Gross Motor Function Measure Scores Research Articles

Age-related changes in energy efficiency of gait, activity, and participation in children with cerebral palsy

The aim of this study was to use a prospective longitudinal study to describe age-related trends in energy efficiency during gait, activity, and participation in ambulatory children with cerebral palsy (CP). Gross Motor Function Measure (GMFM), Paediatric Evaluation of Disability Inventory (PEDI), and Lifestyle Assessment Questionnaire-Cerebral Palsy (LAQ-CP) scores, and energy efficiency (oxygen cost) during gait were assessed in representative sample of 184 children (112 male; 72 female; mean age 10y 9mo; range 4-16y) with CP. Ninety-four children had unilateral spastic CP, 84 bilateral spastic CP, and six had other forms of CP. Fifty-seven were classified as Gross Motor Function Classification System (GMFCS) level I, 91 as level II, 22 as level III, and 14 as level IV). Assessments were carried out on two occasions (visit 1 and visit 2) separated by an interval of 2 years and 7 months. A total of 157 participants returned for reassessment. Significant improvements in mean raw scores for GMFM, PEDI, and LAQ-CP were recorded; however, mean raw oxygen cost deteriorated over time. Age-related trends revealed gait to be most inefficient at the age of 12 years, but GMFM scores continued to improve until the age of 13 years, and two PEDI subscales to age 14 years, before deteriorating (p<0.05). Baseline score was consistently the single greatest predictor of visit 2 score. Substantial agreement in GMFCS ratings over time was achieved (κ(lw) =0.74-0.76). These findings have implications in terms of optimal provision and delivery of services for young people with CP to maximize physical capabilities and maintain functional skills into adulthood.

뇌성마비 아동에 대한 승마시뮬레이션 훈련이 대동작 기능에 미치는 영향

이 연구의 목적은 뇌성마비 아동의 대동작 운동기능에 대한 승마시뮬레이션 훈련의 치료적 효과를 알아보는 것이었다. 뇌성마비진단을 받은 24명의 아동을 무작위 추출하여 두 그룹으로 나누었다. 실험은 12주간, 주 3회로 두 그룹 모두 30분간 운동치료를 시행하였고, 실험군만 승마시뮬레이션 훈련을 15분간 부가적으로 시행하였다. 치료의 전후 변화를 평가하기 위해 대동작 운동기능 측정(GMFM)을 사용하였다. GMFM 점수로 두 군간 맨- 휘트니 검정을 하였고, 통계적 유의성은 <.05로 하였다. 결과는 다음과 같다. 첫째, 각각의 실험군과 대조군의 실험 전과 후를 비교하면, 대조군에서 GMFM A, B 영역은 유의한 차이를 보였고, 실험군은 모든 영역에서 유의한 차이를 보였다. 둘째, 대조군과 비교해서 실험군은 GMFM C,D 와 E영역에서 유의한 차이를 보였다. 결과적으로, 승마시뮬레이션 훈련은 뇌성마비 아동의 기능향상을 위해 치료적 방법으로 고려 될 만하다. The purpose of this study was to evaluate the effects of horseback riding simulation training(HRST) on gross motor function of children with cerebral palsy. Twenty-four children with cerebral palsy participated were divided into two groups randomly. Control group and experimental group both received 30 minutes of regular neuro-rehab exercises for three times a week per twelve weeks, but experimental group received additional 15 minutes of the HRST. Gross Motor Function Measure(GMFM) was used to evaluate the changes before and after HRST. Normalized GMFM scores were compared using Mann-Whitney U test, statistical significance was set at a=.05. The results were as followings: First, in each compared before and after the experiment, the control group showed significantly increased GMFM score in dimensions A and B. The experimental group showed significant increasing in all dimensions of GMFM test. Second, the experimental group showed significant differences comparing to control group in dimensions C, D and E of GMFM test. Consequently, HRST should be considered as a therapeutic method for physical therapy for the children with cerebral palsy to improve the functional movements.

