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Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy

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Content validity of the expanded and revised Gross Motor Function Classification System.

Robert J Palisano¹, Peter Rosenbaum, Doreen Bartlett

¹Programs in Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA. robert.j.palisano@drexel.edu

Developmental Medicine and Child Neurology

|October 7, 2008

Summary

The expanded and revised Gross Motor Function Classification System (GMFCS-E&R) was validated for children with cerebral palsy. This system effectively classifies gross motor function across age bands, aiding clinical practice and research.

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Area of Science:

Pediatric Rehabilitation
Neurology
Physical Therapy

Background:

Cerebral palsy (CP) significantly impacts gross motor function in children and youth.
Accurate classification systems are crucial for effective intervention and research in CP.
The Gross Motor Function Classification System (GMFCS) is widely used but required expansion and revision.

Purpose of the Study:

To validate the expanded and revised Gross Motor Function Classification System (GMFCS-E&R) for children and youth with cerebral palsy.
To establish content validity of the GMFCS-E&R using group consensus methods.
To confirm the utility of the GMFCS-E&R for clinical applications and research.

Main Methods:

A nominal group technique was employed with 18 physical therapists to evaluate a draft 12- to 18-year age band.
A Delphi survey involving 30 health professionals from seven countries was conducted to evaluate revised 6- to 12-year and 12- to 18-year age bands.
Consensus was defined as agreement by at least 80% of participants, achieved after three rounds.

Main Results:

Consensus was reached on the clarity, accuracy, and distinctions between levels for both the 6- to 12-year and 12- to 18-year age bands.
Participants affirmed the value of distinguishing between capability and performance.
The influence of environmental and personal factors on mobility methods was recognized as important for classification.

Conclusions:

The GMFCS-E&R demonstrates content validity, confirming its suitability for classifying gross motor function in children and youth with CP.
The validated GMFCS-E&R enhances communication among healthcare professionals.
The system supports clinical decision-making, databases, registries, and clinical research in cerebral palsy.