Gross Motor Function Measure Total Score Research Articles

Long-term benefits from selective dorsal rhizotomy in a young patient with cerebral palsy

Abstract Introduction Spasticity is considered to be one of the most important factors hampering functional abilities among patients with a cerebral palsy (CP). Aim The aim of the study was to present results of the selective dorsal rhizotomy (SDR) procedure combined with the physiotherapy process in a 3 year follow-up study, presented from a functional and structural perspective. Case study After the diagnosis of CP in the form of spastic diplegia, the 2-years-old patient (GMFCS 4) was directed for a comprehensive rehabilitation. After clinical examination and family consultation, spasticity was found to be important factor limiting patient functional abilities. Results and discussion The patient was directed to SDR operation. The patient was evaluated four times: before the SDR, and then 1, 2 and 3 years after the SDR surgery. The spasticity was assessed using the modified Tardieu scale. A functional assessment was done using the gross motor function measure (GMFM) scale, 6-min walk test and functional assessment questionnaire (FAQ-10). A muscle tension remained decreased throughout the 3 years of the follow up period. The achieved reduction in muscle tone was accompanied by a change in a range of motion, an improvement in GMFM total score result, an increased distance in 6-min walk test and in the FAQ-10 questionnaire. Conclusions SDR procedure combined with comprehensive rehabilitation programs leads to short- and long-term reduction in the spasticity of a 5-year-old boy with a spastic diplegia. Decreased level of spasticity was accompanied by an increased gross motor functioning and mobility.

Relationship between the Gross Motor Function Classification System and Functional Outcomes in Children with Cerebral Palsy

Background/Objectives: The purpose of this study was to investigate the relationship between the Gross Motor Function Classification System (GMFCS) levels and functional outcomes in children with Cerebral Palsy (CP). Methods/Statistical analysis: 217 children with CP were took part in this study. To collect the data, the GMFCS, the Pediatric Evaluation of Disability Inventory (PEDI) self-care and mobility scaled scales and the Gross Motor Function Measure (GMFM) were employed. The Spearman correlation coefficient was calculated to evaluate the relationship between GMFCS levels and functional outcomes and Receiver Operating Characteristic Curve (ROC) was used to investigate the cut-off values for functional outcomes by GMFCS levels. Results: The mean age was 9.86 years. Spastic, dyskinetic, hypotonic, and ataxic CP were noted in 71.9%, 12.0%, 8.8%, and 7.36% of the cases, respectively. The proportions of children at each GMFCS level, from level I to V were 15.2%, 13.4%, 11.1%, 14.3%, and 46.1%, respectively. The significant correlation of the GMFCS level with the GMFM total score and PEDI self-care and mobility scaled scores were detected (p < 0.001). The GMFM total scores and scaled scores of self-care and mobility domain in PEDI showed significant differences according to the GMFCS levels in analyzing one-way analysis of variance (p < 0.05). The cut-off values for the GMFM and scores of self-care and mobility domain in PEDI for GMFCS level I were 81.48, 53.48, and 75.43, respectively; for GMFCS level IV, the cut-off values were 40.92, 34.94, and 33.05, respectively. Conclusion/Application: Understanding of the relationship between GMFCS level and functional outcomes, especially cut-off points according to the GMFCS levels is useful for making inference of the functional outcomes of children with CP in the clinical setting.

Reliability and Applicability of the Bayley Scale of Infant Development-II for Children With Cerebral Palsy

