Gross Motor Function Measure

Posted on: March 13, 2015 | By: ldavis29 | Filed under: Gross Motor Function Measure (GMFM)

Title: Gross Motor Function Test (GMFM-88, and most recent the GMFM-66), Date published, December 2002. Second edition, December 16, 2013

Authors: Dianne J. Russell, Peter L. Rosenbaum, Lisa M. Avery, Mary Lane

Source: Published by Mac Keith Press, ISBN for GMFM-88 # 1 89868329 8 and ISBN for GMFM-66 # 1 89868329 8)

Costs: $119 for User’s Manual, 2nd Edition through Wiley Blackwell Publishing. CanChild grants permission for printing, but does not allow the sale of the GMFCS. Go to the following website to learn more, http://motorgrowth.canchild.ca/en/GMFM/overview.asp

Purpose: To evaluate change in motor function over time or with intervention for children with cerebral palsy. It has also been validated with children who have Down syndrome.

Type of test: Standardized observational test

Target Population and Ages: The original validation sample included children 5 months to 16 years old. The GMFM-88 is appropriate for children or adolescents with cerebral palsy or Down syndrome whose motor skills are at or below those of a 5 year old without a motor disability. The GMFM-66 has only been validated for children with cerebral palsy.

Time requirements-Administration and scoring: Administering the GMFM-88 may take approximately 45-60 minutes for someone familiar with the measure, depending on the skill of the assessor, the ability level of the child, and the child’s level of cooperation and understanding. This time will increase if the assessor wants to evaluate the use of ambulatory aids and/or orthotics in addition to an unaided assessment. Sometimes 2 sessions are required to complete all of the items. Item scoring is completed at the time of test administration. Calculation of dimension and total scores takes approximately 5 minutes with a calculator. The GMFM-66 should take less time to administer, as there are fewer items.

Administration: Items may be tested in any order and verbal encouragement or demonstration is permitting. There is a maximum of three trials allowed for each item and any spontaneous performance is acceptable. Toys and incentives can be used to motivate the child to perform a specific task.

Scoring: There is a 4-point scoring system for each item on the GMFM.

0 Does not initiate task
1 Initiates task (<10%)
2 Partially completes task (10-99%)
3 Completes task (100%)
NT Not tested

Scores range from 0-3, with higher scores denoting better performance. The test assesses 5 gross motor dimensions: lying and rolling, crawling and kneeling, sitting, standing and, walking, running and jumping. The score is given based on the best performance of the three trials. If undecided, choose the lower of the possible scores. The item scoring is the same for the GMFM-88 and the GMFM-66. The GMFM-88 scores can be summed to calculate raw and percent scores for each of the five dimensions, selected goal areas and a total GMFM-88 score. The GMFM-66 requires a user-friendly computer program to enter the individual item scores and convert them to an interval level total score.

Type of information: The GMFM-88 provides a percentage score and the GMFM-66 provides an interval-level total score.

Environment for Testing: The testing environment should be comfortable to the patient and large enough to hold the necessary equipment and allow the child to move freely. One item on the test requires the child to run 15 feet and return. The floor surface should me smooth and firm. Since the test was designed to measure change over time, the testing environment should be kept consistent.

Equipment for Testing: If using the GMFM-66, a computer must be accessible.

Equipment and Materials Needed: Mat, adjustable bench, tape lines, stairs with at least 5 steps, and toys.

Examiner Qualifications: The GMFM was designed for use by pediatric therapists who are able to assess motor skills in children. There is a GMFM Self-Instructional CD ROM that provides training tips and allows the therapist to work through examples of each item. For the GMFM-66, it takes a minimum of 3 hours to read through the manual and an additional 3 or more hours to work through the CD ROM training. Learning how to score and interpret the GMFM-66 using the GMAE (Gross Motor Ability Estimator, a computer-based scoring system) will require additional training.

Psychometric Characteristics: Reliable, valid, and responsive to change. MCID for the GMFM-66 is .8-1.3

Adair B, Said C, Rodda J, Morris M. Psychometric properties of functional mobility tools in hereditary spastic paraplegia and other childhood neurological conditions. Dev Med Child Neurol. 2012 April; 54(7): 596-605

Standardization/normative data: Yes, see graph

Evidence of Reliability: ICC for inter-rater reliability in this study was found to be 0.93 and the ICC for intra-rather reliability in this same study was found to be 0.99-1.0.

