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Form Structure: GROSS MOTOR FUNCTION MEASURE (GMFM) 66 and 88

This form structure is an organized set of data definitions for a copyrighted form
Title:
GROSS MOTOR FUNCTION MEASURE (GMFM) 66 and 88
Short Name:
GMFM66and88
Description:
The Gross Motor Function Measure (GMFM) is a standardized assessment of physical function and change in physical function in children with cerebral palsy. The GMFM-88 has also been used for assessment of children with Down Syndrome and Traumatic Brain Injury. The GMFM-66 version is only valid for use with children with cerebral palsy. Reference: Gross Motor Function Measure (GMFM). Russell, Dianne and Rosenbaum, Peter (2013). Copyright 2013 Dianne Russell and Peter Rosenbaum, McMaster University. www.canchild.ca
Disease:
General (For all diseases) Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-12-27
Owner:
Number of Data Elements:
108
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study. CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

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Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

GMFM 88 Dimension A (Appears Up To 17 Times)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure-SUP Head in midline score  Score to measure subject ability to turn head with extremities symmetrically, as part of Gross Motor Function Measure GMFMSUPHeadInMidlineScore Recommended CDE
2 Gross Motor Function Measure-SUP Hands to midline score  Score to measure subject ability to bring head to midline, fingers one with the other, as part of Gross Motor Function Measure GMFMSUPHandsToMidlineScore Recommended CDE
3 Gross Motor Function Measure-SUP Lifts head 45 degrees score  Score to measure subject ability to lift head 45 degrees, as part of Gross Motor Function Measure GMFMSUPLiftsHead45DegScore Recommended CDE
4 Gross Motor Function Measure-SUP Flexes right hip and knee score  Score to measure subject ability to flex right hip and knee through full range, as part of Gross Motor Function Measure GMFMSUPFlexesRHipAndKneeScore Recommended CDE
5 Gross Motor Function Measure-SUP Flexes left hip and knee score  Score to measure subject ability to flex left hip and knee through full range, as part of Gross Motor Function Measure GMFMSUPFlexesLHipAndKneeScore Recommended CDE
6 Gross Motor Function Measure-SUP reaches out with right arm score  Score to measure subject ability to reach out with right arm and cross hand over midline towards a toy, as part of Gross Motor Function Measure GMFMSUPReachesOutWRArmScore Recommended CDE
7 Gross Motor Function Measure-SUP reaches out with left arm score  Score to measure subject ability to reach out with left arm and cross hand over midline towards a toy, as part of Gross Motor Function Measure GMFMSUPReachesOutWLArmScore Recommended CDE
8 Gross Motor Function Measure-SUP rolls to PR over right side score  Score to measure subject ability to roll to PR over right side, as part of Gross Motor Function Measure GMFMSUPRollsToPROverRSideScore Recommended CDE
9 Gross Motor Function Measure-SUP rolls to PR over left side score  Score to measure subject ability to roll to PR over left side, as part of Gross Motor Function Measure GMFMSUPRollsToPROverLSideScore Recommended CDE
10 Gross Motor Function Measure-PR lifts head score  Score to measure subject ability to lift head upright, as part of Gross Motor Function Measure GMFMPRLiftsHeadScore Recommended CDE
11 Gross Motor Function Measure-PR on forearms lifts head score  Score to measure subject ability to lift head upright with elbows extended and chest raised, as part of Gross Motor Function Measure GMFMPROnForearmsLiftsHeadScore Recommended CDE
12 Gross Motor Function Measure-PR on forearms weight on right score  Score to measure subject ability to fully extend opposite arm forward hwen weight is on the right forearm, as part of Gross Motor Function Measure GMFMPROnForearmsWeightOnRScore Recommended CDE
13 Gross Motor Function Measure-PR on forearms weight on left score  Score to measure subject ability to fully extend opposite arm forward when weight is on the left forearm, as part of Gross Motor Function Measure GMFMPROnForearmsWeightOnLScore Recommended CDE
14 Gross Motor Function Measure-PR rolls to SUP over right score  Score to measure subject ability to roll to SUP over right side, as part of Gross Motor Function Measure GMFMPRRollstoSUPOverRScore Recommended CDE
15 Gross Motor Function Measure-PR rolls to SUP over left score  Score to measure subject ability to roll to SUP over left side, as part of Gross Motor Function Measure GMFMPRRollstoSUPOverLScore Recommended CDE
16 Gross Motor Function Measure-PR pivots to right 90 degrees score  Score to measure subject ability to pivot to the right 90 degress using extremities, as part of Gross Motor Function Measure GMFMPRPivotsToR90DegScore Recommended CDE
17 Gross Motor Function Measure-PR pivots to left 90 degrees score  Score to measure subject ability to pivot to the left 90 degress using extremities, as part of Gross Motor Function Measure GMFMPRPivotsToL90DegScore Recommended CDE

