Clinical Bottom Line
Margaret Barry Michaels, PT, PhD, PCS
School of Physical Therapy, Slippery Rock, University, Slippery Rock, Pennsylvania
Kelly Bossola, PT, MSPT
Children's Hospital of Pittsburgh of UPMC, Pine Center Specialty Care Center, Wexford, Pennsylvania
2. Vohr BR, Msall ME, Wilson D, Wright LL, McDonald S, Poole WK. Spectrum of gross motor function in extremely low birth weight children with cerebral palsy at 18 months of age. Pediatrics. 2005;116:123–129.
“How could I apply this information?”
This article highlights the utility of the Gross Motor Function Classification System (GMFCS) as a clinical and research tool. The GMFCS allows pediatric physical therapists to describe the gross motor abilities of individual children with cerebral palsy (CP) potentially improving communications among therapists providing care for children, physicians, and third-party payers. For example, indicating GMFCS level IV in a letter of medical necessity for a wheelchair may support the expected continued need for the equipment, aiding in the reimbursement process. Initially, a copy of the tool may need to be provided with such letters. A URL link to the revised and expanded version of the GMFCS is provided in the References.1
As consumers of research, understanding the GMFCS will improve therapists' ability to apply current literature to individual patients. If the subjects of a research study are identified as GMFCS level II, a clinician will not know whether the results apply to a specific patient without being able to categorize that patient at the correct level. Through appropriate classification, quality of care may improve. This article cited literature that identified relationships between GMFCS levels and hip displacement, as well as GMFCS levels and metabolic demand; both areas of research have important clinical implications for pediatric therapists.
One study concluded that the GMFCS provided a better characterization of functional impairments than a description of the number of limbs involved.2 As mentors, we can facilitate the transition from a novice to an expert clinician by allowing students to develop clear clinical pictures of levels of functional abilities and general prognoses, moving away from the more general terms of spastic diplegia and tetraplegia.
“What should I be mindful about in applying this information?”
Readers should bear in mind that the quality of literature listed in Appendix A (http://links.lww.com/PPT/A10)1 was not critiqued in this review. That being said, the electronic appendix provides an extensive array of articles relevant to the GMFCS, many of which will be of interest to clinicians. These articles appeared in peer-reviewed journals; thus, each article passed the scrutiny of that particular journal's review and publication criteria. The electronic Appendix B (http://links.lww.com/PPT/A11) provides 5 detailed charts corresponding to the 5 tables presented in the article, allowing readers to more easily identify specific articles of interest.
Clinicians are encouraged to use the scale because it has been validated and avoid the misuses found in the literature. The GMFCS is intended for use:
- only in patients with a diagnosis of CP,
- in infancy through 18 years of age (not adults), and
- as a classification scheme and not an outcome measure.
The development of clinician-researcher partnerships may direct future investigations into the clinical utility of this classification system. The GMFCS may inform further development of standards of care for children with CP.