Question 1

What is the GMFCS classification and why does it matter?

Accepted Answer

The Gross Motor Function Classification System (GMFCS) is a 5-level scale describing your child's walking ability and mobility: Level I = walks without limitations; Level II = walks with limitations (difficulty on uneven surfaces, stairs); Level III = walks with handheld aids (walker, crutches); Level IV = self-mobility with limitations, uses powered wheelchair for community distances; Level V = transported in manual wheelchair, no independent mobility. GMFCS level helps predict orthopaedic complications (hip displacement much more common in levels IV-V), guides treatment decisions (multilevel surgery best for levels II-III), determines equipment needs, and helps families understand long-term prognosis. Most children's GMFCS level is stable by age 2-4 and doesn't change significantly, though function can improve within a level with good therapy and interventions.

Question 2

Why is hip surveillance so important, and what does migration percentage mean?

Accepted Answer

Hip displacement (the hip ball sliding out of the socket) is the most common preventable orthopaedic complication in CP, affecting 35% of all children with CP and up to 90% of non-walkers (GMFCS IV-V). If the hip dislocates completely, it becomes very painful, makes sitting and dressing difficult, and requires major reconstructive surgery with less predictable outcomes. Hip surveillance involves X-rays every 6-12 months to measure the 'migration percentage' (what percentage of the hip ball has slid out of the socket—normal is 0%, over 30% is significant, over 50% requires reconstruction). The key is early detection: preventive soft tissue surgery when migration percentage is 30-40% has much better outcomes and is less invasive than reconstructive bone surgery needed once migration exceeds 50-60%. Australian guidelines recommend hip surveillance every 6 months for GMFCS III-V children, annually for GMFCS I-II. This program has significantly reduced hip dislocation rates.

Question 3

What is multilevel surgery and is it right for my child?

Accepted Answer

Multilevel orthopaedic surgery (also called single-event multilevel surgery or SEMLS) means addressing multiple joints and muscles in one operation to improve walking patterns in ambulatory children with CP. Rather than doing separate surgeries for tight hamstrings, stiff ankles, and foot deformities spread over several years (old approach), the surgeon corrects all problems in one procedure. Typical surgery combines 4-8 procedures such as hamstring lengthening, hip flexor release, rectus femoris transfer (for stiff-knee gait), Achilles lengthening, and foot surgery. Best candidates are children ages 7-12, GMFCS levels II-III, with gait abnormalities limiting function and social participation despite physiotherapy and bracing. Requires detailed 3D gait analysis pre-operatively to plan exactly which procedures are needed. Recovery is intensive (cast 6 weeks, physiotherapy 12 months) but results in permanent improvement in walking efficiency, speed, and cosmesis in 70-80% of children. Not suitable for very young children, GMFCS IV-V, or children with poor therapy engagement.

Question 4

How do I access funding for my child's therapy and equipment through NDIS?

Accepted Answer

The National Disability Insurance Scheme (NDIS) is the primary funding source for children with CP in Australia. All children with CP under age 7 are eligible for NDIS Early Childhood Early Intervention approach, then transition to standard NDIS plans at age 7. NDIS funds physiotherapy, occupational therapy, speech therapy, orthotics (braces), wheelchairs, standing frames, bathroom equipment, home modifications, and more. To access NDIS: (1) Contact NDIS to request an Access Request Form or apply online at myplace.ndis.gov.au; (2) Gather evidence of permanent disability (doctor's reports, therapy assessments); (3) Submit application—decision usually within 21 days; (4) Once approved, you'll develop a plan with an NDIS planner listing your child's goals and funded supports; (5) Plans are reviewed annually and can be adjusted. Your child's treating team (paediatrician, therapists) will support the application process. NDIS covers 'reasonable and necessary' supports—therapy, equipment, and aids are well-covered, but not medical treatments like surgery (Medicare covers those).

Question 5

Will my child walk? What can I expect for the future?

Accepted Answer

Walking ability depends primarily on GMFCS level, which becomes predictable by age 2-4. Children with GMFCS I-II will walk independently, though may have abnormal gait patterns that can improve with physiotherapy, bracing, or multilevel surgery. GMFCS III children will walk with aids (walker, crutches) for household distances but often use wheelchair for community distances. GMFCS IV children will not walk functionally but may stand with support. GMFCS V children will not walk or stand independently. However, GMFCS level doesn't predict intelligence, independence, or quality of life—many GMFCS IV-V children have normal intelligence, attend mainstream school, and live fulfilling lives with appropriate support. The focus of orthopaedic management is different for each level: for walkers (I-III), goal is to optimize walking efficiency and prevent contractures limiting function; for non-walkers (IV-V), goal is to prevent painful hip dislocation and scoliosis to maintain comfortable sitting and quality of life. With modern management including hip surveillance, early intervention, and timely surgery, children with CP can avoid many preventable complications that affected previous generations.

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