Effect of Treadmill Training and Supramalleolar Orthosis Use on Motor Skill Development in Infants With Down Syndrome: A Randomized Clinical Trial

Children with Down syndrome (DS) often display delayed onset of independent walking. Treadmill training is an effective intervention that leads to an earlier walking onset. In addition, orthoses often are provided to infants with DS to increase stability and promote earlier independent walking. However, this early use of orthoses has not been scientifically verified in infants with DS. The purpose of this study was to provide insight into the developmental outcomes of early orthosis use in combination with treadmill training in infants with DS compared with treadmill training alone. This study was a randomized controlled trial. This study was conducted in participants' homes and in the motor development laboratory. Seventeen infants with DS entered the study when they could pull themselves to a standing position. They were randomly assigned to either a control group (which received treadmill training) or an experimental group (which received treadmill training and orthoses). During monthly visits to the infants' homes, 3 minutes of treadmill stepping was recorded and each child's motor development skills were tested. The treadmill training ended once the child took 3 independent steps. One month following walking onset, developmental tests were readministered. The Gross Motor Function Measure (GMFM) was used to test motor skill development. The average (SD) time in the study was 268 (88) days for the control group and 206 (109) days for the experimental group. All infants showed significantly increased GMFM scores over time. At 1 month of walking experience, the control group had higher GMFM scores than the experimental group, with higher standing and walking, running, and jumping subscale scores. Limitations of this study included a small sample of convenience, a statistical model that may have reduced validity at the tail end, and a lack of blinding in the GMFM scorer. Orthoses may have a detrimental effect on overall gross motor skill development.

Gross motor outcomes in children with hemiparesis involved in a modified constraint-induced therapy program

Constraint-Induced Therapy (CIT) has been used in pediatric rehabilitation and targets upper extremity (UE) outcomes. The purpose of this study was to measure concurrent gross motor and lower extremity functional changes using the Gross Motor Function Measure (GMFM) before and after a modified UE CIT program. The Assisting Hand Assessment (AHA) was used to evaluate upper extremity outcomes. Before-after trial design of a 19-day outpatient CIT program at Seattle Children's Hospital in Seattle, WA, USA of six ambulatory children with spastic hemiparesis between the ages of 5 and 11 years with GMFCS scores of 1. GMFM Section D (Standing) and E (Walking, Running, Jumping) and AHA scores were obtained before and after a modified CIT program. Significant differences were found between pre and post-CIT AHA and GMFM section D and E scores (p < 0.05). All children improved from baseline, yet the child with the lowest initial scores revealed the greatest improvements. Improvements in GMFM and AHA scores were noted after a modified CIT program. Such data suggests that CIT may also influence rehabilitation outcomes not only specific to the upper extremity and warrants further investigation.

Effects in children with spastic cerebral palsy of wearing ankle-foot orthoses for different durations

Objective To explore the effects of wearing ankle-foot orthoses (AFOs) on motor function in children with spastic cerebral palsy (SCP). Methods Fifty-two children with SCP were randomly divided into a wearing-for-training group (n = 16, group 1 ), a day-wearing group (n = 19, group 2) and a day-night-wearing group (n = 17, group 3). In addition to the conventional rehabilitative treatment given to all participants, the children in group 1 wore AFOs during movement training, and children in group 2 wore AFOs in the daytime for 6-8 h per day, while AFOs were applied to the children in group 3 for 24 hours a day except for cleaning and during certain training routines. All the treatments were continued for 2 months. Clinical assessments included the range of passive ankle dorsi-and plantarflexion (APROM) , modified Ashworth scale (MAS) ratings, and the D and E dimensions of the Gross Motor Function Measure (GMFM). All were performed before and after treatment. Results Before treat-ment, no statistically significant differences were found among the three groups in terms of APROM, MAS, or GM-FM. There were significant subsequent improvements in groups 2 and 3 when compared with group 1 in terms of APROM, MAS and GMFM results. Group 2's improvements in APROM and MAS results were not significantly better than those of group 3, but their average GMFM score improvements were significantly better. Conclusion Wearing AFOs in the daytime 6-8 hours per day is more effective in reducing spasticity and improving functional performance in children with SCP. Key words: Cerebral palsy ; Spasm ; Ankle-foot orthoses

