Gross Motor Function Classification System - Expanded and Revised (GMFCS-ER): Difference between revisions

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== Introduction ==
== Introduction ==
The Gross Motor Function Classification System - Expanded & Revised (GMFCS - E&R) was developed in 2007. It builds on the original version of the Gross Motor Function Classification System from 1997.<ref>Morris C. [https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-8749.2007.00005.x Development of the gross motor function classification system (1997)]. Developmental Medicine & Child Neurology. 2008 Jan 1;50(1):5-.</ref> It categorises children with cerebral palsy in terms of their self-initiated gross motor function. This 5-level classification system focuses on wheeled mobility, walking and sitting. The levels are defined based on functional abilities, the need for wheeled mobility or assistive technology (canes, crutches or walkers). Quality of movement is also looked at, but to a lesser extent.<ref name=":1" />  
The Gross Motor Function Classification System - Expanded & Revised (GMFCS - E&R) was developed in 2007. It builds on the original version of the Gross Motor Function Classification System from 1997.<ref>Morris C. [https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-8749.2007.00005.x Development of the gross motor function classification system (1997)]. Developmental Medicine & Child Neurology. 2008 Jan 1;50(1):5-.</ref> It categorises children with cerebral palsy in terms of their self-initiated gross motor function.<ref name=":3" />


The GMFCS - E&R is focused on discovering which level best represents the child's "present abilities and limitations in gross motor function".<ref name=":1" /> It considers usual activities, such as a child's performance in school, home and community settings rather than what they can do at their best. It, therefore, distinguishes between what they ''do'' rather than their ''capability''. Classification is based on current performance in gross motor function and should not consider judgments about prognosis or movement quality.<ref name=":1">Can Child. GMFCS - E&R
This five-level classification system focuses on wheeled mobility, walking and sitting. A child is classified based on their ability to perform certain functional activities and their need for assistive technology (such as canes, crutches or walkers) or wheeled mobility.<ref name=":3" /> The GMFCS - E&R also looks at quality of movement, but in much less detail.<ref name=":3" /><ref name=":1" />
 
The GMFCS - E&R is focused on determining which of the five levels best represents the child's "present abilities and limitations in gross motor function".<ref name=":1" /> It considers usual activities, such as a child's performance in school, home and community settings rather than what they can do at their best. It, therefore, distinguishes between what they ''do'' rather than their ''capability''. Classification is based on current performance in gross motor function and should not consider any judgments on prognosis.<ref name=":1">Can Child. GMFCS - E&R


Gross Motor Function Classification System - Expanded & Revised.  Available from: https://canchild.ca/en/resources/42-gross-motor-function-classification-system-expanded-revised-gmfcs-e-r</ref>
Gross Motor Function Classification System - Expanded & Revised.  Available from: https://canchild.ca/en/resources/42-gross-motor-function-classification-system-expanded-revised-gmfcs-e-r</ref>
== Intended Population ==
== Intended Population ==
This classification system is intended for children and young people with CP. The revised version (GMFCS - E&R) includes five age ranges: The age groups are: under 2 years, 2-4 years, 4-6 years, 6-12 years, and 12-18 years of age.<ref name=":1" /> The GMFCS - E&R is available in 22 languages and has been validated in many different countries.
This classification system is intended for children and young people with cerebral palsy. The revised version (GMFCS - E&R) includes five age ranges The age groups are: under 2 years, 2-4 years, 4-6 years, 6-12 years, and 12-18 years of age.<ref name=":1" /> The GMFCS - E&R is available in 22 languages and has been validated in many different countries. It is intended to classify function - it is not a diagnostic tool.<ref>Versfeld, P. Family-Centred Intervention and Early Diagnosis Course. Plus , 2021.</ref>


== Method of Use ==
== Method of Use ==
Physiotherapists, occupational therapists, physicians, and other health service providers familiar with the movement abilities of children with CP can use the GMFCS - E&R. Parents of children with CP are also able to classify their children using an adapted version known as the GMFCS Family Report Questionnaire.<ref name=":1" />
Physiotherapists, occupational therapists, physicians, and other health / rehabilitation service providers familiar with the movement abilities of children with cerebral palsy can use the GMFCS - E&R. Parents / caregivers of children with cerebral palsy are also able to classify their children using an adapted version known as the GMFCS Family Report Questionnaire.<ref name=":1" />


