2. - we should be able to follow maturation after events
that are known to slow down brain development
- To measure small but important changes in motor
function of CP
Motor development may plateau for long or short
durations of time or the movements may become
atypical
5. Structure of GMFM
These gross motor milestones form the basis of GMFM
dimensions
Measurement - defined as the process of assigning
numerals to variables to represent quantities of
characteristics according to certain rules
The items are clinically relevant and show potential
responsiveness to change
6. Nature of GMFM
Evaluative - magnitude of change in function over
time or after treatment
Criterion based measures - relevant items chosen
(domain of interest) and then describing the criterion
by which the observer can assess whether that
characteristic or functional attribute is present or not
There is no comparison with general population
7. Item scoring
0 – does not initiate
1 – initiates (<10 % of the task)
2 – partially completes (10% to < 100% of the task)
3 – completes the task
NT – not tested
8. Difficulty levels
Can viewed in item maps
The difficulty of the items can be viewed by
calculation of expected scores
The expected score is the mean score of the
population
The item maps show the ability at which the given
score is expected
11. GMFM 88 and 66
88 - for Down’s
66 for CP - Identified items which did not “fit” the uni-
dimensional construct - eliminated 22 items
Items are now arranged in order of difficulty (empirical)
Response options within items are weighted according to
difficulty
GMFM is appropriate for children whose motor skills are at or
below those of a typical 5 year old
12. Scoring with aids/orthotics
First complete the GMFM without the aid/orthosis, then
retest with aid/orthosis
For repeat testing at a later dater, apply the same aid
at the same item number
Aids/orthoses could have positive and negative
effects
Mark an “A” for the aided score on the score sheet
13. Scoring with aids/orthotics
Consider what information you are trying to obtain – is
it new orthoses or a walker or both
Entire GMFM does not need to be repeated with aids
and orthoses
It is assumed that aids are intended to assist in
standing or ambulating in standing
Test only when standing is included in the item or
where it may be a part of transition between two
items
14. Please note !
Only following items should be considered when
testing with aids –
Sitting - items 35, 36, 37
Standing – All items
Walking, running and jumping – All items provided criteria
of each score is observed (other than arms free)
e.g. – for item 69 - aid may used to assist in standing and
walking but other criteria of each score should be
observed
“1” – child may use aid to assist in walking forward <3
steps
15. Testing with orthoses
Orthoses can be applied in any dimension
With some children it would good to use in some
lower dimensions - that would help in knowing the
positive and the negative impact on gross motor
function
It is expected that orthoses would great impact on
scores where the person has to stand “arms free”
18. GMFM – 66 B&C
GMFM-66 B&C used 16-17 items for testing, compared
to the GMFM-66-IS, which used 32-33 items
Scores obtained from these 2 versions were highly
correlated when done on the same or different
occasions with the child
Fewer items - when using the GMFM-66-B&C and
these items were more suitable to the individual child’s
abilities
When you have difficulties in making decisions about
which item set to test when using the GMFM-66-IS
19. Advantage ?
Using a shorter motor assessment will provide more
time to assess other aspects of the child and family
Consider using a shorter version to document motor
function in a more efficient manner by assessing items
around a child’s ability level
20. GMFM - as an outcome
measure
Surgery
Drugs (botulinum toxin, intrathecal baclofen)
Physical therapy (including ambulatory aids &
orthoses)
Horseback riding
Strength training & physical fitness
22. Equipments
Need smooth floor, large firm exercise mat, toys for
motivation, large bench or table for cruising
Five steps with railing
Wheeled stool
Tape
Ruler
24. SUP, HEAD IN MIDLINE: TURNS HEAD
WITH EXTREMITIES SYMMETRICAL
Score Description
0 Does not
maintain head in
midline
1 Maintains head
in midline 1-3 sec
2 Maintains head
in midline, turns
head with
extremities
asymmetrically
3 Turns head with
extremities
symmetrical
1.
25. SUP: BRINGS HANDS TO MIDLINE,
FINGERS ONE WITH THE OTHER
Score Description
0 Does not initiate
bilateral hands to
midline
1 Initiates bilateral
hands to midline
2 Brings hands to
front of the body,
does not finger
one with the
other
3 Brings hands to
mid-line fingers
one with the
other
2.