GMFM 88 Dimension A Total Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure (GMFM) -Total dimension A score  Total dimension A score, as part of the Gross Motor Function Measure (GMFM). GMFM88TtlDimenAScore Recommended CDE

GMFM 88 Dimension B (Appears Up To 20 Times)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure-SUP hands grasped score  Score to measure subject ability to pull self to sitting with head control and hands grasped by examiner, as part of Gross Motor Function Measure GMFMSUPHandsGraspedScore Recommended CDE
2 Gross Motor Function Measure-SUP rolls to right side score  Score to measure subject ability to roll to right side and attain sitting, as part of Gross Motor Function Measure GMFMSUPRollsToRSideScore Recommended CDE
3 Gross Motor Function Measure-SUP rolls to left side score  Score to measure subject ability to roll to left side and attain sitting, as part of Gross Motor Function Measure GMFMSUPRollsToLSideScore Recommended CDE
4 Gross Motor Function Measure-Sit on mat for 3 seconds score  Score to measure subject ability to lift head upright for 3 seconds while sitting on a mat with thorax supported by therapist, as part of Gross Motor Function Measure GMFMSitOnMatFor3SecScore Recommended CDE
5 Gross Motor Function Measure-Sit on mat for 10 seconds score  Score to measure subject ability to lift head midline for 10 seconds while sitting on a mat with thorax supported by therapist, as part of Gross Motor Function Measure GMFMSitOnMatFor10SecScore Recommended CDE
6 Gross Motor Function Measure-Sit on mat arms propping score  Score to measure subject ability to sit on mat, arms propping, for 5 seconds, as part of Gross Motor Function Measure GMFMSitOnMatArmsProppingScore Recommended CDE
7 Gross Motor Function Measure-Sit on mat maintain arms score  Score to measure subject ability to sit on mat, arms free, for 3 seconds, as part of Gross Motor Function Measure GMFMSitOnMatMaintainArmsScore Recommended CDE
8 Gross Motor Function Measure-Sit on mat small toy score  Score to measure subject ability to sit on mat and lean forward towards a toy, as part of Gross Motor Function Measure GMFMSitOnMatSmallToyScore Recommended CDE
9 Gross Motor Function Measure-Sit on mat touches toy right side score  Score to measure subject ability to sit on mat and touch toy placed 45 degrees behind child's right side, as part of Gross Motor Function Measure GMFMSitOnMatTchesToyRSideScore Recommended CDE
10 Gross Motor Function Measure-Sit on mat touches toy left side score  Score to measure subject ability to sit on mat and touch toy placed 45 degrees behind child's left side, as part of Gross Motor Function Measure GMFMSitOnMatTchesToyLSideScore Recommended CDE
11 Gross Motor Function Measure-Right side sit score  Score to measure subject ability to sit on right side with arms free for 5 seconds, as part of Gross Motor Function Measure GMFMRSideSitScore Recommended CDE
12 Gross Motor Function Measure-Left side sit score  Score to measure subject ability to sit on left side with arms free for 5 seconds, as part of Gross Motor Function Measure GMFMLSideSitScore Recommended CDE
13 Gross Motor Function Measure-Sit on mat lowers to PR score  Score to measure subject ability to lower to PR with control, as part of Gross Motor Function Measure GMFMSitOnMatLowersToPRScore Recommended CDE
14 Gross Motor Function Measure-Sit on mat with feet right side score  Score to measure subject ability to sit on mat with feet in front and attain 4 point over right side, as part of Gross Motor Function Measure GMFMSitOnMatWFeetRSideScore Recommended CDE
15 Gross Motor Function Measure-Sit on mat with feet left side score  Score to measure subject ability to sit on mat with feet in front and attain 4 point over left side, as part of Gross Motor Function Measure GMFMSitOnMatWFeetLSideScore Recommended CDE
16 Gross Motor Function Measure-Sit on mat pivots 90 degrees score  Score to measure subject ability to sit on a mat and pivot 90 degrees without arms assisting, as part of Gross Motor Function Measure GMFMSitOnMatPivots90DegScore Recommended CDE
17 Gross Motor Function Measure-Sit on bench score  Score to measure subject ability to sit on a bench and maintain free arms and feet for 10 seconds, as part of Gross Motor Function Measure GMFMSitOnBenchScore Recommended CDE
18 Gross Motor Function Measure-STD score  Score to measure subject ability to sit on a small bench , as part of Gross Motor Function Measure GMFMSTDScore Recommended CDE
19 Gross Motor Function Measure-On the floor small bench score  Score to measure subject ability to sit on a small bench from the floor, as part of Gross Motor Function Measure GMFMOnTheFloorSmallBenchScore Recommended CDE
20 Gross Motor Function Measure-On the floor large bench score  Score to measure subject ability to sit on a large bench from the floor, as part of Gross Motor Function Measure GMFMOnTheFloorLrgBenchScore Recommended CDE

