Gross Motor Function Measure Update and Article Summary

Posted on: March 6, 2017 | By: tgalantowicz | Filed under: Gross Motor Function Measure (GMFM)

Updated Information:

The price of the GMFM user’s manual, 2nd edition from Wiley Publishing Co. is now $119.00 for the spiral bound paperback copy. The Gross Motor Ability Estimator (GMAE-2), a computer program used for scoring the GMFM, is free for download at CanChild’s website (www.canchild.ca). Requirements for download include: Java version 7, 100MB Free Hard Disk Space is recommended for software and data storage, Windows XP and above (if using Windows), Mac OSX 10.7 and above (if using a Mac), Adobe Acrobat Reader,  Unzip File utility, and a screen display resolution of at least 1024×768.

 

Article Summary:

Habitual Physical Activity in Children with Cerebral Palsy Aged 4 to 5 Years Across all Functional Abilities

Purpose: The purpose of the study was to explore the impact of habitual physical activity versus sedentary time on functional abilities in preschool aged children with cerebral palsy. Also, to compare the children in the study’s activity levels to the Australian Physical Activity Guidelines. The study defined habitual activity as “physical activity in daily life” and sedentary behavior as, “energy expenditure less than 1.5 METs”. The Australian Physical Activity Guidelines recommends children between 0 to 5 years should be physically active 3 hours per day (at a minimum) and should not be sedentary greater than an hour at a time during waking hours.

Methods: This cross-sectional was conducted in Brisbane, Australia and utilized 2 population-based cohort studies to derive date between October 2010 and December 2014. The study included sixty-seven subjects that had had completed 3 days of activity monitoring, were born between 2006 and 2009, and had a diagnosis of Cerebral Palsy (CP) (n = 67). Forty-six of the participants were classified as independently ambulant (GMFCS I-II), seven were classified as marginally ambulant (GMFCS III), and fourteen were classified as nonambulatory (GMFCS IV-V).

Subjects wore ActiGraph triaxial accelerometers for 3 days (2 weekdays and 1 weekend day) and parents kept a 3-day activity diary. The monitors were worn with a neoprene belt around the subjects’ lower backs, which has been validated in children with CP, ages 18 months to 5 years old, across all functional abilities. The data was then calculated into time spent sedentary as a percentage of total wear time (%TSS) and activity counts. A research physical therapist also assessed each child and used the GMFCS to classify motor function, GMFM-66 to assess motor capacity, and measured height and weight to calculate BMI.

Results: The study found that sedentary behavior (confidence interval -0.69 to -0.53, R2 = 0.74, P < .001) and physical activity levels (confidence interval 17.1 to 23.0, R2 = 0.69, P < .001) were significantly associated with the GMFM-66. Data results showed that the children with CP aged 4 to 5 were more physically active on weekend days than weekdays (i.e. more sedentary during weekdays). Though there were no significant differences between sexes, the girls in the study had higher percentages of sedentary time than the boys. The majority of subjects in the independently (91%) and marginally ambulant (86%) groups met the Australian Physical Activity Guidelines for sedentary behavior. However, only 67% of the independently ambulant subjects and 43% of the marginally ambulant subjects met the recommendation of greater than 3 hours of physical activity for all 3 days. Almost all subjects in the nonambulant group did not meet the guidelines for sedentary or active time.

Strengths/Limitations: The strengths of the study were that it had a large sample size with varied functional abilities, it used high utility outcome measures, and gave thorough detail of the methodology for reproduction of the study. The limitations were that it did not include a control group of children that did not have a diagnosis of CP for comparison, the monitor was not able to record any water-based activity (which is a common source of physical activity in this population), and that outcome measures focused solely on the activity domain of the ICF model without taking into consideration how environmental and/or personal factors (neighborhood, socio-economic status, cultural beliefs, etc.) may have impacted activity counts/sedentary behavior.

Conclusion: Overall, I feel this article highlighted the importance of encouraging children with CP, especially those who are nonambulatory or marginally ambulatory, to be active each day. Also, the difference in activity levels during weekdays versus weekend days demonstrates how finding ways to include physical activity into school days could help children with CP (and all school aged children) meet activity recommendations during weekdays. Clinically, the association between functional capacity and physical activity/sedentary behavior in children with CP can be used as guide for intervention. By practicing skills on the GMFM it can improve the child’s functional capacity and therefore improve their physical activity, which in turn can benefit their overall health and quality of life.

 

Keawutan P, Bell KL, Oftedal S, Davies PSW, Ware RS, Boyd RN. Habitual Physical Activity in Children With Cerebral Palsy Aged 4 to 5 Years Across All Functional Abilities: Pediatric Physical Therapy. 2017;29(1):8-14. doi:10.1097/PEP.0000000000000327.

 

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