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| == Introduction == | | == Introduction == |
| The Gross Motor Function Classification System - Expanded & Revised (GMFCS - E&R) categories children with cerebral palsy on the basis of self-initiated gross motor function. This 5-level classification system highlights wheeled mobility, walking and sitting. The difference in levels are 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. | | 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" /> |
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| The center of the GMFCS- E&R is to discover which level best represents the child's present limitations and abilities in gross motor function. Attention is on everyday performance in school, home and community settings rather than what they are capable of. Thus, classification is based on current performance in gross motor function and should not comprise judgements about prognosis for improvement.<ref>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" /> |
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| 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>
| | 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 |
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| == Objective ==
| |
| The revised and expanded version of the [[Classification of Cerebral Palsy|GMFCS]] (2007) builds upon the original version of the Gross Motor Function Classification System developed in 1997 to classify and describe the abilities of children and youth with [[Cerebral Palsy Introduction|cerebral palsy]]. It has 4 age bands namely, less than 2 years, 2-4 years, 4-6 years and 6-12 years. This newer version describes the movement ability of a child with cerebral palsy in one of five levels across five age ranges, with emphasis on the child’s functional ability and performance in different settings, particularly sitting, walking, and wheeled mobility.
| |
| | |
| == Intended Population ==
| |
| This classification system is intended for children and youth with CP from 0-18 years old. The GMFCS-ER contains five age groups, those being under 2 years, 2-4 years, 4-6 years, 6-12 years, and 12-18 years of age.
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| The GMFCS-ER is available in 22 languages and has been validated in many different countries.
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| | |
| == Method of Use ==
| |
| Physical therapists, occupational therapists, physicians, and other health service providers familiar with movement abilities of children with CP can use the GMFCS-ER. Parents of children with CP are able to classify their children using an adapted version known as the GMFCS Family Report Questionnaire.
| |
| | |
| Health care providers familiar with a child can typically classify him or her within 5 minutes. Those unfamiliar with the child may require 15 to 20 minutes to complete as more observation is required.
| |
| | |
| Distinctions are usually quite clear and decisions about which level most closely represents a child's functional ability can be made quite quickly. However, distinctions between two adjacent levels can sometimes be very subtle, so more careful deliberation is required before a classification can be made.
| |
| | |
| Generally, the higher the level the poorer the functional ability of the child. The theme of each level is as follows:
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| * '''Level I''': Walks without Limitations
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| * '''Level II''': Walks with Limitations
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| * '''Level III''': Walks Using a Hand-Held Mobility Device
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| * '''Level IV''': Self-Mobility with Limitations; May Use Powered Mobility
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| * '''Level V''': Transported in a Manual Wheelchair
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| | |
| Children classified as Level I perform the same activities as their peers but with some degree of difficulty in speed, balance, and coordination. In contrast, children classified as Level V have difficulty in most positions controlling their head/trunk posture and voluntary control of movement.
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| {| class="wikitable"
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| |
| |
| |}
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| == Evidence ==
| |
| | |
| === Reliability ===
| |
| The inter-tester reliability between physiotherapists and parents has been determined to have an ICC value of 0.96 (95% CI, 0.95-0.97). This indicates that parents and clinicians can use the same terms and understand each other when determining the motor functional classification of their child if the GMFCS-ER is carefully administered.
| |
| | |
| === Validity ===
| |
| The GMFCS-ER has been evidenced with the content validity of 80% by consensus process in a Delphi study. The content has been validated for clarity and accuracy of the descriptions for each level and the distinctions between levels of 6 to 12 years and 12-18 years age bands. The GMFCS-ER has utility for communication related to the condition between the various health professionals, therapists and parents etc. and also for clinical decision making, databases, registries and clinical research.The study published in the Europian journal of Physiotherapy "suggests that the GMFCS-E&R, if administered carefully, can be used as when comparing longitudinal data with the GMFCS."
