Page 11 - Mobility Management, January 2019

Pediatric Series
THE GMFCS LEVEL V CHILD
When Independent Mobility Isn’t Likely, Optimal Positioning Is Imperative
Much of the work of the seating and wheeled mobility professional focuses on independence: moving via a manual or power wheelchair. But when independent mobility is not possible, what objectives
should the seating and wheeled mobility team set for themselves and their client?
One example of that scenario is the child who has cerebral palsy and has been classified at GMFCS Level V.
Understanding GMFCS Scores
The Gross Motor Function Classification System (GMFCS) describes a child’s motor function while also indicating the level or complexity of mobility-related assistive technology a child would be expected to require, according to the Cerebral Palsy Alliance Research Foundation (cparf.org).
A GMFCS score (see sidebar) typically doesn’t change after age 5, so that score can be used to forecast future equipment needs.
The GMFCS scores motor function on a scale of 1 to 5, with higher scores indicating greater involvement.
Briefly, the different levels are as follows:
• Level I: Walks without limitations.
• Level II: Walks with limitations.
• Level III: Walks using a hand-held mobility device. Uses
wheeled mobility for longer distances, and may self-propel a
manual wheelchair for shorter distances.
• Level IV: Self-mobility with limitations; may use powered
mobility.
• Level V: Transported in a manual wheelchair. Limited in his/
her ability to maintain head and trunk posture against gravity, and has limited control of leg and arm movements.
Given those typical abilities, what should the most important positioning considerations be for a child at Level V?
Weight Shifting & Pressure Relief
For example, do children at Level V need help with weight shifting and pressure relief?
Jed Malmberg is the Regional Category VP, Rehab Division, for Inspired by Drive.
“A dependent Level V child is typically unable to propel a manual wheelchair or operate a power chair due to physical strength limitations and sometimes cognitive impairment,” he said. “Often, they have poor trunk stability and poor head control. For these same reasons, being able to reposition themselves often becomes a concern. Anybody who is unable to pressure relieve effectively is at risk for pressure injury, especially in a seated posture for as many
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MOBILITY MANAGEMENT | JANUARY 2019 11
BABY AND FATHER’S HANDS: ISTOCKPHOTO.COM/MAGICAL_LIGHT