Health care providers who are familiar with a child can typically classify them using the GMFCS - E&R within 5 minutes. Those unfamiliar with the child may require 15 to 20 minutes to complete the classification as more observation is required.<ref name=":1" />
Health care providers who are familiar with a child can typically classify them using the GMFCS - E&R within 5 minutes. Those unfamiliar with the child may require 15 to 20 minutes to complete the classification as more observation is required.<ref name=":1" />
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There is strong evidence for the reliability and construct validity of the GMFCS - E&R when used by both health professionals and families/caregivers,<ref name=":2">Piscitelli D, Ferrarello F, Ugolini A, Verola S. Pellicciari, L. Measurement properties of the Gross Motor Function Classification System, Gross Motor Function Classification System-Expanded & Revised, Manual Ability Classification System, and Communication Function Classification System in cerebral palsy: a systematic review with meta-analysis. Dev Med Child Neurol. 2021;63:1251-61.</ref> which indicates that it can be used in research and clinical practice.<ref name=":3">Nylén E, Grooten WJA. [https://www.tandfonline.com/doi/full/10.1080/01942638.2020.1830915 The stability of the Gross Motor Function Classification System in children with cerebral palsy living in Stockholm and factors associated with change]. Phys Occup Ther Pediatr. 2021;41(2):138-49. </ref>
There is strong evidence for the reliability and construct validity of the GMFCS - E&R when used by both health professionals and families/caregivers,<ref name=":2">Piscitelli D, Ferrarello F, Ugolini A, Verola S. Pellicciari, L. Measurement properties of the Gross Motor Function Classification System, Gross Motor Function Classification System-Expanded & Revised, Manual Ability Classification System, and Communication Function Classification System in cerebral palsy: a systematic review with meta-analysis. Dev Med Child Neurol. 2021;63:1251-61.</ref> which indicates that it can be used in research and clinical practice.<ref name=":3">Nylén E, Grooten WJA. [https://www.tandfonline.com/doi/full/10.1080/01942638.2020.1830915 The stability of the Gross Motor Function Classification System in children with cerebral palsy living in Stockholm and factors associated with change]. Phys Occup Ther Pediatr. 2021;41(2):138-49. </ref>


* Various studies have shown that its intra- and inter-reliability is "almost excellent".<ref name=":3" />  
* Various studies have shown that its intra- and inter-reliability is "almost excellent" with high intraclass correlation coefficient.<ref name=":3" />
* Palisano et al.<ref name=":4">Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. [https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-8749.2008.03089.x Content validity of the expanded and revised Gross Motor Function Classification System]. Developmental Medicine & Child Neurology. 2008 Oct 1;50(10):744-50.</ref> used Delphi survey consensus methods (where consensus was defined as "agreement with a question by at least 80% of participants"<ref name=":4" />) to confirm the content validity of the GMFCS - E&R.
* Palisano et al.<ref name=":4">Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. [https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-8749.2008.03089.x Content validity of the expanded and revised Gross Motor Function Classification System]. Developmental Medicine & Child Neurology. 2008 Oct 1;50(10):744-50.</ref> used Delphi survey consensus methods (where consensus was defined as "agreement with a question by at least 80% of participants"<ref name=":4" />) to confirm the content validity of the GMFCS - E&R.
* However, it has been found that the GMFCS - E&R cannot be used to detect change over time,<ref name=":2" /> and while it was previously considered a stable measure, some authors have shown that a child's GMFCS can change.<ref name=":3" />
* The GMFCS - E&R cannot be used to detect change over time.<ref name=":2" /> Towns et al.<ref>Towns M, Rosenbaum P, Palisano R, Wright FV. [[Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?]]. Developmental Medicine & Child Neurology. 2018 Feb;60(2):147-54.</ref> note that it cannot be used as an outcome measure to check progression or changes after treatment and it is not intended for conditions other than cerebral palsy.
* Towns et al.<ref>Towns M, Rosenbaum P, Palisano R, Wright FV. [[Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?]]. Developmental Medicine & Child Neurology. 2018 Feb;60(2):147-54.</ref> note that it cannot be used as an outcome measure to check progression or changes after treatment and it is not intended for conditions other than cerebral palsy.
* While the GMFCS - E&R has been considered a stable measure, it has been found that a child's GMFCS level can change.<ref name=":3" /> Research on the stability of the GMFCS - E&R is ongoing.<ref name=":1" />
** Gorter et al.<ref>Gorter JW, Ketelaar M, Rosenbaum P, Helders PJ, Palisano R. [https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-8749.2008.03117.x Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older]. Dev Med Child Neurol. 2009 Jan;51(1):46-52. </ref> found that infants may need to be re-classified after 2 years.
** Palisano et al.<ref name=":5">Palisano RJ, Avery L, Gorter JW, Galuppi B, McCoy SW. [https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.13903 Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System]. Dev Med Child Neurol. 2018 Oct;60(10):1026-32.</ref> found that the GMFCS has higher stability than the Manual Ability Classification System and Communication Function Classification System.<ref name=":5" /> However, they also recommend repeated classification over time and note that younger children are more likely to require reclassification.<ref name=":5" />


