How does the intensity of physical therapy affect the Gross Motor Function Measure (GMFM-66) total score in children with cerebral palsy? A systematic review protocol (original) (raw)
Pediatric Physical Therapy, 2006
Purpose/Hypothesis: The purpose of this pilot study was to examine the effects of an intensive therapy protocol that uses the TheraSuit TM on the gross motor performance of children with cerebral palsy (CP). Number of Subjects: Participants were 20 children with CP. The mean age was 7 years with a range of 3-17. Children were classified into Gross Motor Function Classification System (GMFCS) levels. Materials/Methods: A pre and posttest design with one group was used. The children received therapy 4 hours a day, 5 days a week for 3 weeks using primary equipment of a TheraSuit TM and a universal exercise unit. The GMFM was videotaped for each child. The outcome measures were the Gross Motor Function Measure (GMFM), clinical judgment of change, and observation of postural alignment, latency of response, and duration of movement [quality of movement]. Rater reliability on the measures was determined before data collection. An investigator who was unfamiliar with the children and blinded to test order assessed the videotapes by scoring the GMFM and a clinical observation checklist that assessed quality of movement. Spearman rho correlation coefficients examined relationships among GMFM scores and participant characteristics. Paired sample t tests assessed changes in GMFM88, GMFM66, and quality of movement. A repeated measure MANOVA examined changes in pre and post GMFM88 and GMFM66 mean scores based on GMFCS levels. Results: The GMFM88 and GMFM Goal Total mean scores increased following the intervention (t ϭ-3.566, P ϭ 0.002 and t ϭ-3.094, P ϭ 0.006, respectively), but the GMFM66 mean scores and quality of movement mean totals did not. The correlation coefficients between Pediatric Physical Therapy Abstracts for the 2006 Combined Sections Meeting 73 strength training on quality of life. The purpose of this case study is to report the effect of strength training in a 17 year old female with cerebral palsy. Case Description: The subject is a 17 year old female with spastic quadriplegic CP who received Botox and Phenol injections to her bilateral lower extremities. She attended a day hospital rehabilitation program where she received 1.5 hours of physical therapy and 1 hour of occupational therapy 5 days per week. The subject participated in a 6 week therapy regimen which focused on quadriceps and gluteal strengthening 3 days per week and general balance and gait training on alternate days. Initial load for weight training was calculated as 65% of her maximal isometric knee extension and hip extension peak torque as measured on the Biodex System 3. Repetitions and/or exercise load was increased as the subject demonstrated improvement in ability to perform prescribed exercises. Isometric peak torque, TUG, the 9 minute walk run, EEI, GMFM, and the PedsQL were performed pre and post physical therapy intervention. Outcomes: Isometric peak torque for knee extension increased 92% and hip extension 57%, 9 minute walk run improved 1105 feet, EEI decreased from 4.7 to 0.99 beats/m, GMFM total increased 12% and standing domain increased 41%, TUG decreased 3.72 seconds, PedsQL decreased 9 points Discussion: Dramatic improvements were noted in gluteal and quadriceps strength following the 6 week strength training program. Although items from the GMFM were not specifically practiced, the subject showed improvement in all areas, most significantly in the domain of standing. Additionally, while endurance training was not a focus of physical therapy, significant change was made on the 9 minute walk run as well as the EEI. Most notably, the subjects EEI improved to within normal limits for healthy age-matched peers. Items of improvement on the PedsQL included attitude toward walking, participation in household chores, feeling afraid and keeping up with and fitting in with peers. Though the PedsQL has been shown as a reliable and valid measure of quality of life in pediatric populations, there have been few comments in the literature associating a physical therapist prescribed strengthening program with quality of life in children with chronic health conditions such as cerebral palsy. The dramatic improvements in strength, function, endurance, and energy expenditure seen in this subject corresponded to an improvement in quality of life as measured by the PedsQL. Further research is warranted to examine this relationship. This case supports the use of intensive strength training as a primary physical therapy intervention to achieve patient and family goals related to function and quality of life.
Indonesian Journal of Physical Medicine & Rehabilitation, 1970
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 co...
Acta Medica Academica, 2010
Objective. To determine the outcome of rehabilitation treatment after orthopedic-surgical treatment of the lower extremities in relation to motor function and degree of disability in children with cerebral palsy. Subjects and methods. An historical-prospective study included 44 treated children with CP from May 2000 until June 2009 at the Department of Physical Medicine and Rehabilitation University Clinical Centre Tuzla. The main criteria for entering the study were diagnosed CP and performed orthopedic-surgery of the lower extremities during rehabilitation treatment. Assessment of the motor function score was performed according to the Gross Motor Function Measure 88 (GMFM-88), and classification of the degree of disability was developed based on the scale of the Gross Motor Function Classification System (GM-FCS). Results. In our study, motor functions were improved, so that the median value and interquartil range (IQR) of the total GMFM score before surgery was 35.7 (IQR from 22.9 to 57.2), and after postoperative rehabilitation 58.6 (IQR from 31.2 to 85.2) with a high statistical significance (p<0.0001). Median value GMFCS scores before surgery ranged around 5 (IQR from 4 to 5), and after postoperative rehabilitation ranged around 3 (IQR from 2 to 5), which shows a highly statistically significant reduction in the degree of disability (p<0.001). Conclusion. Surgical intervention performed on the lower extremities in children with cerebral palsy may improve motor function in all developmental stages and reduce the degree of disability with intensive rehabilitation.
