Gross Motor Performance Measure (GMPM) 대구보건대학교고주연 PhD. RPT in NY, USA

Transcription

1 Gross Motor Performance Measure (GMPM) 대구보건대학교고주연 PhD. RPT in NY, USA

2 GMPM Purpose Age range To evaluate change over time in gross motor performance (quality of movement) in CP children o CP children from 5 months to 12 years Areas tested o 20 items (3 static & 17 dynamic items) Time o 5 attributes of gross motor performance o Alignment o Coordination o Dissociated movement o Stability o Weight shift o 45 to 60 minutes Scoring o 5 point Likert scale (1,2,3,4,5) o % Limitations o Requires training and practice to administer

3 GMPM 5 attributes o Alignment The adjustment or arrangement of parts or segments of the body in relation to each other. o Coordination The smooth and controlled use of movements in motor performance. This takes into account timing, velocity, direction, force, and amplitude. o Dissociated movement Isolated movement. Movement that combines components if different motor patterns (i.e., extension of the hip with flexion of the knee). o Stability The active maintenance of a body position in the presence of disturbing forces.cc o Weight shift Movement that involves a transfer of the body s center of gravity; posteriorly, laterally, anteriorly, vertically

4 GMPM Scoring o 1 Severe the majority of the time o 2 Moderate the majority of the time; severe or mild sometimes o 3 Mild the majority of the time; never severe o 4 At least one trial with no evidence of movement pathology in the body part(s) being assessed o 5 All three trials within normal variations; No evidence of movement pathology in the body part(s) being assessed; freedom and variation in movement; Efficient; Normal effort and timing

5 GMPM Administration o GMFM based performance testing o Items should be tested in the order given. o Practical trial Three test trial o Spontaneous performance of an item can be scored. o Verbal encouragement or demonstration is permitted. o The score assigned will be based on the average performance observed over the three trials. o At least 10 seconds rest between trials o Simple cloth and shoes off o All items in Lying, Rolling, Sitting, Crawling and kneeling are on the floor. o All Standing, Running, and Jumping activities on the floor. o Equipment (based on the GMFM)

6 A. 눕기와뒤집기 8/9. 바로누운자세 : 오른쪽 / 왼쪽으로뒤집는다 0. 뒤집기를시작하지못한다 1. 뒤집기를시작한다 2. 부분적으로뒤집는다 3. 오른쪽 ( 왼쪽 ) 으로엎드린자세까지뒤집는다 o Alignment of Head and Trunk Adjustment or arrangement of the head and trunk in relation to each other o Coordination Smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Stability in pelvis and lower extremities The active maintenance of a body position in the presence of disturbing forces (e.g., lifting of one leg)

7 A. 눕기와뒤집기 11. 전완으로지지하고엎드려누운자세 : 머리를똑바로들고, 팔꿈치는펴고, 가슴을들어올린다 0. 머리들기를시도하지못한다 1. 머리들기를시작하지만, 턱이매트에서떨어지지않는다 2. 머리를들지만, 똑바로들지못하고전완으로체중을지지한다 3. 머리를똑바로들고, 두팔꿈치는펴고, 가슴을들어올린다 o Alignment of head and trunk Adjustment of the head and trunk in relation to each other o Alignment of the upper extremities Adjustment or arrangement of the shoulder girdle, arm and hand in relation to each other. If the score is not equal bilaterally, score the more involved side only. o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

8 A. 눕기와뒤집기 12/13. 전완으로지지하고엎드려누운자세 : 오른쪽 / 왼쪽전완으로체중을지지하고왼팔 / 오른팔을앞으로완전히편다 0. 오른쪽 / 왼쪽전완으로체중을지지하지못한다 1. 오른쪽 / 왼쪽전완으로체중을지지하여왼팔 / 오른팔이자유롭지만앞으로펴지못한다 2. 오른쪽 / 왼쪽전완으로체중을지지하고왼팔 / 오른팔을앞으로부분적으로편다 3. 오른쪽 / 왼쪽전완으로체중을지지하고왼팔 / 오른팔을앞으로완전히편다 o Alignment of trunk and UE on weight bearing side Adjustment of the trunk and UE in relation to each other o Dissociated move. of sh. girdle and elbow of reaching UE Dissociation of the arm from the shoulder girdle Shoulder flexion with elbow extension o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