== Resources  ==
== Resources  ==
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*[https://canchild.ca/system/tenon/assets/attachments/000/000/058/original/GMFCS-ER_English.pdf GMFCS-ER (English)]  
*[https://canchild.ca/system/tenon/assets/attachments/000/000/058/original/GMFCS-ER_English.pdf GMFCS-ER (English)]  
*[https://canchild.ca/system/tenon/assets/attachments/000/001/399/original/GMFCS_English_Illustrations.pdf GMFCS-ER Descriptors and Illustrations]
*[https://canchild.ca/system/tenon/assets/attachments/000/001/399/original/GMFCS_English_Illustrations.pdf GMFCS-ER Descriptors and Illustrations]
*[https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-8749.2008.03117.x GMFCS in Infants with CP]<ref>Gorter JW, Ketelaar M, Rosenbaum P, Helders PJ, Palisano R. Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older. Developmental Medicine & Child Neurology. 2009 Jan 1;51(1):46-52. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-8749.2008.03117.x </ref>
*[https://www.canchild.ca/en/resources/86-use-of-the-gross-motor-function-classification-system-to-optimize-rehabilitation-management-of-children-with-cerebral-palsy GMFCS in Rehabilitation of Cerebral Palsy]
*[https://www.canchild.ca/en/resources/86-use-of-the-gross-motor-function-classification-system-to-optimize-rehabilitation-management-of-children-with-cerebral-palsy GMFCS in Rehabilitation of CP]
*Gorter JW, Ketelaar M, Rosenbaum P, Helders PJ, Palisano R. [https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-8749.2008.03117.x Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older]. Dev Med Child Neurol. 2009 Jan;51(1):46-52.


== References  ==
== References  ==

Revision as of 01:49, 22 May 2023

Original Editor - Evan Thomas

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Introduction[edit | edit source]

The Gross Motor Function Classification System - Expanded & Revised (GMFCS - E&R) was developed in 2007. It builds on the original version of the Gross Motor Function Classification System from 1997.[1] It categorises children with cerebral palsy in terms of their self-initiated gross motor function.[2]

This five-level classification system focuses on wheeled mobility, walking and sitting. A child is classified based on their ability to perform certain functional activities and their need for assistive technology (such as canes, crutches or walkers) or wheeled mobility.[2] The GMFCS - E&R also looks at quality of movement, but in much less detail.[2][3]

The GMFCS - E&R is focused on determining which of the five levels best represents the child's "present abilities and limitations in gross motor function".[3] It considers usual activities, such as a child's performance in school, home and community settings rather than what they can do at their best. It, therefore, distinguishes between what they do rather than their capability. Classification is based on current performance in gross motor function and should not consider any judgments on prognosis.[3]

Intended Population[edit | edit source]

This classification system is intended for children and young people with cerebral palsy. The revised version (GMFCS - E&R) includes five age ranges The age groups are: under 2 years, 2-4 years, 4-6 years, 6-12 years, and 12-18 years of age.[3] The GMFCS - E&R is available in 22 languages and has been validated in many different countries. It is intended to classify function - it is not a diagnostic tool.[4]

Method of Use[edit | edit source]

Physiotherapists, occupational therapists, physicians, and other health / rehabilitation service providers familiar with the movement abilities of children with cerebral palsy can use the GMFCS - E&R. Parents / caregivers of children with cerebral palsy are also able to classify their children using an adapted version known as the GMFCS Family Report Questionnaire.[3]

Health care providers who are familiar with a child can typically classify them using the GMFCS - E&R within 5 minutes. Those unfamiliar with the child may require 15 to 20 minutes to complete the classification as more observation is required.[3]

Distinguishing between levels of the GMFCS - E&R is usually quite clear. However, it is important to note that at some ages, it is more difficult to distinguish between adjacent levels, so more time may be required to classify a child.[3]