Relação entre alinhamento postural e desempenho motor em crianças com paralisia cerebral

O objetivo deste estudo foi verificar se há correlação entre alinhamento postural e desempenho motor em crianças com paralisia cerebral (PC), além de compará-las com crianças de desenvolvimento motor típico. Participaram 14 crianças com PC tipo espástico, entre 4 e 12 anos, classificadas nos níveis III, IV e V no sistema de classificação de função motora ampla (GMFCS); e 20 com idades entre 4 e 8 anos e desenvolvimento motor adequado, que constituíram o grupo controle. Foi avaliado o alinhamento de lordose cervical e cifose torácica na postura sentada por meio de fotometria; o desempenho motor foi avaliado pelo índice de função motora ampla (Gross motor function measure, GMFM) apenas nas dimensões sentar (B) e ficar em pé (D). O subgrupo de PC nível III obteve maiores escores no GMFM do que o dos níveis IV e V, com diferença significativa nas dimensões B (p=0,00) e D (p=0,016). Quanto ao alinhamento postural, os dois subgrupos de PC apresentaram menor angulação da lordose cervical do que o GC, com diferença significativa; também foram medidos ângulos menores da cifose torácica nos subgrupos PC, sendo que o subgrupo dos níveis IV e V apresentou diferença significativa tanto em relação ao outro subgrupo PC quanto ao controle. Foi encontrada correlação positiva (r=0,748) entre o desempenho motor e o alinhamento postural nos subgrupos de PC, mostrando que, quanto melhor o alinhamento postural, melhor o desempenho motor dessas crianças.

Activities of daffy living performance in children with cerebral palsy with different gross motor function

Objective To analyze the activities of daily living (ADL) performance in children with cerebral palsy (CP) with different gross motor function and the correlation between gross motor function and ADL perform-ance. Methods A total of 118 children (81 boys and 37 girls; mean age: 47.7 months, SD: 20.1 months, age range: 18-90 months) with CP were recruited from three different rehabilitation centers in Shanghai. Types of CP included hemiplegia (n = 27), spastic diplegia (n = 53), spastic quadriplegia(n = 29), athetoid (n = 4), dystonic (n = 4), ataxic (n = 1). Gross motor function classification system (GMFCS) and Gross motor function measure (GMFM) were adopted to assess and classify the gross motor function. Pediatric evaluation of disability inventory (PEDI) was adopted to assess ADL performance. Differences of PEDI scores were compared among different levels of GMFCS; and the correlation between GMFCS levels, GMFM scores and PEDI scores were analyzed. Resnlts PEDI scores showed significant differences among CP children with different levels of GMFCS. The PEDI score usually de-creased with the increase of the GMFCS level, and mobility ability was the lowest. Significant correlations were found between PEDI scaled scores and GMFCS (rs = 0.85～0. 50, P < 0.001). Various levels of correlations (r = 0. 85～ 0.54, P<0.001) were found between GMFM scores and PEDI scaled scores. Higher correlations were found between GMFCS levels, GMFM scores and mobility ability. Conclusion ADL performance was significantly different among CP children with different gross motor function. The higher the gross motor function, the better the performance of ADL. Mobility would be improved by promoting gross motor function in CP children. The training of self-care and so-cial communication ability should be emphasized. Key words: Cerebral palsy; Gross motor function; Activities of daily living