| |
| | |
| === Responsiveness ===
| |
| In a study conducted where 18 Physical therapists participated to evaluate the draft version of the 12-18 years age band and a Delphi survey where 30 health professionals from 7 countries participated to evaluate the revised 12-18 years and 6-12 years age band and consensus was gained by 80% of participants.It has been agreed as useful tool for classification of gross motor function.
| |
| | |
| The GMFCS or the GMFCS-ER is a classification system. It has been developed for the purpose of classification alone. It is just to determine the type of cerebral palsy. It is neither to be used as an outcome measure for checking the progression over time or after treatment nor to be used for conditions other than CP unless there is an evidenced research saying so for a condition.
| |
| | |
| == Resources == | |
| | |
| | |
| | |
| | |
| == Objective ==
| |
| The revised and expanded version of the [[Classification of Cerebral Palsy|GMFCS]] (2007) builds upon the original version of the Gross Motor Function Classification System developed in 1997 to classify and describe the abilities of children and youth with [[Cerebral Palsy Introduction|cerebral palsy]]. It has 4 age bands namely, less than 2 years, 2-4 years, 4-6 years and 6-12 years. This newer version describes the movement ability of a child with cerebral palsy in one of five levels across five age ranges, with emphasis on the child’s functional ability and performance in different settings, particularly sitting, walking, and wheeled mobility.
| |
| | |
| == Intended Population ==
| |
| This classification system is intended for children and youth with CP from 0-18 years old. The GMFCS-ER contains five age groups, those being under 2 years, 2-4 years, 4-6 years, 6-12 years, and 12-18 years of age.
| |
| | |
| The GMFCS-ER is available in 22 languages and has been validated in many different countries.
| |
| | |
| == Method of Use ==
| |
| Physical therapists, occupational therapists, physicians, and other health service providers familiar with movement abilities of children with CP can use the GMFCS-ER. Parents of children with CP are able to classify their children using an adapted version known as the GMFCS Family Report Questionnaire.
| |
| | |
| Health care providers familiar with a child can typically classify him or her within 5 minutes. Those unfamiliar with the child may require 15 to 20 minutes to complete as more observation is required.
| |
| | |
| Distinctions are usually quite clear and decisions about which level most closely represents a child's functional ability can be made quite quickly. However, distinctions between two adjacent levels can sometimes be very subtle, so more careful deliberation is required before a classification can be made.
| |
| | |
| Generally, the higher the level the poorer the functional ability of the child. The theme of each level is as follows:
| |
| | |
| * '''Level I''': Walks without Limitations
| |
| * '''Level II''': Walks with Limitations
| |
| * '''Level III''': Walks Using a Hand-Held Mobility Device
| |
| * '''Level IV''': Self-Mobility with Limitations; May Use Powered Mobility
| |
| * '''Level V''': Transported in a Manual Wheelchair
| |
| | |
| Children classified as Level I perform the same activities as their peers but with some degree of difficulty in speed, balance, and coordination. In contrast, children classified as Level V have difficulty in most positions controlling their head/trunk posture and voluntary control of movement.
| |
| {| class="wikitable"
| |
| |
| |
| |}
| |
| | |
| == Evidence ==
| |
| | |
| === Reliability ===
| |
| The inter-tester reliability between physiotherapists and parents has been determined to have an ICC value of 0.96 (95% CI, 0.95-0.97). This indicates that parents and clinicians can use the same terms and understand each other when determining the motor functional classification of their child if the GMFCS-ER is carefully administered.
| |
| | |
| === Validity ===
| |
| The GMFCS-ER has been evidenced with the content validity of 80% by consensus process in a Delphi study. The content has been validated for clarity and accuracy of the descriptions for each level and the distinctions between levels of 6 to 12 years and 12-18 years age bands. The GMFCS-ER has utility for communication related to the condition between the various health professionals, therapists and parents etc. and also for clinical decision making, databases, registries and clinical research.The study published in the Europian journal of Physiotherapy "suggests that the GMFCS-E&R, if administered carefully, can be used as when comparing longitudinal data with the GMFCS."
