Gross Motor Function Measure (GMFM)- What is it? Why would I use it? 88 or 66?

Here is a breakdown between the GMFM-88 and the GMFM-66.
In this video, I'll cover facets to the GMFM I consider to be most influential. I describe both the GMFM-88 and the GMFM-66, when to use one version over the other, some of the limitations associated with this assessment and a few key points to understand.
Here are a few timestamps that might be useful:
What is the GMFM? 1:01 and 4:26
What populations does this serve? 1:34 and 2:40
How long does this outcome measure take to administer? 4:50
Is there a tool that can help me identify the GMFM's use? 5:47
What is the GMFM? 6:55
When should I use the GMFM-88 vs the GMFM-66? 7:57
Primary limitations to the GMFM: 10:50
Other points to consider: 11:47
Helping me: 13:07
Quick takeaways:
The GMFM is a criterion-referenced observational scale.
Validity and reliability are most substantiated in children with cerebral palsy from 5 months to 16 years of age who possess motor skill equivalents less than or equal to 5 years of age.
GMFM is broken into 5 dimensions:
Laying and Rolling,
Sitting,
Crawling and Kneeling,
Standing,
Walking, Running and Jumping (all coupled into one category)
Consider using in conjunction with the Gross Motor Function Classification System (GMFCS).
GMFM-66:
Less time consuming.
Primarily used in children with CP.
GMFM-88:
More descriptive, but more time consuming.
In addition to use in children with CP, you can use it for Down Syndrome, SMA, TBIs.
More preferred for children of higher GMFCS level (aka more disabled), given it’s a better descriptor and provides a more precise representation of the child's actual motor level and change over time.
If a child requires footwear, orthoses, or other mobility aids during assessment.
Limitations:
The measure does not evaluate fine motor skills.
The measure is based on observation, and thus the results are subject to inter-observer variability.
If a child is ambulatory, you need access to stairs.
Only tracks the LEVEL of completion for various tasks.
Lack of ability to assess or track QUALITY of movement.
Inability to accurately assess the severity of asymmetries present.
Links to my other videos on standardized outcome measures:
AIMS: kzbin.info/www/bejne/a4K3n4inmb-GmKM
BOT-2: kzbin.info/www/bejne/gXnTqJKAgLiHh6s
PDMS-2: kzbin.info/www/bejne/b5W4mZqrhN2Jhas
Links mentioned in the video for supportive resources:
PDMS-2: kzbin.info/www/bejne/b5W4mZqrhN2Jhas
GMFCS: cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/severity-of-cerebral-palsy/gross-motor-function-classification-system/
GMFM-88: canchild.ca/system/tenon/assets/attachments/000/000/218/original/gmfm-88_and_66_scoresheet.pdf
GMFM-66 (with associated algorithm for identification of which item set to use): canchild.ca/system/tenon/assets/attachments/000/000/217/original/GMFM-66-IS_Scoresheets.pdf
Background by 'Free Creative Stuff' from Pexels: www.pexels.com/video/a-pastel-of-yellow-liquid-forms-different-patterns-3051357/
#physicaltherapy #education #training #rehab #GMFM

[@yohandelacruz5032]

Very informative. If I have a 3 year old with spastic Diplegia Px who has fair sitting balance and poor standing balance needing a stander/gait trainer. What will be my best option to use? PDMS-2, GMFM 88 or GMFM 66 for outcome measures? Im trying to see to efficacy of core stability training in improving balance. Thanks in advance!

[@WarrenMcAdamsPT]

Yohan, that’s a great question! Given your patient’s presentation, if my choices are limited to the PDMS-2 or GMFM (66 or 88), I would probably choose one of the GMFMs. This is because diplegia will likely induce a premature ceiling effect in the PDMS-2 scores as the child develops. Additionally, the GMFM is geared more towards CP in general. Next, since you are wanting to track change in the same child over time, you’ll want to use a test that’s criterion-referenced. The GMFM satisfies this desire whereas the PDMS-2 is more so a powerhouse in norm-referencing (comparing your child to others). Furthermore, when deciding between the GMFM 88 vs 66, based on your indication that the child uses a gait trainer, I would use the 88- it will also give you a more comprehensive/”finer-tuned” representation of the child’s performance from one point in time to another. However, since your sole purpose is to track change in core stability/balance, I would personally consider the use of the Segmental Assessment of Trunk Control (SATCO) or the Pediatric Balance Scale (PBS) depending on the child's age. Since this child is 3 years old, the PBS is not applicable since it’s established for children 5-15 years of age vs the SATCO which can be used for any age. But, if your child were in the age range for the PBS, I would prefer to use that assessment over the SATCO since the PBS is criterion-referenced AND it has cut-off and normative scores based on age AND it’s great in tracking change in children with CP (there are even MCD and MCID’s for Static items, Dynamic items, and Total Score)- but, again, the PBS is for children 5-15 years of age. In summation, the tests I would consider most for your purposes given the child’s presentation would be the GMFM-88 and the SATCO.

[@Monikaverma16jul]

Gmfm66

[@brandongarner7730]

I know I commented earlier but I’m rewatching this after 6 months and I’ve got to say that your videos on Standardized Outcome Measures are a diamond in the rough. I couldn’t find a lot of this information anywhere without having to pay for manuals and read a lot to orient myself. But these videos are so concise and to the point that it saves me hours of time and money.