26. SUP: LIFTS HEAD 45 degrees
Score Description
0 Does not initiate
neck flexion
1 Initiates neck
flexion but does
not lift head
2 Lifts head <45
deg
3 Lifts head 45 deg
3.
27. SUP: FLEXES R/L HIP & KNEE THROUGH
FULL RANGE
Score Description
0 Does not initiate
R/L hip & knee
flexion
1 Initiates R/L hip &
knee flexion
2 Flexes R/L hip &
knee through
partial range
3 Flexes R/L hip &
knee through full
range
4/5.
28. SUP: REACHES OUT WITH R/L ARM,
HAND CROSSES MIDLINE TOWARD TOY
Score Description
0 Does not initiate
reaching towards
midline
1 Initiates reaching
towards midline
2 Reaches out with
R/L arm, hand
does not cross
midline
3 Reaches out with
R/L arm, hand
crosses midline
toward toy
6/7.
29. SUP: ROLLS TO PR OVER R/L SIDE
Score Description
0 Does not initiate
rolling
1 Initiates rolling
2 Rolls part way to
prone
3 Rolls to prone
over R/L side
8/9.
30. PR: LIFTS HEAD UPRIGHT
Score Description
0 Does not initiate
reaching towards
midline
1 Initiates reaching
towards midline
2 Reaches out with
R arm, hand does
not cross midline
3 Reaches out with
R arm, hand
crosses midline
toward toy
10.
32. PR ON FOREARMS: LIFTS HEAD
UPRIGHT, ELBOWS EXT., CHEST RAISED
Score Description
0 Does not initiate
head lifting
1 Initiates head
lifting chin does
not clear mat
2 Lifts head, does
not attain up
right, weight on
forearms
3 Lifts head upright,
elbows extended,
chest raised
11.
33. PR ON FOREARMS: WEIGHT ON R/L
FOREARM, FULLY EXTENDS OPPOSITE
ARM FORWARD
Score Description
0 Does not initiate
supporting wt. on
R/L forearm
1 Wt. on R/L forearm,
opposite arm
comes free does
not extend forward
2 Wt. on R/L forearm,
partially extends
opposite arm
forward
3 Wt. on R/L forearm,
fully extends
opposite arm
forward
12/13.
34. PR: ROLLS TO SUP OVER R/L SIDE
Score Description
0 Does not initiate
rolling
1 Initiates rolling
2 Rolls part to supine
3 Rolls to supine over
R/L side
14/15.
35. PR: PIVOTS TO R/L 90 degrees
USING EXTREMITIES
Score Description
0 Does not initiate
pivot to R/L
1 Initiates pivot to
R/L using
extremities
2 Pivots to R/L <90
deg using
extremities
3 Pivots to R/L 90
deg using
extremities
16/17.
36. SUP, HANDS GRASPED BY EXAMINER:
PULLS SELF TO SITTING WITH HEAD
CONTROL
Score Description
0 Does not initiate
Head control
when pulled to
sitting
1 initiates Head
control when
pulled to sitting
2 Assists with pulling
to sitting, head
control present
part of the time
3 Pulls self to sitting
with head control
18.
37. SUP: ROLLS TO R/L SIDE, ATTAINS
SITTING
Score Description
0 Does not initiate
sitting from right
side lying
1 Roles to R/ L side,
sitting
2 Roles to R/ L side,
partially attains
sitting
3 Roles to R/L side,
attains sitting
19/20.
38. SIT ON MAT, SUPPORTED AT THORAX BY
THERAPIST: LIFTS HEAD UPRIGHT,
MAINTAINS 3 SECONDS
Score Description
0 Does not initiate
Head lift
1 Initiates head lift
2 Lifts head, does
not attain upright,
holds 3 seconds
3 Lifts head upright,
maintains 3
seconds
21.
39. SIT ON MAT, SUPPORTED AT THORAX BY
THERAPIST: LIFTS HEAD MIDLINE,
MAINTAINS 10 SECONDS
Score Description
0 Does not initiate
Head lift
1 Initiates head lift,
but does not
attain midline
2 Lifts head to
midline, maintains
< 10 seconds
3 Lifts head to
midline, maintains
10 seconds
22.
40. SIT ON MAT, ARM(S) PROPPING:
MAINTAINS, 5 SECONDS
Score Description
0 Does not
maintains with
arm(s) propping
1 Maintains < 1
second
2 Maintains 1-4
second
3 Maintains 5
second
23.
