Classification of topographical pattern of spasticity in cerebral palsy: a registry perspective.
CP registries label the same child differently, so check definitions before you trust diplegia or quadriplegia numbers.
01Research in Context
What this study did
The authors looked at 27 cerebral-palsy registries around the world. They asked each registry how they label spastic topography.
They wanted to know if everyone uses the same meaning for words like diplegia, quadriplegia, and bilateral CP.
What they found
The labels were all over the map. Some registries called the same child diplegic, others called the same child quadriplegic.
Laterality-only terms like unilateral vs bilateral were not enough to sort kids.
How this fits with other research
Fahmie et al. (2013) and Laugeson et al. (2014) took the messy labels this paper exposed and showed they still matter. They found clear upper-body and gait differences between kids tagged diplegic vs hemiplegic.
Galli et al. (2010) went one level deeper. They showed even within unilateral CP, left-sided kids walk slower than right-sided kids. This proves laterality-only is too blunt.
O'Sullivan et al. (2018) tracked bilateral CP kids over time and saw crouch gait get worse. Their review pooled studies that used different diplegia definitions, exactly the problem Amore et al. (2011) flagged.
Why it matters
When you read gait studies or compare clinic data, check how CP topography was defined. If diplegia means one thing in Paper A and another in Paper B, the outcomes may not match. Push for the new standard set before you share your own data.
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02At a glance
03Original abstract
This study used data from a population-based cerebral palsy (CP) registry and systematic review to assess the amount of heterogeneity between registries in topographical patterns when dichotomised into unilateral (USCP) and bilateral spastic CP (BSCP), and whether the terms diplegia and quadriplegia provide useful additional epidemiological information. From the Victorian CP Register, 2956 individuals (1658 males, 1298 females), born 1970-2003, with spastic CP were identified. The proportions with each topographical pattern were analysed overall and by gestational age. Binary logistic regression analysis was used to assess temporal trends. For the review, data were systematically collected on topographical patterns from 27 registries. Estimates of heterogeneity were obtained, overall and by region, reporting period and definition of quadriplegia. Among individuals born <32 weeks, 48% had diplegia, whereas the proportion for children born ≥ 32 weeks was 24% (p < 0.001). Evidence was weak for a temporal trend in the relative proportions of USCP and BSCP (p = 0.038), but much clearer for an increase in the proportion of spastic diplegia relative to quadriplegia (p < 0.001). The review revealed wide variations across studies in the proportion of diplegia (range 34-90%) and BSCP (range 51-86%). These findings argue against a topographical classification based solely on laterality.
Research in developmental disabilities, 2011 · doi:10.1016/j.ridd.2011.05.012