Pediatric Evaluation Mok-po Rehabilitation Hospital Lee Su-hyun,PT.
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Pediatric Evaluation
Mok-po Rehabilitation Hospital
Lee Su-hyun ,PT
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CONTENTS• GMFCS• GMFM “ how much “• MBBS
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Gross Motor Functional Classification System E-R
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• Before 2nd Birthday• 2nd ~ 4th birthday• 4th ~ 6th birthday• 6th ~ 12th birthday• 12th ~ 18th birthday
ICF Model concept
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OPERATIONAL DEFINITIONS
• Walks –An orthosis (i.e., brace or splint) may be worn.
• Hand-held mobility device – Canes, crutches, and anterior and posterior walkers
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OPERATIONAL DEFINITIONS
• Physical assistance – Another person manually assists the child/youth to move.
• Self-propels manual wheelchair – The child/youth actively uses arms and hands or feet to propel the wheels and move.
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OPERATIONAL DEFINITIONS
• Wheeled mobility – enables movement
• Powered mobility – joystick or electrical switch , independent mobility.
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OPERATIONAL DEFINITIONS
• Body support walker – A mobility device that supports the pelvis and trunk. The child/youth is physically positioned in the walker by another person.
• Transported – A person manually
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• LEVEL I - Walks without Limitations• LEVEL II - Walks with Limitations• LEVEL III - Walks Using a Hand-Held Mobility Device• LEVEL IV - Self-Mobility with Limitations; May Use Powered Mobility
• LEVEL V - Transported in a Manual Wheelchair
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BETWEEN 6TH AND 12TH BIRTHDAY
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Level I• walk at home, school, outdoors,
and in the community.• Children are able to walk up and
down curbs without physical assistance
• stairs without the use of a railing.
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• Children perform gross motor skills such as running and jumping but speed, balance, and coordination are limited.
• Children may participate in physical activities and sports depending on personal choices and environmental factors.
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Level II• walk in most settings.• Children may experience difficulty
walking long distances and balancing on uneven terrain, inclines, in crowded areas, confined spaces or when carrying objects.
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• walk up and down stairs holding onto a railing or with physical assistance if there is no railing.
• Outdoors and in the community, children may walk with physical assistance, a hand-held mobility device, Or use wheeled mobility when traveling long distances.
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• Children have at best only minimal ability to perform gross motor skills such as running and jumping.
• Limitations in performance of gross motor skills may necessitate adaptations to enable participation in physical activities and sports
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Level III• walk using a hand-held mobility
device in most indoor settings.• When seated, children may require
a seat belt for pelvic alignment and balance.
• Sit-to-stand and floor-to-stand transfers require physical assistance of a person or support surface.
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• When traveling long distances, children use some form of wheeled mobility.
• Children may walk up and down stairs holding onto a railing with supervision or physical assistance.
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• Limitations in walking may necessitate adaptations to enable participation in physical activities and sports including self-propelling a manual wheelchair or powered mobility.
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Level IV• Children use methods of mobility
that require physical assistance or powered mobility in most settings.
• Children require adaptive seating for trunk and pelvic control and physical assistance for most transfers.
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• At home, children use floor mobility (roll, creep, or crawl), walk short distances with physical assistance, or use powered mobility.
• When positioned, children may use a body support walker at home or school.
• At school, outdoors, and in the community, children are transported in a manual wheelchair or use powered mobility.
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• Limitations in mobility necessitate adaptations to enable participation in physical activities and sports, including physical assistance and/or powered mobility.
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Level V• Children are transported in a
manual wheelchair in all settings.• Children are limited in their ability
to maintain antigravity head and trunk postures and control arm and leg movements.
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• Assistive technology is used to improve head alignment, seating, standing, and and/or mobility but limitations are not fully compensated by equipment.
• Transfers require complete physical assistance of an adult.
• At home, children may move short distances on the floor or may be carried by an adult.
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• Children may achieve self-mobility using powered mobility with extensive adaptations for seating and control access.
• Limitations in mobility necessitate adaptations to enable participation in physical activities and sports including physical assistance and using powered mobility.
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GMFCS Family Report Questionnaire
• Chris Morris , 2007 • Why ?• How?• What was found?• What do the finding mean?
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GMFCS Family Report Questionnaire
• How can the GMFCS Family Report Questionnaire be used?
• 2y~4y , 4y~6y , 6y~12y
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Gross Motor Function Measures-66
• 5M ~12Y• 5 dimension 66 item (interval
measurement)• 4 point ordinal score• Inter - rater ICC = .97
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Modified Berg Balance Scale
• School –age child with Mild to Moderate Motor Impairment
• 0~4 score• Inter-rater reliability ICC = .997
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Modified Berg Balance Scale
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• 14 Item1. Sitting to standing2. Standing to sitting3. Transfers4. Standing unsupported5. Sitting unsupported
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• 14 Item6. Standing with eyes closed7. Standing with feet together8. Standing with one foot in front9. Standing on one foot
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• 14 Item10.Turning 360 degrees11. Turning to look behind12. Retrieving objective from floor13. Placing alternate foot on stool14. Reaching forward with outstretched
arm
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a question period