ObjectiveTo obtain reliability and applicability of the Korean version Bayley Scale of Infant Development-II (BSID-II) in evaluating the developmental status of children with cerebral palsy (CP).MethodsThe inter-rater reliability of BSID-II scores from 68 children with CP (46 boys and 22 girls; mean age, 32.54±16.76 months; age range, 4 to 78 months) was evaluated by 10 pediatric occupational therapists. Patients were classified in several ways according to age group, typology, and the severity of motor impairment by the level of the Gross Motor Function Classification System (GMFCS). The measures were performed by video analysis, and the results of intraclass correlation (ICC) were obtained for each of the above classifications. To evaluate the clinical applicability of BSID-II for CP, its correlation with the Gross Motor Function Measure (GMFM), which has been known as the standard motor assessment for CP, was investigated.ResultsICC was 0.99 for the Mental scale and 0.98 for the Motor scale in all subjects. The values of ICC ranged from 0.92 to 0.99 for each age group, 0.93 to 0.99 for each typology, and 0.99 to 1.00 for each GMFCS level. A strong positive correlation was found between the BSID-II Motor raw score and the GMFM total score (r=0.84, p<0.001), and a moderate correlation was observed between the BSID-II Mental raw score and the GMFM total score (r=0.65, p<0.001).ConclusionThe Korean version of BSID-II is a reliable tool to measure the functional status of children with CP. The raw scores of BSID-II showed a great correlation with GMFM, indicating validity of this measure for children with CP on clinical basis.

Aquatic Therapy for a Child with Type III Spinal Muscular Atrophy: A Case Report

ABSTRACTSpinal muscular atrophy (SMA) is a neuromuscular disorder characterized by degeneration of alpha motor neurons. This case report describes an aquatic therapy program and the outcomes for a 3-year-old girl with type III SMA. Motor skills were examined using the 88-item Gross Motor Function Measure (GMFM), the Peabody Developmental Motor Scales (PDMS-2), and the GAITRite system. The child received aquatic therapy twice per week for 45-min sessions, for 14 weeks. The intervention included aquatic activities designed to improve gross motor skills and age-appropriate functional mobility. The GMFM total score improved by 11% following the intervention. The Standing Dimension score improved by 28% and the Walking, Running, and Jumping Dimension score improved by 18%. The gross motor quotient for the PDMS-2 improved from 66 to 74. The child's gait showed improvement in walking velocity, stride length, and single-limb support time as a percentage of the gait cycle. The outcomes of this case report demonstrate the successful improvement of gross motor function and gait in a 3-year-old child with SMA. This study provides clinical information for therapists utilizing aquatic therapy as a modality for children with neuromuscular disorders.

Two-year placebo-controlled trial of botulinum toxin A for leg spasticity in cerebral palsy

The controlled evidence favoring botulinum toxin A (BtA) treatment for spasticity in cerebral palsy is based on short-term studies. We conducted a randomized, double-blind, placebo-controlled, parallel-group study of BtA (Dysport) for leg spasticity in 64 children with cerebral palsy. For 2 years, the children received trial injections of up to 30 mu/kg every 3 months if clinically indicated. For the primary endpoints of Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Index (PEDI) scaled scores at 2 years (trough rather than peak effect), there were no differences between the mean change scores of each group. For the GMFM total score, the 95% CI of -4.81 to 1.90 excluded a 5-point difference in either direction, and a 2-point benefit with 95% confidence. There were no differences in adverse events. There was no evidence of cumulative or persisting benefit from repeated botulinum toxin A (BtA) at the injection cycle troughs at 1 year or 2 years. The dose was not enough to change spasticity measures and thus GMFM in this heterogeneous group. Ceiling effects in GMFM and Pediatric Evaluation of Disability Index (PEDI) may have reduced responsiveness. This finding does not deny the value, individually, of single injection cycles or prove that repeating them is unhelpful. In this regard, BtA treatment can be viewed in the same light as other temporary measures to relieve spasticity, such as oral or intrathecal agents: there is no evidence of continuing benefit if the treatment ceases. The study provides long-term, fully controlled adverse event data and has not revealed any long-term adverse effects.

