Contributing Factors Analysis for the Changes of the Gross Motor Function in Children with Spastic Cerebral Palsy After Physical Therapy
Additional information about the GMFM: There is no overall magnitude of change for the GMFM-66 that is “clinically important.” As physical therapists, we must use our clinical judgment to determine this magnitude for each child that we encounter.
CanChild Resources. Gross Motor Function Measure (GMFM). Accessed Feb 25th 2018.
Article Review
Contributing Factors Analysis for the Changes of the Gross Motor Function in Children with Spastic Cerebral Palsy After Physical Therapy
Purpose: This study was aimed to assess different factors that may impact gross motor function in those patients with spastic cerebral palsy.
Study population: The patients were children diagnosis with spastic cerebral palsy from 2 to 6 years old. This study included 24 males and 21 females (45 children total) with spastic CP. Those included were not allowed to receive botulinum toxin injection or surgery within the past 6 months.
Methods: It was a retrospective study reviewing patient’s medical records. It included patients at level I-IV on the GMFCS. This study reviewed patient’s age, BMI, duration of admission, hearing problem, microcephaly, number of affected limbs (spasticity through the Modified Ashworth Scale), visual impairment, seizure, dysphagia, and CFCS (communication skills of patients with CP).
Outcome measures: This study used the GMFM-88 at both initial evaluation and at discharge to determine change. In addition, statistical analysis were performed to show changes between variables as noted above.
Intervention: Patients received physical therapy twice a day for 40 minutes 5x a week in a hospital setting.
Results: The aspects that may influence changes as a result from this study included “duration of admission, initial GMFM-88, microcephaly, dysphagia, the number of affected limbs, composite spasticity index of upper extremity, composite spasticity index of lower extremity, and physical therapists.” Of those factors: duration of admission, initial GMFM-88, presence of dysphagia, and degree of lower extremity spasticity showed to have significant effects on the improvements in GMFM-88. Aspects that did not influence changes in GMFM-88 are visual impairments, hearing problems, seizures, age, BMI, and gender.
Strengths: The same physical therapist performed the GMFM-88 at evaluation and discharge to improve reliability. All subjects improved their GMFM-88 scores. The groups were similar at baseline proving that GMFM-88 can be used appropriately with patients diagnosed with spastic CP.
Limitations: There were several limitations in this study. Only one subject had hearing impairments, therefore it is difficult to generalize that hearing impairment do not affect the GMFM-88 scores. There was a small sample size of only 45 patients and only ages 2-6 years old. This does not represent the entire population of patients with CP.
Conclusion: Patients aged 2-6 years old with spastic CP improved on the GMFM-88. The longer the duration of admission the more intense physical therapy, which showed greater improvements in the GMFM-88. Other positive factors for greater improvements included initial GMFM-88 scores in the middle range, no dysphagia, and less spasticity in the lower extremities.
Yi TI, Jin JR, Kim SH, Han KH. Contributing Factors Analysis for the Changes of the Gross Motor Function in Children With Spastic Cerebral Palsy After Physical Therapy. Annals of Rehabilitation Medicine. 2013;37(5):649-657. doi:10.5535/arm.2013.37.5.649.
2 responses to “Contributing Factors Analysis for the Changes of the Gross Motor Function in Children with Spastic Cerebral Palsy After Physical Therapy”
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Is the takeaway here that the GMFM-88 is more sensitive to
“duration of admission, initial GMFM-88, microcephaly, dysphagia, the number of affected limbs, composite spasticity index of upper extremity, composite spasticity index of lower extremity, and physical therapists.”
…or is it that these factors are more significant indicators of gross motor function improvement in this population?
Devan, those were all the factors that the study was looking at as to reasons that may affect the changes in the GMFM. Overall the factors that were of significant importance of affecting changes in the GMFM were: duration of admission, initial GMFM-88, presence of dysphagia, and degree of lower extremity spasticity. Longer durations, initial GMFM-88 in the middle range, no dysphagia, and less spasticity in the lower extremity were found as factors that affected positive improvements in the GMFM-88 (aka. the patients improved when these were present).