Gross Motor Function Measure (GMFM)
The GMFM is a clinical measure designed to evaluate change in gross motor function in children with cerebral palsy. There are two versions of the GMFM: the original 88-item measure (GMFM-88) and the more recent 66-item GMFM (GMFM-66). Items on the GMFM-88 span the spectrum from activities in lying and rolling up to walking, running and jumping skills. The GMFM-66 is comprised of a subset of the 88 items that has been shown to be unidimensional.

To order the GMFM Manual:  The GMFM is available from Cambridge Press - www.cup.org or  www.cambridge.org/catalogue/catalogue.asp?isbn=1898683298

Cost:  Cost information is available from the publisher.

Reference for the manual:  The Gross Motor Function Measure (GMFM-66 & GMFM-88) User's Manual (Russell, D., Rosenbaum, P., Avery, L. & Lane, M.) Clinics in Developmental Medicine No. 159, 2002. Published through Mac Keith Press in the U.K. and distributed through Cambridge University Press.

More information about the GMFM:  Who is the GMFM appropriate for? While the measure was designed and validated for children with cerebral palsy, there is evidence that the GMFM-88 version of the measure is also valid for use with children with Down syndrome.Because the GMFM samples motor skills that are typical of normal developmental milestones, it may be useful for children other than for those with whom it has been validated; however, reliability and validity should be established prior to using it with other groups of children. The original validation sample included children 5 months to 16 years old. The GMFM would be appropriate for children whose motor skills were at or below those of a 5 year old child without any motor disability.





How is the GMFM administered? The GMFM requires the child to demonstrate various motor skills as outlined in the GMFM administration and scoring guidelines.




Where should it be administered? The GMFM should be administered in an environment which is comfortable for the child and is large enough to hold the necessary equipment and allow the child to move freely [e.g. one item requires the child to run 4.5m (15 feet) and return]. The floor should be a smooth, firm surface. Because the GMFM was designed to measure change over time it is important to keep the environment and assessment conditions as consistent as possible for each assessment.





How is the GMFM scored? There is a 4-point scoring system for each item on the GMFM. Specific descriptors for scoring items are detailed in the administration and scoring guidelines. The item scoring is the same for the GMFM-88 and GMFM-66. The GMFM-88 item scores can be summed to calculate raw and percent scores for each of the five GMFM dimensions, selected goal areas and a total GMFM-88 score. The GMFM-66 requires a user-friendly computer programme (called the Gross Motor Ability Estimator or GMAE) to enter individual item scores and convert them to an interval level total score.



How long does it take? Administering the GMFM-88 may take approximately 45 to 60 minutes for someone familiar with the measure, depending on the skill of the assessor, the ability level of the child and the child's level of cooperation and understanding. The GMFM-66 should take less time to administer as there are fewer items.



What qualifications are required to administer and score the GMFM? The GMFM was designed for use by pediatric therapists who are familiar with assessing motor skills in children. Users should familiarize themselves with the GMFM guidelines and scoresheet prior to assessing children. It may be helpful to practise on several children with and without motor disabilities prior to using it for clinical assessments. There is a GMFM self-instructional CD ROM which provides useful training tips and allows assessors to work through several examples of each GMFM item. It is recommended that users assess their reliability with the GMFM prior to using it.

What equipment is needed? The equipment required is described in detail in the GMFM manual. Most of what is needed is standard equipment in a physiotherapy gym (e.g. mat, bench, toys). Access to stairs (with at least 5 steps) is also necessary.





Reprinted from the GMFM manual with permission from Mac Keith press.


Articles and software related to the GMFM: Russell, D., Leung, K. & Rosenbaum, P. Accessibility and Perceived Clinical Utility of the GMFM-66: Evaluating Therapists' Judgement of a Computer-based Scoring Program. Physical and Occupational Therapy in Pediatrics (in press).

Avery, L., Russell, D., Raina, P., Rosenbaum, P. & Walter, S. Rasch Analysis of the gross motor function measure: Validating the assumptions of the Rasch model to create an interval level measure. Archives of Physical Medicine and Rehabilitation, 84:697-705.

Avery, L.M. (2002) Gross Motor Ability Estimator: Interpreting the scores of the Gross Motor Function Measure (GMFM) for children with cerebral palsy. (Version 1.0) [Computer software], London, UK. Mac Keith Press.

Gemus, M., Palisano, R., Russell, D., Rosenbaum, P., Walter, S.D., Galuppi, B., Lane, M. (2001) Using the Gross Motor Function Measure to evaluate motor development in children with Down syndrome. Physical and Occupational Therapy in Pediatrics, 21:69-79.

Palisano, R.J., Hanna, S.E., Rosenbaum, P.L., et al. (2000) Validation of a model of gross motor function for children with cerebral palsy. Physical Therapy, 80 (10), 974-985.

Palisano, R.J., Walter, S.D., Russell, D.J., Rosenbaum P.L., Gemus, M., Galuppi, B.E., Cunningham, L. (2001) Gross motor function of children with Down syndrome: Creation of motor growth curves. Archives of Physical Medicine and Rehabilitation, 82, 494-500.

Russell, D.J., Avery, L.M., Rosenbaum, P.L., Raina, P.S., Walter, S.D., Palisano R.J. (2000) Improved scaling of the Gross Motor Function Measure for children with cerebral palsy: Evidence of reliability and validity. Physical Therapy, 80(9), 873-885.

Russell, D., Palisano, R., Walter, S., Rosenbaum, P., Gemus, M., Gowland, C., Galuppi, B. Lane, M. (1998) Evaluating motor function in children with Down syndrome: validity of the GMFM. Developmental Medicine and Child Neurology, 40, 693-701.

Russell, D., Rosenbaum, P., Cadman, D., Gowland, C., Hardy, S., Jarvis, S. (1989) The gross motor function measure: A means to evaluate the effects of physical therapy. Developmental Medicine and Child Neurology, 31, 341-352.

Russell, D.J., Rosenbaum, P.L., Lane, M., Gowland, C., Goldsmith, C.H., Boyce, W.F., Plews, N. (1994) Training users in the Gross Motor Function Measure: methodological and practical issues. Physical Therapy, 74 (7), 630-636.