Association of therapeutic occasion, gross motor function grading and developmental level with gross motor functional recovery in children with cerebral palsy

Background The abnormal posture and motor pattern have not stabilized in children with cerebral palsy at early period, thus timely treatment can establish normal postural reflex and motor pattern, and prevent complications of muscle contracture, ankylosis, skeletal deformity, etc. The clinical factors affecting the rehabilitative efficacy of gross motor function in children with cerebral palsy should be observed. Objective To observe the effects of therapeutic occasion, grading of gross motor function and developmental level on the rehabilitative efficacy in children with cerebral palsy. Design A case-controlled analysis. Setting Qilu Children's Hospital of Shandong University. Participants Totally 138 children with cerebral palsy, who were hospitalized for 12 months in the Rehabilitation Center of Qilu Children's Hospital, Shandong University, were selected from April 2004 to September 2006, and all the children were diagnosed to be accorded with the standard set by the national seminar on cerebral palsy in 2004. There were 97 males and 41 females, including 55 cases of 0–2 years old, 47 cases of 2–4 years and 36 cases of 4–6 years. Informed contents were obtained from relatives of all the children. Methods ▪ Comprehensive rehabilitation treatment: Vojta method was to induce the children to turn over the body and crawl by stimulating reflective turn over and crawling on belly. Bobath method including trainings of head control, turning over body, keeping sitting position, keeping balance, crawling, keeping standing position, and walking, etc.; The children were massaged by using the maneuvers of push, press, rub, pull, wave, etc. according to the sites and types of palsy. Acupuncture was performed mainly at bilateral motor areas, the needle was retained for 1 hour per time, 6 days continuously every week, and followed by a 1-day interval. ▪ Prognosis assessment: The gross motor functional grading of the children with cerebral palsy at admission was assessed using the Chinese version of gross motor function classification system (GMFCS). The gross motor functions of the children with cerebral palsy were assessed before rehabilitation treatment and 12 months after rehabilitation treatment by using gross motor function measure (GMFM). The improved GMFM total score was calculated. Developmental quotient was evaluated using Gesell developmental schedules (GDS) after 12-month rehabilitation treatment. Univariate analysis of variance was performed using the improved GMFM total score with age, GMFCS grade and developmental level (developmental quotient). Main outcome measures Effects of age started to accept rehabilitation treatment, GMFCS grade and developmental level on the recovery of gross motor function in children with cerebral palsy. Results All the 138 children with cerebral palsy were involved in the analysis of results. The improved GMFM total scores were significantly different among the children with cerebral palsy of different ages started to accept treatment, GMFCS grades and developmental levels ( F=13.464, 37.283, 30.814, P < 0.01). The younger the children started to accept treatment, the lower the their GMFCS grades and the higher their developmental levels, then the higher their improved GMFM total scores. Conclusion The recovery of gross motor function is better in younger children started to accepted treatment with cerebral palsy with lower GMFCS grades and higher developmental levels.

Responsiveness and Uniqueness of the Pediatric Outcomes Data Collection Instrument Compared to the Gross Motor Function Measure for Measuring Orthopaedic and Neurosurgical Outcomes in Cerebral Palsy

The Pediatrics Outcomes Data Collection Instrument (PODCI) is a valid and reliable measure of functional health status in children with acute and chronic musculoskeletal disorders, including cerebral palsy (CP), but its responsiveness has not been documented specifically for this population. The Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI) are the only two instruments validated specifically as evaluative measures for CP, and while widely used, they are limited by a ceiling effect when assessing higher-functioning children. The PEDI is further restricted to children who are 7 years old or less. The goal of this study was to evaluate the responsiveness, and secondarily the uniqueness, of the PODCI compared with the GMFM for evaluating surgical outcomes in CP. Changes in the GMFM and PODCI Parent forms were assessed at two time points in 64 children with spastic CP who underwent muscle-tendon lengthenings (MT; n = 22) or neurosurgical spasticity reduction consisting of either selective dorsal rhizotomy (SDR; n = 18) or intrathecal baclofen pump implantation (ITB; n = 11) or who had no surgery between assessments (n = 13). The GMFM Total score was responsive to change after both MT surgery and SDR, with a nearly equivalent magnitude of change in both groups. However, the PODCI Global Function Scale was responsive to changes only after MT surgery, with improvement in the Sports and Physical Function subscale particularly prominent. No significant changes were noted in the ITB group for either measure.