Mahasup N, Sritipsukho P, Lekskulchai R, Keawutan P. Inter-rater and intra-rater reliability of the gross motor function measure (GMFM-66) by Thai pediatric physical therapists. J Med Assoc Thai. 2011 Dec; 94:S139-44.

Evidence of Validity: The GMFM-88 has been validated on children 5 months to 16 years with cerebral palsy or Down syndrome whose motor skills are at or below those of a 5-year old child without any motor disability. The GMFM-66 has only been validated for children with cerebral palsy.

Palisano R, Hanna S, Rosenbaum P, et al. Validation of a Model of Gross Motor Function for Children With Cerebral Palsy. Phys Ther. 2000; 80:974-985.

Discriminative: Yes

Predictive: The motor growth curves describe patterns of gross motor function for children with CP over time. They can be used to predict a child’s future motor capabilities.

Growth Motor Curves

Strengths: The test has normative data, is predictive, valid and reliable. It shows change over time and the GMFM-66 provides information of level of difficulty of each item, which can help the therapist set realistic goals. The test is also accepted internationally.

Weakness: The test requires the assessor to have some practice with the test before administering it, and if utilizing the GMFM-66, the online training can take several hours. The test has only been validated for cerebral palsy and Down syndrome. The test can also take up to two sessions to complete. If using the GMFM-66, the use of a computer is required and therapist must be able to interrupt results.

Clinical Applications: The test has good clinical application in that it is designed to assess motor function change over time or with intervention in children with CP or Down syndrome if using the GMFM-88. The gross motor function curves can assist parents and health care professionals to make evidence-based management decisions more effectively. The curves can also assist in determining whether a child’s gross motor function is comparable to expectations for children with CP of the same age.

Summary of article utilizing the GMFM

Article: Christovão T, Pasini H, Grecco L, Ferreira L, Duarte N, Oliveira C. Effect of postural insoles on static and functional balance in children with cerebral palsy: A randomized controlled study. Braz J Phys Ther. 2015 Jan-Feb; 19(1):44-51.

 

The purpose of this randomized, controlled, double-blind, clinical trail was to determine the effect of the combination of postural insoles and ankle-foot orthoses on static and functional balance in children with cerebral palsy. Twenty children ages 4-12 years old were randomly allocated to either a control group (n=10) that used placebo insoles or the experimental group (n=10), which used postural insoles. The patients were instructed to wear the insoles for three months, 6 hours a day. The BBS, TUG, 6-minute walk test and GMFM-88 were used to assess balance as well the determination of oscillations from the COP in the anteroposterior and mediolateral directions with eyes open/closed. The participants were evaluated immediately after placement of the insoles, after three months of use of the insoles and one month after suspending use of the insoles. The results demonstrated no significant differences immediately after placement of the insoles except that the experimental group had shorted TUG times. After three months of insole use, no significant differences were found in any of the variables except again, the experimental group demonstrated significant reductions in TUG time and reduction in sway in the anteroposterior and mediolateral directions with eyes open.

References:

Palisano R, Hanna S, Rosenbaum P, et al. Validation of a Model of Gross Motor Function for Children With Cerebral Palsy. Phys Ther. 2000; 80:974-985.

Mahasup N, Sritipsukho P, Lekskulchai R, Keawutan P. Inter-rater and intra-rater reliability of the gross motor function measure (GMFM-66) by Thai pediatric physical therapists. J Med Assoc Thai. 2011 Dec; 94:S139-44.

Adair B, Said C, Rodda J, Morris M. Psychometric properties of functional mobility tools in hereditary spastic paraplegia and other childhood neurological conditions. Dev Med Child Neurol. 2012 April; 54(7): 596-605

GMFM. CanChild Centre for Childhood Disability Research. Available at: http://motorgrowth.canchild.ca/en/GMFCS/originalversion.asp Assessed March 10, 2015.

 

 

 

 

 

 

 

One response to “Gross Motor Function Measure”

  1. gwentz says:

    Lindsey great job. This seems like a great test with it being predictive, valid, and reliable along with having normative data. Nice illustration of the growth motor curves for predicting future motor capabilities. I remember Dr. DiBiasio teaching these in class but this was a good refresher. I thought it was interesting to see that this measure is validated for children with Down Syndrome. The only con to this study which I saw you mentioned in the weaknesses was that it takes almost an hour to administer. However, it could be worth it since this test can give valuable information.

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