GMFM Score Interpretation

What is gross motor function?

Gross motor function uses large muscle groups to perform coordinated and controlled movements involving the whole body. These movements are fundamental for walking, running, jumping, crawling, climbing, and maintaining balance. They are essential for everyday tasks and are foundational for more complex physical activities.

In infants and young children, gross motor skills develop progressively, from simple movements like lifting the head and rolling over to more intricate actions such as walking and running. These skills are crucial as they lay the groundwork for further physical and cognitive development. For instance, the ability to sit independently allows a child to use their hands freely to explore objects, aiding in cognitive and sensory development.

Several factors contribute to the development of gross motor skills. Muscular strength, coordination, balance, and proprioception (the sense of body position) play significant roles. As children grow, their nervous system matures, enhancing their ability to perform more sophisticated movements.

Conditions or delays in gross motor skill development can arise due to various factors, including neurological conditions, muscular disorders, injuries, or environmental influences. Children with delays might struggle with activities that involve balance, coordination, or basic movements, impacting their ability to participate fully in physical activities and affecting their confidence and social interactions.

Therapies and interventions aim to support and improve gross motor function in individuals with delays or difficulties. Physical therapy, occupational therapy, and specific exercise programs can help enhance strength, coordination, balance, and overall motor skills. These interventions often involve tailored exercises and activities designed to target specific areas of improvement.

In adulthood, maintaining and improving gross motor function remains essential for overall health and functionality. Regular exercise, including activities focusing on strength, flexibility, and balance, helps preserve motor skills and prevent age-related decline.

How is gross motor function assessed?

Assessing gross motor function involves evaluating an individual's ability to perform large muscle group movements and coordinated activities involving the whole body. Various methods and assessments evaluate and measure gross motor skills across different age groups and abilities.

Observational assessment

Observing a person engaging in activities such as walking, running, jumping, throwing, catching, climbing, or balance tasks provides valuable insights into their gross motor abilities. Observers note the quality, coordination, balance, and fluidity of movements.

Standardized tests and scales

Standardized assessments provide structured tools to measure gross motor skills against established developmental norms. Examples include the Movement Assessment Battery for Children (MABC), Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), or Peabody Developmental Motor Scales (PDMS). These tests consist of specific tasks and activities to assess different aspects of gross motor function.

Developmental milestones checklists

Pediatricians often use developmental milestones checklists to track a child's progress in achieving gross motor milestones, such as sitting, crawling, standing, walking, and running, at different ages.

Functional assessments

Assessing an individual's ability to perform functional tasks relevant to their daily life, such as getting dressed, navigating stairs, or using playground equipment, can provide insight into their gross motor abilities and limitations.

Gait analysis

Analyzing an individual's gait pattern through technology such as video analysis or motion capture systems helps assess walking patterns, symmetry, and any abnormalities in movement.

Physical examination and clinical assessments

Clinical assessments by healthcare professionals may involve testing muscle strength, range of motion, balance, coordination, and reflexes to assess gross motor function.

Questionnaires and parent/caregiver reports

Gathering information from caregivers or individuals through questionnaires or interviews provides additional insights into daily functioning, challenges faced, and limitations in gross motor skills.

Assessments of gross motor function vary based on age, developmental stage, and individual needs. They aim to identify strengths, weaknesses, and areas needing improvement, guiding interventions and therapy plans tailored to enhance gross motor skills and overall functional abilities. These assessments help track progress, guide treatment strategies, and offer insights into an individual's physical development and capabilities.

Introduction to the gross motor function measure

The Gross Motor Function Measure (GMFM) is a widely used standardized assessment tool designed to evaluate and quantify gross motor function in children with cerebral palsy (CP) or other neuromuscular conditions. It assesses a child's abilities in performing gross motor skills and activities relevant to their age and developmental stage.

The GMFM is divided into five dimensions or domains, each focusing on specific gross motor skills:

• Lying and rolling: This dimension assesses the child's ability to control head and trunk movements while lying down and rolling from side to side.
• Sitting: It evaluates the child's ability to maintain balance and control in various sitting positions, such as sitting without support or maintaining balance while reaching.
• Crawling and kneeling: Assessing the child's ability to move from lying to crawling, crawling on hands and knees, and transitioning into kneeling positions.
• Standing: This dimension measures the child's capacity to stand, stand without support, and perform various activities while standing, such as reaching or shifting weight.
• Walking, running, and jumping: It evaluates the child's ability to walk, run, jump, and perform related activities that involve mobility and coordination.

How is the GMFM scored?

