With good reliability and validity in children with

With a prevalence of approximately 2 per 1,000 births (Reid
et al., 2016), cerebral palsy (CP) is the most common physical disability in
childhood and is considered to be a permanent disorder of movement and posture.
McIntyre (2013) suggests that early
diagnosis of cerebral palsy at 12 weeks of age is now possible for
approximately half the population via comprehensive diagnostic workups among
neonatal intensive care unit graduates with identifiable risk factors (eg,
prematurity, encephalopathy, neonatal seizures, neonatal or postnatal stroke,
multiple births, postnatal infection, and postnatal surgery. Physical
therapists play a crucial role in treatment, prevention of further
deterioration and complications and help in optimal functioning of children with

The GMFCS and the MACS are the two major classification
systems used to classify functional ability in patients with Cerebral Palsy. The
Gross Motor Function Classification System (GMFCS) (Palisano, Rosenbaum,
Bartlett, & Livingston, 2008), categorizes gross motor ability with a focus
on self-initiated movements in sitting, transferring, and mobility. The Manual
Ability Classification System (MACS) (Eliasson et al., 2006) classifies hand
functioning, with emphasis on how children use their hands to handle and
manipulate objects in everyday activities. These two systems have very good
reliability and validity in children with CP across age groups (Palisano et
al., 2008)

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By using
the GMFCS and motor development curves, physical therapists have the clinical
instruments to assist with examination, prediction, intervention planning, and
outcome evaluation for children with CP. Considering Sam`s abilities to sit by
himself, belly crawl, get onto hands and knees, pull to stand and side step
using furniture by 18 months helps to create a baseline function to establish a
high possibility of Sam being able to walk in the future. Hanna et al. (2008)
state that the GMFCS levels can be used to establish broad expectations for
motor development and achievement in CP children. With
the given description, Sam is considered at level III GMFCS, which is described
as ability to move in and out sitting postures and is mobile with hand held
mobility device. He is dependent on transportation in long distances and uneven
terrain. The ACPR (2013) report states that sixty percent of
CP children are independent ambulators (35.5% Gross Motor Function
Classification System I; 24.5% Gross Motor Function
Classification System II); 10% are aided ambulators (10.7% Gross Motor Function
Classification System III); and 30% are wheelchair users (12.2% Gross Motor
Function Classification System IV; 14.1% Gross Motor Function Classification
System V).

Sam being described as MACS
level I makes him capable for an independent living and at most limited in
manual tasks that need speed and accuracy and in new and unfamiliar situations.
In addition, as a level II CFCS communicator, Sam is effective but a slow-paced
communicator. It may be expected that Sam takes more time to understand and
compose messages and repair misunderstandings. At level I of MACS and level II
of CFCS Sam can be an active participant in planning goals for physical therapy
treatment and present his likes and dislikes during treatment. For successful
rehabilitation, a cooperative approach between parents and therapist is crucial.
Brandao et al. (2014) state that collaborative
actions between family and therapists are essential for developing
individualized rehabilitation strategies that effectively promote the child’s
functionality. The
study also noted that there was improvement in functional performance and
parental satisfaction with functional objectives considered important.

suggested by Palisano et al. (2017) it is important to consider efficiency,
safety, self-sufficiency, environmental factors with involvement from patient
and family in discussion of goals. With Sam`s parents being engaged in
treatment sessions, home exercise programs to maintain muscle extensibility,
Sam`s ability to communicate and participate in setting goals, the physical
therapist must focus on maintaining his mobility on crutches indoors and
improve his mobility on wheelchair for outdoor activities like visiting parks
and zoos. In addition,
the therapist must also plan to build Sam`s endurance to help him propel the wheelchair
and to prevent fatigue along with strengthening his extremities, trunk and