1. Gross Motor Function Classification System (GMFCS)
Kathy McKellar
Motor Growth Measures Knowledge Broker
December 2006/January 2007

2. Knowledge Broker Project
Research project through CanChild Centre for Childhood Disability Research
Co-Principal Investigators: Dianne Russell and Dr. Peter Rosenbaum
Goal: measure the effectiveness of using a knowledge broker to promote the use of motor growth measures in clinical practice
GMFCS
GMFM
Motor Growth Curves (MCG’s)

3. Overview of GMFCS Presentation
Why classify?
GMFCS: a focus on function
Development of the GMFCS
Training, how to classify kids
Clinical utility
Summary

4. Why classify? Kids with CP are a heterogeneous population
Clinicians need a quick descriptor for more information
Traditional approaches to classification: type of movement disorder; distribution of involvement; ambulatory status; severity of involvement

5. GMFCS: A Focus on Function
A standardized system to classify gross motor function of children with CP, 12 months to 12 years (Palisano et al 1997)
Classification is based on observation of the child’s self-initiated movement and need for assistive techonology and wheeled mobility
Usual performance at home, school and in the community

6. GMFCS: A Focus on Function
5 levels:
I child able to walk and run, but limited in more advanced skills
V very limited voluntary movement ability
4 age bands:
Under 2; 2-4 years; 4-6 years; 6-12 years
Work currently being done to add year age band

7. Development of the GMFCS
Phase 1: Drafting of the system
Phase 2: validity testing with clinicians using consensus process
Phase 3: Validity testing with acknowledged experts using the Delphi technique (consensus process with emphasis on the distinctions between levels)
Phase 4: Reliability testing: More reliable for children 2-12 years than for those under 2 years (Wood and Rosenbaum, 2000)

8. Training to use the GMFCS
Therapists and physicians can reliably use the GMFCS with no training, simply by reading the criteria on the brochure (available on the CanChild website (
Parents can reliably classify their children aged 6 to 12 years (Morris, Galuppi, & Rosenbaum, 2004) and 2 to 4 years (Dietrich, Abercombie, Fanning, & Bartlett , 2005) using modified forms
A 45-minute DVD provides an introduction to the system and shows videoclips of several children for each classification level

9. The GMFCS
Please refer to handouts
2 lay-outs

10. Classifying Children
Some video clips…

11. Clinical Utility
How can the GMFCS be used to optimize clinical management of kids with CP?

12. Enhances Communication
The system provides a simple and clear description of current motor ability for communication among all team members, including families
The system provides a basis from which students in the rehabilitation disciplines can better understand the range of variation in manifestation of children with CP

13. Sharpens Focus on Function
More useful than severity, type, and distribution of involvement in clinical management
Aligned with the current focus on function in rehabilitation
Consistent with the shift in focus from impairment-level variables to consideration of activity and participation (World Health Organization, 2001)

14. Other Clinical Uses of the GMFCS
Assists with treatment planning
Assists with prognosticating
Facilitates evidence-based practice
Assists with caseload distribution and resource allocation
Contributes to Continuing Competency

15. Summary
The GMFCS is: reliable, valid and easy to use in a clinical or community setting.
This is considered best practice!
Other resources available: DVD training video, foundation article, update article
Kathy is available to help!