| |
| | |
| === Responsiveness ===
| |
| In a study conducted where 18 Physical therapists participated to evaluate the draft version of the 12-18 years age band and a Delphi survey where 30 health professionals from 7 countries participated to evaluate the revised 12-18 years and 6-12 years age band and consensus was gained by 80% of participants.It has been agreed as useful tool for classification of gross motor function.
| |
| | |
| The GMFCS or the GMFCS-ER is a classification system. It has been developed for the purpose of classification alone. It is just to determine the type of cerebral palsy. It is neither to be used as an outcome measure for checking the progression over time or after treatment nor to be used for conditions other than CP unless there is an evidenced research saying so for a condition.
| |
| | |
| == Resources ==
| |
| | |
| | |
| == Objective ==
| |
| The revised and expanded version of the [[Classification of Cerebral Palsy|GMFCS]] (2007) builds upon the original version of the Gross Motor Function Classification System developed in 1997 to classify and describe the abilities of children and youth with [[Cerebral Palsy Introduction|cerebral palsy]]. It has 4 age bands namely, less than 2 years, 2-4 years, 4-6 years and 6-12 years. This newer version describes the movement ability of a child with cerebral palsy in one of five levels across five age ranges, with emphasis on the child’s functional ability and performance in different settings, particularly sitting, walking, and wheeled mobility.
| |
| | |
| == Intended Population == | |
| This classification system is intended for children and youth with CP from 0-18 years old. The GMFCS-ER contains five age groups, those being under 2 years, 2-4 years, 4-6 years, 6-12 years, and 12-18 years of age.
| |
| | |
| The GMFCS-ER is available in 22 languages and has been validated in many different countries.
| |
| | |
| == Method of Use ==
| |
| Physical therapists, occupational therapists, physicians, and other health service providers familiar with movement abilities of children with CP can use the GMFCS-ER. Parents of children with CP are able to classify their children using an adapted version known as the GMFCS Family Report Questionnaire.
| |
| | |
| Health care providers familiar with a child can typically classify him or her within 5 minutes. Those unfamiliar with the child may require 15 to 20 minutes to complete as more observation is required.
| |
| | |
| Distinctions are usually quite clear and decisions about which level most closely represents a child's functional ability can be made quite quickly. However, distinctions between two adjacent levels can sometimes be very subtle, so more careful deliberation is required before a classification can be made.
| |
| | |
| Generally, the higher the level the poorer the functional ability of the child. The theme of each level is as follows:
| |
| | |
| * '''Level I''': Walks without Limitations
| |
| * '''Level II''': Walks with Limitations
| |
| * '''Level III''': Walks Using a Hand-Held Mobility Device
| |
| * '''Level IV''': Self-Mobility with Limitations; May Use Powered Mobility
| |
| * '''Level V''': Transported in a Manual Wheelchair
| |
| | |
| Children classified as Level I perform the same activities as their peers but with some degree of difficulty in speed, balance, and coordination. In contrast, children classified as Level V have difficulty in most positions controlling their head/trunk posture and voluntary control of movement.
| |
| {| class="wikitable"
| |
| |
| |
| |}
| |
| | |
| == Evidence ==
| |
| | |
| === Reliability ===
| |
| The inter-tester reliability between physiotherapists and parents has been determined to have an ICC value of 0.96 (95% CI, 0.95-0.97). This indicates that parents and clinicians can use the same terms and understand each other when determining the motor functional classification of their child if the GMFCS-ER is carefully administered.
| |
| | |
| === Validity ===
| |
| The GMFCS-ER has been evidenced with the content validity of 80% by consensus process in a Delphi study. The content has been validated for clarity and accuracy of the descriptions for each level and the distinctions between levels of 6 to 12 years and 12-18 years age bands. The GMFCS-ER has utility for communication related to the condition between the various health professionals, therapists and parents etc. and also for clinical decision making, databases, registries and clinical research.The study published in the Europian journal of Physiotherapy "suggests that the GMFCS-E&R, if administered carefully, can be used as when comparing longitudinal data with the GMFCS."