Responsiveness of the Test of Basic Motor Skills of Children with Down Syndrome

The aim of this study was to examine the responsiveness of the Test of Basic Motor Skills for Children with Down Syndrome (BMS). Forty-one children with Down Syndrome, 3 to 36 months of age, participated in the study. Gross motor skills were assessed three times using the BMS and the Gross Motor Function Measure (GMFM) before and after a baseline period of 2 weeks (T1-T2) and after a period of 16 weeks (T2-T3). Internal and external responsiveness of the BMS was analyzed using Guyatt's Responsiveness Index (GRI) and 2 × 2 repeated measures. Change in BMS scores was compared to change in GMFM scores and parent and physiotherapist ratings of change. The responsiveness of the BMS was large (GRI = 2.55). A significant Time × Age interaction [F(1,37) = 8.87, p < .01] indicated that BMS scores increased more for children ≤ 2 years compared with children 2 to 3 years of age. The difference in GRI between the BMS and GMFM was 0.75 (95% CI −0.25–1.75), indicating that the BMS and GMFM did not significantly differ in responsiveness. The Time × Measure interaction was not significant, indicating that the increase in mean BMS and GMFM scores did not differ. Change in BMS scores were correlated with parent ratings of change (r = 0.65, p < .001) but not physiotherapist ratings (r = 0.36, p = .23). The results provide evidence that the BMS is responsive to change in gross motor development in children with Down Syndrome from 3 to 36 months of age.

Muscle strength training to improve gait function in children with cerebral palsy

The aim of the study was to investigate the influence of muscle strength training on gait outcomes in children with cerebral palsy. Sixteen children (two females, 14 males, Gross Motor Function Classification System levels I-II, mean age 12y 6mo, range 9y 4mo-15y 4mo) underwent muscle strength measurement using a handheld device, Gross Motor Function Measure (GMFM) assessment, three-dimensional gait analysis, joint range of motion assessment, and grading of spasticity before and after 8 weeks of training. All participants had a diagnosis of spastic diplegia and could walk without aids. Training consisted of exercises for lower extremity muscles with free weights, rubber bands, and body weight for resistance, three times a week. Values for muscle strength below normal were identified in all children; this was most pronounced at the ankle, followed by the hip muscles. After training, muscle strength and GMFM scores increased, velocity was unchanged, stride length increased, and cadence was reduced. There was an increase in hip extensor moment and power generated at push off. Eight weeks of muscle strength training can increase muscle strength and improve gait function.

Long-term effect of repeated injections of botulinum toxin in children with cerebral palsy: a prospective study.

To prospectively evaluate long-term effects of repeated botulinum toxin A (BTX-A) injections in children with cerebral palsy (CP). Repeated injections of BTX-A were offered to children with CP, according to clinical indications, for a maximum of four injections within a period of two years. Injections were administered into lower extremity muscles of 26 consecutive children (age 3.7 +/- 1.2 years, 16 boys) with hemiplegic or diplegic CP. Clinical assessments before and one month following each injection included a gross motor function measure (GMFM), a modified Ashworth scale, and range-of-motion of knee extension and ankle dorsiflexion. Twelve children received two injections, six received three injections, five received one injection, and three received four injections. The most common reason for discontinuing treatment was the need for orthopedic surgery (n = 17). A long-term effect was demonstrated by a significant increase of the GMFM score before the first injection compared with the last injection for each patient (P < 0.0001). There was no comparable change in the muscle tone or range-of-motion. The mean rate of GMFM change during the study was significantly higher than literature norms for CP children (13.2 vs. 5.37 per year, respectively, P < 0.01). The increase of the GMFM score before and one-month after injection (short-term effect) was significantly higher after the first injection than after the last injection (P < 0.05). Similar results were found for the Ashworth scale and popliteal angle. Botulinum toxin A injections have a long-term effect on gross motor function in children with CP even though the effect on muscle tone is short-term. The effect apparently declines with repeated injections, with most children benefitting from 2 to 3 injections.

