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

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)

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

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

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

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

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)

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

The GMFCS Please refer to handouts 2 lay-outs

Classifying Children Some video clips…

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

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

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)

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

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!