Outcome assessments in children with cerebral palsy, Part II: discriminatory ability of outcome tools

GMPMGross Impaired gross motor development and function are defining features of cerebral palsy (CP). 1 Interventions aim to optimize what the child can do (functional skills) and how they do it (movement quality).2 Both are important prerequisites for advanced motor skills related to activity and participation. Enhancement of quality of movement may be an important precursor to attainment of new gross motor skills.2 While function is the ultimate goal, identifying challenges in quality of movement helps to guide therapists to develop individualized therapy approaches to enhance function. Without measuring movement, quality changes can only be inferred from improvements in other aspects of function, such as timed walk tests, acquisition of new motor skills, or indications of greater functional skill independence. Clinicians and researchers, therefore, remain uncertain about what aspects of quality are changing and when, how, and why. 'No difference' findings in trials that failed to assess quality of movement may have missed important changes in this underlying component of motor skill.Instrumented systems quantify selected attributes of movement quality (e.g. force, amplitude, speed), but their use is limited to specialized centres. Paediatric physiotherapists typically rate quality of performance through clinical observation and Gestalt perceptions of movement.3,4 The absence of appropriate clinical instruments to evaluate movement quality was the impetus to the development of the Gross Motor Performance Measure (GMPM), 3 created through an expert consensus approach as a companion to the original Gross Motor Function Measure (GMFM-88). 5The GMPM was designed to quantify key aspects of movement quality and evaluate change in children with CP and acquired brain injury. 6 Five attributes (Alignment, and it detected change with interventions (orthopaedic surgery, rhizotomy, and ankle orthoses). 11,12The GMPM remains the only published measure that addresses multiple components of quality of gross motor skills for children with CP. Other published upper or lower extremity/total body quality of movement scales are outlined in Table SI (online supporting information). Three concerns about the GMPM are its lack of item-specific response option descriptions, the need for highly experienced raters, 8 and the small representation of motor skills (20 GMFM-88 items). While the GMPM may be suitable for a therapist who is working with a child on basic motor skills that have quality components to them (e.g. Co-ordination and Dissociated movement are relevant attributes to assess for lying/rolling and crawling skills), its evaluation of movement quality across all aspects of motor function does not align well with goals of children who are working specifically on ambulation-based skills. For these children in Gross Motor Function Classification System (GMFCS) levels I to III, evaluation of movement quality should be intensely focused on standing and walking skills with a sufficient number of items to give a complete picture of...

Section: Discussionmentioning

confidence: 99%

The Quality Function Measure: reliability and discriminant validity of a new measure of quality of gross motor movement in ambulatory children with cerebral palsy

Wright

Rosenbaum

Mesterman

et al. 2014

“…Future work from this study includes analysis of the tools' discriminatory ability, 30 the relationships among tools and their redundancy, 31 and the differences in scoring profiles of patients with hemiplegia and diplegia. 32 Future work from the longitudinal component of this study will provide data on sensitivity to change over time in both non-treatment and treatment groups.…”

Section: Discussionmentioning

confidence: 99%

Outcome assessments in children with cerebral palsy, Part I: descriptive characteristics of GMFCS Levels I to III

Oeffinger

Gorton²,

Bagley³

et al. 2007

Self Cite

This prospective cross‐sectional multicenter study assessed the relationships between Gross Motor Function Classification System (GMFCS) level and scores on outcome tools used in pediatric orthopedics. Five hundred and sixty‐two participants with cerebral palsy (CP; 339 males, 223 females; age range 4‐18y, mean age 11y 1mo [SD 3y 7mo]; 400 with diplegia, 162 with hemiplegia; GMFCS Levels I‐III;) completed the study. The Functional Assessment Questionnaire (FAQ), Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Quality of Life Inventory (PedsQL), the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Functional Independence Measure (WeeFIM), temporal‐spatial gait parameters, and O2 cost were collected during one session. Descriptive characteristics are reported by GMFCS level clinicians can use for comparison with individual children. Tools with a direct relationship between outcome scores and GMFCS levels were the PODCI Parent and Child Global Function, Transfers & Basic Mobility, and Sports and Physical Function; PODCI Parent Upper Extremity Function; WeeFIM Self‐care and Mobility; FAQ Question 1; GMFM Dimensions D and E; GMFM‐66; O2 cost; and temporal‐spatial gait parameters. Child report scores differed significantly higher than Parent scores for six of eight PODCI subscales and three of four PedsQL dimensions. Children classified into different GMFCS levels function differently.

“…[4][5][6] Inclusion criteria consisted of a diagnosis of CP; the ability to ambulate at least 15 feet with or without assistive devices; a Gross Motor Function Classification System (GMFCS) Level of I, II, or III; an age between 4 and 18 years; and literacy in English. Patients excluded were those with musculoskeletal surgery within the previous year, botulinum toxin A injections within the previous 6 months, a currently implanted and operational baclofen pump, or previous selective dorsal rhizotomy.…”

Section: Methodsmentioning

confidence: 99%

Relationships among functional outcome measures used for assessing children with ambulatory CP

Sullivan¹,

Barnes

Linton

et al. 2007

Self Cite

In ambulatory children with cerebral palsy (CP), practitioners often examine outcomes using measures related to functions necessary for daily life. The Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Outcomes Data Collection Instrument (PODCI) Parent and Child versions, Gillette Functional Assessment Questionnaire (FAQ) Walking subscale, Functional Independence Measure for Children (WeeFIM), Pediatric Quality of Life Inventory (PedsQL), temporal‐spatial gait parameters, and O2 cost during ambulation were selected for study. Cross‐sectional data were collected in a prospective multicenter study of 562 participants with CP (339 males, 223 females), between 4 and 18 years of age (mean age 11y 1mo). There were 240 classified as Gross Motor Function Classification System Level I, 196 as Level II, and 126 as Level III. The tools that had the best interrelationships and underlying constructs predominately measured changes in physical function. These included portions of the FAQ, Parent PODCI, WeeFIM, and GMFM. GMFM Dimensions D and E exhibited a very strong relationship. Temporal‐spatial gait parameters and O2 cost measures represented a different construct of physical function. The Child PODCI reports and both the Parent and Child PedsQL reports did not relate well to other measures, suggesting a pattern of answers not related to question content. The Parent PODCI, the FAQ Walking subscale, and GMFM Dimension E were found to be an appropriate minimum set of instruments for assessment of functional outcomes in patients with ambulatory CP.