41. SIT ON MAT: MAINTAIN, ARMS FREE, 3
SECONDS
Score Description
0 Does not
maintain unless
both arms
propping
1 Maintain, one
arm propping
2 Maintains arms
free, < 3 seconds
3 Maintains arms
free, 3 seconds
24.
42. SIT ON MAT SMALL TOY IN FRONT:
LEANS FORWARD, TOUCHES TOY, RE-
ERECTS WITHOUT ARM PROPPING
Score Description
0 Does not initiate
leaning forward
1 Leans forward,
does not re-erect
2 Leans forward,
touches toy, re-
erects with arms
propping
3 Leans forward,
touches toy, re-
erects without
arms propping
25.
43. SIT ON MAT: TOUCHES TOY PLACED 45°
BEHIND CHILD’S R/L SIDE, RETURNS TO
START
Score Description
0 Does not initiate
touching toy
1 Initiates reaching
does not reach
behind
2 Reaches behind,
does not touch
toy or return to
start
3 Touches toy
placed 45 deg.
behind child’s
right / left side,
returns to start
26/27.
44. R/L SIDE SIT: MAINTAINS, ARMS
FREE, 5 SECONDS
Score Description
0 Does not
maintain R/L side
sitting
1 Maintains, both
arms propping, 5
seconds
2 Maintains, R/L
arm propping, 5
seconds
3 Maintains, arm
free, 5 seconds
28/29.
45. SIT ON MAT: LOWERS TO PR WITH
CONTROL
Score Description
0 Does not initiate
lowering to prone
1 Initiates lowering
to prone
2 Lowers to prone
but crashes
3 Lowers to prone
with control
30.
46. SIT ON MAT WITH FEET IN FRONT:
ATTAINS 4 POINT OVER R/L SIDE
Score Description
0 Does not initiate 4
point over R/L
side
1 Initiates 4 point
over R/L side
2 Partially attains 4
point over R/L
side
3 Attains 4 point
over R/L side
31/32.
47. SIT ON MAT: PIVOTS 90 degrees,
WITHOUT ARMS ASSISTING
Score Description
0 Does not pivoting
1 Initiates pivot
2 Pivots 90 degrees
with arms assisting
3 Pivots 90 degrees
without arms
assisting
33.
48. SIT ON BENCH: MAINTAINS, ARMS AND
FEET FREE, 10 SECONDS
Score Description
0 Does not
maintain sitting
on bench
1 Maintains, arms
propping and
feet supported,
10 seconds
2 Maintains, arms
free and feet
supported, 10
seconds
3 Maintains, arms
free and feet
free, 10 seconds
34.
49. STD: ATTAINS SIT ON SMALL BENCH
Score Description
0 Does not initiate
sitting on small
bench
1 Initiates sitting on
small bench
2 Partially attains
sitting on small
bench
3 Attains sitting on
small bench
35.
50. ON THE FLOOR: ATTAINS SIT ON SMALL
BENCH
Score Description
0 Does not initiate
sitting on small
bench
1 Initiates sitting on
small bench
2 Partially attains
sitting on small
bench
3 Attains sitting on
small bench
36.
51. STD: ATTAINS SIT ON LARGE BENCH
Score Description
0 Does not initiate
sitting on large
bench
1 Initiates sitting on
large bench
2 Partially attains
sitting on large
bench
3 Attains sitting on
large bench
37.
53. PR: CREEPS FORWARD 1.8m (6')
Score Description
0 Does not initiate
creeping forward
1 creeps forward
<60cms
2 creeps forward
60cms – 1.5m
3 creeps forward
1.8 m
38.
54. 4 POINT: MAINTAINS, WEIGHT ON
HANDS AND KNEES, 10 SECONDS
Score Description
0 Does not
maintain weight
on hands and
knees
1 Maintains weight
on hands and
knees, < 3 sec
2 Maintains weight
on hands and
knees, 3 - 9 sec
3 Maintains weight
on hands and
knees, 10sec
39.
55. 4 POINT: ATTAINS SIT ARMS FREE
Score Description
0 Does not initiate
sitting
1 Initiates sitting
2 Attains sitting,
arm(s) propping
3 Attains sitting,
arms free
40.
56. PR: ATTAINS 4 POINT, WEIGHT ON
HANDS AND KNEES
Score Description
0 Does not initiate 4
point
1 Initiates 4 point
2 Partially attains 4
point
3 Attains 4 point,
weight on hands
and knees
41.