Targeted selection of physical exercises and right use of methods made on the basis of correct diagnosis represent important factors for ensuring targetoriented physical therapy treatment. The objective of our research was measuring effectiveness of physical therapy treatment in cases of cerebral palsy, and defining the influence of correct and targeted physical therapy treatment on functional independence. Importance of the research outcomes on early regular physical therapy treatment effects [using Gross Motor Function Measure] lies in fact that according to the study, it is essential to start treatment from the very early age for the purpose of effective controlling of anomalous patterns. The study has also shown that the goal and target oriented physical therapy treatment results in decrease of disability levels and increases quality life of persons with disabilities
Disability & Rehabilitation, 2005
Purpose. The aim of this study is to describe responsiveness of the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI) in a group of children with cerebral palsy (CP). Method. The subjects were 55 children with cerebral palsy aged 2 to 7 years (mean 4.6 years). We described the responsiveness of the GMFM and PEDI for all children (n = 55), for children younger than 4 years of age (n = 22) and those older or equal to 4 years (n = 33). Two frames of references for determining responsiveness were used: change over time and external criterion. Responsiveness was calculated with help of the Effect Size (ES), Standardised Response Mean (SRM) and Spearman rank order correlations of change on both the PEDI and GMFM, with change in motor functioning according to the parents as external criterion. Results. The PEDI has ES and SRM values higher than 0.8. The GMFM has ES and SRM values higher than 0.5. For all dimensions of the PEDI and for almost all dimensions of the GMFM, the ESs and SRMs of the younger group are higher than those of the older group. The ES and the SRM of the GMFM increase with the complexity of the task. When looking at the correlations of the PEDI and GMFM change scores with the opinion of parents, the results are less unequivocal.
GMPM Gross Motor Performance Measure LoA Limits of agreement MDC Minimal detectable change QFM Quality Function Measure AIM Optimizing movement quality is a common rehabilitation goal for children with cerebral palsy (CP). The new Quality Function Measure (QFM)a revision of the Gross Motor Performance Measure (GMPM)evaluates five attributes: Alignment, Co-ordination, Dissociated movement, Stability, and Weight-shift, for the Gross Motor Function Measure (GMFM) Stand and Walk/Run/Jump items. This study evaluated the reliability and discriminant validity of the QFM. METHOD Thirty-three children with CP (17 females, 16 males; mean age 8y 11mo, SD 3y 1mo; Gross Motor Function Classification System [GMFCS] levels I [n=17], II [n=7], III [n=9]) participated in reliability testing. Each did a GMFM Stand/Walk assessment, repeated 2 weeks later. Both GMFM assessments were videotaped. A physiotherapist assessor pair independently scored the QFM from an assigned child's GMFM video. GMFM data from 112 children. That is, (GMFCS I [n=38], II [n=27], III [n=47]) were used for discriminant validity evaluation. RESULTS QFM mean scores varied from 45.0% (SD 27.2; Stability) to 56.2% (SD 27.5; Alignment). Reliability was excellent across all attributes: intraclass correlation coefficients (ICCs) ≥0.97 (95% confidence intervals [CI] 0.95-0.99), interrater ICCs ≥0.89 (95% CI 0.80-0.98), and test-retest ICCs ≥0.90 (95% CI 0.79-0.99). QFM discriminated qualitative attributes of motor function among GMFCS levels (maximum p<0.05).
Research in Developmental Disabilities, 2015
Purpose: The aims of this study were to adapt the Gross Motor Function Measure-88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) and to determine the test-retest and interobserver reliability of the adapted version. Method: Sixteen paediatric physical therapists familiar with CVI participated in the adaptation process. The Delphi method was used to gain consensus among a panel of experts. Seventy-seven children with CP and CVI (44 boys and 33 girls, aged between 50 and 144 months) participated in this study. To assess test-retest and interobserver reliability, the GMFM-88 was administered twice within three weeks (Mean = 9 days, SD = 6 days) by trained paediatric physical therapists, one of whom was familiar with the child and one who wasn't. Percentages of identical scores, Cronbach's alphas and intraclass correlation coefficients (ICC) were computed for each dimension level. Results: All experts agreed on the proposed adaptations of the GMFM-88 for children with CP and CVI. Test-retest reliability ICCs for dimension scores were between 0.94 and 1.00, mean percentages of identical scores between 29 and 71, and interobserver reliability ICCs of the adapted GMFM-88 were 0.99-1.00 for dimension scores. Mean percentages of identical scores varied between 53 and 91. Test-retest and interobserver reliability of the GMFM-88-CVI for children with CP and CVI was excellent. Internal consistency of dimension scores lay between 0.97 and 1.00. Conclusion: The psychometric properties of the adapted GMFM-88 for children with CP and CVI are reliable and comparable to the original GMFM-88.