The Gross Motor Function Measure (GMFM)

摘要

Summary Description and administration: The Gross Motor Function Measure GMFM-88 is valid for use with children with Down syndrome and (GMFM) is a tool that has been developed to assess change in gross acquired brain injury.5 motor function in childrenwith cerebral palsy aged 5months to 16 years Shortened versions of GMFM-66 have been developed more recently. of age.1 The GMFM measures activity as defined within the Interna- The GMFM-66 Items Sets (IS)6 uses a scoring algorithm, whereby a tional Classification of Functioning, Disability andHealth.2 To administer number of decision items guide the therapist toward a predetermined the GMFM, a trained therapist observes the child completing a number set of items relevant to a child functioning at that level, and the child is of gross motor tasks in a standardised environment, and the childs best then tested on that item set. The GMFM- 66 Basal and Ceiling (B&C)7 ability is measured. The tool measures capacity (what a person can do in approach establishes the basal score of three successes in a row as the a standardised, controlled environment) rather than performance (what start of the test and testing ends when the ceiling is reached, which a person actually does do in his/her daily environment).3 The assessment is indicated by scoring three zeros in a row. However, if the primary typically takes 45 to 60 minutes to complete and only requires usual goal of assessment is to measure change, the full GMFM-66 should be therapy equipment. used.8 The original GMFM version has 88 items each scored on a 4-point ordinal scale of 0 to 3, where 0 indicates that the child does not initiate The GMFM users manual for all versions can be purchased from Wiley 5 the task; 1 indicates that the child initiates the task (completes < 10% of Blackwell Publishing and the GMFM score sheets are freely available for the activity); 2 indicates that the child partially completes the task personal and non-commercial use. In addition, the Gross Motor Ability (completes from 10 to 99% of the activity); 3 indicates that the child Estimator (GMAE-2) Scoring Software for the GMFM-66 can be down- 9 completes the task (100%); and NT indicates that the child was not loaded from the CanChild website (https://www.canchild.ca/). tested. The 88 items are grouped into five dimensions: 1) lying and Reliability, validity and responsiveness to change: Studies have reported rolling, 2) sitting, 3) crawling and kneeling, 4) standing, and 5) walking, excellent interrater and test-retest reliability and internal consistency in running and jumping. A maximum of three trials is allowed for each childrenwith cerebral palsy and Down syndrome,10 as well as supporting item and the best trial is recorded. Scores for each dimension are content, concurrent, construct, and discriminative validity in the same expressed as a percentage of the maximum score for that dimension populations.10,11 Responsiveness to change has been tested using various and the total score is obtained by averaging the percentage scores across 4 statistical methods, including comparison of parental and clinicianthe five dimensions. responses, investigating minimum clinically important difference, effect Rasch analysis was applied to the GMFM-88 in order to improve its size, receiver operating curves and standardised responsemeans.10,11 The interpretability and clinical usefulness, which resulted in a unidimen- minimum clinically important difference is 0.8 to 1.6 for medium effect sional interval-measure hierarchical scale C the GMFM-66 C consisting sizeand1.3to2.6 for largereffectsize.12Differentversionsof theGMFMare of 66 items from the original 88.4 The GMFM-66 is only valid for usewith responsive in childrenwith cerebral palsy, Downsyndromeand traumatic children with cerebral palsy, while there is some evidence that the brain injury.10.