Gross Motor Function Classification System (GMFCS)

1. Gross Motor Function Classification System (GMFCS) • Kathy McKellar • Motor Growth Measures Knowledge Broker • December 2006/January 2007

2. 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)

3. Overview of GMFCS Presentation • Why classify? • GMFCS: a focus on function • Development of the GMFCS • Training, how to classify kids • Clinical utility • Summary

4. 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

5. 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

6. 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

7. 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)

8. 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

9. The GMFCS • Please refer to handouts • 2 lay-outs

10. Classifying Children • Some video clips…

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

12. 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

13. 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)

14. 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

15. 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!