The GMFM is scored using a 4-point ordinal scale to assess the gross motor abilities of children with cerebral palsy or other neuromuscular conditions across five dimensions. Each dimension contains specific items related to different gross motor skills.

The 88 and 66-item Gross Motor Function Measure (GMFM-88 and GMFM-66) are standardized assessment tools used to evaluate gross motor function in children with cerebral palsy or other neuromuscular conditions.

• GMFM-88: This version includes 88 items across five dimensions, assessing a wide range of gross motor skills in children with varying abilities. It provides a comprehensive evaluation of sitting, lying and rolling, crawling and kneeling, standing, and walking, running, and jumping.
• GMFM-66: The GMFM-66 is a subset of the GMFM-88, comprising 66 items selected from the original 88 items. It maintains the ability to assess a child's gross motor function across the same five dimensions but offers a shorter assessment time. The GMFM-66 retains strong reliability and validity similar to the GMFM-88.

Both versions of the GMFM use a scoring system to evaluate a child's abilities in performing various motor tasks. Trained professionals administer these assessments, and the scores provide insights into a child's gross motor function, helping to track progress, set therapy goals, and measure the effectiveness of interventions over time.

The GMFM-88 and GMFM-66 are valuable tools in clinical settings, guiding healthcare professionals and therapists in designing targeted interventions and therapy plans tailored to improve gross motor skills and overall functional abilities in children with motor impairments.

The scoring classification system used for the GMFM involves the following:

Scoring scale

The 4-point scoring scale ranges from 0 to 3:

• 0: The child is unable to perform the task.
• 1: The child performs the task partially or with limitations.
• 2: The child completes the task, but with some difficulty or modifications.
• 3: The child performs the task fully and independently without difficulty.

Task-specific scoring

Trained assessors observe the child's performance on each task within the five dimensions and assign the appropriate score based on the child's ability to complete the task according to the predefined criteria.

Composite scores

After scoring all items within a dimension, the scores are summed and averaged to calculate the dimension score. Each dimension receives its score, assessing the child's abilities in lying and rolling, sitting, crawling and kneeling, standing, and walking, running, and jumping.

Total score

The GMFM can also generate a motor function classification system and a total score, which is calculated by summing all dimension scores and then averaging them to obtain an overall gross motor function score.

Percentile ranks

In addition to the dimension and total scores, percentile ranks are sometimes provided, comparing the child's scores to those of a reference population of children with similar ages and conditions. These percentile ranks offer a perspective on where the child's gross motor function falls relative to their peers.

The GMFM scoring system quantitatively measures a child's gross motor function, allowing healthcare professionals, therapists, and caregivers to track progress over time, set functional goals, monitor changes, and evaluate the effectiveness of interventions and therapies targeted at improving gross motor skills.

The daily impact and implications of gross motor skills

Gross motor skills play a crucial role in everyday life, influencing an individual's ability to perform essential activities, engage in social interactions, and navigate their environment effectively. These skills impact daily life in several ways:

• Mobility and independence: Gross motor skills, such as walking, running, and climbing stairs, are fundamental for independent mobility. They allow individuals to move from one place to another, perform self-care tasks, and participate in daily routines without assistance.
• Physical fitness and health: Engaging in activities that require gross motor skills, like sports, running, or dancing, contributes to overall physical fitness and health. These activities promote cardiovascular health, muscular strength, and endurance, reducing the risk of obesity and related health issues.
• Participation in activities: Gross motor skills enable participation in recreational and leisure activities. Playing sports, riding a bicycle, swimming, or engaging in outdoor games relies on these skills, contributing to social interaction, enjoyment, and a sense of belonging.
• Academic performance: Gross motor skills indirectly influence academic performance. For instance, sitting posture and stability affect attention and focus during classroom activities. Better-developed gross motor skills can enhance a child's readiness for learning and engagement in educational tasks.
• Safety and environmental interaction: Navigating and moving safely in various environments relies on gross motor skills. These skills contribute to maintaining balance, avoiding obstacles, and responding appropriately to changing environmental demands, reducing the risk of accidents or injuries.
• Socialization and peer interaction: Gross motor skills are often integral in social settings. Children playing together, joining sports teams, or engaging in group activities rely on these skills to interact, cooperate, and build relationships with peers.
• Independence in daily tasks: Activities like dressing, grooming, cooking, or carrying objects require coordination and stability provided by gross motor skills. The ability to perform these tasks independently enhances autonomy and self-confidence.

Overall, the development and proficiency of gross motor skills significantly impact an individual's quality of life. They are essential for functional independence, physical well-being, social participation, and successful engagement in various activities, contributing to overall health, confidence, and a sense of accomplishment in daily life.