Effectiveness of intensive training for children with cerebral palsy – a comparison between child and youth rehabilitation and conductive education

To compare the short-term effectiveness of 1 intensive training period in child and youth rehabilitation with Move&Walk conductive education and describe the effects of 1 intensive training period in terms of changes at 1 year. The amount and influence of additional consumption of training during the 1-year follow-up was also analysed. Quasi-experimental with 2 groups: Lemo (n=23) and Move&Walk (n=29). A total of 52 children with cerebral palsy, age range 3-16 years. Data included repeated measures with Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory-Functional Skills (PEDI-FS). Data on additional consumption of training was collected at the 1-year follow-up. There was no difference in proportion of change on the clinical measures between the training programmes, except for a higher proportion of improvement on the GMFM total score in Lemo. At the group level, small improvements were shown on GMFM and PEDI FS in the short-term and on PEDI FS only at 1 year. A higher proportion of children who participated in repeated intensive training periods showed improved social functioning. No major differences were shown between the 2 training programmes. One intensive training period facilitated small improvements in gross motor function. The majority of children had a high consumption of training during the 1-year follow-up and the added value of repeated intensive training periods was limited.

Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: a preliminary study

This study aimed to evaluate functional effects of Bobath therapy in children with cerebral palsy (CP). Fifteen children with a diagnosis of CP were recruited (9 males, 6 females; mean age 7 years 4 months, SD 2 years 8 months; age range 2 to 12 years). Types of motor disorder were as follows: spastic quadriplegia (n=9); spastic diplegia (n=4); athetoid quadriplegia (n=1), and ataxia (n=1). Participants were distributed across the following Gross Motor Function Classification levels: level I, n=1; level II, n=4; level III, n=5; level IV, n=4; and level V, n=1. Children awaiting orthopaedic intervention were excluded. A repeated measures design was used with participants tested with the Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) at 6‐weekly intervals (baseline, before and after Bobath therapy, and follow‐up). As the data were of ordinal type, non‐parametric statistics were used, i.e. Wilcoxon's test. Participants showed a significant improvement in scores in the following areas following Bobath therapy compared with the periods before and after Bobath therapy: GMFM total score (p=0.009); GMFM goal total (p=0.001); PEDI self care skills (p=0.036); and PEDI caregiver assistance total score (p=0.012). This demonstrates that in this population, gains were made in motor function and self care following a course of Bobath therapy.

Horseback riding in children with cerebral palsy: effect on gross motor function

The effects of recreational horseback riding therapy (HBRT) on gross motor function in children with cerebral palsy (CP: spastic diplegia, spastic quadriplegia, and spastic hemiplegia) were determined in a blinded study using the Gross Motor Function Measure (GMFM). Seventeen participants (nine females, eight males; mean age 9 years 10 months, SE 10 months) served as their own control. Their mean Gross Motor Function Classification System score was 2.7 (SD 0.4; range 1 to 5). HBRT was 1 hour per week for three riding sessions of 6 weeks per session (18 weeks). GMFM was determined every 6 weeks: pre‐riding control period, onset of HBRT, every 6 weeks during HBRT for 18 weeks, and 6 weeks following HBRT. GMFM did not change during pre‐riding control period. GMFM Total Score (Dimensions A‐E) increased 7.6% (p&lt;0.04) after 18 weeks, returning to control level 6 weeks following HBRT. GMFM Dimension E (Walking, Running, and Jumping) increased 8.7% after 12 weeks (p&lt;0.02), 8.5% after 18 weeks (p&lt;0.03), and remained elevated at 1.8% 6 weeks following HBRT (p&lt;0.03). This suggests that HBRT may improve gross motor function in children with CP, which may reduce the degree of motor disability. Larger studies are needed to investigate this further, especially in children, with more severe disabilities. Horseback riding should be considered for sports therapy in children with CP.

