Changes in the Gross Motor Function Measure in Children With Different Types of Cerebral Palsy: An Eight-Month Follow-up Study.

Trahan J, Malouin F (Institut de readaptation en deficience physique de Quebec, Ste-Foy; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Canada), Ped Phys Ther. 1999;11:12-17.

The aim of this article was to describe the natural evolution of the gross motor performance of children with 3 different types of cerebral palsy (quadriplegia, diplegia, hemiplegia) over an 8-month period using the Gross Motor Function Measure (GMFM). The GMFM was developed to measure the gross motor performance of children with cerebral palsy (CP). The measure consists of 88 items grouped into 5 dimensions: lying and rolling; sitting; crawling and kneeling; standing; and walking, running, and jumping. The measure is scored using a 4-point Likert scale.

According to the researchers, studies have validated the use of the GMFM as a measure of change in gross motor function in children with CP. In addition, previous studies have established the usefulness of the GMFM as an outcome measure for assessing gross motor function in specific intervention trials. Based on these studies, the authors believed that the changes within the 5 GMFM dimensions may depend on the type of CP the age of the children, or the type of intervention that the children received.

Fifty children aged 12 to 79 months who were diagnosed with CP were enrolled in the study group. Physical therapy intervention, the study's constant variable, consisted of a 45-minute individualized session, twice a week, which was generally based on a neuro-developmental therapy (NDT) approach. Children were evaluated at baseline, 4 months, and 8 months using the GMFM. A total score and separate dimension scores were collected for each subject. Other data, including age, sex, and neurological impairment, were collected at baseline.

The results indicated that the GMFM is able to detect changes in gross motor performance of children with various types of CP over an 8-month period. There was an increase in motor performance at the first retest session for each dimension of the GMFM as well as the total score. In addition, children continued to improve between retest sessions. These increases were statistically significant at 4 and 8 months within each dimension and the total score. No relationship existed between the type of CP and time, and the rate of improvement was the same across groups. Within each group, there were significant increases in total and dimension scores at 4 and 8 months. Children with diplegia (n=10) exhibited motor improvements primarily in the standing and walking, running, and jumping dimensions. Children with hemiplegia (n=16) also exhibited significant increases in motor performance in these same dimensions. At baseline, post hoc analysis showed that the children with diplegia tended to show the largest mean percent change in motor performance (7.0%), followed closely by children with quadriplegia (n=24) (6.2%). The children with hemiplegia tended to show the lowest mean change in motor performance (4.2%).

According to the authors, this study shows the value of the GMFM as a tool to provide information regarding the changes in motor performance in children with spastic quadriplegia, diplegia, and hemiplegia over an 8-month period of time.

Angela Easley Rosenberg, DrPH, PT
The University of North Carolina
Chapel Hill, NC