| |
| | |
| === Responsiveness ===
| |
| In a study conducted where 18 Physical therapists participated to evaluate the draft version of the 12-18 years age band and a Delphi survey where 30 health professionals from 7 countries participated to evaluate the revised 12-18 years and 6-12 years age band and consensus was gained by 80% of participants.It has been agreed as useful tool for classification of gross motor function.
| |
| | |
| The GMFCS or the GMFCS-ER is a classification system. It has been developed for the purpose of classification alone. It is just to determine the type of cerebral palsy. It is neither to be used as an outcome measure for checking the progression over time or after treatment nor to be used for conditions other than CP unless there is an evidenced research saying so for a condition.
| |
| | |
| == Resources ==
| |
| | |
| == Objective ==
| |
| The revised and expanded version of the [[Classification of Cerebral Palsy|GMFCS]] (2007) builds upon the original version of the Gross Motor Function Classification System developed in 1997 to classify and describe the abilities of children and youth with [[Cerebral Palsy Introduction|cerebral palsy]]. It has 4 age bands namely, less than 2 years, 2-4 years, 4-6 years and 6-12 years. This newer version describes the movement ability of a child with cerebral palsy in one of five levels across five age ranges, with emphasis on the child’s functional ability and performance in different settings, particularly sitting, walking, and wheeled mobility.
| |
|
| |
|
| | 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 youth with CP from 0-18 years old. The GMFCS-ER contains five age groups, those being under 2 years, 2-4 years, 4-6 years, 6-12 years, and 12-18 years of age. | | 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> |
| | |
| The GMFCS-ER is available in 22 languages and has been validated in many different countries. | |
|
| |
|
| == Method of Use == | | == Method of Use == |
| Physical therapists, occupational therapists, physicians, and other health service providers familiar with movement abilities of children with CP can use the GMFCS-ER. Parents of children with CP are able to classify their children using an adapted version known as the GMFCS Family Report Questionnaire.
| | 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" /> |
|
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|
| Health care providers familiar with a child can typically classify him or her within 5 minutes. Those unfamiliar with the child may require 15 to 20 minutes to complete as more observation is required. | | 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" /> |
|
| |
|
| Distinctions are usually quite clear and decisions about which level most closely represents a child's functional ability can be made quite quickly. However, distinctions between two adjacent levels can sometimes be very subtle, so more careful deliberation is required before a classification can be made.
| | 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.<ref name=":1" /> |
|
| |
|
| Generally, the higher the level the poorer the functional ability of the child. The theme of each level is as follows:
| | The levels are as follows:<ref>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</ref><ref>Paulson A, Vargus-Adams J. [https://www.mdpi.com/2227-9067/4/4/30 Overview of four functional classification systems commonly used in cerebral palsy]. Children (Basel). 2017 Apr 24;4(4):30. </ref> |
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| * '''Level I''': Walks without Limitations | | * '''Level I''': able to walk without limitations |
| * '''Level II''': Walks with Limitations | | * '''Level II''': can walk with limitations (e.g. balance, endurance limitations) |
| * '''Level III''': Walks Using a Hand-Held Mobility Device | | * '''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 with Limitations; May Use Powered Mobility | | * '''Level IV''': self-mobility is limited - may be transported in a manual wheelchair or may use powered mobility |
| * '''Level V''': Transported in a Manual Wheelchair | | * '''Level V''': transported in manual wheelchair |
| | | Reid et al.<ref name=":0">Reid SM, Carlin JB, Reddihough DS. [https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-8749.2011.04044.x 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.</ref> 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.<ref name=":0" /> |
| Children classified as Level I perform the same activities as their peers but with some degree of difficulty in speed, balance, and coordination. In contrast, children classified as Level V have difficulty in most positions controlling their head/trunk posture and voluntary control of movement.
| |
| {| class="wikitable"
| |
| |
| |
| |}
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|
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|
| == Evidence == | | == Evidence == |
| | 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> |
|
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| === Reliability ===
| | * Various studies have shown that its intra- and inter-reliability is "almost excellent" with high intraclass correlation coefficient.<ref name=":3" /> |
| The inter-tester reliability between physiotherapists and parents has been determined to have an ICC value of 0.96 (95% CI, 0.95-0.97). This indicates that parents and clinicians can use the same terms and understand each other when determining the motor functional classification of their child if the GMFCS-ER is carefully administered.
