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Gross Motor Function Classification System - Expanded & Revised (GMFCS - ER)
Availability
Please visit this website for more information about the instrument: Gross Motor Function Classification System – Expanded & Revised
Classification
Supplemental – Highly Recommended: Cerebral Palsy (CP)
Short Description of Instrument
Construct measured: Gross motor function.
 
Generic vs. disease specific: Disease specific.
 
Means of administration: Examiner administered or parent report.
 
Intended respondent: Administrator.
 
Background: The Gross Motor Function Classification System - Expanded& Revised (GMFCS - ER) is a standardized system to classify gross motor function of children with CP aged 12 months to 12 years based on observation of a child's self-initiated movement and need for assistive technology and/or wheeled mobility. There are five age bands: under 2 years, 2 to < 4 years, 4 to < 6 years, 6 to < 12 years, and 12–18 years.
Comments/Special Instructions
The focus of the GMFCS-ER is on determining which level best represents the child's or youth's present abilities in gross motor function. Emphasis is on usual performance in home, school, and community settings, rather than what they are known to do at their best. Do not include judgments about the quality of movement or prognosis for improvement.
Scoring
Scoring of the GMFCS-ER is based on child’s age and typical gross motor abilities. There are five age bands: under 2 years, 2 to < 4 years, 4 to < 6 years, 6 to < 12 years, and 12–18 years, with 5 levels per age band (scored as I, II, III, IV, V).
 
Level I is highest level of gross motor skills, with generally the ability to walk without restrictions but with tendency to be limited in some of the more advanced motor skills. Children with motor function classified at Level V are generally very limited in their mobility even with access to use of assistive technology.
Rationale/Justification
Strengths/Weaknesses: Can be performed quickly in a clinical setting without special equipment. Can be be performed by a clinical provider or reported by a  parent/family member familiar with the child or youth. However, it is not sensitive to smaller changes in function, such as gain in mobility distance, if the child is still using the same mobility devices.
 
Psychometric Properties: Interrater reliability and test-retest reliability are high. The GMFCS can validly predict motor function for children with CP with the positive predictive value of the GMFCS at 1 to 2 years of age to predict walking by age 12 years being 0.74 and negative predictive value being 0.90.
References
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214–223.
 
Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008;50(10):744–750.
 
Rosenbaum PL, Palisano RJ, Bartlett DJ, Galuppi BE, Russell DJ. Development of the Gross Motor Function Classification System for cerebral palsy. Dev Med Child Neurol. 2008;50(4):249–253.
 
Wood E, Rosenbaum P. The gross motor function classification system for cerebral palsy: a study of reliability and stability over time. Dev Med Child Neurol. 2000;42(5):292–296.
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