Table of Content - Volume 20 Issue 3 - December 2021

Standardization of GMFM- 88 evaluation tool as parent administered - physician [PA-PO] observed tool for tele- rehabilation services with a custom made simulation[DOLL]

K Nithya¹, A Rajakumar^2*

¹Department of Physical Medicine & Rehabilitation, Government Mohan Kumaramanglam Medical College Hospital, Salem, INDIA.

²Department of Physical Medicine & Rehabilitation, Madras Medical College/GIRM KK Nagar, Chennai, INDIA.

Email: drrajakumar1965@gmail.com

Abstract Background: COVID -19 pandemic has severely affected differently abled children from attending regular therapy sessions by means of transportation and fear of contracting infection. It made the parents and the children to refrain themselves from attending regular therapy sessions. So as a means to bridge the gap an alternative way to provide therapy arises, hence we started Telerehabilitation services. Aim: To find if GMFM -88 evaluation tool can be done as parent administered – Physician observed tool for evaluation and progress in children with cerebral palsy in Telerehabilitation services. Methods: 49 children with cerebral palsy of age 1 – 9 years were enrolled for the study. Care was taken in selecting child’s parents in respect to basic educational qualification, Comprehension and Cognitive abilities to ensure that they understand the instructions correctly. The child’s parents were explained about each tool, item of the evaluation tool in detail and the same was demonstrated by the therapist in a simulated manner using a custom-made child figurine (A stuffed toy/Doll) which the parents followed. The tool items were administered by both child’s mother and father individually and observation scoring done by two Physician at a gap of one day. Results: All the parents were able to follow the instructions carefully and the scores were documented. Comparison of the scores showed p value is >.01 which is statistically non – significant. Conclusion: l GMFM-88 tool can be used as PA-PO tool for assessment and prognosis for cerebral palsy children in Telerehab services.

Key words: Tele- rehabilitation, GMFM – 88 Assessment tool, cerebral palsy, Custom made child figurine.

INTRODUCTION

Tele- rehabilitation is a relatively new and developing field of tele-health. Tele – rehabilitation refers to delivery of rehabilitation services via information and communication technologies. Due to COVID- 19 pandemic, regular therapy sessions at the hospital are affected, so as a means to deliver therapy sustainably to differently abled children, tele rehabilitation services like exercise therapy, Occupational therapy were started. We hunted for a standardized assessment tool to evaluate the status of children in tele rehabilitation services for cerebral palsy children before prescribing medications and therapy, through database search engines like pubmed, researchgate, etc. But we couldn’t find any. Hence we came up with the study. GMFM88 (Gross Motor Functional Measure-88) is an observational clinical tool designed to evaluate the motor functions of a child with Cerebral palsy. It is essential to monitor and adjust the rehabilitation protocols in the treatment of the patients

AIM AND OBJECTIVES: To test the validity of GMFM – 88 tool for assessment and prognostic evaluation in cerebral palsy children as a Parent administered-Physician observed (PA-PO) tool in tele rehab services. To validate the use of a custom made simulation doll to demonstrate the evaluation tool to parents. To check for administrator bias / observer bias during this test.

MATERIALS: GMFM -88 Score sheet. Smartphone/Laptop/Desktop with good network connectivity. Custom made child figurine (Doll).

METHODS: DESIGN SETTING: PARTICIPANTS: Pilot study Home setting - telerehab services 49 children with cerebral Palsy of age 1 – 9 years

INCLUSION CRITERIA: Spastic and flaccid type of Cerebral palsy children. Child’s parents with basic educational qualification, Good comprehension and cognitive abilities, Understanding both Tamil and English language. Children with GMFCS level II to V.

EXCLUSION CRITERIA: Congenital heart disease. Respiratory problems. Weight issues (less than 7kg at one year of age)

METHODOLOGY: Physician1 and Physician 2 were trained for administration of GMFM – 88 Tool via Tele rehab services with specific instructions on Demonstration of each component of the tool with a stuffed girl doll.

RESULTS

P- Value analysis for significance of intervention was done between Physician-1, Observation of Care taker- SCORE (A) and Care taker – 2 SCORE (B). Likewise P-Value analysis for significance of intervention was done between Physician-2, observation of care taker-1(SCORES - C) and Care taker -2(SCORE -D). The Analysis reveals P-value of 0.97 which means the difference was Insignificant. The analysis shows that there is no observer bias in administering the tool, provided both of them were trained to use similar standard verbal and instructions. Also P-value analysis for significance if Intervention done between observation of care taker-1 with Physician-1 (SCORE A) Physician2 (SCORE C) Observation of Care taker-2 with Physician-1( SCORE B) and Physician 2 (SCORE D). P-Value was 0.91 which means administrator bias was Insignificant and the use of a simulation doll as a visual cue in addition to verbal instruction was clear and consistent way of demonstration. P value of both the paired analysis is > 0.01 which means statistically insignificant.