Horseback riding in children with cerebral palsy: effect on gross motor function.

The effects of recreational horseback riding therapy (HBRT) on gross motor function in children with cerebral palsy (CP: spastic diplegia, spastic quadriplegia, and spastic hemiplegia) were determined in a blinded study using the Gross Motor Function Measure (GMFM). Seventeen participants (nine females, eight males; mean age 9 years 10 months, SE 10 months) served as their own control. Their mean Gross Motor Function Classification System score was 2.7 (SD 0.4; range 1 to 5). HBRT was 1 hour per week for three riding sessions of 6 weeks per session (18 weeks). GMFM was determined every 6 weeks: pre-riding control period, onset of HBRT, every 6 weeks during HBRT for 18 weeks, and 6 weeks following HBRT. GMFM did not change during pre-riding control period. GMFM Total Score (Dimensions A-E) increased 7.6% (p<0.04) after 18 weeks, returning to control level 6 weeks following HBRT. GMFM Dimension E (Walking, Running, and Jumping) increased 8.7% after 12 weeks (p<0.02), 8.5% after 18 weeks (p<0.03), and remained elevated at 1.8% 6 weeks following HBRT (p<0.03). This suggests that HBRT may improve gross motor function in children with CP, which may reduce the degree of motor disability. Larger studies are needed to investigate this further, especially in children. with more severe disabilities. Horseback riding should be considered for sports therapy in children with CP.

Muscle-Tendon Surgery in Diplegic Cerebral Palsy: Functional and Mechanical Changes

A prospective assessment of muscle-tendon (M-T) surgery was conducted on 30 patients with spastic diplegia. Muscle-tendon surgery consisted of recessions or releases to improve gait function by correcting restricted joint motion and joint malalignment. Functional-outcome measures included the Gross Motor Function Measure (GMFM) and temporal gait factors. Kinematic gait data were evaluated to determine the mechanical effects. The mean age at surgery was 8.7 years (4-20 years), and 3.5 muscle tendon units per extremity were recessed or released at surgery. The primary kinematic change for the hip and the knee was a shift in the sagittal joint position with minimal effects on overall excursion. Changes in ankle-joint dynamics after gastrocsoleus recessions included a reduction in plantarflexion and a shift in the timing of maximal dorsiflexion to later in stance. Improvements in walking velocity and stride length were evident by 6 month after surgery. Functional changes from M-T surgery included a 25% increase in velocity and an 18% increase in stride length over preoperative values seen at 9 months after surgery. Improvements in these parameters were maintained at 2 years after surgery. The GMFM total score showed minimal change after surgery with improvements occurring primarily in the standing dimension and the walking, running, and jumping dimensions.

Changes in the Gross Motor Function Measure in Children with Different Types of Cerebral Palsy

The aim of the study was to monitor the changes over an eight-month period in gross motor performance of a group of children with different types of cerebral palsy (CP) using the GMFM (Gross Motor Function Measure). Fifty children aged between 12 and 79 months and undergoing active physical therapy (twice a week) participated in the study. The children were evaluated three times at four-month intervals (baseline, four, and 8 months later) with the GMFM test under standardized conditions. Children with quadriplegia (n = 24), hemiplegia (n = 16), and diplegia (n = 10) showed significant improvement of their gross motor function over the eight-month period (mean GMFM total change score = 6.2%; 4.2%, and 7.0%, respectively) and there was no difference in the rate of change across types. The mean GMFM scores of the children with quadriplegia were always significantly lower than corresponding scores of the two other groups (p < 0.001). Results indicate that, irrespective of the type of CP, the GMFM is sensitive to changes in motor performance of children over time.