9 A. 눕기와뒤집기 16. 엎드려누운자세 : 팔 다리를움직여오른쪽 / 왼쪽으로 90 까지방향을돌린다 (pivoting) 0. 오른쪽 / 왼쪽으로방향돌리기를시작하지못한다 1. 팔 다리를움직여오른쪽 / 왼쪽으로방향돌리기를시작한다 2. 팔 다리를움직여오른쪽 / 왼쪽으로 90 미만으로방향을돌린다 3. 팔 다리를움직여오른쪽 / 왼쪽으로 90 까지방향을돌린다 o Alignment of UE Adjustment of the UE segments in relation to each other o Coordination The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

10 B. 앉기 *22. 치료사가흉곽을지지하고매트에앉은자세 : 머리를신체중심선으로들고 10초동안유지한다 0. 머리들기를시작하지못한다 1. 머리들기를시작하지만, 고개가신체중심선에있지않다 2. 머리를신체중심선으로들고 10초미만으로유지한다 3. 머리를신체중심선으로들고 10초동안유지한다 o Alignment of the head and neck Adjustment of the head and neck in relation to each other o Alignment of the shoulder girdle and trunk Adjustment of the shoulder girdle and trunk in relation to each other o Stability in head, neck, and shoulder girdle The active maintenance of head, neck, and shoulder girdle position in the presence of disturbing forces

11 B. 앉기 *25. 작은장난감을앞에두고매트에앉은자세 : 몸을앞으로기울여장난감을만지고, 팔로지탱하지않고다시몸통을세워앉는다 0. 몸을앞으로기울이기를시작할수없다 1. 몸을앞으로기울이지만, 다시몸통을세워앉지못한다 2. 몸을앞으로기울여장난감을만진후팔로지탱해서다시몸통을몸통을세워앉는다 3. 몸을앞으로기울여장난감을만지고팔로지탱하지않고다시몸통을세워앉는다 o Alignment of trunk and pelvis Adjustment of the trunk and pelvis in relation to each other o Dissociated movement if the reaching upper extremity Isolated movement (dissociation of the arm from the shoulder girdle); combination of different motor component (shoulder flexion with elbow extension) o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical ) or any combination of these

12 B. 앉기 *31/32. 매트위에양발을앞으로펴고앉은자세 : 오른쪽 ( 왼쪽 ) 으로네발자세를취한다 0. 오른쪽 ( 왼쪽 ) 으로네발자세취하기를시작하지못한다 1. 오른쪽 ( 왼쪽 ) 으로네발자세를취하기시작한다 2. 오른쪽 ( 왼쪽 ) 으로네발자세를부분적으로취한다 3. 오른쪽 ( 왼쪽 ) 으로네발자세를취한다 o Alignment of trunk and pelvis Adjustment of the trunk and pelvis in relation to each other o Coordination of pelvis and lower extremity (LE) The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Stability of upper extremity on designated side The active maintenance of the UE position in the designated side in the presence of disturbing forces (i.e., movement of the rest of the body)

13 B. 앉기 *34. 벤치에앉은자세 : 양팔과발로지탱하지않고 10초동안유지한다 0. 벤치에앉은자세를유지하지못한다 1. 양팔을짚고양발로지탱하여 10초동안유지한다 2. 양팔은자유롭지만, 양발로지탱하여 10초동안유지한다 3. 양팔과양발로지탱하지않고 10초동안유지한다 o Alignment of head and shoulder girdle Adjustment of the head and shoulder girdle in relation to each other o Alignment of trunk and pelvis Adjustment of the trunk and pelvis in relation to each other o Stability The active maintenance of a body position in the presence of disturbing forces (e.g., the lifting of one leg)

14 C. 네발기기와무릎서기 *39. 네발자세 : 양손과양무릎으로체중을지지하고 10초동안유지한다 0. 양손과양무릎으로체중을지지하지못한다 1. 양손과양무릎으로 3초미만의체중지지를유지한다 2. 양손과양무릎으로 3~9초동안체중지지를유지한다 3. 양손과양무릎으로 10초동안체중지지를유지한다 o Alignment of upper extremities and trunk Adjustment of the upper extremity segments in relation to each other o Alignment of lower extremities Adjustment of the pelvis, legs, and feet in relation to each other o Stability The active maintenance of a body position in the presence of disturbing forces (e.g., the lifting of one leg)