GMFM 88 Dimension B Total Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure (GMFM) -Total dimension B score  Total dimension B score, as part of the Gross Motor Function Measure (GMFM). GMFM88TtlDimenBScore Recommended CDE

GMFM 88 Dimension C (Appears Up To 14 Times)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure-PR creeps forward score  PR creeps forward score , as part of Gross Motor Function Measure GMFMPRCreepsForwardScore Recommended CDE
2 Gross Motor Function Measure-4 point 10 seconds score  Score of 4 point, 10 seconds question, as part of Gross Motor Function Measure GMFM4Point10SecScore Recommended CDE
3 Gross Motor Function Measure-4 point attains score  Score of 4 point, attains question, as part of Gross Motor Function Measure GMFM4PointAttainsScore Recommended CDE
4 Gross Motor Function Measure-PR attains score  Score of PR, attains question, as part of Gross Motor Function Measure GMFMPRAttainsScore Recommended CDE
5 Gross Motor Function Measure-4 point reaches right arm score  Score for 4 point reaches forward with the right arm, hand above shoulder level, as part of Gross Motor Function Measure GMFM4PointReachesRArmScore Recommended CDE
6 Gross Motor Function Measure-4 point reaches left arm score  Score for 4 point reaches forward with the left arm, hand above shoulder level, as part of Gross Motor Function Measure GMFM4PointReachesLArmScore Recommended CDE
7 Gross Motor Function Measure-Crawls score  Score for crawls or hitches forward, as part of Gross Motor Function Measure GMFM4PointCrawlsScore Recommended CDE
8 Gross Motor Function Measure-Crawls reciprocally score  Score for reciprocal crawls forward, as part of Gross Motor Function Measure GMFM4PointCrawlsRecipScore Recommended CDE
9 Gross Motor Function Measure-Crawls up score  Score for crawls up, as part of Gross Motor Function Measure GMFM4PointCrawlsUpScore Recommended CDE
10 Gross Motor Function Measure-Crawls backwards score  Score for crawls backwards, as part of Gross Motor Function Measure GMFM4PointCrawlsBackwardsScore Recommended CDE
11 Gross Motor Function Measure-Sit on mat attains high knee score  Score to measure subject ability to attain high knee using arms, and maintaining for 10 seconds while sitting on a mat, as part of Gross Motor Function Measure GMFMSitOnMatAttainsHighKnScore Recommended CDE
12 Gross Motor Function Measure-High knee attains half on right score  Score to measure subject ability to attain half high knee on right knee using arms and maintaing for 10 seconds, as part of Gross Motor Function Measure GMFMHighKnAttainsHalfOnRScore Recommended CDE
13 Gross Motor Function Measure-High knee attains half on left score  Score to measure subject ability to attain half high knee on right knee using arms and maintaing for 10 seconds, as part of Gross Motor Function Measure GMFMHighKnAttainsHalfOnLScore Recommended CDE
14 Gross Motor Function Measure-High knee walks forward score  Score to measure high walks walks forward 10 steps performed by the subject, as part of Gross Motor Function Measure GMFMHighKnWalksForwardScore Recommended CDE

GMFM 88 Dimension C Total Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure (GMFM) -Total dimension C score  Total dimension C score, as part of the Gross Motor Function Measure (GMFM). GMFM88TtlDimenCScore Recommended CDE