The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years

The aim of this study was to explore motor development in children with cerebral palsy (CP) using developmental curves for CP, subtypes, and the five severity levels of the Gross Motor Function Classification System (GMFCS). The Gross Motor Function Measure (GMFM) and the GMFCS were applied to 317 children (145 females, 172 males) with CP, aged between 1 and 15 years. The CP type distribution was spastic diplegia in 157 (49%), spastic hemiplegia in 101 (33%), spastic tetraplegia in 11 (3%), dyskinesia in 38 (12%), and ataxia in 10 (3%). Forty-five physiotherapists were trained in the GMFM and intra- and interrater reliability was tested. The GMFM was measured prospectively every 6 months up to the age of 4 years and once a year thereafter. Developmental curves were constructed for 258 children with spastic CP. About three-quarters of the children at GMFCS Level I reached 90% of the maximum GMFM score at 5 years of age. The performance peaked at 7 years of age. Children at GMFCS Level II reached 90% at a median age of 5 years, which was also the upper limit, reached by about three-quarters at 7 years of age. The majority of children at GMFCS Level III reached 80% of the GMFM by 7 years of age and most of the children at GMFCS Level IV reached 30% at 5 years and remained there. The median score for children at GMFCS Level V was 20%. The intra- and interrater reliability for the GMFM 88 among physiotherapists were Spearman's rank correlation coefficient 0.91 and 0.99 respectively. There were 931 measurements with a median of 2 (1-11) per child. The gross motor development was demonstrated for the five GMFCS levels in children with spastic CP. These kind of curves may be useful for monitoring and predicting motor development, for planning treatment, and for evaluating outcome after interventions.

Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study

Calf muscles of five adolescents aged 12 to 15 years (three males, two females) with spastic diplegia were massaged for 14 minutes twice a week for 5 weeks in a controlled sequence, stretching the muscles transversely rather than longitudinally, without eliciting pain. Slow, passive test stretches were applied before and after massage. After massage, the range of movement was not consistently increased but, on average, greater force was needed to stretch the muscle than before massage. However, after massage the resting ankle angle sometimes changed so that the calf muscles were either shorter or longer. We suggest that these phenomena could be explained if massage resets sarcomere lengths which corrects for thixotropic effects (i.e. previous use modifies a muscle's mechanical behaviour). A redistribution on sarcomere lengths within muscles could also have reset proprioceptive feedback. The incidence of abnormal stretch reflexes during test stretches fell from 40 to 22%, comparing the first five sessions with the last five sessions. The amplitude of voluntary alternating ankle rotation increased in three participants. Motor skills were assessed with the Gross Motor Function Measure-66 (GMFM-66) 1 week before the test period, during the 5th week, and 12 weeks later. Our participants in Gross Motor Function Classification System (GMFCS) Levels I and II made sustained improvements in GMFM-66 scores (6.4% at 5 weeks falling to 5.5% at 17 weeks), one increase being significant. One participant in GMFCS Level III improved significantly only after massage of all leg muscles for 30 weeks.

The Relationship between Aquatic Independence and Gross Motor Function in Children with Neuro-Motor Impairments

The purpose of this study was to investigate the relationship between motor performance in the aquatic setting as measured by the Aquatic Independence Measure (AIM) to motor performance on land as measured by the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI). Fourty- nine children with neuro-motor impairments ages 3 to 7 participated in the study. Pearson correlations were applied to determine the relationships between the AIM and the GMFM, PEDI, and Gross Motor Function Classification System (GMFCS). Significant correlations were found between the total AIM and GMFM scores (r = 69, p &lt; .01) and PEDI self-care sub-scale (r = .79, p &lt; .01) as well as the PEDI mobility sub-scale scores (r = .35, p &lt; .05). The water adjustment sub-scale as measured by the AIM showed the strongest relationship to motor performance on land as measured by the GMFM and PEDI in our sample of 49 children.