15 C. 네발기기와무릎서기 *41. 엎드려누운자세 : 네발자세를취하고, 양손과양무릎으로체중을지지한다 0. 네발자세를시작하지못한다 1. 네발자세를시작한다 2. 네발자세를부분적으로취한다 3. 네발자세를취하고양손과무릎으로체중을지지한다 o Alignment of upper extremities and trunk Adjustment of the head and upper extremities in relation to each other o Coordination The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

16 C. 네발기기와무릎서기 *45. 네발자세 : 앞으로 1.8m 교대로네발기기한다 0. 앞으로교대로네발기기를시작하지못한다 1. 교대로네발기기하여 60cm 미만으로앞으로나간다 2. 교대로네발기기하여 60cm~1.5m 앞으로나간다 3. 교대로네발기기하여 1.8m 앞으로나간다 o Coordination The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Dissociated movement of lower extremities Isolated movement (LE/trunk, between LE segments); combination of different motor component (hip and knee flexion with plantar flexion) o Stability in upper extremities The active maintenance of upper extremity position in the presence of disturbing forces (i.e., movement of the rest of the body)

17 C. 네발기기와무릎서기 50. 무릎서기자세 : 양팔을이용해서왼쪽반무릎서기자세를취한후, 양팔을자유롭게 자세를 10초동안유지한다 0. 왼쪽반무릎서기자세를만들어주어도유지하지못한다 1. 왼쪽반무릎서기자세를만들어주면잡고 10초동안유지한다 2. 팔을이용해왼쪽반무릎서기자세를취한상태로 10초동안유지한다 3. 팔을이용해왼쪽반무릎서기자세를취한후, 양팔을자유롭게 자세를 10초동안유지한다 o Alignment of trunk and pelvis Adjustment of the trunk and pelvis in relation to each other o Dissociated movement of lower extremities Isolated movement (LE/trunk, between LE segments); combination of different motor component o Stability in trunk and lower extremity The active maintenance of trunk and lower extremity position in the presence of disturbing forces (e.g., movement onto right foot)

18 D. 서기 *54/55. 선자세 : 한손으로큰벤치를잡고, 3 초동안오른발 ( 왼발 ) 을든다 0. 오른발 ( 왼발 ) 들기를시작하지못한다. 1. 양손으로큰벤치를잡고, 3 초미만으로오른발 ( 왼발 ) 을든다 2. 양손으로큰벤치를잡고, 3 초동안오른발 ( 왼발 ) 을든다 3. 한손으로큰벤치를잡고, 3 초동안오른발 ( 왼발 ) 을든다 o Alignment of the weight bearing lower extremity Adjustment of the weight-bearing LE segments in relation to each other o Stability The active maintenance of body position in the presence of disturbing forces (e.g., the lifting of one leg) o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

19 D. 서기 *56. 선자세 : 양팔을자유롭게, 20초동안서서유지한다 0. 양팔이자유로운상태로선자세를유지하지못한다 1. 양팔을자유롭게, 3초미만으로선다 2. 양팔을자유롭게, 3~19초동안선다 3. 양팔을자유롭게, 20초동안선다 o Alignment of head, neck and trunk Adjustment of head and trunk in relation to each other o Alignment of lower extremities Adjustment of the LE segments in relation to each other o Stability The active maintenance of body position in the presence of disturbing forces (e.g., the lifting of one leg)

20 D. 서기 *60. 무릎서기자세 : 팔을사용하지않고오른쪽반무릎서기자세를거쳐일어선다 0. 일어서기를시작하지못한다 1. 일어서기를시작한다 2. 한팔혹은양팔을이용해서일어선다 3. 양팔을사용하지않고오른쪽반무릎서기자세를거쳐일어선다 o Coordination The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Dissociated movement Isolated movement (one limb/another limb; one segment of a limb or trunk/another segment); combination of different motor components (extension of hip with flexion of knee) o Stability of trunk and right lower extremity The active maintenance of the trunk and right LE in the presence of disturbing forces (i.e., movement onto the left foot)

