2):176–185. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Sullivan E, Barnes D, Linton JL, Calmes J, Damiano D, Oeffinger D, Rogers S (2007) Relationships among functional outcome measures used for assessing children with ambulatory CP. Dev Med Child Neurol 49(5):338–344. CrossRefPubMedGoogle Scholar
  30. 30.
    Berry JO, Jones WH (1995) The parental stress scale: initial psychometric evidence. J Soc Pers Relat 12(3):463–472. CrossRefGoogle Scholar
  31. 31.
    Zelman JJ, Ferro MA (2018) The parental stress scale: psychometric properties in families of children with chronic health conditions. Fam Relat 67(2):240–252. CrossRefGoogle Scholar
  32. 32.
    Kelsey JL, Whittemore AS, Evans AS, Thompson WD (1996) Methods in observational epidemiology (vol 26). Monographs in epidemiology and biostatistics, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  33. 33.
    Tan SS, van der Slot WM, Ketelaar M, Becher JG, Dallmeijer AJ, Smits DW, Perrin+ study group (2016) Factors contributing to the longitudinal development of social participation in individuals with cerebral palsy. Res Dev Disabil 57:125–135. CrossRefPubMedGoogle Scholar
  34. 34.
    Imms C, Reilly S, Carlin J, Dodd K (2008) Diversity of participation in children with cerebral palsy. Dev Med Child Neurol 50(5):363–369. CrossRefPubMedGoogle Scholar
  35. 35.
    Smits DW, Ketelaar M, Gorter JW, van Schie P, Dallmeijer A, Jongmans M, Lindeman E (2011) Development of daily activities in school-age children with cerebral palsy. Res Dev Disabil 32(1):222–234. CrossRefPubMedGoogle Scholar
  36. 36.
    Schenker R, Coster WJ, Parush S (2005) Neuroimpairments, activity performance, and participation in children with cerebral palsy mainstreamed in elementary schools. Dev Med Child Neurol 47(12):808–814. CrossRefPubMedGoogle Scholar
  37. 37.
    Harvey A, Baker R, Morris ME, Hough J, Hughes M, Graham HK (2010) Does parent report measure performance? A study of the construct validity of the functional mobility scale. Dev Med Child Neurol 52(2):181–185. CrossRefPubMedGoogle Scholar
  38. 38.
    Østensjø S, Carlberg EB, Vøllestad NK (2005) The use and impact of assistive devices and other environmental modifications on everyday activities and care in young children with cerebral palsy. Disabil Rehabil 27(14):849–861. CrossRefPubMedGoogle Scholar
  39. 39.
    Cousino MK, Hazen RA (2013) Parenting stress among caregivers of children with chronic illness: a systematic review. J Pediatr Psychol 38:809–828. CrossRefPubMedGoogle Scholar
  40. 40.
    Wang HY, Jong YJ (2004) Parental stress and related factors in parents of children with cerebral palsy. Kaohsiung J Med Sci 20(7):334–340. CrossRefGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Faculty of Physical Therapy and RehabilitationHacettepe UniversityAltındağTurkey
  2. 2.Şefkatevi Private Education and Rehabilitation CenterİstanbulTurkey

Personalised recommendations