| | * 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. |
| | | * 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. [https://onlinelibrary.wiley.com/doi/10.1111/dmcn.13602 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. |
| === Validity ===
| | * 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" /> |
| The GMFCS-ER has been evidenced with the content validity of 80% by consensus process in a Delphi study. The content has been validated for clarity and accuracy of the descriptions for each level and the distinctions between levels of 6 to 12 years and 12-18 years age bands. The GMFCS-ER has utility for communication related to the condition between the various health professionals, therapists and parents etc. and also for clinical decision making, databases, registries and clinical research.The study published in the Europian journal of Physiotherapy "suggests that the GMFCS-E&R, if administered carefully, can be used as when comparing longitudinal data with the GMFCS."
| | ** 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" /> |
| === Responsiveness ===
| |
| In a study conducted where 18 Physical therapists participated to evaluate the draft version of the 12-18 years age band and a Delphi survey where 30 health professionals from 7 countries participated to evaluate the revised 12-18 years and 6-12 years age band and consensus was gained by 80% of participants.It has been agreed as useful tool for classification of gross motor function.
| |
| | |
| The GMFCS or the GMFCS-ER is a classification system. It has been developed for the purpose of classification alone. It is just to determine the type of cerebral palsy. It is neither to be used as an outcome measure for checking the progression over time or after treatment nor to be used for conditions other than CP unless there is an evidenced research saying so for a condition.
| |
| | |
| == Resources ==
| |
| | |
| == Objective ==
| |
| | |
| The revised and expanded version of the [[Classification of Cerebral Palsy|GMFCS]] (2007) builds upon the original version of the Gross Motor Function Classification System developed in 1997<ref>1. Morris C. Development of the gross motor function classification system (1997). Developmental Medicine & Child Neurology. 2008 Jan 1;50(1):5-.https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-8749.2007.00005.x </ref> to classify and describe the abilities of children and youth with [[Cerebral Palsy Introduction|cerebral palsy]]. It has 4 age bands namely, less than 2 years, 2-4 years, 4-6 years and 6-12 years. This newer version describes the movement ability of a child with cerebral palsy in one of five levels across five age ranges, with emphasis on the child’s functional ability and performance in different settings, particularly sitting, walking, and wheeled mobility.<ref name="reid et al">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.https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-8749.2011.04044.x</ref><ref name="canchild">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</ref>
| |
| | |
| == Intended Population ==
| |
| | |
| This classification system is intended for children and youth with CP from 0-18 years old. The [https://canchild.ca/system/tenon/assets/attachments/000/000/058/original/GMFCS-ER_English.pdf GMFCS-ER] contains five age groups, those being under 2 years, 2-4 years, 4-6 years, 6-12 years, and 12-18 years of age.
