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Gross Motor Function Measure-66 trajectories in children recovering after severe acquired brain injury
Gemma Kelly1, Sue Mobbs, Joshua N Pritkin
1Harrison Research Centre, The Children's Trust, Tadworth, UK.
Insights
The Gross Motor Function Measure (GMFM-66) is suitable for assessing recovery in children with acquired brain injury (ABI). Recovery trajectories vary by injury cause and age, with younger children showing slower progress.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Clinical assessment
Background:
- Acquired brain injury (ABI) significantly impacts gross motor function in children.
- The Gross Motor Function Measure (GMFM-66) is a standard tool, but its use in ABI populations requires validation.
- Understanding recovery patterns is crucial for effective intervention.
Purpose of the Study:
- To evaluate the appropriateness of the GMFM-66 for children with ABI.
- To describe gross motor recovery trajectories in pediatric ABI.
- To identify factors influencing GMFM-66 recovery.
Main Methods:
- Observational study design.
- Repeated GMFM-66 assessments during inpatient rehabilitation.
- Analysis of recovery trajectories in children with severe ABI.
Main Results:
- The GMFM-66 is appropriate for pediatric ABI, with comparable item difficulties to the cerebral palsy population.
- Gross motor recovery followed lag-exponential trajectories.
- Hypoxic-ischemic injuries resulted in slower, less complete recoveries.
- Older age at injury correlated with faster gross motor recovery.
- Motor function improvement began around the time of rehabilitation admission.
Conclusions:
- Injury aetiology is a significant determinant of gross motor recovery post-ABI.
- Younger age at injury is associated with slower recovery rates.
- The GMFM-66 effectively captures gross motor ability reacquisition sequences in pediatric ABI.
Aim:
To explore the appropriateness of using the interval-scale version of the Gross Motor Function Measure (GMFM-66) in paediatric acquired brain injury (ABI), and to characterize GMFM-66 recovery trajectories and factors that affect them.
Method:
An observational study of gross motor recovery trajectories during rehabilitation at a single specialist paediatric in-patient rehabilitation centre using repeated GMFM-66 observations. The cohort comprised children rehabilitating after severe ABI of various causes.
Results:
A total of 287 GMFM observations were made on 74 children (45 males, 29 females; age-at-injury range 0.3-17.3y, median age 11.3y, interquartile range 6.6-15.0y). Differences in item-difficulty estimates between this sample and the cerebral palsy population in which the GMFM-66 was initially developed are not detectable at this sample size. Changes in GMFM over time show lag-exponential forms. Children sustaining hypoxic-ischaemic injuries made the slowest and least complete recoveries. Older children made faster gross motor recoveries after controlling for aetiology. The time at which gross motor ability began to rise coincided approximately with admission to the rehabilitation facility.
Interpretation:
Aetiology is strongly associated with gross motor recovery after ABI. Younger age at injury was associated with slower recovery. Comparable item-difficulty scores in this sample and in the cerebral palsy population suggest comparable sequences of gross motor ability reacquisition.
