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)”

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”

6 Months: Pivot Prone

“My 6-month old daughter rocks on her belly and moves her arms all around.  It looks like she is swimming on land!  What is going on while she is playing like that?”

This swimming motion, common during the development of 5-6 month olds, is also known as pivot prone.   The first time you might see something like this would be during a Landau reaction.  The Landau reaction emerges at approximately 3 months as a reflex/postural reaction, allowing the baby to extend against gravity while held at the stomach.  However, by 5-6 months of age, the baby has developed the strength and flexibility to play with it in a variety of ways while on the floor.  These new sensations and movement keep interest in the activity.  You might see a few seconds of swimming motion followed by a push into the floor or rocking back and forth.  In these actions, the baby is strengthening their postural control system to balance flexion and extension.  The difference in this stage is that the gluteals are becoming active and the hips are fully elongated.  With practice the thighs begin to come off the ground through the action of the gluteals.  During pivot prone, there is eccentric action of the abdominals as the baby extends so there is also controlled motion through the range.

During pivot prone play, the baby is strengthening and discovering:

Continue reading “6 Months: Pivot Prone”

Nice Weight Through Your Heels, Little One

“Is my baby standing OK?  It seems like he is up on his toes, and toe walking runs in my family”.

The answer to this question, of course, depends on how old the baby is and how long he or she has been on their feet.  I teach in an infant mobility class every week and have the amazing opportunity to watch children pull to stand at the big drum in the middle of the room.  How they love to pound on that drum!   I love their joy and their success.  However, as the class physical therapist, I’m also looking closely at how they are standing.  Are they up on their tip toes and leaning into the drum, or are they standing with their hips a little behind their firmly planted feet?   Continue reading “Nice Weight Through Your Heels, Little One”

What Makes a Good Quality Squat?

The couch creaks and slides every time she sits down.  “I have no control once I start to bend my legs!”, she says.  

Controlled squatting allows babies to get down to the mattress after pulling to stand in their crib.  It allows children to sit down in a chair with control.  It is the ready position,  allowing a low basketball dribble or ease while moving wet clothes from the washing machine into the dryer.    If we don’t have the required alignment, strength and endurance,  falls and crashes start to happen.  Squat with good alignment and build the strength and endurance to squat and recover over and over again in daily life. Continue reading “What Makes a Good Quality Squat?”