| |
| | |
| The GMFCS-ER is available in 22 languages and has been validated in many different countries.<ref name="canchild" />
| |
| | |
| == Method of Use ==
| |
| | |
| Physical therapists, occupational therapists, physicians, and other health service providers familiar with movement abilities of children with CP can use the GMFCS-ER. Parents of children with CP are able to classify their children using an adapted version known as the GMFCS Family Report Questionnaire.<ref name="canchild" />
| |
| | |
| Health care providers familiar with a child can typically classify him or her within 5 minutes. Those unfamiliar with the child may require 15 to 20 minutes to complete as more observation is required.<ref name="canchild" />
| |
| | |
| Distinctions are usually quite clear and decisions about which level most closely represents a child's functional ability can be made quite quickly. However, [https://canchild.ca/system/tenon/assets/attachments/000/000/058/original/GMFCS-ER_English.pdf distinctions between two adjacent levels] can sometimes be very subtle, so more careful deliberation is required before a classification can be made.<ref name="canchild" />
| |
| | |
| Generally, the higher the level the poorer the functional ability of the child. The theme of [https://canchild.ca/system/tenon/assets/attachments/000/000/058/original/GMFCS-ER_English.pdf each level] is as follows:
| |
| | |
| *'''Level I''': Walks without Limitations
| |
| *'''Level II''': Walks with Limitations
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| *'''Level III''': Walks Using a Hand-Held Mobility Device
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| *'''Level IV''': Self-Mobility with Limitations; May Use Powered Mobility
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| *'''Level V''': Transported in a Manual Wheelchair<br><br>
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| Children classified as Level I perform the same activities as their peers but with some degree of difficulty in speed, balance, and coordination. In contrast, children classified as Level V have difficulty in most positions controlling their head/trunk posture and voluntary control of movement.<ref name="reid et al" />
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| | {{#ev:youtube|5u2sLAznhnY|300}}<ref>Freedom Concepts. GMFCS for Cerebral Palsy. Available from: http://www.youtube.com/watch?v=5u2sLAznhnY [last accessed 28/08/16] </ref>
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| == Evidence ==
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| === Reliability ===
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| The inter-tester reliability between physiotherapists and parents has been determined to have an ICC value of 0.96 (95% CI, 0.95-0.97). This indicates that parents and clinicians can use the same terms and understand each other when determining the motor functional classification of their child if the GMFCS-ER is carefully administered.<ref name="Mutlu et al">Mutlu A, Kara OK, Gunel MK, Karahan S, Livanelioglu A. Agreement between parents and clinicians for the motor functional classification systems of children with cerebral palsy. Disabil Rehabil, 2011; 33(11): 927-32. https://www.tandfonline.com/doi/abs/10.3109/09638288.2010.514645 </ref>
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| === Validity ===
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| The GMFCS-ER has been evidenced with the content validity of 80% by consensus process in a Delphi study. The content has been validated for clarity and accuracy of the descriptions for each level and the distinctions between levels of 6 to 12 years and 12-18 years age bands. The GMFCS-ER has utility for communication related to the condition between the various health professionals, therapists and parents etc. and also for clinical decision making, databases, registries and clinical research.<ref name=":0">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. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-8749.2008.03089.x </ref>The study published in the Europian journal of Physiotherapy "suggests that the GMFCS-E&R, if administered carefully, can be used as when comparing longitudinal data with the GMFCS."<ref>Gudmundsson C, Nordmark E. The agreement between GMFCS and GMFCS-E&R in children with cerebral palsy. The European Journal of Physiotherapy. 2013 Sep 1;15(3):127-33. https://www.tandfonline.com/doi/abs/10.3109/21679169.2013.814072 </ref>
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| === Responsiveness ===
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| In a study conducted where 18 Physical therapists participated to evaluate the draft version of the 12-18 years age band and a Delphi survey where 30 health professionals from 7 countries participated to evaluate the revised 12-18 years and 6-12 years age band and consensus was gained by 80% of participants.It has been agreed as useful tool for classification of gross motor function.<ref name=":0" />
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| The GMFCS or the GMFCS-ER is a classification system.<ref>Oeffinger DJ, Tylkowski CM, Rayens MK, Davis RF, Gorton Iii GE, D'Astous J, Nicholson DE, Damiano DL, Abel MF, Bagley AM, Luan J. Gross Motor Function Classification System and outcome tools for assessing ambulatory cerebral palsy: a multicenter study. Developmental medicine and child neurology. 2004 May;46(5):311-9. https://www.ncbi.nlm.nih.gov/pubmed/15132261 </ref> It has been developed for the purpose of classification alone. It is just to determine the type of cerebral palsy. It is neither to be used as an outcome measure for checking the progression over time or after treatment nor to be used for conditions other than CP unless there is an evidenced research saying so for a condition.<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. https://www.ncbi.nlm.nih.gov/pubmed/29105760 </ref>
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| == 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. |
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| == References == | | == References == |
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| [[Category:Neurological - Conditions]] | | [[Category:Neurological - Conditions]] |
| [[Category:Neurological - Assessment and Examination]] | | [[Category:Neurological - Assessment and Examination]] |
| | [[Category:Paediatrics - Assessment and Examination]] |