Validity of a 1 minute walk test for children with cerebral palsy

The concurrent validity of a 1 minute walk test at a child's maximum walking speed was assessed in children with bilateral spastic cerebral palsy (BSCP). The distance covered during the 1 minute walk test was compared with the children's gross motor function as assessed by the Gross Motor Function Measure (GMFM). Twenty‐four male and 10 female children with CP (mean age 11y, range 4 to 16y) participated in the study. Gross Motor Function Classification System (GMFCS) levels were; level I (n=3), level II (n=17), level III (n=10), and level IV (n=4). Participants had clinical diagnoses of symmetrical diplegia (n=19), asymmetrical diplegia (n=14), and quadriplegia (n=1). Results showed a significant correlation between GMFM score and the distance covered during the 1 minute walk (r=0.92; p&lt;0.001). There was also a significant decrease in the distance walked with increasing GMFCS level (p&lt;0.001). We concluded that the 1 minute walk test is a valid measure for assessing functional ability in children with ambulatory BSCP. Its cost‐effectiveness and user friendliness make it a potentially useful tool in the clinical setting. Further study needs to address its reliability and ability to detect change over time.

Validity of a 1 minute walk test for children with cerebral palsy

The concurrent validity of a 1 minute walk test at a child's maximum walking speed was assessed in children with bilateral spastic cerebral palsy (BSCP). The distance covered during the 1 minute walk test was compared with the children's gross motor function as assessed by the Gross Motor Function Measure (GMFM). Twenty-four male and 10 female children with CP (mean age 11y, range 4 to 16y) participated in the study. Gross Motor Function Classification System (GMFCS) levels were; level I (n=3), level II (n=17), level III (n=10), and level IV (n=4). Participants had clinical diagnoses of symmetrical diplegia (n=19), asymmetrical diplegia (n=14), and quadriplegia (n=1). Results showed a significant correlation between GMFM score and the distance covered during the 1 minute walk (r=0.92; p<0.001). There was also a significant decrease in the distance walked with increasing GMFCS level (p<0.001). We concluded that the 1 minute walk test is a valid measure for assessing functional ability in children with ambulatory BSCP. Its cost-effectiveness and user friendliness make it a potentially useful tool in the clinical setting. Further study needs to address its reliability and ability to detect change over time.

GMFM 1 year after continuous intrathecal baclofen infusion

The purpose of this study was to assess whether there is an improvement in motor function in persons with cerebral palsy (CP) who have had a reduction of muscle tone by continuous intrathecal baclofen infusion. This was a prospective, open label, non-blinded case series without a control group, conducted at multiple centres. There were 31 subjects, aged 4-29 years. All had a pre-treatment mean lower extremity Ashworth scores of >or= 3 and a significant reduction in tone after a bolus injection of intrathecal baclofen (ITB) and received an implanted pump for continuous delivery of ITB. Motor function was assessed by the Gross Motor Function Measure (GMFM) prior to and 1 year following pump implantation. Significant improvement (p < 0.05) in mean GMFM scores was seen in subjects < 8 years (mean change 4.1) and in those from 8-18 years (mean change 3.7) and in subjects with CP Classes 2 and 5 (mean changes 6.2 and 2.9). There was a statistically significant decrease (p < 0.05) in Ashworth scores in CP classes 2-5. Subjects or their caregivers that completed a survey about perceived changes stated that motor control, positioning and endurance improved.

Effectiveness of selective muscle-release surgery for children with cerebral palsy: longitudinal and stratified analysis.

The purpose of this study was to determine the effectiveness of muscle-release surgery for children with cerebral palsy (CP) using longitudinal and stratified analysis. Twenty-five children with CP (15 females, 10 males; age range 4 to 16 years; mean age 8 years 2 months, SD 3 years 2 months) were selected from five treatment centres in Japan. Twenty-two children had spastic diplegia, two had spastic quadriplegia, and one had athetospastic quadriplegia. Motor function for each child was assessed using the Gross Motor Function Measure (GMFM). Assessment was conducted on eight separate occasions: 1 month and 1 week before surgery, and 1, 2, 4, 6, 9, and 12 months after surgery. Participants' motor function before surgery was classified using the Gross Motor Function Classification System (GMFCS). Six children were classified at level I, three at level II, six at level III, and 10 at level IV. A significant difference was found after surgery in the GMFCS levels III and IV groups (p<0.05). Improvement in GMFM scores between 1 week before surgery and 12 months after surgery were 1, 5, 8.5, and 8.5 for GMFCS levels I to IV respectively. Results indicate that this treatment is advantageous for improving motor function in children within GMFCS levels III and IV.