57. 4 POINT: REACHES FORWARD WITH R/L
ARM, HAND ABOVE SHOULDER LEVEL
Score Description
0 Does not initiate
reaching forward
with R/L arm
1 Initiates reaching
forward with R/L
arm
2 Partially reaches
forward with R/L
arm
3 Reaches forward
with R/L arm,
hand above
shoulder level
42/43.
58. 4 POINT: CRAWLS OR HITCHES
FORWARD 1.8m(6')
Score Description
0 Does not initiate
crawling or
hitching forward
1 Crawls or hitches
forward forward
<60cms
2 Crawls or hitches
forward 60cms –
1.5m
3 Crawls or hitches
forward 1.8 m
44.
60. 4 POINT: CRAWLS UP 4 STEPS ON
HANDS AND KNEES/FEET
Score Description
0 Does not initiate
crawling up 4
steps
1 Crawls up one
step on hands
and knees/feet
2 Crawls up two or
three step on
hands and
knees/feet
3 Crawls up four
step on hands
and knees/feet
46.
61. 4 POINT: CRAWLS BACKWARDS DOWN
4 STEPS ON HANDS AND KNEES/FEET
Score Description
0 Does not initiate
crawling
backwards down
steps
1 Crawls backward
down one step
on hands and
knees / feet
2 Crawls backward
down 2 or 3 step
on hands and
knees / feet
3 Crawls backward
down 4 step on
hands and knees
/ feet
47.
62. SIT ON MAT: ATTAINS HIGH KN USING
ARMS, MAINTAINS, ARMS FREE, 10
SECONDS
Score Description
0 When placed
does not
maintain, holding
on
1 When placed
maintains,
holding on 10 sec
2 Attains high
kneel, holding on,
maintains 10 sec
3 Attains high
kneel, using arms,
maintains arms
free for 10 sec
48.
63. HIGH KN: ATTAINS HALF KN ON R/L
KNEE USING ARMS, MAINTAINS, ARMS
FREE, 10 SECONDS
Score Description
0 When placed
does not
maintain, holding
on
1 When placed
maintains,
holding on 10 sec
2 Attains half kneel,
holding on,
maintains 10 sec
3 Attains half kneel,
using arms,
maintains arms
free for 10 sec
49/50.
64. HIGH KN: KN WALKS FORWARD 10
STEPS, ARMS FREE
Score Description
0 Does not initiate
kneel walking
forward
1 Kneel walks
forwards 10 steps,
two hands
holding on
2 Kneel walks
forwards 10 steps,
one hand holding
on
3 Kneel walks
forwards 10 steps,
arms free
51.
66. 52. ON THE FLOOR: PULLS TO STD AT
LARGE BENCH
Score Description
0 Does not initiate
pulling to stand
1 Initiates pulling to
stand
2 Partially pulls to
stand
3 Pulls to stand at
large bench
52.
67. STD: MAINTAINS, ARMS FREE, 3
SECONDS
Score Description
0 Does not
maintain standing
holding on
1 Maintains, 2
hands holding on,
3 sec
2 Maintains, one
hand holding on,
3 sec
3 Maintains, arms
free, 3 sec
53.
68. STD: HOLDING ON TO LARGE BENCH
WITH ONE HAND, LIFTS R/L FOOT, 3
SECONDS
Score Description
0 Does not initiate
lifting R/L foot
1 Holding on to
large bench with
2 hands, lifts R/L
foot < 3 sec
2 Holding on to
large bench with
2 hands, lifts R/L
foot, 3 sec
3 Holding on to
large bench with
1 hand, lifts R/L
foot, 3 sec
54/55.
71. SIT ON SMALL BENCH: ATTAINS STD
WITHOUT USING ARMS
Score Description
0 Does not initiate
sanding
1 Initiates sanding
2 Attains standing
using arms
3 Attains standing
without using
arms
59.
72. HIGH KN: ATTAINS STD THROUGH HALF
KN ON R KNEE, WITHOUT USING ARMS
Score Description
0 Does not initiate
sanding
1 Initiates sanding
2 Attains standing
using arms
3 Attains standing
through half kneel
on R/L knee
without using
arms
60/61.