Validity of the Gross Motor Function Measure

The objective of this study was to evaluate the validity of the Gross Motor Function Measure (GMFM) in children with spastic diplegia. The GMFM is a criterion-referenced evaluative tool designed to quantify change in motor function over time. The GMFM was administered to 37 children with spastic diplegia three times: once as a baseline and again after 12− and 24-month intervals. Paired videotapes of the GMFM assessments were viewed by a therapist familiar with the GMFM, but unfamiliar with the child. The therapist was asked to judge how much change in motor skills was observed between the tapes. The hypothesis was that correlation of change scores on the GMFM and masked therapist's judgment of change by videotaped assessment would be ≥0.45. Spearman correlation coefficients for the GMFM total percent score were 0.66 and 0.79 at 12 and 24 months, respectively. The study provides evidence of the construct validity of the GMFM to measure change in motor function over a 12− and 24-month period of time in children with spastic diplegia.

Early and Intensive Treadmill Locomotor Training for Young Children with Cerebral Palsy

This feasibility study describes the development and application of a new intensive treadmill locomotor training program for young children with cerebral palsy (CP). The premise is that early, intensive, and task-specific locomotor training initiated even before independent walking is attained will promote improved locomotor skills. Four children, three girls and one boy, with spastic cerebral palsy (age range: 1.7–2.3 years) received a combination of conventional therapy and treadmill training four times per week for four months. To enable treadmill locomotor training, a customized treadmill capable of very low speeds and with several safety features, including a harness that could also be used for weight support, was custom built. Change in locomotor performance was evaluated with three clinical measures: the Gross Motor Function Measure (GMFM), a gait videographic test and the Supported Walker Ambulation Performance Scale (SWAPS). In addition, a full laboratory gait analysis was performed at baseline and at two and four months posttherapy. The results confirm the feasibility of early and intensive treadmill locomotor training in young children with CP even before independent walking is attained. Gait spatiotemporal parameters and the GMFM total score did not reveal changes observed in the video records by trained observers while laboratory gait evaluations were confounded by the poor locomotor capacity, especially at baseline. The GMFM D and E subscore and the SWAPS, were more sensitive to changes in the supported locomotor status and may be more appropriate than the GMFM total score for future studies requiring the matching of children who are nonindependent walkers. The results of this study pave the way for additional work on the SWAPS or for future efficacy trials using treadmills.

Validity and Reliability of the Indonesian Version Gross Motor Function Measure to Measure Gross Motor Function in Cerebral Palsy Children

Objectives: Cerebral palsy (CP) is the most physical disabling disease in children. Gross motor capacity in CP usually measured and evaluated by Gross Motor Function Measure (GMFM), a standardizedobservational instrument to evaluate gross motor function. Studies showed GMFM reliable, valid, and responsive to change of CP gross motor function. This research aims to examine validity and reliabilityof GMFM translated into Indonesian.Methods: Cross sectional study with consecutive sampling of CP children aged 2-­15 years came to pediatric rehabilitation clinic at RSCM Medical Rehabilitation Department or YPAC Jakarta. Subjects classified by age, type, anatomical distribution, and severity.Gross motor function evaluated with 88 GMFM items translated into Indonesia. Inter-­rater evaluated gross motor function through video records. Criterion validity tested by correlation coefficient, construct validity tested by comparing GMFM item with dimension total scores and GMFM total score with corrected Spearman correlation. Inter-­rater reliability tested by unpaired T-­test, internal consistency by alpha Cronbach.Results: Thirty one CP children with mean age 7 years 11 months, mean GMFM score 58.40 (SD=49.09).No significant difference of all GMFM dimensions; almost all GMFM items obtained from inter-rater evaluation. Good internal consistency (alpha Cronbach 0.884) and good criterion validity of all dimensions;; inter-­item and total correlations good to strong (r=0.523-­0.859).Conclusion: GMFM Indonesian has good to strong criterion validity. Construct validity of all dimensions was quite good. Internal consistency was good. No significant difference between inter-raters showed GMFM inter-­rater reliability good enough.Keywords: Cerebral palsy, gross motor function, gross motor function measure, validity, reliability.