Gross Motor Function Classification System
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The Gross Motor Function Classification System or GMFCS is a 5 level clinical classification system that describes the gross
motor function Motor control is the regulation of movement in organisms that possess a nervous system. Motor control includes reflexes as well as directed movement. To control movement, the nervous system must integrate multimodal sensory information (both ...
of people with
cerebral palsy Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensa ...
on the basis of self-initiated movement abilities. Particular emphasis in creating and maintaining the GMFCS scale rests on evaluating sitting, walking, and wheeled mobility. Distinctions between levels are based on ''functional'' abilities; the need for walkers, crutches, wheelchairs, or canes / walking sticks; and to a much lesser extent, the actual quality of movement. The original version of the GMFCS was developed in 1997. As of 2007, the expanded and revised version, known as GMFCS - E&R, further includes an age band for youth 12 to 18 years. The original concept was developed collaboratively by Robert Palisano, Professor of Physiotherapy at
Drexel University Drexel University is a private research university with its main campus in Philadelphia, Pennsylvania. Drexel's undergraduate school was founded in 1891 by Anthony J. Drexel, a financier and philanthropist. Founded as Drexel Institute of Art, S ...
; Peter Rosenbaum, Professor of Developmental Paediatrics at
McMaster University McMaster University (McMaster or Mac) is a public research university in Hamilton, Ontario, Canada. The main McMaster campus is on of land near the residential neighbourhoods of Ainslie Wood and Westdale, adjacent to the Royal Botanical Ga ...
; Stephen Walter, Professor of Biostatistics at McMaster University; Dianne Russell; Ellen Wood; and Barbara Galuppi. GMFCS is now the standard in both North America and Western Europe for mobility assessment and ambulatory ability prediction for cerebral palsy. The examination is done using the "Gross Motor Function Measure", (GMFM), a set of 66 sitting (truncal control) as well as walking exercises conducted during the GMFM assessment that help the specialist classify the person into one of the system's five levels or, sometimes, to classify the person as "in between" two different levels.


GMFCS Level I

• Can walk indoors and outdoors and climb stairs without using hands for support
• Can perform usual activities such as running and jumping
• Has decreased speed, balance and coordination


GMFCS Level II

• Can climb stairs with a railing
• Has difficulty with uneven surfaces, inclines or in crowds
• Has only minimal ability to run or jump


GMFCS Level III

• Walks with assistive mobility devices indoors and outdoors on level surfaces
• May be able to climb stairs using a railing
• May propel a manual wheelchair and need assistance for long distances or uneven surfaces


GMFCS Level IV

• Walking ability severely limited even with assistive devices
• Uses wheelchairs most of the time and may propel own power wheelchair
• Standing transfers, with or without assistance


GMFCS Level V

• Has physical impairments that restrict voluntary control of movement
• Ability to maintain head and neck position against gravity restricted
• Impaired in all areas of motor function
• Cannot sit or stand independently, even with adaptive equipment
• Cannot independently walk but may be able to use powered mobility


Use

The GMFCS has been used to describe study samples in terms of the number of children in each band. Hence, the GMFCS is much more of a categorization tool or an independent variable rather than an outcome measure. For example, cerebral palsy children with higher GMFCS levels i.e. (III, IV, V) have a greater risk of developing hip subluxation/dislocation than those with lower GMFCS levels i.e. (I, II). A limitation of the original GMFCS was that parents and therapists would rate a child on their best performance rather than their average performance. There seems to be more uncertainty between classifying children at level I or II than in other levels. The GMFCS has been used to classify people with conditions other than cerebral palsy. This use is not recommended by the authors of the GMFCS.


Alternatives

The
Gross Motor Functional Measure Gross may refer to: Finance *Gross Cash Registers, a defunct UK company with a high profile in the 1970s *Gross (economics), is the total income before deducting expenses Science and measurement * Gross (unit), a counting unit equal to 144 ...
is sometimes used instead of the GMFCS.


See also

*
Communication Function Classification System The Communication Function Classification System (CFCS) for individuals with cerebral palsy (CP) is a five-level classification system which began development at Michigan State University and currently under further refinement at the University ...
*
Manual Ability Classification System The Manual Ability Classification System (MACS) is a medical classification system used to describe how children aged from 4 to 18 years old with cerebral palsy use their hands with objects during activities of daily living, with a focus on the use ...


References

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External links


Gross Motor Function Classification System - Expanded & Revised (GMFCS - E&R) at CanChild web site
{{Cerebral palsy Cerebral palsy and other paralytic syndromes Medical scoring system