Join My Cerebral Palsy :: My Cerebral Palsy

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Email *

May we email you updates from MyCP? *

Yes, please!

No, thank you.

We will email you when we have new studies available or with research news or significant changes to MyCP. You can change this setting at anytime in your profile in MyCP.org.

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Display Name *

This field is how your name will be displayed in discussions on our forum. Feel free to remain anonymous with this ID or to choose something informal or formal. Our forum is not public so this name will only be seen by other forum members and is not indexed by search engines.

Primary Reason for Joining MyCP *

I am a person with CP or a caregiver to a person with CP

I am a clinician scientist who treats people with CP

I am a research scientist who studies CP

I am an advocate for people with CP

MyCP Referrer

Demographics

Please fill these important facts about the person with CP. We use these data to determine which surveys are appropriate for you.

Relationship to the person with CP? *

Full Name *

The name as it appears on the birth certificate of the person with CP. It will not be displayed. We use it to create a unique ID but we do not store the name. Want to learn more?

How should we refer to the person with CP? *

E.g. "Will" or "Susan"

Birth Date *

Date of birth for the person with CP

Age

Gender *

Gender of the person with CP

Race *

African-American or Black

American Indian or Alaskan Native

Asian

Hawaiian or other Pacific Islander

White

Not Reported

Refused to Answer

Unknown

Race of the person with CP (check all that apply)

Ethnicity *

Yes

Is the person with CP Hispanic or Latino?

Cerebral Palsy Characteristics

These three characteristics are essential to determining which studies/surveys you will be offered.

CP Distribution *

One side affected

Both legs affected

Both arms and both legs affected

Both sides - right side predominant

Both sides - left side predominant

Unknown

Please select which ever option best describes the limbs affected by CP.

Primary CP diagnosis *

What is the movement disorder/tone diagnosis for the person with CP? Check all that apply. (For a brief description of the different types, visit the CDC site.)

Gross Motor Function Classification System (GMFCS) *

III

Unknown

Based on the descriptions on the right, select the Gross Motor Function Classification System (GMFCS) that most closely aligns with the motor abilities of the person with CP.

My child…
Has difficulty sitting on their own and controlling their head and body posture in most
positions

and has difficulty achieving any voluntary control of movement
and needs a specially-adapted supportive chair to sit comfortably
and has to be lifted or hoisted by another person to move

Can sit on their own but does not stand or walk without significant support and adult
supervision

and may need extra body / trunk support to improve arm and hand function
and usually needs adult assistance to get in and out of a chair
and may achieve self-mobility using a powered wheelchair or is transported in the community

Can walk on their own using a walking aid (such as a walker, rollator, crutches, canes, etc.)

and can usually get in and out of a chair without adult assistance
and may use a wheelchair when travelling long distances or outside
and finds it difficult to climb stairs or walk on an uneven surface without considerable help

Can walk on their own without using a walking aid, but has difficulty walking long distances
or on uneven surfaces

and can sit in a normal adult chair and use both hands freely
and can move from the floor to standing without adult assistance
and needs to hold the handrail when going up or down stairs
and is not yet able to run and jump

Can walk on their own without using a walking aid, including fairly long distances, outdoors

and on uneven surfaces
and can move from the floor or a chair to standing without using their hands for support
and can go up and down stairs without needing to hold the handrail
and is beginning to run and jump

My Child...

Level V - Has difficulty controlling head and trunk posture in most positions

and uses specially adapted seating to sit comfortably
and has to be lifted by another person to move about

Level IV - Can sit on own when placed on the floor and can move within a room

and uses hands for support to maintain sitting balance
and usually uses adaptive equipment for sitting and standing
and moves by rolling, creeping on stomach or crawling

Level III - Can sit on own and walk short distances with a walking aid (such as a walker, rollator, crutches,
canes, etc.)

and may need help from an adult for steering and turning when walking with an aid
and usually sits on floor in a “W-sitting” position and may need help from an adult to get into sitting
and may pull to stand and cruise short distances
and prefers to move by creeping and crawling

Level II - Can sit on own and usually moves by walking with a walking aid

and may have difficulty with sitting balance when using both hands to play
and can get in and out of sitting positions on own
and can pull to stand and cruise holding onto furniture
and can crawl, but prefers to move by walking

Level I - Can sit on own and moves by walking without a walking aid

and is able to balance in sitting when using both hands to play
and can move in and out of sitting and standing positions without help from an adult
and prefers to move by walking

Full Name

Clinical Discipline

Developmental Pediatrics

Neurology

Neurosurgery

Occupational Therapy

Orthopedic Surgery

Physical Medicine & Rehabilitation

Physical Therapy

Social Work

OtherOther

Hospital Affiliation

University Affiliation

Do you treat adults, children or both?

Adults

Children

Both

What are your research interests?

Full Name *

University Affiliation

Hospital Affiliation

Research Focus Areas

Full Name

Organization Name

Role at organization

Executive Director, CEO, Communications Director, Community Outreach, etc.

Organizational Mission