Table 1

S. No	Age and Sex of the Child	A Physician -1 to Caretaker -1	B Physician -1 to Caretaker -2	C Physician -2 to Caretaker -1	D Physician-2 to Caretaker -2
1	6Y/F	59.4%	59.2%	59.3%	59.2%
2	3Y/F	24.6%	4.8%	24.6%	24.8%
3	7Y/F	28.8%	28.8%	28.7%	28.8%
4	5Y/F	6.5%	6.5%	6.4%	6.5%
5	6Y/M	84.2%	84.2%	84.2%	84.2%
6	4Y/F	20.3%	20.2%	20.3%	20.2%
7	7Y/M	18.7%	18.7%	18.5%	18.6%
8	3Y/F	11.1%	11.2%	11.1%	11.2%
9	3Y/M	62.9%	62.8%	62.7%	62.8%
10	4Y/M	76.7%	76.8%	76.8%	76.7%
11	4Y/F	43.8%	43.7%	43.7%	43.7%
12	2Y/F	12.2%	12.2%	12.1%	12.1%
13	3Y/M	79.5%	79.5%	79.6%	79.6%
14	1Y/M	9.1%	9.2%	9.1%	9.1%
15	2Y/F	16.6%	16.6%	16.5%	16.6%
16	8Y/F	30.4%	30.5%	30.5%	30.6%
17	2Y/M	66.9%	66.9%	66.9%	66.9%
18	1Y/M	91.2%	91.1%	91.1%	91.2%
19	5Y/F	33.5%	33.5%	33.6%	33.6%
20	3Y/F	14.1%	14.2%	14.1%	14.2%
21	6Y/M	73.7%	73.8%	73.7%	73.8%
22	9Y/F	67.2%	67.2%	67.2%	67.2%
23	8Y/M	86.7%	86.6%	86.5%	86.6%
24	4Y/F	19.6%	19.7%	19.7%	19.8%
25	9Y/M	35.3%	35.2%	35.2%	35.2%
26	3Y/M	28.9%	28.9%	28.9%	28.8%
27	2Y/F	79.2%	79.3%	79.3%	79.3%
28	8Y/M	55.8%	55.8%	55.7%	55.8%
29	3Y/M	43.2%	43.1%	43.2%	43.2%
30	7Y/F	31.9%	31.8%	31.9%	31.8%
31	8Y/F	42.1%	42.0%	42.1%	42.1%
32	4Y/M	58.6%	58.6%	58.5%	58.6%
33	3Y/M	79.9%	79.8%	79.8%	79.9%
34	6Y/M	27.5%	27.5%	27.5%	27.5%
35	6Y/F	19.3%	19.3%	19.2%	19.1%
36	8Y/M	44.7%	44.6%	44.7%	44.6%
37	1Y/F	44.7%	44.6%	44.6%	44.7%
38	4Y/M	62.4%	62.3%	62.3%	62.2%
39	2Y/M	77.7%	77.7%	77.7%	77.7%
40	3Y/F	35.6%	35.5%	35.5%	35.5%
41	2Y/M	39.8%	39.8%	39.8%	39.8%
42	7Y/F	71.1%	71.0%	71.0%	71.1%
43	5Y/M	20.9%	20.8%	20.9%	20.8%
44	3Y/M	57.6%	57.6%	57.5%	57.5%
45	9Y/M	70.6%	70.5%	70.6%	70.5%
46	1Y/F	32.8%	32.8%	32.8%	32.8%
47	5Y/M	66.1%	66.1%	66.0%	66.1%
48	3Y/M	29.7%	29.6%	29.6%	29.7%
49	8Y/F	34.2%	34.1%	34.1%	34.1%
	MEAN VALUE	46.2%	46.21%	46.21%	46.20%

CONCLUSIONS

Difference in GMFM -88 Scores remain constant even with the change in person administered the test and change in persons observing the test. Overall GMFM -88 tool can be used as a valid Parent administered-Physician observed (PA-PO) standardized evaluation tool for assessment and prognosis of children with cerebral palsy in Tele rehabilitation services.

REFERENCES

The Efficacy of GMFM88and GMFM 66 to detect changes in gross motor function in children with cerebral palsy: a literature review Madavi Alotaibi, Toby Long. Disabil Rehabil.2014; 36(8):617_27.
Evaluation of a Telerehabilitation system for community based rehabilitation. James Schutte et al. Intl J Telerehabilitation 2012; Apr 13;4(1):15-24
A systematic review of tests to predict Cerebral palsy in young children Bosanquet M et al. Dev Med Child Neurol.2013.May 55(5): 418-26
Feasibility and acceptability of clinical pediatric Telerehabilitation services Kelly Tanner, Rachel Bican. Intl J Telerehabilitation 2020;12(2):13-52.

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