Gross Motor Function Classification System (GMFCS)

• Kathy McKellar

• Motor Growth Measures Knowledge Broker

• December 2006/January 2007

Knowledge Broker Project

• Research project through CanChild Centre for Childhood Disability Research

• Co-Principal Investigators: Dianne Russell and Dr. Peter Rosenbaum

• Goal: measure the effectiveness of using a knowledge broker to promote the use of motor growth measures in clinical practice– GMFCS– GMFM– Motor Growth Curves (MCG’s)

Overview of GMFCS Presentation

• Why classify?

• GMFCS: a focus on function

• Development of the GMFCS

• Training, how to classify kids

• Clinical utility

• Summary

Why classify?

• Kids with CP are a heterogeneous population

• Clinicians need a quick descriptor for more information

• Traditional approaches to classification: type of movement disorder; distribution of involvement; ambulatory status; severity of involvement

GMFCS: A Focus on Function

• A standardized system to classify gross motor function of children with CP, 12 months to 12 years (Palisano et al 1997)

• Classification is based on observation of the child’s self-initiated movement and need for assistive techonology and wheeled mobility

• Usual performance at home, school and in the community

GMFCS: A Focus on Function

• 5 levels:» I child able to walk and run, but limited in more

advanced skills

» V very limited voluntary movement ability

• 4 age bands:» Under 2; 2-4 years; 4-6 years; 6-12 years

» Work currently being done to add 13-20 year age band

Development of the GMFCS

• Phase 1: Drafting of the system• Phase 2: validity testing with clinicians using

consensus process• Phase 3: Validity testing with acknowledged

experts using the Delphi technique (consensus process with emphasis on the distinctions between levels)

• Phase 4: Reliability testing: More reliable for children 2-12 years than for those under 2 years (Wood and Rosenbaum, 2000)

Training to use the GMFCS

• Therapists and physicians can reliably use the GMFCS with no training, simply by reading the criteria on the brochure (available on the CanChild website (www.canchild.ca)

• Parents can reliably classify their children aged 6 to 12 years (Morris, Galuppi, & Rosenbaum, 2004) and 2 to 4 years (Dietrich, Abercombie, Fanning, & Bartlett , 2005) using modified forms

• A 45-minute DVD provides an introduction to the system and shows videoclips of several children for each classification level

The GMFCS

• Please refer to handouts

• 2 lay-outs

Classifying Children

• Some video clips…

Clinical Utility

• How can the GMFCS be used to optimize clinical management of kids with CP?

Enhances Communication

• The system provides a simple and clear description of current motor ability for communication among all team members, including families

• The system provides a basis from which students in the rehabilitation disciplines can better understand the range of variation in manifestation of children with CP

Sharpens Focus on Function

• More useful than severity, type, and distribution of involvement in clinical management

• Aligned with the current focus on function in rehabilitation

• Consistent with the shift in focus from impairment-level variables to consideration of activity and participation (World Health Organization, 2001)

Other Clinical Uses of the GMFCS

• Assists with treatment planning

• Assists with prognosticating

• Facilitates evidence-based practice

• Assists with caseload distribution and resource allocation

• Contributes to Continuing Competency

Summary

• The GMFCS is: reliable, valid and easy to use in a clinical or community setting.

• This is considered best practice!• Other resources available: DVD

training video, foundation article, update article

• Kathy is available to help!