[@WarrenMcAdamsPT]

I really appreciate that feedback Brandon! Thank you for the thoughtful comments. It definitely is motivating to read.

[@kyleparrish8745]

Thank you so much! I'll be using this assessment for the first time today and you've taught me how to choose between the 88 and 66. Keep up the great work! This is a huge help to me as I am starting to transition into the pediatric PT setting.

[@WarrenMcAdamsPT]

Kyle, welcome to the pediatric setting and I'm happy that you found it helpful! If there are other outcome measures or topics within pediatrics that you might find helpful, feel free to send them my way and I'll add it to my list of future videos.

[@carim4089]

Please do keep posting...I’m very interested in learning the GMFM, PDMS-2 & BOT2 assessments.

[@WarrenMcAdamsPT]

Cari, if you're interested in the PDMS-2 and the GMFM, feel free to view my videos on those two assessments as well. As for the BOT-2, I plan on making that one in the near future.

[@brandongarner7730]

Nice video. Again, really helpful information. The PDMS-2 video was also really helpful. Thanks man.

[@WarrenMcAdamsPT]

I'm glad it was appreciated!

[@MovewithMarcia]

All great points! I've used it for kiddos without a formal diagnoses that fit conditions the scale covers as well. Not sure if I missed it, it's also interested that certain insurances have a list of "acceptable scales" and this is one of few that covers older kids.

[@karinalopez4033]

I really liked how you explained everything I have a presentation on GMFM coming up. I would love to see a video of how to go about the scoring.

[@drewelena]

I am currently on my pediatric clinical rotation and this was extremely helpful in preparing for a reevaluation I need to perform this week. Thank you for your time!

[@WarrenMcAdamsPT]

I'm glad you found it helpful Drew! I hope clinical rotation is enjoyable and goes well!

[@user-ij1ey1xq5f]

Excellent video, clear, concise, I will share this video with my DPT students. Thank you!

[@kimh-sq6di]

Very concise and super helpful, thanks Warren!

[@meganvance4670]

I would love a demonstration of how you may go through the measure with a client :) Otherwise, stellar resource! OT student here studying this measure and its appropriateness for use in a hippotherapy setting with pediatric clients. Also, a quick takeaways list or pros and cons of the measure list may be helpful just to summarize info.

[@WarrenMcAdamsPT]

Megan, thank you for your feedback, and I apologize for my delayed reply! I'm glad you found the video to be a helpful resource. A demonstration of the GMFM-88 and GMFM-66 measures with a client would be a great idea. Unfortunately, I cannot provide a video of that at the moment, but I can give you a quick takeaways list and a few pros and cons of the measure for your reference. Quick takeaways: The GMFM is a criterion-referenced observational scale. Validity and reliability are most substantiated in children with cerebral palsy from 5 months to 16 years of age who possess motor skill equivalents less than or equal to 5 years of age. GMFM is broken into 5 dimensions: Laying and Rolling, Sitting, Crawling and Kneeling, Standing, Walking, Running and Jumping (all coupled into one category) Consider using in conjunction with the Gross Motor Function Classification System (GMFCS). 66- less time consuming primarily used in children with CP. 88- more descriptive In addition to use in children with CP, you can use it for Down Syndrome, SMA, TBIs. More preferred for children of higher GMFCS level (aka more disabled), given it’s a better descriptor and provides a more precise representation of the child's actual motor level. If a child requires footwear, orthoses, or other mobility aids Limitations: The measure does not evaluate fine motor skills. The measure is based on observation, and thus the results are subject to inter-observer variability. If a child is ambulatory, you need access to stairs. Only tracks the LEVEL of completion for various tasks. Lack of ability to assess or track QUALITY of movement. Inability to accurately assess the severity of asymmetries present. It's also important to know that GMFM-88 and GMFM-66 are suitable for use in a hippotherapy setting with pediatric clients, and it helps track the therapy progress.

[@CBR.Physio]

Great video! physio student doing paeds, these are super helpful! Please do more!

[@WarrenMcAdamsPT]

Thank you for the encouraging feedback Lisa!

[@franciscojavierrivera7962]

Im actually studying this subject for a school project, thanks!!

[@WarrenMcAdamsPT]

Francisco, I'm glad to help and I hope your project goes well!

[@drsyedmazhar5501]

Great explanation dr Please make more videos on pediatric exercises

[@moniqueparagua1378]

This will help me in my clinical case review. Thank you!

[@WarrenMcAdamsPT]

I'm glad it helped Monique and I hope your clinical case review goes well!

[@mackenzievandenheuvel6963]

Would love to see an example of administration of items! Current PT student and the lack of practice we get for these standardized tests is horrendous.

[@syedaamal9844]

Please make video on GMFM 88 Observational Assessment

[@LiLy-jt7ws]

Hi Warren, can you please discuss the PEDI as well? You mentioned about not really using GMFM for conditions such as SCI, probably same as well with babies born with Spina Bifida but are adult now and non ambulatory. Would you consider PEDI for them? By the way I love all your discussions with standardized testing tool, BOT-2 and PDMS.

[@andressabrump4729]

excelent

[@WarrenMcAdamsPT]

Thank you for the positive feedback Andressa!

[@genesisseyer7730]

what is mcid of 88?

[@pragya4834]

Please share ppt