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Gross Motor Function Measure (GMFM-88, GMFM-66)
Availability
Please visit this website for more information about the instrument: Gross Motor Function Measure (GMFM-88, GMFM-66)
Classification
Supplemental Highly Recommended: Cerebral Palsy (CP)
 
Supplemental: Traumatic Brain Injury (TBI), Spinal Muscular Atrophy (SMA), Myotonic Dystrophy (DM) and Mitochondrial Disease (Mito)
 
Exploratory: Congenital Muscular Dystrophy (CMD), Duchenne/Becker Muscular Dystrophy (DMD/BMD) and Spinal Cord Injury (SCI)-Pediatric (5 months to 16 years)
Short Description of Instrument
Construct measured: Gross Motor Physical Function
 
Generic vs. disease specific: Generic
 
Means of administration: Examiner administered.
 
Intended respondent: Administrator.
 
Background: The Gross Motor Function Measure (GMFM) is a standardized assessment of physical function and change in physical function in children with cerebral palsy. The GMFM-88 has also been used for assessment of children with Down Syndrome and Traumatic Brain Injury. The GMFM-66 (created using Rasch analysi of GMFM-88) has been validated only in children with CP. Both GMFM-88 and GMFM-66 measure gross motor function and change in function over time in 5 domains of Lying&Rolling, Sitting, Crawling&Kneeling, Standing; and Walking,Running &Jumping. The GMFM-66 also provides information on level of difficulty of each item.
 
The GMFM requires the child to demonstrate various motor skills. The GMFM measures five areas of motor function: 1) lying and rolling; 2) sitting; 3) crawling and kneeling; 4) standing; and 5) walking, running, and jumping. The GMFM-66 is derived from the GMFM-88. Both tests are free to use with translations in Spanish and German.
The GMFM 88 is a validated, age-appropriate tool for children with severe neurological and neuromuscular impairment. Validated for children with cerebral palsy (5 months to 16 years).
 
Used as an outcome measure in many previous therapeutic trials for children with cerebral palsy: dorsal rhizotomy, intrathecal baclofen, physical therapy, strength training, muscle tendon surgery, gait, and overall fitness. This instrument is also used in trials of children with Down syndrome, traumatic brain injury, musculoskeletal disease, lysosomal storage disease.
Comments/Special Instructions
The GMFM should be administered in an area that permits free movement for ambulatory children (on item requires a 15-foot run in one direction and return). In general, no special tools or equipment are required other than those typically found in a pediatric therapy gym. As the GMFM is intended to measure change in function over time, keeping the environment similar at each testing for the child is important for consistency in administration.
Scoring
The test is administered in less than 40 minutes by a trained individual. A training manual, CD and standardized scoring forms are available. The manual contains information on score interpretation and is required for administration and scoring.
 
A four-point scoring system is used for each item in the GMFM-88 and GMFM-66 (Range of 0 (Does not initiate) to 3 (Completes)). These are added to obtain raw and percent scores for each of the five dimensions, selected goal areas and for total score. Higher scores indicate higher functional level. The GMFM-88 scores can be summed and used to calculate both raw and percent scores for each of the five dimensions. GMFM-66 must be scored using the Gross Motor Ability Estimator (GMAE).
 
Administration Time: Approximately 45-60 minutes. Administration time varies depending on the child’s ability, level of cooperation, and skill of the administrator. A training manual, CD and standardized scoring forms are available. The manual contains information on score interpretation and is required for administration and scoring.
Rationale/Justification
Strengths: The GMFM 88 is a clinical measure designed to evaluate change in gross motor function in children with cerebral palsy (CP), who have many neuromuscular features also seen in children with mitochondrial diseases.
 
The GMFM 88 total score is the most frequent measure employed to detect changes in gross motor function in interventional trials. Can measure change even in children with little neurological functioning using subtle changes (head turning).
 
Weaknesses: Not yet proven to be reliable or validated for mitochondrial disease.
 
The GMFM 88 is a validated, age-appropriate tool for children with severe neurological and neuromuscular impairment. While currently validated for children with cerebral palsy (5 months to 16 years), the instrument considers quality of movement and is designed to track change over time. The GMFM does not provide age equivalency; all items can be performed by a typically developing 5-year-old. Allows for testing of all motor skills, allowing children to demonstrate strength in any skill area, rather than cutting off due to inability to perform a skill.
 
SCI-Pediatric: There are no studies of the GMFM for youth with SCI.
 