GMFM 88 Dimension D (Appears Up To 13 Times)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure-On the floor pulls score  Score to measure pulls to standing at a large bench on the floor, as part of Gross Motor Function Measure GMFMOnTheFloorPullsScore Recommended CDE
2 Gross Motor Function Measure-STD maintains arms 3 seconds score  Score to measure subject ability to stand with arms free for 3 seconds, as part of Gross Motor Function Measure GMFMSTDMaintainsArms3SecScore Recommended CDE
3 Gross Motor Function Measure-STD holding on lift right foot score  Score to measure subject ability to hold on to a large bench with one and life the right foot for 3 seconds, as part of Gross Motor Function Measure GMFMSTDHoldingOnLiftRFtScore Recommended CDE
4 Gross Motor Function Measure-STD holding on lift left foot score  Score to measure subject ability to hold on to a large bench with one and life the left foot for 3 seconds, as part of Gross Motor Function Measure GMFMSTDHoldingOnLiftLFtScore Recommended CDE
5 Gross Motor Function Measure-STD maintains arms 20 seconds score  Score to measure subject ability to stand with arms free for 20 seconds, as part of Gross Motor Function Measure GMFMSTDMaintiansArms20SecScore Recommended CDE
6 Gross Motor Function Measure-STD lifts left foot 10 seconds score  Score to measure subject ability to lift left foot, arms free, for 10 seconds, as part of Gross Motor Function Measure GMFMSTDLiftsLFt10SecScore Recommended CDE
7 Gross Motor Function Measure-STD lifts right foot 10 seconds score  Score to measure subject ability to lift right foot, arms free, for 10 seconds, as part of Gross Motor Function Measure GMFMSTDLiftsRFt10SecScore Recommended CDE
8 Gross Motor Function Measure-Sit on small bench score  Score to measure subject ability to stand after sitting on a small bench, as part of Gross Motor Function Measure GMFMSitOnSmallBenchScore Recommended CDE
9 Gross Motor Function Measure-High knee right knee without arms score  Score to measure subject ability to attain standing through half knee on the right knee without using arms, as part of Gross Motor Function Measure GMFMHighKnRKnWOArmsScore Recommended CDE
10 Gross Motor Function Measure-High knee left knee without arms score  Score to measure subject ability to attain standing through half knee on the left knee without using arms, as part of Gross Motor Function Measure GMFMHighKnLKnWOArmsScore Recommended CDE
11 Gross Motor Function Measure-STD lowers to sit score  Score to measure subject ability to lower to sit on floor with control and arms free, as part of Gross Motor Function Measure GMFMSTDLowersToSitScore Recommended CDE
12 Gross Motor Function Measure-STD attains squat score  Score to measure subject ability to attain a squat with arms free, as part of Gross Motor Function Measure GMFMSTDAttainsSquatScore Recommended CDE
13 Gross Motor Function Measure-STD pick objects from floor score  Score to measure subject ability to pick up objects from the floor with hands free and return to a standing position, as part of Gross Motor Function Measure GMFMSTDPickObjsFromFloorScore Recommended CDE

GMFM 88 Dimension D Total Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure (GMFM) -Total dimension D score  Total dimension D score, as part of the Gross Motor Function Measure (GMFM). GMFM88TtlDimenDScore Recommended CDE

