We thought it would be helpful to provide more clarity regarding the various levels of CP, as it has a very wide spectrum of abilities. The team that we see at Grandview provided us with a copy of "The Gross Motor Function Classification System (GMFCS)" which is used in the medical world to define the levels of CP (Levels 1 to 5). We are unsure of what level James is as of yet. It will be more clear once James is 2 (corrected age not actual). Grandview and Sick Kids will "correct" James' age until he is 3. In other words, because he was born 12 weeks early, motor abilities will be assessed using his full term expected birthday (October 22nd instead of August 1st). We've had the hope that James is level 1 but according to the criteria below he is looking to be more like a level 3 at his stage of development right now. Of course, more will be revealed with time. We've also discovered that there appears to be quite a variety and range within each level as well. Here's a detailed description of the levels:
Level 1- Walks without restrictions, limitations in more advanced gross motor skills.
Before 2nd Birthday: Infants move in and out of sitting and floor sit with both hands free to manipulate objects. Infants crawl on hands and knees, pull to stand and take steps holding on to furniture. Infants walk between 18 months and 2 years of age without the need for any assistive mobility device.
From age 2 to 4th birthday: Children floor sit with both hands free to manipulate objects. Movements in and out of floor sitting and standing are performed without adult assistance. Children walk as the preferred method of mobility without the need for any assistive mobility device.
From age 4 to 6th birthday: Children get into and out of, and sit in, a chair without the need for hand support. Children move from the floor and from chair sitting and standing without the need for objects for support. Children walk indoors and outdoors, and climb stairs. Emerging ability to run and jump.
From age 6 to 12th birthday: Children walk indoors and outdoors, and climb stairs without limitations. Children perform gross motor skills including running and jumping but speed, balance, and coordination are reduced.
Level 2- Walks without assistive devices, limitations walking outdoors and in the community.
Before 2nd birthday: Infants maintain floor sitting but may need to use their hands for support to maintain balance. Infants creep on their stomach or crawl on hands and knees. Infants may pull to stand and take steps holding on to furniture.
From age 2 to 4th birthday: Children floor sit but may have difficulty with balance when both hands are free to manipulate objects. Movements in and out of sitting are performed without adult assistance. Children pull to stand on a stable surface. Children crawl on hands and knees with a reciprocal pattern, cruise holding onto furniture and walk using an assistive mobility device as preferred methods of mobility.
From age 4 to 6th birthday: Children sit in a chair with both hands free to manipulate objects. Children move from the floor to standing and from chair sitting to standing but often require a stable surface to push or pull up on with their arms. Children walk without the need for any assistive mobility device indoors and for short distances on level surfaces outdoors. Children climb stairs holding onto a railing but are unable to run or jump.
From age 6 to 12th birthday: Children walk indoors and outdoors, and climb stairs holding onto a railing but experience limitations walking on uneven surfaces and inclines, and walking in crowds or confined spaces. Children have at best only minimal ability to perform gross motor skills such as running and jumping.
Level 3- Walks with assistive mobility devices, limitations walking outdoors and in the community.
Before 2nd birthday: Infants maintain floor sitting when the low back is supported. Infants roll and creep forward on their stomachs.
From age 2 to 4th birthday: Children maintain floor sitting often by "W-sitting" (sitting between flexed and internalizing rotated hips and knees) and may require adult assistance to assume sitting. Children creep on their stomachs or crawl on hands and knees (often without reciprocal leg movements) as their primary methods of self-mobility. Children may pull to stand on a stable surface and cruise short distances. Children may walk short distances indoors using an assistive mobility device and adult assistance for steering and turning.
From age 4 to 6th birthday: Children sit on a regular chair but may require pelvic or trunk support to maximize hand function. Children move in and out of chair sitting using a stable surface to push or pull up with their arms. Children walk with an assistive mobility device on level surfaces and climb stairs with assistance from an adult. Children frequently are transported when travelling for long distances or outdoors on uneven terrain.
From age 6 to 12th birthday: Children walk indoors or outdoors on a level surface with an assistive mobility device. Children may climb stairs holding onto a railing. Depending on upper limb function, children propel a wheelchair manually or are transported when travelling for long distances or outdoors on uneven terrain.
Level 4- Self mobility with limitations; Children are transported or use power mobility outdoors and in the community
Before 2nd birthday: Infants have head control but trunk support is required for floor sitting. Infants can roll to supine (from front to back) and may roll to prone (from back to front).
From age 2 to 4th birthday: Children floor sit when placed, but are unable to maintain alignment and balance without use of their hands for support. Children frequently require adaptive equipment for sitting and standing. Self-mobility for short distances (within a room) is achieved through rolling, creeping on stomach, or crawling on hands and knees without reciprocal leg movement.
From age 4 to 6th birthday: Children sit on a chair but need adaptive seating for trunk control and to maximize hand function. Children move in and out of chair sitting with assistance from an adult or a stable surface to push or pull up on with their arms. Children may at best walk short distances with a walker and adult supervision but have difficulty turning and maintaining balance on uneven surfaces. Children are transported in the community. Children may achieve self-mobility using a power wheelchair.
From age 6 to 12th birthday: Children may maintain levels of function achieved before age 6 or rely more on wheeled mobility at home, school, and in the community. Children may achieve self-mobility using a power wheelchair.
Level 5- Self-mobility is severely limited even with the use of assistiv\e technology
Before 2nd birthday: Physical impairments limit voluntary control of movement. Infants are unable to maintain antigravity head and trunk postures in prone and sitting. Infants require adult assistance to roll.
From 2 to 12th birthday: Physical impairments restrict voluntary control of movement and the ability to maintain antigravity head and trunk postures. All areas of motor function are limited. Functional limitations in sitting and standing are not fully compensated for through the use of adaptive equipment and assistive technology. At level 5, children have no means of independent mobility and are transported. Some children achieve self-mobility using a power wheelchair with extensive adaptations.
Distinctions between Levels 1 & 2: Compared with children in level 1, children in level 2 have limitations in the ease of performing movement transitions, walking outdoors and in the community, the need for assistive mobility devices when beginning to walk, quality of movement, and the ability to perform gross motor skills such as running and jumping.
Distinctions between Levels 2 & 3: Differences are seen in the degree of achievement of functional mobility. Children in level 3 need assistive mobility devices and frequently orthoses to walk, while children in level 2 do not require assistive mobility devices after age 4.
Distinctions between levels 3 & 4: Differences in sitting ability and mobility exist, even allowing for extensive use of assistive technology. Children in level 3 sit independently, have independent floor mobility, and walk with assistive mobility devices. Children in level 4 function in sitting (usually supported) but independent mobility is very limited. Children in level 4 are more likely to be transported or use power mobility.
Distinctions between levels 4 & 5: Children in level 5 lack independence even in basic antigravity postural control. Self mobility is achieved only if the child can learn how to operate an electrically powered wheelchair.
Fueling Up!
Since James started ABM therapy he has made some major progress in rolling (and I'm not so bad myself...it's harder than it looks!)