Cerebral Palsy:
 
Strengths/Weaknesses: It’s a well-validated, commonly used measure. However, it can take a significant amount of time to administer.
 
Psychometric Properties: This has been validated in children with CP ages 5 months to 16 years old. Reliabilty is high for both GMFM-88 and GMFM 66. A clinically important change in score is dependent on the dimensions being tested, GMFCS level of the child, and which GMFM is being used. Please refer to the GMFM manual for more information.
References
Russell DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palisano RJ. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther. 2000;80(9): 873–885.
 
Russell DJ, Rosenbaum PL, Cadman DT, Gowland C, Hardy S, Jarvis S. The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol. 1989;31(3): 341–352.
 
Additional References:
 
Alotaibi MT, Kennedy LE, Bavishi S. The efficacy of GMFM-88 and GMFM-66 to detect changes in gross motor function in children with cerebral palsy (CP): a literature review. Disabil Rehabil. 2014;36(8): 617–627.
 
Durkot MJ, De Garavilla L, Caretti D, Francesconi R. The effects of dichloroacetate on lactate accumulation and endurance in an exercising rat model. Int J Sports Med. 1995;16(3): 167–171.
 
Folmes CD, Sowah D, Clanachan AS, Lopaschuk GD. High rates of residual fatty acid oxidation during mild ischemia decrease cardiac work and efficiency. J Mol Cell Cardiol. 2009;47(1): 142–148.
 
Fujii T, Nozaki F, Saito K, Hayashi A, Nishigaki Y, Murayama K, Tanaka M, Koga Y, Hiejima I,and Kumada T. Efficacy of pyruvate therapy in patients with mitochondrial disease: a semi-quantitative clinical evaluation study. Mol Genet Metab. 2014;112(2): 133–138.
 
Gandhi MB, Finegan A, Clanachan AS. Role of glucose metabolism in the recovery of postischemic LV mechanical function: effects of insulin and other metabolic modulators. Am J Physiol Heart Circ Physiol. 2008;294(6): H2576–H2586.
 
Hanna SE, Bartlett DJ, Rivard LM, Russell DJ. Reference curves for the Gross Motor Function Measure: percentiles for clinical description and tracking over time among children with cerebral palsy. Phys Ther. 2008;88(5):596–607.
 
Kuhtz-Buschbeck JP, Hoppe B, Golge M, Dreesmann M, Damm-Stunitz, U Ritz A. Sensorimotor recovery in children after traumatic brain injury: analyses of gait, gross motor, and fine motor skills. Dev Med Child Neurol. 2003;45(12): 821–828.
 
Linder-Lucht M, Othmer V, Walther M, Vry J, Michaelis U, Stein S, Weissenmayer H, Korinthenberg R, Mall V; Gross Motor Function Measure-Traumatic Brain Injury Study Group. Validation of the Gross Motor Function Measure for use in children and adolescents with traumatic brain injuries. Pediatr. 2007;120(4):e880–e886.
 
Lundkvist Josenby A, Jarnlo GB, Gummesson C, Nordmark E. Longitudinal construct validity of the GMFM-88 total score and goal total score and the GMFM-66 score in a 5-year follow-up study. Phys Ther. 2009;89(4): 342–350.
 
Oeffinger D, Bagley A, Rogers S, Gorton G, Kryscio R, Abel M, et al. Outcome tools used for ambulatory children with cerebral palsy: responsiveness and minimum clinically important differences. Dev Med Child Neurol. 2008;50(12):918–925.
 
Platz TA, Wilson JS, Kline JA, Rushing G, Parker JL, Moore EM, Southern FN. The beneficial effects of dichloroacetate in acute limb ischemia. Mil Med. 2007;172(6): 628–633.
 
Schneider SH, Komanicky PM, Goodman MN, Ruderman NB. Dichloroacetate: effects on exercise endurance in untrained rats. Metabolism. 1981;30(6): 590–595.
 
Thomas-Stonell N, Johnson P, Rumney, Wright PV, Oddson B. An evaluation of the responsiveness of a comprehensive set of outcome measures for children and adolescents with traumatic brain injuries. Pediatr Rehabil.2006; 9(1): 14–23.
 
Wilson JS, Rushing G, Johnson BL, Kline JA,Back MR,Bandyk DF. Dichloroacetate increases skeletal muscle pyruvate dehydrogenase activity during acute limb ischemia. Vasc Endovascular Surg. 2003;37(3): 191–195.
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