GMFM 88 Dimension E (Appears Up To 24 Times)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure-STD 2 hands on large bench to right score  Score to measure subject ability to cruise 5 steps to the right with 2 hands on a large bench, as part of Gross Motor Function Measure GMFMSTDHandsOnLrgBenchToRScore Recommended CDE
2 Gross Motor Function Measure-STD 2 hands on large bench to left score  Score to measure subject ability to cruise 5 steps to the left with 2 hands on a large bench, as part of Gross Motor Function Measure GMFMSTDHandsOnLrgBenchToLScore Recommended CDE
3 Gross Motor Function Measure- STD 2 hands held score  Score to measure subject ability to walk forward 10 steps with two hands held, as part of Gross Motor Function Measure GMFMSTD2HandHeldScore Recommended CDE
4 Gross Motor Function Measure- STD 1 hand held score  Score to measure subject ability to walk forward 10 steps with one hand held, as part of Gross Motor Function Measure GMFMSTD1HandHeldScore Recommended CDE
5 Gross Motor Function Measure- STD walks forward score  Score to measure subject ability to walk forward 10 steps, as part of Gross Motor Function Measure GMFMSTDWalksForwardScore Recommended CDE
6 Gross Motor Function Measure- STD walks forward 180 degrees score  Score to measure subject ability to walk forward 10 steps, stop, and turn 180 degrees to return, as part of Gross Motor Function Measure GMFMSTDWalksForward180DegScore Recommended CDE
7 Gross Motor Function Measure- STD walks backward score  Score to measure subject ability to walk backwards 10 steps, as part of Gross Motor Function Measure GMFMSTDWalksBackwardScore Recommended CDE
8 Gross Motor Function Measure- STD walks forward with object score  Score to measure subject ability to walk forward 10 consequtive steps, carrying a large object with 2 hands, as part of Gross Motor Function Measure GMFMSTDWalksForwardWObjScore Recommended CDE
9 Gross Motor Function Measure- STD walks forward with parallel lines score  Score to measure subject ability to walk forward 10 consequtive steps between parallel lines 20 cm apart, as part of Gross Motor Function Measure GMFMSTDWalksForwardWPrlLsScore Recommended CDE
10 Gross Motor Function Measure- STD walks forward on straight line score  Score to measure subject ability to walk forward 10 consequtive steps on a striaght line 2cm wide, as part of Gross Motor Function Measure GMFMSTDWalksForwardOnStLScore Recommended CDE
11 Gross Motor Function Measure- STD steps over stick right foot score  Score to measure subject ability to step over a stick at knee level with the right foot leading, as part of Gross Motor Function Measure GMFMSTDStepsOverStickRFtScore Recommended CDE
12 Gross Motor Function Measure- STD steps over stick left foot score  Score to measure subject ability to step over a stick at knee level with the left foot leading, as part of Gross Motor Function Measure GMFMSTDStepsOverStickLFtScore Recommended CDE
13 Gross Motor Function Measure- STD runs score  Score to measure subject ability to run 4.5m, stop, and return, as part of Gross Motor Function Measure GMFMSTDRunsScore Recommended CDE
14 Gross Motor Function Measure- STD kick ball with right foot score  Score to measure subject ability to kick a ball with right foot, as part of Gross Motor Function Measure GMFMSTDKickBallWRFtScore Recommended CDE
15 Gross Motor Function Measure- STD kick ball with left foot score  Score to measure subject ability to kick a ball with left foot, as part of Gross Motor Function Measure GMFMSTDKickBallWLFtScore Recommended CDE
16 Gross Motor Function Measure- STD jumps 30 cm score  Score to measure subject ability to jump 30 cm high with both feet simultaneously, as part of Gross Motor Function Measure GMFMSTDJumps30CmScore Recommended CDE
17 Gross Motor Function Measure- STD jumps forward 30 cm score  Score to measure subject ability to jump 30 cm high with both feet simultaneously, as part of Gross Motor Function Measure GMFMSTDJumpsForward30CmScore Recommended CDE
18 Gross Motor Function Measure- STD hops on right foot score  Score to measure subject ability to hop on right foot within a 60 cm circle, as part of Gross Motor Function Measure GMFMSTDHopsOnRFtScore Recommended CDE
19 Gross Motor Function Measure- STD hops on left foot score  Score to measure subject ability to hop on left foot within a 60 cm circle, as part of Gross Motor Function Measure GMFMSTDHopsOnLFtScore Recommended CDE
20 Gross Motor Function Measure- STD walks up holding rail score  Score to measure subject ability to walk up 4 steps holding 1 rail, alternating feet, as part of Gross Motor Function Measure GMFMSTDWalksUpHoldingRailScore Recommended CDE
21 Gross Motor Function Measure- STD walks down holding rail score  Score to measure subject ability to walk down 4 steps holding 1 rail, alternating feet, as part of Gross Motor Function Measure GMFMSTDWalksDnHoldingRailScore Recommended CDE
22 Gross Motor Function Measure- STD walks up score  Score to measure subject ability to walk up 4 steps, alternating feet, alternating feet, as part of Gross Motor Function Measure GMFMSTDWalksUpScore Recommended CDE
23 Gross Motor Function Measure- STD walks down score  Score to measure subject ability to walk down 4 steps, alternating feet, alternating feet, as part of Gross Motor Function Measure GMFMSTDWalksDnScore Recommended CDE
24 Gross Motor Function Measure- STD jumps off both feet score  Score to measure subject ability to jump off both feet simultaneously on a 15 cm step, as part of Gross Motor Function Measure GMFMSTDJumpsOffBothFeetScore Recommended CDE

GMFM 88 Dimension E Total Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Gross Motor Function Measure (GMFM) -Total dimension E score  Total dimension E score, as part of the Gross Motor Function Measure (GMFM). GMFM88TtlDimenEScore Recommended CDE
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