21 D. 서기 *62. 선자세 : 양팔이자유로운상태로자세를조절하며마룻바닥으로내려앉는다 0. 마룻바닥으로내려앉기를시작하지못한다 1. 마룻바닥에털썩주저앉는다 2. 한팔혹은양팔을사용해자세를조절하며마룻바닥으로내려앉는다 3. 양팔이자유로운상태로자세를조절하며마룻바닥으로내려앉는다 o Coordination The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Stability The active maintenance of the trunk and right LE in the presence of disturbing forces (e.g., the lifting of one leg) o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

22 E. 걷기, 달리기그리고깡충뛰기 *65/66. 양손으로큰벤치잡고선자세 : 오른쪽 / 왼쪽옆으로 5 발짝간다 0. 오른쪽 / 왼쪽옆으로걸음떼기를시작하지못한다 1. 오른쪽 / 왼쪽옆으로걸음떼기를시작해서 1 발짝미만간다 2. 오른쪽 / 왼쪽옆으로 1~4 발짝간다 3. 오른쪽 / 왼쪽옆으로 5 발짝간다 o Alignment of lower extremities Adjustment of the pelvis, legs, and feet in relation to each other o Coordination The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

23 E. 걷기, 달리기그리고깡충뛰기 *69. 선자세 : 앞으로 10 걸음걷는다 0. 앞으로걷기를시작하지못한다 1. 앞으로 3 걸음미만걷는다 2. 앞으로 3~9 걸음걷는다 3. 앞으로 10 걸음걷는다 o Coordination The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Dissociated movement of lower extremities Isolated movement (LE/trunk, LE segments/segments); combination of different motor components o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

24 E. 걷기, 달리기그리고깡충뛰기 *71. 선자세 : 뒤로 10 걸음걷는다 0. 뒤로걷기를시작하지못한다 1. 뒤로 3 걸음미만걷는다 2. 뒤로 3~9 걸음걷는다 3. 뒤로 10 걸음걷는다 o Coordination The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Dissociated movement of lower extremities Isolated movement (LE/trunk, LE segments/segments); combination of different motor components o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

25 E. 걷기, 달리기그리고깡충뛰기 *82/83. 선자세 : 60cm 원안에서오른발 / 왼발로 10 회깡충뛴다 0. 오른발 / 왼발로깡충뛰기를시작하지못한다 1. 60cm 원안에서오른발 / 왼발로 3 회미만깡충뛴다 2. 60cm 원안에서오른발 / 왼발로 3~9 회깡충뛴다 3. 60cm 원안에서오른발 / 왼발로 10 회깡충뛴다 o Coordination The smooth and controlled use of movements in motor performance; direction, force, velocity, and amplitude o Stability The active maintenance of the trunk and right LE in the presence of disturbing forces (e.g., while hopping) o Weight shift Movement that involves a transfer of the body s center of gravity; 4 body planes (posterior, lateral, anterior, vertical )or any combination of these

26 Purposes o To investigate the impact on motor function and everyday activities of a 3 week-period of intensive, goal-directed, activityfocused physiotherapy in a group setting for children with CP o To examine the relationship between acquisition of basic motor abilities and quality of movements. 26

27 Results A main effect of time was shown in the primary outcome measure; Gross Motor Function Measure-66 (GMFM-66), mean change being 4.5 (p < 0.01) from last baseline to last follow up assessment. An interaction between time and GMFCS-levels was found, implying that children classified to GMFCS-levels I-II improved more than children classified to levels III-V. There were no main or interaction effects of age or anti-spastic medication. Change scores in the Pediatric Evaluation of Disability Inventory (PEDI) ranged , p < 0.01 in the Self-care domain of the Functional Skills dimension, and the Self-care and Mobility domains of the Caregiver Assistance dimension. The children's individual goals were on average attained, Mean Goal Attainment Scaling (GAS) T-score being Non-significant improved scores on the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremities Skills Test (QUEST) were demonstrated. Significant improvement in GMPM scores were found in improved items of the GMFM, not in items that maintained the same score. 27

28 Conclusion A main effect of time was shown in the primary outcome measure; Gross Motor Function Measure-66 (GMFM-66), mean change being 4.5 (p < 0.01) from last baseline to last follow up assessment. Basic motor abilities and self-care improved in young children with CP after goal-directed activityfocused physiotherapy with involvement of their local environment, and their need for caregiver assistance in selfcare and mobility decreased. The individualized training within a group context during a limited period of time was feasible and well-tolerated. The coherence between acquisition of basic motor abilities and quality of movement should be further examined. 28