Updated Information:
GMFM (GMFM-66 and GMFM-88) User’s manual, 2nd edition from Wiley Publishing Co. is $119 for a spiral bound paperback
The GMFM-88 can be best utilized for children with Cerebral Palsy or Down Syndrome who are very young or whose highest motor ability is lying and rolling.
The GMFM-66 is a quicker to administrate than the GMFM-88 and can only be used for children with Cerebral Palsy. The online computer system required for the GMFM-66 has been updated to the GMAE-2 which offers the ability to import data from the original GMAE program and export into CSV files, an updated tutorial, the ability to plot the child’s percentile compared to peers, score sheets, and the ability to calculate scores for the GMFM-88, GMFM-66, GMFM-IS (item set), and GMFM-66-B&C (basal and ceiling).
The GMAE-2 is available for free download on the Canchild website https://canchild.ca/en/resources/191-gross-motor-ability-estimator-gmae-2-scoring-software-for-the-gmfm
Article Summary:
This study aimed to adapt the Gross Motor Function Measure- 88 for Children who have both Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) and to determine the test- retest and interobserver reliability of the adapted version. The GMFM-88 detects changes in motor functioning and can be sued to measure changes in fundamental gross motor skills over time, as well as physiotheraputic intervention, for children with CP. Cerebral Visual Impairment (CVI) is a condition of central origin, defined as a deficit in visual function related to the malformation of retrogeniculate visual pathways including optic radiations, occipital cortex and visual association areas, without damage to the anterior visual pathways or other ocular disease. CVI is prevalent in approximately 30% of children diagnosed with variations of CP and is thought to play a role in disrupting the accuracy of the GMFM-88 in these patients. Thus, there evolved a need for an adaptation in the GMFM for these patients in order to generate a more accurate evaluation.
The study included 77 children aged 50 to 144 months along with 16 pediatric physical therapists who assessed them. A test-retest and interobserver reliability were conducted and administered twice within three weeks by these trained pediatric physical therapists. One of the therapists was familiar with the child and one of them was not. Seventy percent of experts agreed on the instruction portion of the GMFM-88 and most of the proposed adaptations were on the ‘crawling and kneeling’ (GMFM-C) and ‘walking, running, jumping’ (GMFM-E) dimensions. The believed the GMFM-E needed adaptations secondary to the complexity of jumping requiring more visual support for depth perception in varying heights. Adaptations were then made to these areas. Additionally, experts agreed that children with CVI may have difficulty visually localizing an object, may need assistance determining the height and position of stairs, and may require specific positioning of the therapist with rolling. Therefore, in accordance with GMFM-A for rolling, FMFM-B for sitting, and GMFM-D for standing, the following adaptations were made. These students should be told of the toy’s location in advance, body position of the therapist with rolling should be on the side the child is rolling towards, and that these students are allowed to use their hand for orientation when climbing stairs, but not for supporting purposes.
The strengths of the article were the strong n value of 77 children, the strong test-retest reliability and interobserver reliability. Additionally, the randomization of pediatric therapists with the children they were observing. They accounted for the personal bias that may have played a role in therapy by adding a random pediatric therapist who would also observe that child. A thorough Delphi method was used to select experts who agreed on the adaptations. The test-retest reliability ICC’s ranged between .94 to 1.0, mean percentages of identical scores between 29 to 71, and interobserver reliability ICC’s of the adapted GMFM-88 were .99-1.0 for dimension scores. Mean percentages of the identical scores varied between 53 and 91. Test-retest and interobserver reliability of the GMFM-88 CVI for children with CP and CVI was excellent. Researchers deem this adaptation to be reliable and comparable to the original GMFM-88. The weaknesses of the article were that although primarily spastic CP (96%), participants with different types of CP were included with different degrees of severity were included. This may have created a more vast array of motor function between children included in the study. Similarly, Cerebral Visual Impairment also differed along a spectrum of deficit.
In conclusion, M. Salavati et. al has provided reasonable evidence to support the adaptation for CVI to be reliable and comparable to the original GMFM-88 to increase reliability of the GMFM assessment of children with CP and CVI.
Salavati, M., W. P. Krijnen, E.A. A. Rameckers, P. L. Looijestijin, C.G. B. Maathius, C.P. Van Der Schans, and B. Steenbergen. “Reliability of the Modified Gross Motor Function Measure-88 (GMFM-88) for Children with Both Spastic Cerebral Palsy and Cerebral Visual Impairment: A Preliminary Study ☆.” Reliability of the Modified Gross Motor Function Measure-88 (GMFM-88) for Children with Both Spastic Cerebral Palsy and Cerebral Visual Impairment: A Preliminary Study. Elsevier, July 2015. Web. 28 Feb. 2017.