Utilization of the ICF-CY for the classification of therapeutic objectives in the treatment of spasticity in children with cerebral palsy

• Objective: To identify objectives for treatment of spasticity with botulinum toxin type A (BTX) in children with cerebral palsy (CP), standardize the objectives according to typology, and classify them according to the International Classification of Functioning for Children and Youth (ICF-CY), as well as to analyze treatment goals in relationship to CP clinical type, severity level, and age. • Methods: 188 children were included in the study (mean age, 12 years; 42% female, 58% male). The diplegic type made up 38% of CP cases, the tetraplegic type 35%, and the hemiplegic type 24%. Children were mainly classified in the lowest and highest levels in the Gross Motor Function Classification System (GMFCS 1, 39%; GMFCS 5, 26%). Treatment objectives for individual therapies were discussed, identified, and transcribed in the therapeutic proposals. The objectives were then collected and subjected to an internal audit in order to standardize their denomination. Two trained health care providers expert in the use of the ICF-CY classification mapped the objectives to ICFCY domains and categories. The objectives were then analyzed in relationship to CP clinical type, GMFCS level, and age. • Results: Of the objectives, 88% (246) were in the "Body Functions" domain. In this domain, there were 28 typologies of objectives in 6 categories. Only 12% (32) of the objectives were in the "Activity" domain; there were 11 typologies in 5 categories. In diplegic and hemiplegic patients with mild disability (GMFCS 1), objectives were aimed at improving gait pattern. For quadriplegic patients with severe disability (GMFCS 5), objectives were aimed mainly at controlling deformities and improving health care provision. Objectives concerning pain treatment were proposed principally for patients with diplegic and quadriplegic type CP. • Conclusions: The ICF-CY can be used to categorize treatment objectives proposed for patient improvement in the domains of Body Functions and Activity. Goal setting for BTX injections occurs mainly in the Body Functions domain and aims at finding changes in the gait pattern.