Using the Gross Motor Function Classification System- Expanded & Revised Version (GMFCS-E&R)

Michaela is a five-year-old girl who loves ballet.  She has a diagnosis of diplegic cerebral palsy,  GMFCS level III.  What does this mean?

GMFCS Level III (Between 4th & 6th Birthday)

Children walk using a hand-held mobility device in most indoor settings. They may climb stairs holding onto a railing with supervision or assistance. Children use wheeled mobility when traveling long distances and may self-propel for shorter distances.

From the GMFCS E&R instruction guide

 

GMFCS-E&R Quick facts:

  • Five-level classification system
  • Based on the child’s self-initiated, regular movement
  • For use with children with cerebral palsy only
  • Used to classify children with CP from 1-18 years
  • Not for use to classify infants under 1 year of age
  • Not for use as an outcome measure

The Gross Motor Function Classification System (GMFCS) levels I-V are gross motor function categories for children with cerebral palsy.    This post describes what GMFCS levels I through V mean, how they are used, and some of the controversy around them. Continue reading “Using the Gross Motor Function Classification System- Expanded & Revised Version (GMFCS-E&R)”

Are You Helping a Child Move Before They are Ready? Thinking About Latency in the Context of Movement.

“Nate,   stand up”.  Nathan is five, has cerebral palsy and takes a while to prepare to move his body.  Thirty seconds or more can pass between the request to move and getting a response.  He is quiet, then there may be a quiver of movement. Sure enough, after some patience, up comes the leg and he rises to standing with only a little assistance.  In the context of the classroom, this extra waiting time is surely difficult.  Nathan either arrives late to an activity or his aide is lifting and initiating for him throughout the day and a behavioral expectation is set up.

Children with motor planning difficulty need extra time to initiate and carry out their movement.  Many of us live in a world where time is scarce and we don’t feel that we have time to wait. On the other hand, starting with the end in mind is crucial and takes a lot of training, repetition and patience.  What have you decided to do when faced with this dilemma?

Continue reading “Are You Helping a Child Move Before They are Ready? Thinking About Latency in the Context of Movement.”

How to Use the Timed Floor to Stand-Natural Test (TFTS-N)

Alina loves going to school and spending time with her classmates. She is a first grader with hemiplegic cerebral palsy (GMFCS level 1).   Alina’s typical school day involves getting up and down from circle time, getting in and out of chairs at various stations, and moving to get supplies.  As a PT coming into the classroom for the first time, you are pleased with the number of activities she joins.  However, her teacher shares concern that Alina struggles to keep up with the movement pace of the classroom.   How can you compare Alina’s classroom mobility to that of her peers?  Is there a test with norms that you can use?

TFTS-N Quick Facts:

  • 5-14 years
  • Stand-alone test for children in school environments
  • Walking at a natural pace
  • Timing begins at “go,” not when movement is initiated
  • Tape 3m apart on floor
  • Face validity:  activity of transitioning to/from floor and walking short distance.
  • Test-retest reliability: 0.871
  • Intertester reliability: 0.988

The Timed Floor to Stand-Natural (TFTS-N) test measures time as a child transitions from floor sitting to standing, walks 3m at a natural pace, turns around, walks back to the starting point and then returns to floor sitting.   The sitting position is tailor (criss-cross).   Continue reading “How to Use the Timed Floor to Stand-Natural Test (TFTS-N)”

1 Month: Starting to Lift the Head

“Jack has had tummy time every day since he was three days old.   At first he didn’t like being on his stomach, but now he is happy to play a while in this position.  He is interested in lifting his head to get his mouth on his hand.  It’s like a game to him.”

In tummy time, we want to see a progression of extension through the baby’s back over the first several months.  I’m always in awe and a little surprised at the slow but steady day-by-day progression, especially in the first month.   In the first days of tummy time the weight is on the baby’s face and it is not the most comfortable looking position, but exciting changes are on the way!

Continue reading “1 Month: Starting to Lift the Head”

3 Months: Chin Tuck

Fin is 3 1/2  months old and is learning to hold a toy between his hands.  He can tuck his chin and gaze at the toy in hands for a moment.   Why is chin tuck considered an important early developmental milestone?

The three-month-old is discovering postural control in midline.  One of the first stabilizing motions is the chin tuck.  The baby is able to stabilize the head and trunk in midline and begin to touch his hands together over the chest.  He will begin to spend moments looking down toward the hands as they are together.   Continue reading “3 Months: Chin Tuck”

How to Use the 30-Second Walk Test (30sWT)

Walking from class to the school library, Josh falls to the back of the line.   Shortly thereafter, a gap forms between Josh and the rest of his class.  He is last to arrive and gets the half-functioning computer that everyone else avoids.   As his PT,  you are there to observe, problem-solve and treat.   The computer lab is a half-minute walk from class.    His teacher comments “Is that really as fast as Josh can walk? Has it always been that way?”.  Do you have an answer for this question?

30sWT Quick Facts:

  • Age 5-17
  • natural environment
  • walking at natural pace

Josh’s slow walking speed was a major concern at the begining of the school year.  At that time you did the thirty-second walk test (30sWT) and the result was clear; he was below the 5th percentile for boys his age and off the low-end of the chart.   Although you are having this conversation right now, you think he has improved because he has propulsion and a more efficient gait. Continue reading “How to Use the 30-Second Walk Test (30sWT)”

5 Months: Sitting

“Zahra has been practicing and yesterday she sat all by herself!  Of course I had to put her in this position first, but she is so happy!  She can’t take her hands off her feet or else she falls backwards.  I put soft things all around her so she is safe, even though I’m still right there.”  

Zahra is five-months old and has attained the developmental milestone of sitting independently.  Her parents are proud and it is easy to see that Zahara is proud too.  What are the building blocks for independent sitting? Continue reading “5 Months: Sitting”