Normative values for the ACTIVLIM-CP Article Summary
ACTIVLIM-CP was recently developed for children who have cerebral palsy (CP) and used to assess their global activity performance in 43 different areas focusing on self-care, mobility, and domestic life. The purpose of this article was to provide normative values in regards to the ACTIVLIM-CP, determine its ability to discriminate between various functional levels in children with cerebral palsy, and determine its precision, construct validity, and clinical relevance.
The study population included 503 typically developing children (259 boys and 244 girls) ages 2 to 18 years old and 285 children with cerebral palsy (134 boys and 15 girls) also aged 2 to 18 years old.
Data was collected by having the parents complete the ACTIVLIM-CP questionnaire. For typically developing children, the parents completed the questionnaire through the child’s school, and for parents of children with CP, they completed the questionnaire either during the child’s usual care from health professionals or at rehabilitation during the pre-treatment assessment. For children with CP, the GMFCS and MACS were added to the forms for further classification of the child’s abilities. The parents’ responses to the ACTIVLIM-CP were converted by the Rasch model into a linear measure.
The results showed that age was the strongest predictor of ACTIVLIM-CP measures in children who are typically developing, and those measures improved with older aged children. For children with CP, lower ACTIVLIM-CP measures were observed compared to children who are typically developing and was not associated with age. The percentage of children with CP under the 5th percentile of the normative values increased as limitations in manual ability increased. For example, children with CP with a MACS level of 1 had 57% under the 5th percentile, whereas children with a MACS level of 5 had 100% under the 5th percentile. When looking at gross motor function, similar trends were noted. For example, children with CP with a GMFCS level of 1 had 62% under the 5th percentile, whereas children with GMFCS level of 5 had 100% under the 5th percentile.
It was determined that in typically developing children, ACTIVLIM-CP measures increased rapidly during childhood and plateaued around 12 years of age, but continued to slightly develop till age 17 to 18 in some children, and normative values were able to be developed from this data. In children with CP, ACTIVLIM-CP is able to discriminate across all MACS and GMFCS levels, except for MACS levels 3 and 4 due to overlapping.
This study determined that ACTIVLIM-CP scores in children with CP corresponded to their associated MACS and GMFCS levels validating its ability to discriminate between various MACS and GMFCS levels, and allowing for clinicians to place them within a normative values chart comparing between other children with CP, as well as those children who are typically developing. This measure can be utilized to not only compare a child’s ACTIVLIM-CP score and MACS and GMFCS levels, but can also be used in later sessions to determine whether there has been improvement in the child’s abilities after interventions have been utilized.
Strengths for this study included having the minimum required amount of participants needed to create normative values, and having a group of participants who represented a good distribution among the focused population. That being said, a limitation to this study included the fact that all participants came from either Belgium or France, meaning this can’t be generalized all over the world, and all children with CP were recruited from centers specific for those with CP, meaning that excludes any individuals who were not able to receive care or assistance from those centers.
Julie Paradis, Carlyne Arnould & Yannick Bleyenheuft (2020) Normative values and discriminative ability across functional levels of ACTIVLIM-CP, a measure of global activity performance for children with cerebral palsy, Disability and Rehabilitation, 42:19, 2790-2796, DOI: 10.1080/09638288.2019.1573270
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