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GMFCS-ER.pdf

GMFCS-ER

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2011-12-21 0人阅读 举报 0 0 暂无简介

简介:本文档为《GMFCS-ERpdf》,可适用于自然科学领域

GMFCSER©RobertPalisano,PeterRosenbaum,DoreenBartlett,MichaelLivingston,CanChildCentreforChildhoodDisabilityResearch,McMasterUniversityGMFCS©RobertPalisano,PeterRosenbaum,StephenWalter,DianneRussell,EllenWood,BarbaraGaluppi,CanChildCentreforChildhoodDisabilityResearch,McMasterUniversity(Reference:DevMedChildNeurol:)TheGrossMotorFunctionClassificationSystem(GMFCS)forcerebralpalsyisbasedonselfinitiatedmovement,withemphasisonsitting,transfers,andmobilityWhendefiningafivelevelclassificationsystem,ourprimarycriterionhasbeenthatthedistinctionsbetweenlevelsmustbemeaningfulindailylifeDistinctionsarebasedonfunctionallimitations,theneedforhandheldmobilitydevices(suchaswalkers,crutches,orcanes)orwheeledmobility,andtoamuchlesserextent,qualityofmovementThedistinctionsbetweenLevelsIandIIarenotaspronouncedasthedistinctionsbetweentheotherlevels,particularlyforinfantslessthanyearsofageTheexpandedGMFCS()includesanagebandforyouthtoyearsofageandemphasizestheconceptsinherentintheWorldHealthOrganization’sInternationalClassificationofFunctioning,DisabilityandHealth(ICF)WeencourageuserstobeawareoftheimpactthatenvironmentalandpersonalfactorsmayhaveonwhatchildrenandyouthareobservedorreportedtodoThefocusoftheGMFCSisondeterminingwhichlevelbestrepresentsthechild’soryouth’spresentabilitiesandlimitationsingrossmotorfunctionEmphasisisonusualperformanceinhome,school,andcommunitysettings(ie,whattheydo),ratherthanwhattheyareknowntobeabletodoattheirbest(capability)ItisthereforeimportanttoclassifycurrentperformanceingrossmotorfunctionandnottoincludejudgmentsaboutthequalityofmovementorprognosisforimprovementThetitleforeachlevelisthemethodofmobilitythatismostcharacteristicofperformanceafteryearsofageThedescriptionsoffunctionalabilitiesandlimitationsforeachagebandarebroadandarenotintendedtodescribeallaspectsofthefunctionofindividualchildrenyouthForexample,aninfantwithhemiplegiawhoisunabletocrawlonhisorherhandsandknees,butotherwisefitsthedescriptionofLevelI(ie,canpulltostandandwalk),wouldbeclassifiedinLevelIThescaleisordinal,withnointentthatthedistancesbetweenlevelsbeconsideredequalorthatchildrenandyouthwithcerebralpalsyareequallydistributedacrossthefivelevelsAsummaryofthedistinctionsbetweeneachpairoflevelsisprovidedtoassistindeterminingthelevelthatmostcloselyresemblesachild’syouth’scurrentgrossmotorfunctionWerecognizethatthemanifestationsofgrossmotorfunctionaredependentonage,especiallyduringinfancyandearlychildhoodForeachlevel,separatedescriptionsareprovidedinseveralagebandsChildrenbelowageshouldbeconsideredattheircorrectedageiftheywereprematureThedescriptionsforthetoyearandtoyearagebandsreflectthepotentialimpactofenvironmentfactors(eg,distancesinschoolandcommunity)andpersonalfactors(eg,energydemandsandsocialpreferences)onmethodsofmobilityAnefforthasbeenmadetoemphasizeabilitiesratherthanlimitationsThus,asageneralprinciple,thegrossmotorfunctionofchildrenandyouthwhoareabletoperformthefunctionsdescribedinanyparticularlevelwillprobablybeclassifiedatorabovethatleveloffunctionincontrast,thegrossmotorfunctionofchildrenandyouthwhocannotperformthefunctionsofaparticularlevelshouldbeclassifiedbelowthatleveloffunctionINTRODUCTIONUSERINSTRUCTIONSCanChildCentreforChildhoodDisabilityResearchInstituteforAppliedHealthSciences,McMasterUniversity,MainStreetWest,Room,Hamilton,ON,CanadaLSCTel:extFax:Email:canchildmcmastercaWebsite:wwwcanchildcaGMFCS–ERGrossMotorFunctionClassificationSystemExpandedandRevised©Palisano,Rosenbaum,BartlettLivingston,PageofBodysupportwalker–AmobilitydevicethatsupportsthepelvisandtrunkThechildyouthisphysicallypositionedinthewalkerbyanotherpersonHandheldmobilitydevice–Canes,crutches,andanteriorandposteriorwalkersthatdonotsupportthetrunkduringwalkingPhysicalassistance–AnotherpersonmanuallyassiststhechildyouthtomovePoweredmobility–ThechildyouthactivelycontrolsthejoystickorelectricalswitchthatenablesindependentmobilityThemobilitybasemaybeawheelchair,scooterorothertypeofpoweredmobilitydeviceSelfpropelsmanualwheelchair–ThechildyouthactivelyusesarmsandhandsorfeettopropelthewheelsandmoveTransported–Apersonmanuallypushesamobilitydevice(eg,wheelchair,stroller,orpram)tomovethechildyouthfromoneplacetoanotherWalks–UnlessotherwisespecifiedindicatesnophysicalassistancefromanotherpersonoranyuseofahandheldmobilitydeviceAnorthosis(ie,braceorsplint)maybewornWheeledmobility–Referstoanytypeofdevicewithwheelsthatenablesmovement(eg,stroller,manualwheelchair,orpoweredwheelchair)LEVELIWalkswithoutLimitationsLEVELIIWalkswithLimitationsLEVELIIIWalksUsingaHandHeldMobilityDeviceLEVELIVSelfMobilitywithLimitationsMayUsePoweredMobilityLEVELVTransportedinaManualWheelchairDistinctionsBetweenLevelsIandIIComparedwithchildrenandyouthinLevelI,childrenandyouthinLevelIIhavelimitationswalkinglongdistancesandbalancingmayneedahandheldmobilitydevicewhenfirstlearningtowalkmayusewheeledmobilitywhentravelinglongdistancesoutdoorsandinthecommunityrequiretheuseofarailingtowalkupanddownstairsandarenotascapableofrunningandjumpingDistinctionsBetweenLevelsIIandIIIChildrenandyouthinLevelIIarecapableofwalkingwithoutahandheldmobilitydeviceafterage(althoughtheymaychoosetouseoneattimes)ChildrenandyouthinLevelIIIneedahandheldmobilitydevicetowalkindoorsandusewheeledmobilityoutdoorsandinthecommunityDistinctionsBetweenLevelsIIIandIVChildrenandyouthinLevelIIIsitontheirownorrequireatmostlimitedexternalsupporttosit,aremoreindependentinstandingtransfers,andwalkwithahandheldmobilitydeviceChildrenandyouthinLevelIVfunctioninsitting(usuallysupported)butselfmobilityislimitedChildrenandyouthinLevelIVaremorelikelytobetransportedinamanualwheelchairorusepoweredmobilityDistinctionsBetweenLevelsIVandVChildrenandyouthinLevelVhaveseverelimitationsinheadandtrunkcontrolandrequireextensiveassistedtechnologyandphysicalassistanceSelfmobilityisachievedonlyifthechildyouthcanlearnhowtooperateapoweredwheelchairOPERATIONALDEFINITIONSGENERALHEADINGSFOREACHLEVELDISTINCTIONSBETWEENLEVELS©Palisano,Rosenbaum,BartlettLivingston,PageofGrossMotorFunctionClassificationSystem–ExpandedandRevised(GMFCS–ER)LEVELI:InfantsmoveinandoutofsittingandfloorsitwithbothhandsfreetomanipulateobjectsInfantscrawlonhandsandknees,pulltostandandtakestepsholdingontofurnitureInfantswalkbetweenmonthsandyearsofagewithouttheneedforanyassistivemobilitydeviceLEVELII:InfantsmaintainfloorsittingbutmayneedtousetheirhandsforsupporttomaintainbalanceInfantscreepontheirstomachorcrawlonhandsandkneesInfantsmaypulltostandandtakestepsholdingontofurnitureLEVELIII:InfantsmaintainfloorsittingwhenthelowbackissupportedInfantsrollandcreepforwardontheirstomachsLEVELIV:InfantshaveheadcontrolbuttrunksupportisrequiredforfloorsittingInfantscanrolltosupineandmayrolltoproneLEVELV:PhysicalimpairmentslimitvoluntarycontrolofmovementInfantsareunabletomaintainantigravityheadandtrunkposturesinproneandsittingInfantsrequireadultassistancetorollLEVELI:ChildrenfloorsitwithbothhandsfreetomanipulateobjectsMovementsinandoutoffloorsittingandstandingareperformedwithoutadultassistanceChildrenwalkasthepreferredmethodofmobilitywithouttheneedforanyassistivemobilitydeviceLEVELII:ChildrenfloorsitbutmayhavedifficultywithbalancewhenbothhandsarefreetomanipulateobjectsMovementsinandoutofsittingareperformedwithoutadultassistanceChildrenpulltostandonastablesurfaceChildrencrawlonhandsandkneeswithareciprocalpattern,cruiseholdingontofurnitureandwalkusinganassistivemobilitydeviceaspreferredmethodsofmobilityLEVELIII:Childrenmaintainfloorsittingoftenby"Wsitting"(sittingbetweenflexedandinternallyrotatedhipsandknees)andmayrequireadultassistancetoassumesittingChildrencreepontheirstomachorcrawlonhandsandknees(oftenwithoutreciprocallegmovements)astheirprimarymethodsofselfmobilityChildrenmaypulltostandonastablesurfaceandcruiseshortdistancesChildrenmaywalkshortdistancesindoorsusingahandheldmobilitydevice(walker)andadultassistanceforsteeringandturningLEVELIV:Childrenfloorsitwhenplaced,butareunabletomaintainalignmentandbalancewithoutuseoftheirhandsforsupportChildrenfrequentlyrequireadaptiveequipmentforsittingandstandingSelfmobilityforshortdistances(withinaroom)isachievedthroughrolling,creepingonstomach,orcrawlingonhandsandkneeswithoutreciprocallegmovementLEVELV:PhysicalimpairmentsrestrictvoluntarycontrolofmovementandtheabilitytomaintainantigravityheadandtrunkposturesAllareasofmotorfunctionarelimitedFunctionallimitationsinsittingandstandingarenotfullycompensatedforthroughtheuseofadaptiveequipmentandassistivetechnologyAtLevelV,childrenhavenomeansofindependentmovementandaretransportedSomechildrenachieveselfmobilityusingapoweredwheelchairwithextensiveadaptationsLEVELI:Childrengetintoandoutof,andsitin,achairwithouttheneedforhandsupportChildrenmovefromthefloorandfromchairsittingtostandingwithouttheneedforobjectsforsupportChildrenwalkindoorsandoutdoors,andclimbstairsEmergingabilitytorunandjumpLEVELII:ChildrensitinachairwithbothhandsfreetomanipulateobjectsChildrenmovefromthefloortostandingandfromchairsittingtostandingbutoftenrequireastablesurfacetopushorpulluponwiththeirarmsChildrenwalkwithouttheneedforahandheldmobilitydeviceindoorsandforshortdistancesonlevelsurfacesoutdoorsChildrenclimbstairsholdingontoarailingbutareunabletorunorjumpLEVELIII:ChildrensitonaregularchairbutmayrequirepelvicortrunksupporttomaximizehandfunctionChildrenmoveinandoutofchairsittingusingastablesurfacetopushonorpullupwiththeirarmsChildrenwalkwithahandheldmobilitydeviceonlevelsurfacesandclimbstairswithassistancefromanadultChildrenfrequentlyaretransportedwhentravelingforlongdistancesoroutdoorsonuneventerrainLEVELIV:ChildrensitonachairbutneedadaptiveseatingfortrunkcontrolandtomaximizehandfunctionChildrenmoveinandoutofchairsittingwithassistancefromanadultorastablesurfacetopushorpulluponwiththeirarmsChildrenmayatbestwalkshortdistanceswithawalkerandadultsupervisionbuthavedifficultyturningandmaintainingbalanceonunevensurfacesChildrenaretransportedinthecommunityChildrenmayachieveselfmobilityusingapoweredwheelchairLEVELV:PhysicalimpairmentsrestrictvoluntarycontrolofmovementandtheabilitytomaintainantigravityheadandtrunkposturesAllareasofmotorfunctionarelimitedFunctionallimitationsinsittingandstandingarenotfullycompensatedforthroughtheuseofadaptiveequipmentandassistivetechnologyAtLevelV,childrenhavenomeansofindependentmovementandaretransportedSomechildrenachieveselfmobilityusingapoweredwheelchairwithextensiveadaptationsBETWEENNDANDTHBIRTHDAYBETWEENTHANDTHBIRTHDAYBEFORENDBIRTHDAY©Palisano,Rosenbaum,BartlettLivingston,PageofLevelI:Childrenwalkathome,school,outdoors,andinthecommunityChildrenareabletowalkupanddowncurbswithoutphysicalassistanceandstairswithouttheuseofarailingChildrenperformgrossmotorskillssuchasrunningandjumpingbutspeed,balance,andcoordinationarelimitedChildrenmayparticipateinphysicalactivitiesandsportsdependingonpersonalchoicesandenvironmentalfactorsLevelII:ChildrenwalkinmostsettingsChildrenmayexperiencedifficultywalkinglongdistancesandbalancingonuneventerrain,inclines,incrowdedareas,confinedspacesorwhencarryingobjectsChildrenwalkupanddownstairsholdingontoarailingorwithphysicalassistanceifthereisnorailingOutdoorsandinthecommunity,childrenmaywalkwithphysicalassistance,ahandheldmobilitydevice,orusewheeledmobilitywhentravelinglongdistancesChildrenhaveatbestonlyminimalabilitytoperformgrossmotorskillssuchasrunningandjumpingLimitationsinperformanceofgrossmotorskillsmaynecessitateadaptationstoenableparticipationinphysicalactivitiesandsportsLevelIII:ChildrenwalkusingahandheldmobilitydeviceinmostindoorsettingsWhenseated,childrenmayrequireaseatbeltforpelvicalignmentandbalanceSittostandandfloortostandtransfersrequirephysicalassistanceofapersonorsupportsurfaceWhentravelinglongdistances,childrenusesomeformofwheeledmobilityChildrenmaywalkupanddownstairsholdingontoarailingwithsupervisionorphysicalassistanceLimitationsinwalkingmaynecessitateadaptationstoenableparticipationinphysicalactivitiesandsportsincludingselfpropellingamanualwheelchairorpoweredmobilityLevelIV:ChildrenusemethodsofmobilitythatrequirephysicalassistanceorpoweredmobilityinmostsettingsChildrenrequireadaptiveseatingfortrunkandpelviccontrolandphysicalassistanceformosttransfersAthome,childrenusefloormobility(roll,creep,orcrawl),walkshortdistanceswithphysicalassistance,orusepoweredmobilityWhenpositioned,childrenmayuseabodysupportwalkerathomeorschoolAtschool,outdoors,andinthecommunity,childrenaretransportedinamanualwheelchairorusepoweredmobilityLimitationsinmobilitynecessitateadaptationstoenableparticipationinphysicalactivitiesandsports,includingphysicalassistanceandorpoweredmobilityLevelV:ChildrenaretransportedinamanualwheelchairinallsettingsChildrenarelimitedintheirabilitytomaintainantigravityheadandtrunkposturesandcontrolarmandlegmovementsAssistivetechnologyisusedtoimproveheadalignment,seating,standing,andandormobilitybutlimitationsarenotfullycompensatedbyequipmentTransfersrequirecompletephysicalassistanceofanadultAthome,childrenmaymoveshortdistancesonthefloorormaybecarriedbyanadultChildrenmayachieveselfmobilityusingpoweredmobilitywithextensiveadaptationsforseatingandcontrolaccessLimitationsinmobilitynecessitateadaptationstoenableparticipationinphysicalactivitiesandsportsincludingphysicalassistanceandusingpoweredmobilityLevelI:Youthwalkathome,school,outdoors,andinthecommunityYouthareabletowalkupanddowncurbswithoutphysicalassistanceandstairswithouttheuseofarailingYouthperformgrossmotorskillssuchasrunningandjumpingbutspeed,balance,andcoordinationarelimitedYouthmayparticipateinphysicalactivitiesandsportsdependingonpersonalchoicesandenvironmentalfactorsLevelII:YouthwalkinmostsettingsEnvironmentalfactors(suchasuneventerrain,inclines,longdistances,timedemands,weather,andpeeracceptability)andpersonalpreferenceinfluencemobilitychoicesAtschoolorwork,youthmaywalkusingahandheldmobilitydeviceforsafetyOutdoorsandinthecommunity,youthmayusewheeledmobilitywhentravelinglongdistancesYouthwalkupanddownstairsholdingarailingorwithphysicalassistanceifthereisnorailingLimitationsinperformanceofgrossmotorskillsmaynecessitateadaptationstoenableparticipationinphysicalactivitiesandsportsLevelIII:YoutharecapableofwalkingusingahandheldmobilitydeviceComparedtoindividualsinotherlevels,youthinLevelIIIdemonstratemorevariabilityinmethodsofmobilitydependingonphysicalabilityandenvironmentalandpersonalfactorsWhenseated,youthmayrequireaseatbeltforpelvicalignmentandbalanceSittostandandfloortostandtransfersrequirephysicalassistancefromapersonorsupportsurfaceAtschool,youthmayselfpropelamanualwheelchairorusepoweredmobilityOutdoorsandinthecommunity,youtharetransportedinawheelchairorusepoweredmobilityYouthmaywalkupanddownstairsholdingontoarailingwithsupervisionorphysicalassistanceLimitationsinwalkingmaynecessitateadaptationstoenableparticipationinphysicalactivitiesandsportsincludingselfpropellingamanualwheelchairorpoweredmobilityLevelIV:YouthusewheeledmobilityinmostsettingsYouthrequireadaptiveseatingforpelvicandtrunkcontrolPhysicalassistancefromorpersonsisrequiredfortransfersYouthmaysupportweightwiththeirlegstoassistwithstandingtransfersIndoors,youthmaywalkshortdistanceswithphysicalassistance,usewheeledmobility,or,whenpositioned,useabodysupportwalkerYoutharephysicallycapableofoperatingapoweredwheelchairWhenapoweredwheelchairisnotfeasibleoravailable,youtharetransportedinamanualwheelchairLimitationsinmobilitynecessitateadaptationstoenableparticipationinphysicalactivitiesandsports,includingphysicalassistanceandorpoweredmobilityLevelV:YoutharetransportedinamanualwheelchairinallsettingsYoutharelimitedintheirabilitytomaintainantigravityheadandtrunkposturesandcontrolarmandlegmovementsAssistivetechnologyisusedtoimproveheadalignment,seating,standing,andmobilitybutlimitationsarenotfullycompensatedbyequipmentPhysicalassistancefromorpersonsoramechanicalliftisrequiredfortransfersYouthmayachieveselfmobilityusingpoweredmobilitywithextensiveadaptationsforseatingandcontrolaccessLimitationsinmobilitynecessitateadaptationstoenableparticipationinphysicalactivitiesandsportsincludingphysicalassistanceandusingpoweredmobilityBETWEENTHANDTHBIRTHDAYBETWEENTHANDTHBIRTHDAY

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