Gross Motor Function Measure (GMFM) Developers: GMFM-88: D. Russell, P. Rosenbaum, C. Gowland, S. Hardy, M. Lane, N. Plews, H. McGavin, D. Cadman and S. Jarvis (1989, 1993, 2002) GMFM-66: D. Russell, P. Rosenbaum, L. Avery, and M. Lane (2000) Access: Available for purchase from http://www.cambridge.org/us/catalogue/catalogue.asp?isbn=1898683298 Cost: $US 85.00 Copyright: Mac Keith Press Description: The GMFM is a measure designed to assess change in gross motor function for children aged 5 months to 16 years with cerebral palsy (CP). There are two versions of the GMFM: the original 88-item version (Russell, Rosenbaum, Cadman, Gowland, Hardy & Jarvis, 1989; Russell, Rosenbaum, Gowland, Hardy, Lane, Plews, et al., 1993; Russell, Rosenbaum & Avery, 2002) and the newer 66-item version (Russell, Rosenbaum, Avery & Lane, 2002; Russell, Avery, Rosenbaum, Raina, Walter, & Palisano, 2000). The 88-item GMFM is a performance based measure with 5 dimensions: lying and rolling; crawling and kneeling; sitting; standing; and walking, running and jumping (Finch, Brooks, Stratford, & Mayo, 2002; Russell, Rosenbaum, Gowland, Hardy, Lane, Plews et al., 1993). The 66-item GMFM was developed using Rasch analysis in an attempt to improve the interpretability and clinical usefulness of the measure. Sixty-six of the original 88 items were retained and represent a uni-dimensional construct gross motor ability (Russell, Avery, Rosenbaum, Raina, Walter & Palisano, 2000). Administration: The GMFM is a standardised observational instrument designed for use by clinicians familiar with assessing childrens motor skills. Children are required to perform the gross motor tasks identified in the administration and scoring guidelines. The start position for each task is specified (Russell et al., 1993). Administration of the GMFM-88 takes between 45 and 60 minutes. The GMFM-66 should take less time. Training is not required, however a self training CD-ROM is provided with the GMFM manual (Finch et al., 2002). The GMFM should be administered in an environment that is comfortable for the child and allows the child to move freely (one task requires the child to run 4.5 metres and return). The floor should be a smooth, firm surface. A mat, bench, toys and access to stairs with at least 5 steps are also required. It is important to keep the environment for assessment as consistent as possible for each administration of the measure (Finch et al., 2002). Gross Motor Function Measure (GMFM): General Information Summary Julia Bowman, UWS, 2005

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Scoring and Interpretation: Use of the GMFM manual is essential for scoring and interpretation of the measure (Russell et al., 1993). Each item of the GMFM is scored on a 4 point scale (0 to 3) 0 = does not participate, 1 = initiates, 2 = partially completes and 3 = completes (Finch et al., 2002). Any item that has been omitted or the child is unable, or unwilling to attempt is scored as 0 (Russell et al., 1993). The child is allowed a maximum of three trials on each item. Percentage scores are calculated within each dimension and averaged to obtain a total score that ranges from 0 to 100. A goal score can also be calculated for the GMFM. To determine the goal total score, only the dimensions identified as goal areas by the clinician are included these are the areas where greatest change is expected to take place (Russell et al., 1993). This helps to increase the responsiveness of the measure. For example, if standing and walking, running and jumping activities were targeted, then the goal score is obtained by calculating the mean of these two dimension scores (Russell et al., 1993). Determining minimal clinically important change is difficult, due to the uniqueness of each childs situation. Ideally it id desirable to establish how much change is important to the client, this may be difficult when dealing with children, so parents may have to be involved. The scoring for the 66-item GMFM is the same as for the 88-item version; however the scores must be entered into a computer program (included when the GMFM is purchased) for conversion and analysis to an interval level total score (Finch et al., 2002). Refer to the manual for more details (Russell et al., 2002). Population Groups: The GMFM has been validated for children with CP, Down syndrome, and osteogenesis imperfecta. The GMFM has also been used, but not tested for children with developmental delay, acquired brain injury, and acute lymphoblastic leukaemia. The GMFM is designed for use only with children with CP (Finch et al., 2002; Russell et al., 1993). Languages: English, French, Dutch, German and Japanese.

Gross Motor Function Measure (GMFM): General Information Summary Julia Bowman, UWS, 2005

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ICF Levels:

Level Addressed by Measure Yes No Body Function/Structure Activity Participation

9

X

X

Psychometric Properties:

Published Data Available for the Measure Yes No Validity

Face 1 Content 1 11 Criterion 11 Construct 2 7 8 9 10 11

Reliability

Test-retest 2 5 6 Intra-rater 11 Inter-rater 2 3 4 11 Internal consistency 1

Other information available

Responsiveness to change 2 11 Standardised 1 11 Clinically important change 11 Clinical utility 11

9 9 9 9 9 9 9 9 9 9 9 9

1 Russell, Rosenbaum, Avery & Lane (2002) 2 Russell, Rosenbaum, Cadman, Gowland, Hardy & Jarvis (1989) 3 Russell, Rosenbaum, Lane, Gowland, Goldsmith, Boyce et al. (1994). 4 Bjornson, Graubert, McLaughlin & Astley (1994) 5 Bjornson, Graubert, McLaughlin, Kerfeld & Clark (1998) 6 Nordmark, Hagglund & Jarnlo (1997) 7 Palisano, Hanna, Rosenbaum, Russell, Walter, Wood et al., (2000) 8 Damiano & Abel (1996) 9 Drouin, Malouin, Richards & Marcoux (1996) 10 Bjornson, Graubert, Burford & McLaughlin (1998) 11 (Russell et al., 1993)

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References: Bjornson, K. F., Graubert, C. S., Burford, V. L. & McLaughlin, J. F. (1998). Validity of

the Gross Motor Function Measure. Pediatric Physical Therapy, 10, 43-47. Bjornson, K. F., Graubert, C. S., McLaughlin, J. F., & Astley, S. J. (1994). Inter-rater

reliability of the Gross Motor Function Measure. Developmental Medicine and Child Neurology,70, S27-28.

Bjornson, K. F., Graubert, C. S., McLaughlin, J. F., Kerfeld, C. I., & Clark, E. M. (1998). Test-retest reliability of the Gross Motor Function Measure in children with cerebral palsy. Physical and Occupational Therapy in Pediatrics, 18, 51-61.

Damiano, D. L., & Abel, M. F. (1996). Relation of gait analysis to gross motor function for children with cerebral palsy. Developmental Medicine and Child Neurology,38, 389-396.

Finch, E., Brooks, D., Stratford, P. W., & Mayo, N. E. (2002). Physical rehabilitation outcome measures: A guide to enhanced clinical decision making (2nd ed.). Hamilton: B. C. Decker.

Russell, D., Rosenbaum, P., Gowland, C., Hardy, S., Lane, M., Plews, N., et al. (1993). Gross Motor Function Measure Manual (2nd ed.). Hamilton: McMaster University.

Russell, D. J., Rosenbaum, P. L., Lane, M., Gowland, C., Goldsmith, C. H., Boyce, W. F., et al. (1994). Training users in the Gross Motor Function Measure: Methodological and practice issues. Physical Therapy, 74, 630-636.

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