Transcript Gross Motor Function Classification System (GMFCS)

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
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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
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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!