Gross Motor Function Measure (GMFM): A Clinical Tool for the Assessment of Motor Function in Children with Cerebral Palsy

The Gross Motor Function Measure (GMFM) is a clinical observational tool developed specifically to assess changes in gross motor function in children with cerebral palsy. Two versions of this instrument exist: the original 88-item version (GMFM-88) and a newer 66-item version (GMFM-66), the latter of which includes an adaptation that allows for a more efficient and focused assessment [1] .

Objective of gross motor function measurement

The main objective of the GMFM is to assess gross motor functions in children with Cerebral Palsy (CP). Accurate assessment of motor function is crucial for monitoring and adjusting therapies, thus optimizing the effect of rehabilitation in these children. This monitoring is vital to ensure that interventions are as beneficial as possible [2] .

Target Population of Gross Motor Function

The GMFM is designed for use in children with Cerebral Palsy (CP) aged 5 months to 16 years, whose motor skills are delayed compared to other children of the same age. Although the GMFM-88 was initially developed for children with CP, it has also been validated in other populations, such as children with Down syndrome and acquired brain injury. In contrast, the GMFM-66 has so far only been validated in children with CP [2] .

Method of Using Gross Motor Function

For the GMFM-88, item scores are summed to calculate total and percentage scores for each of the five GMFM dimensions of interest, selected target areas, and a total GMFM-88 score. For the GMFM-66, a free software program, the Gross Motor Ability Estimator (GMAE), is required to calculate total scores [1] .

Gross motor ability estimator

GMFM Scores

The GMFM scoring system is a four-point scale consisting of 66 items divided into five dimensions of gross motor function:

Specific descriptors for item scoring are detailed in the administration and scoring guidelines. A 5-year-old child without motor disabilities is capable of achieving the maximum score [3].

Gross motor function administration time

Administering the GMFM-88 may take approximately 45 to 60 minutes for someone familiar with the measure, depending on the assessor's skill, the child's ability, and the child's level of cooperation and understanding. The GMFM-66 should take less time to administer because it has fewer items [1] .

Required Qualifications for Gross Motor Function

The GMFM was designed for use by pediatric therapists familiar with assessing motor skills in children. Users should familiarize themselves with the GMFM guidelines and scoring sheet before assessing children.

Equipment needed to apply gross motor function

An equipped physiotherapy gym (e.g., mat, bench, toys). Access to stairs (with at least 5 steps) is also required.

Scientific evidence of gross motor function

The GMFM shows sufficient validity, responsiveness and reliability for the assessment of motor skills of children with Cerebral Palsy in rehabilitation [4] . Therefore, for young children and children with severe motor disabilities, the GMFM-88 provides a more detailed description of their abilities and limitations. Furthermore, the GMFM-88 can be administered with shoes, walking aids and/or orthoses, while the GMFM-66 must be administered barefoot and without aids [5].

Reliability and Validity

Reliability refers to the dependability, consistency, and stability of scores on an assessment tool. Both versions of the GMFM have been shown to be highly reliable, with an intraclass correlation coefficient (ICC) greater than .98 (95% confidence interval = 0.965–0.994), and both can be used in clinical practice or research.

Validity and Responsiveness

Validity includes responsiveness, defined as the ability to differentiate clinically important differences. Both versions of the GMFM also demonstrated high levels of validity, with an intraclass correlation coefficient (ICC) of .99 (95% confidence interval = 0.972–0.997), mirroring associations with the GMFM-66.

Diverse

Assessing a child's skills and level of difficulty using the GMFM can be helpful in identifying deficiencies in motor skills and assessing improvement as a result of intervention, thus providing much more information to assist with setting realistic goals [4]

If you want to have the SCORE SHEET FOR EVALUATING GROSS MOTOR SKILLS (GMFM-88) click here

Bibliographic References

1. Russell, D., et al. (2002). "GMFM Manual: Methods for the Clinical Assessment of Motor Function." CanChild Centre for Childhood Disability Research, McMaster University.

2. Russell, D.J., et al. (2013). "Outcome Measurement in Children with Cerebral Palsy." Cambridge University Press.

3. [Russell, D.J., Wright, M., et al. (2013). "Assessment of Cerebral Palsy."]

4. Russell DJ, Rosenbaum P, Wright M, Avery LM. Gross motor function measure (GMFM-66 & GMFM-88) users manual. Mac keith press; 2002

5. Beckers LW, Bastiaenen CH. Application of the Gross Motor Function Measure-66 (GMFM-66) in Dutch clinical practice: a survey study. BMC pediatrics. 2015 Dec;15(1):1-10

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