**7. A holistic (standardized) classification of CP: the future**

The development of a standardized or holistic classification of CP is topical and in tandem with advances in understanding of CP, imaging techniques and quantitative motor assessments [1]. Bax et al. [1] in 2005 proposed a standardized CP classification scheme with four major components namely:


**Classification Minear's** 

**Classification Criterion/**

GMFCS Gross motor/

MACS Manual dexterity/ upper limb function (usual performance in handling objects with two hands).

CFCS Communication function (everyday communication performance)

> drinking ability/ oropharyngeal/ swallowing function (safe and efficiency of eating and drinking and level of assistance required)

**Table 3.** Comparison of current (functional) classifications.

EDACS Eating &

Swedish classification

Edinburg classification

SCPE Classification **classifications combined**

38 Cerebral Palsy - Clinical and Therapeutic Aspects

Physiological and topographic

Physiological and topographic

Physiological and modified topographic

**characteristic used**

ambulatory/ lower limb function (current gross motor abilities/activity limitations)

**Criteria/characteristics** 

abnormality + localization of motor impairment

abnormality + localization of motor impairment

abnormality + localization of motor impairment as unilateral and bilateral

**Inter rater/ inter observer reliability**

**Suitability for research (on a scale of 1–5)**

Poor ++ No No

Poor ++ No No

Fair +++ No No

**Aiding/ guiding current management**

Yes Yes GMFCS

Yes Yes MACS

Yes Yes ≥3 years.

Yes Yes 2–12 years.

**Indication of functional abilities**

> **Age range included (year developed)**

(birth– 12 years) (1997) GMFCS-E&R (birth– 18 yreas) (2007)

(4–18 years) (2006) Mini-MACS (1–4 years) (2016)

(2011)

(2014)

**Nature of scale(s)**

Ordinal (5-level)

Ordinal (5-level)

Ordinal (5-level)

Two ordinal scales (one 5-level, one 3-level)

**Aiding/ guiding current management**

**used**

Type of motor

Type of motor

Type of motor

only.

**Table 2.** Comparison of traditional classifications based on multiple variables.

**Inter rater/ inter observer reliability**

Good Yes (valid and reliable)

Good Yes (valid and reliable)

Good Yes (valid and reliable)

Good Yes (valid and reliable)

**Suitability for research**

**Indication of functional abilities**


Currently, there are obvious limitations with categorization of neuroimaging findings and identifying specific causes of CP. Therefore, as we await comprehensive and acceptable neuroanatomic and etiologic classifications, the minimum acceptable multiaxial classification of CP for both developed and developing countries should include:


This implies that only the first two components of the standardized classification proposed by Bax et al. [1] are applicable currently. The classification by SCPE provides enough clinical descriptive information about children with CP while the supplemental and functional classifications are useful for management and service delivery. The use of the functional scales in clinical context (to aid management) and in research is in accordance with current thinking and the reconceptualization of the management of CP.
