Gross Motor Function Classification System: impact and utility

Abstract

The Gross Motor Function Classification System (GMFCS) was developed in response to the need to have a standardized system to measure the 'severity of movement disability' in children with cerebral palsy (CP). 1 The Surveillance of Cerebral Palsy in Europe classification ably describes the primary neurological impairment, subtypes, and topography of body involvement but currently includes non-standardized estimations of the degree of functional limitation. 2 The reliability of other classification systems that measure functional ability such as 'mild', 'moderate' and 'severe', or 'restricted walking', 'walking with aids' or 'non-walking', or 'household and community ambulator' have not, to our knowledge, been evaluated.Palisano and colleagues 1 used the underlying construct of self-initiated functional abilities in sitting and walking and the need for assistive devices, such as walkers or wheelchairs, to develop a new system, and set out to test its validity and reliability.The GMFCS now provides a method of describing the functional ability of children with CP in one of five levels.Children in Level I can perform all the activities of their agematched peers, albeit with some difficulty with speed, balance, and coordination; children in Level V have difficulty controlling their head and trunk posture in most positions and in achieving any voluntary control of movement.Over the past few years the developers of the GMFCS have provided further evidence of the measurement properties of the system and it is being widely used.Here we systematically review publications that have cited the GMFCS, to describe the state of our knowledge about its properties and to describe its impact in the fields of research, clinical practice, and education to enhance our understanding of children with CP. Search strategyWe searched MEDLINE (PubMed), CINAHL and AMED (Ovid) and Recal (www.recal.org.uk), and the internet search engine Google, using the terms 'Gross Motor Function Classification System' or 'GMFCS'.We also searched the Science Citation Index (Institute for Scientific Information Web of Science) for papers citing the original 1997 reference by Palisano and colleagues. 1 In addition to journal articles, we were interested in abstracts from specialist conferences to provide a more detailed description of the current uptake of the GMFCS, by taking into account the delay in getting research published.The Recal database was searched because it catalogues some of the abstracts from the American and European CP related conferences published in 'Developmental Medicine & Child Neurology' and 'Gait and Posture'.We supplemented this by hand searching and also asked the developers if they knew of any publications that we had not otherwise identified.The search concluded at the end of June 2003. ResultsIn total we found 102 citations, including 75 journal articles published in English, 22 abstracts that had not been published in full, 2 editorials and 3 letters.There were three articles published in languages other than English: one each in French, Spanish, and Portuguese, which we did not retrieve.After the initial publication of the GMFCS in 1997, there were 9 references during 1998/9 (including 5 journal articles), then 14 references in 2000 (including 11 journal articles), 26 in 2001 (including 21 journal articles), and 41 in 2002 (including 31 journal articles).