The Use of Lycra Garments in Children with Cerebral Palsy: A Report of a Descriptive Clinical Trial

This study aimed to evaluate the effects of wearing Lycra garments in children with cerebral palsy. Eight participants, aged 3 years 5 months to 13 years (male = 4, female = 4) and with a diagnosis of cerebral palsy, were recruited. A repeated measures design was used, with participants tested with the Gross Motor Function Measure (GMFM) and the Quality of Upper Extremity Skills Test (QUEST) before and after intervention. Both parents and participants recorded the perceived advantages and disadvantages of the participant wearing the Lycra garment at the end of the trial. Each participant received a baseline test, was then provided with a Lycra garment and was re-tested once wear time was more than 4 hours per day. Four participants withdrew from the trial (discomfort from suit, n = 3; prescribed spinal jacket, n = 1). Of the remaining four participants, all showed an improvement in either GMFM or QUEST score and one showed improvement in both test scores. All but one of the eight participants recorded functional improvements when wearing their suit. In this population, the participants showed improvements in function when wearing a Lycra garment, but problems with discomfort remained a barrier for some children to their more sustained use.

Gross motor function of children with down syndrome: Creation of motor growth curves

Objective:To create gross motor function growth curves for children with Down syndrome (DS) and to estimate the probability that motor functions are achieved by different ages. Design:Nonlinear growth curve analysis by using a 2-parameter (rate, upper limit) model. Setting:Early intervention programs, schools, and children's homes. Participants:One hundred twenty-one children with DS, ages 1 month to 6 years. Main Outcome Measures:Gross Motor Function Measure (GMFM) and severity of motor impairment. Results:The curves for children with mild (n = 51) and moderate/severe (n = 70) impairment were characterized by a greater increase in GMFM scores during infancy and smaller increases as the children approached the predicted maximum score of 85.9 or 87.9. The estimated probability that a child would roll by 6 months was 51 %; sit by 12 months, 78%; crawl by 18 months, 34%; walk by 24 months, 40%; and run, walk up stairs, and jump by 5 years, 45% to 52%. Conclusions:Children with DS require more time to learn movements as movement complexity increases. Impairment severity affected the rate but not the upper limit of motor function. The results have implications for counseling parents, making decisions about motor interventions, and anticipating the time frame for achievement of motor functions.

Validation of a Model of Gross Motor Function for Children With Cerebral Palsy

Development of gross motor function in children with cerebral palsy (CP) has not been documented. The purposes of this study were to examine a model of gross motor function in children with CP and to apply the model to construct gross motor function curves for each of the 5 levels of the Gross Motor Function Classification System (GMFCS). A stratified sample of 586 children with CP, 1 to 12 years of age, who reside in Ontario, Canada, and are known to rehabilitation centers participated. Subjects were classified using the GMFCS, and gross motor function was measured with the Gross Motor Function Measure (GMFM). Four models were examined to construct curves that described the nonlinear relationship between age and gross motor function. The model in which both the limit parameter (maximum GMFM score) and the rate parameter (rate at which the maximum GMFM score is approached) vary for each GMFCS level explained 83% of the variation in GMFM scores. The predicted maximum GMFM scores differed among the 5 curves (level I=96.8, level II=89.3, level III=61.3, level IV=36.1, and level V=12.9). The rate at which children at level II approached their maximum GMFM score was slower than the rates for levels I and III. The correlation between GMFCS levels and GMFM scores was (.91. Logistic regression, used to estimate the probability that children with CP are able to achieve gross motor milestones based on their GMFM total scores, suggests that distinctions between GMFCS levels are clinically meaningful. Classification of children with CP based on functional abilities and limitations is predictive of gross motor function, whereas age alone is a poor predictor. Evaluation of gross motor function of children with CP by comparison with children of the same age and GMFCS level has implications for decision making and interpretation of intervention outcomes.