The levels are as follows:[5][6]

  • Level I: able to walk without limitations
  • Level II: can walk with limitations (e.g. balance, endurance limitations)
  • Level III: can walk using a hand-held mobility device (may use additional support, such as wheeled mobility, for longer distances, outdoors)
  • Level IV: self-mobility is limited - may be transported in a manual wheelchair or may use powered mobility
  • Level V: transported in manual wheelchair

Reid et al.[7] note that a child classified as Level I will be able to perform the same activities as their peers but their speed, balance or coordination may be impacted. However, a child classified as Level V will have difficulty achieving voluntary control of movement and their head/trunk control is affected in many positions.[7]

Evidence[edit | edit source]

There is strong evidence for the reliability and construct validity of the GMFCS - E&R when used by both health professionals and families/caregivers,[8] which indicates that it can be used in research and clinical practice.[2]

  • Various studies have shown that its intra- and inter-reliability is "almost excellent" with high intraclass correlation coefficient.[2]
  • Palisano et al.[9] used Delphi survey consensus methods (where consensus was defined as "agreement with a question by at least 80% of participants"[9]) to confirm the content validity of the GMFCS - E&R.
  • The GMFCS - E&R cannot be used to detect change over time.[8] Towns et al.[10] note that it cannot be used as an outcome measure to check progression or changes after treatment and it is not intended for conditions other than cerebral palsy.
  • While the GMFCS - E&R has been considered a stable measure, it has been found that a child's GMFCS level can change.[2] Research on the stability of the GMFCS - E&R is ongoing.[3]
    • Gorter et al.[11] found that infants may need to be re-classified after 2 years.
    • Palisano et al.[12] found that the GMFCS has higher stability than the Manual Ability Classification System and Communication Function Classification System.[12] However, they also recommend repeated classification over time and note that younger children are more likely to require reclassification.[12]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Morris C. Development of the gross motor function classification system (1997). Developmental Medicine & Child Neurology. 2008 Jan 1;50(1):5-.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Nylén E, Grooten WJA. The stability of the Gross Motor Function Classification System in children with cerebral palsy living in Stockholm and factors associated with change. Phys Occup Ther Pediatr. 2021;41(2):138-49.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Can Child. GMFCS - E&R Gross Motor Function Classification System - Expanded & Revised. Available from: https://canchild.ca/en/resources/42-gross-motor-function-classification-system-expanded-revised-gmfcs-e-r
  4. ↑ Versfeld, P. Family-Centred Intervention and Early Diagnosis Course. Plus , 2021.
  5. ↑ CanChild. GMFCS-ER Resources. Last Accessed July 17, 2016 from https://canchild.ca/en/resources/42-gross-motor-function-classification-system-expanded-revised-gmfcs-e-r
  6. ↑ Paulson A, Vargus-Adams J. Overview of four functional classification systems commonly used in cerebral palsy. Children (Basel). 2017 Apr 24;4(4):30.
  7. ↑ 7.0 7.1 Reid SM, Carlin JB, Reddihough DS. Using the Gross Motor Function Classification System to describe patterns of motor severity in cerebral palsy. Developmental Medicine & Child Neurology, 2011 Nov 1;53(11):1007-12.
  8. ↑ 8.0 8.1 Piscitelli D, Ferrarello F, Ugolini A, Verola S. Pellicciari, L. Measurement properties of the Gross Motor Function Classification System, Gross Motor Function Classification System-Expanded & Revised, Manual Ability Classification System, and Communication Function Classification System in cerebral palsy: a systematic review with meta-analysis. Dev Med Child Neurol. 2021;63:1251-61.
  9. ↑ 9.0 9.1 Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Developmental Medicine & Child Neurology. 2008 Oct 1;50(10):744-50.
  10. ↑ Towns M, Rosenbaum P, Palisano R, Wright FV. Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?. Developmental Medicine & Child Neurology. 2018 Feb;60(2):147-54.
  11. ↑ Gorter JW, Ketelaar M, Rosenbaum P, Helders PJ, Palisano R. Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older. Dev Med Child Neurol. 2009 Jan;51(1):46-52.
  12. ↑ 12.0 12.1 12.2 Palisano RJ, Avery L, Gorter JW, Galuppi B, McCoy SW. Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System. Dev Med Child Neurol. 2018 Oct;60(10):1026-32.
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