The inability to use scores on the BBS to distinguish
between children with no motor impairment and children
with mild balance deficits may also have been influenced by
the method of administration of the BBS. The BBS does not
specify which side the subject must use when performing
items such as single leg stance. Thus, the children with spastic
hemiplegia were able to use the non–involved side to perform
these activities. The administration protocol, as recommended
by Berg, may have masked their balance deficits.
These results suggest that neither the BBS nor the
GMFM are appropriate tests to measure balance deficits in
children with mild functional limitations. The results also
indicate that classification of children clearly affects the ability
to use scores on the BBS and the GMFM to differentiate
among groups of children with differing balance abilities. This
finding contributes to the growing belief that the traditional
classification of cerebral palsy by tonus and distribution provides
an incomplete reflection of a child’s functional abilities.
Using the International Classification of Functioning
and Disability (ICIDH 2) drafted by the World Health Organization
(WHO),18 traditional classification of children
with cerebral palsy is at the level of impairment. Traditional
classification using medical diagnosis provides an
incomplete indication of the child’s gross motor abilities,
except that it is assumed that the more severe the impairment,
the more limited the child’s function. Because rehabilitation
professionals should be addressing client issues
at the functional level of activity, clients should be classified
in terms of function. Only then will measurement of
Fig. 1. Reclassification of subjects using the GMFCS. *This is not a level of the GMFCS. It is an artificially created group for the subjects with
no motor impairment.
Fig. 2. Summary of findings using traditional classification and the GMFCS. Group 1 spastic hemiplegia; Group 2 spastic diplegia (no
ambulatory aids); Group 3 spastic diplegia (ambulatory aids); Group 4 no motor impairment. * Indicates a significant difference.