73. STD: LOWERS TO SIT ON FLOOR WITH
CONTROL, ARMS FREE
Score Description
0 Does not lower to
floor
1 Lowers to sitting
on floor, but
‘crashes’ down
2 Lowers to sitting
on floor with
control, using
arm(s) or holding
on
3 Lowers to sitting
on floor with
control, arms free
62.
74. STD: ATTAINS SQUAT, ARMS FREE
Score Description
0 Does not initiate
squat
1 Initiates squat
2 Attains squat,
using arm(s) or
holding on
3 Attains squat,
arms free
63.
75. STD: PICKS UP OBJECT FROM FLOOR,
ARMS FREE, RETURNS TO STAND
Score Description
0 Does not initiate
picking up object
from the floor
1 Initiates picking
up object from
the floor
2 Picks up object
from the floor
using arm(s) or
holding on
3 Picks up object
from the floor ,
arms free, returns
to standing
64.
77. STD, 2 HANDS ON LARGE BENCH:
CRUISES 5 STEPS TO R/L
Score Description
0 Does not initiate
cruising to R/L
1 Initiates cruising,
<1 complete step
to R/L
2 Cruises 1-4 steps
to R/L
3 Cruises 5steps to
R/L
65/66.
83. STD: WALKS FORWARD 10 STEPS,
CARRYING A LARGE OBJECT WITH 2
HANDS
Score Description
0 Does not initiate
walking, carrying
large object
1 Walks forward 10
steps, carrying
small object with
1 hand
2 Walks forward 10
steps, carrying
small object with
2 hands
3 Walks forward 10
steps, carrying
large object with
2 hands
72.
85. STD: WALKS FORWARD 10
CONSECUTIVE STEPS ON A STRAIGHT
LINE 2cm (3/4") WIDE
Score Description
0 Does not initiate
walking forward
on a straight line
2 cm wide
1 Walks <3 consec
utive steps
2 Walks 3-9 consec
utive steps
3 Walks 10 consec
utive steps
74.
86. STD: STEPS OVER STICK AT KNEE LEVEL,
R/L FOOT LEADING
Score Description
0 Does not initiate
stepping over
stick R/L foot
leading
1 Steps over sick 5-
7.5 cm high R/L
foot leading
2 Steps over sick at
mid-calf level R/L
foot leading
3 Steps over sick at
knee level R/L
foot leading
75/76.
87. STD: RUNS 4.5m (15’), STOPS & RETURNS
Score Description
0 Does not initiate
running
1 Initiates running
by walking
quickly
2 Runs < 4.5 m (15ft)
3 Runs < 4.5 m
(15ft), stops and
returns
77.
88. STD: KICKS BALL WITH R/L FOOT
Score Description
0 Does not initiate
kicking
1 Lifts R/L foot, does
not kick
2 Kicks ball with R/L
foot but falls
3 Kicks ball with R/L
foot
78/79.
89. STD: JUMPS 30cm (12") HIGH, BOTH
FEET SIMULTANEOUSLY
Score Description
0 Does not initiate
Jump
1 Jumps < 5 cm
high both feet
simultaneously
2 Jumps 5 – 28 cm
high both feet
simultaneously
3 Jumps 30 cm high
both feet
simultaneously
80.
90. STD: JUMPS FORWARD 30 cm (12"),
BOTH FEET SIMULTANEOUSLY
Score Description
0 Does not initiate
jumping forward,
both feet
simultaneously
1 Jumps forward
<5cm both feet
simultaneously
2 Jumps forward 5-
28 cm both feet
simultaneously
3 Jumps forward 30
cm both feet
simultaneously
81.
91. STD ON R/L FOOT: HOPS ON R/L FOOT
10 TIMES WITHIN A 60cm (24") CIRCLE
Score Description
0 Does not initiate
hopping on R/L
foot
1 Hops on R/L foot
< 3 times within a
60 cm circle
2 Hops on R/L foot
3 – 9 times within
a 60 cm circle
3 Hops on R/L foot
10 times within a
60 cm circle
82.
94. STD ON 15cm (6") STEP: JUMPS OFF,
BOTH FEET SIMULTANEOUSLY
Score Description
0 Does not initiate
jumping off step,
both feet
simultaneously
1 Jumps off step,
both feet simult -
aneously, but falls
2 Jumps off step,
both feet simult -
aneously, uses
hands on floor to
avoid falling
3 Jumps off, both
feet
simultaneously
88.