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Issues in Measuring Change in Motor Function in Children with Cerebral Palsy: A Special Communication

P Rosenbaum, MD, FRCP(C), is Professor, Department of Pediatrics, and Affiliate Member, Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1200 Main St W, Hamilton, Ontario, Canada L8N 3Z5. He is also Director of Pediatrics, Chedoke Child and Family Centre, Chedoke-McMaster Hospitals, PO Box 2000, Station "A," Hamilton, Ontario, Canda L8N 3Z5.
D Russell, MSc, is Research Coordinator, Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University.
D Cadman, MD, MSc, FRCP(C), is Associate Professor, Department of Clinical Epidemiology and Biostatistics and Department of Pediatrics, Faculty of Health Sciences, McMaster University. Dr Cadman holds a Career Scientist Award from the Ministry of Health, Government of Ontario.
C Gowland, MHSc(PT), is Clinical Specialist in Neurology, Chedoke-McMaster Hospitals, and Assistant Professor, Department of Medicine (PT/OT), Faculty of Health Sciences, McMaster University.
S Jarvis, MSc, is Director of Physiotherapy, Hugh MacMillan Medical Centre, 350 Rumsey Rd, Toronto, Ontario, Canada M4G 1R8.
S Hardy, MSc, is Research Physiotherapist, Hugh MacMillan Medical Centre.

Assessing clinical change in motor function in children with cerebral palsy is a complex measurement task. Whereas a variety of methods have been developed to quantify specific aspects of gross motor behavior (eg, gait analysis, electrophysiological tests, energy-consumption techniques), systematic measurement of overall gross motor function is a more difficult problem. This special communication reviews the structural and performance characteristics required of a well-developed, valid, and responsive clinically based evaluative measure. We discuss several recent approaches used to assess responsiveness and critically examine clinical measures used in randomized controlled trials of physical therapy for children with cerebral palsy. It is argued that the creation and validation of responsive evaluative measures is essential if we are to assess accurately whether our treatments do more good than harm.

Key Words: Cerebral palsy, evaluation • Child development disorders • Pediatrics, evaluation • Tests and measurements, functional

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