The Functional mobility scale (FMS)
ABSTRACT We devised a new Functional Mobility Scale (FMS) to describe functional mobility in children with cerebral palsy, as an aid to communication between orthopaedic surgeons and health professionals. The unique feature of the FMS is the freedom to score functional mobility over three distinct distances, chosen to represent mobility in the home, at school and in the wider community. We examined the construct, content, and concurrent validity of the FMS in a cohort of 310 children with cerebral palsy by comparing the FMS to existing scales and to instrumented measures of physical function. We demonstrated the scale to be both valid and reliable in a consecutive population sample of 310 children with cerebral palsy seen in our tertiary referral center. The FMS was useful for discriminating between large groups of children with varying levels of disabilities and functional mobility and sensitive to detect change after operative intervention.
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- "According to the gross motor function classification system (GMFCS) (Palisano et al. 1997), 2 children were at level I, 23 were at level II, and 9 were at level III preoperatively. Gait function was evaluated with the functional mobility scale (FMS), rating walking ability at 3 specific distances: 5, 50, and 500 m (Graham et al. 2004). A rating of 6 means that the child walks independently on all surfaces, and 5 means walking without support on level surfaces. "
ABSTRACT: Background and purpose — Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have shown improved gait function 1 year postoperatively. Using GA, we assessed the outcome after 5 years and evaluated parental satisfaction with the surgery and the need for additional surgery. Patients and methods — 34 ambulatory children with spastic diplegia had preoperative GA. Based on this GA, the children underwent 195 orthopedic procedures on their lower limbs at a mean age of 11.6 (6–19) years. On average, 5.7 (1–11) procedures per child were performed. Outcome measures were evaluation of gait quality using the gait profile score (GPS) and selected kinematic parameters, functional level using the functional mobility scale (FMS), and the degree of parental satisfaction. Results — The mean GPS improved from 20.7° (95% CI: 19–23) preoperatively to 15.4° (95% CI: 14–17) 5 years postoperatively. There was no significant change in GPS between 1 and 5 years. The individual kinematic parameters at the ankle, knee, and hip improved statistically significantly, as did gait function (FMS). The mean parental satisfaction, on a scale from 0 to 10, was 7.7 (2–10) points. There was a need for additional surgical procedures in 14 children; this was more frequent in those who had the index operation at an early age. Interpretation — The main finding was that orthopedic surgery based on preoperative GA gave marked improvements in gait function and quality, which were stable over a 5-year period. Nevertheless, additional orthopedic procedures were necessary in almost half of the children and further follow-up with GA for more than 1 year postoperatively is recommended in children with risk factors for such surgery.Acta Orthopaedica 01/2015; DOI:10.3109/17453674.2015.1011927 · 2.45 Impact Factor
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- "The pain score ranged from a minimum of " 0 " to a maximum of " 10 " corresponding to " no pain " and " the worst pain he had ever had in his entire life " , respectively. The patient was also assessed with functional mobility scale (FMS) before and after the end of six months of treatment [Graham et al., 2004]. "
ABSTRACT: Camurati–Engelmann disease is characterized by hyperostosis of the long bones and the skull, muscle atrophy, severe limb pain, and progressive joint contractures in some patients. It is caused by heterozygous mutations in the transforming growth factor β1 (TGFβ1) believed to result in improper folding of the latency-associated peptide domain of TGFβ1 and thus in increased or deregulated bioactivity. Losartan, an angiotensin II type 1 receptor antagonist, has been found to downregulate the expression of TGFβ type 1 and 2 receptors. Clinical trials with losartan have shown a benefit in Marfan syndrome, while trials are underway for Duchenne muscular dystrophy and other myopathies associated with TGFβ1 signaling. We hypothesized that due to its anti-TGFβ1 activity, losartan might be beneficial in Camurati–Engelmann disease. This report concerns a boy who presented at age 13 years with severe limb pain and difficulty in walking. Clinical and radiographic evaluation results were compatible with Camurati–Engelmann disease and the diagnosis was confirmed by mutation analysis (c.652C > T [p.Arg218Cys]). The boy underwent an experimental treatment with losartan at a dosage of 50 mg/day, orally. During the treatment period of 18 months, the intensity and frequency of limb pain decreased significantly (as shown by a pain diary), and muscle strength improved, allowing the boy to resume walking and climbing stairs. No obvious side effects were observed. We cautiously conclude that TGFβ1 inhibition with losartan deserves further evaluation in the clinical management of Camurati–Engelmann disease. © 2014 Wiley Periodicals, Inc.American Journal of Medical Genetics Part A 10/2014; 164(10). DOI:10.1002/ajmg.a.36692 · 2.05 Impact Factor
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- "In addition to classifying function using the GMFCS, gait function may be further classified using simple scoring systems, such as the Functional Mobility Scale (FMS) and the Gillette Functional Assessment Questionnaire [24, 25]. We have found these systems simple to use, reliable and sensitive to change following intervention and also with natural history. "
ABSTRACT: The majority of children with orthopaedic conditions in childhood survive to adult life, and there is a need for many of them to transition to adult services. This includes children with disorders such as club foot or developmental dislocation of the hip as well as those with complex syndromic conditions, bone dysplasias or neuromuscular disorders such as cerebral palsy and myelomeningocele. In many tertiary paediatric centres, transition has become a formal process in which clinicians document and communicate the status of patients who have been under their care to ensure a smooth transfer to adult services. The purpose of this report is to support the need for clear communication when children with cerebral palsy transition to adult services and to suggest that this transition represents a significant opportunity for audit and clinical research. Some of the factors to be considered in developing a minimum data sheet for the transfer or transition of children with cerebral palsy to adult services are described. Using the model of adolescents with cerebral palsy transitioning to adult services, orthopaedic surgeons can be encouraged to develop similar methodology and documentation for many other conditions for the purposes of communication, facilitation of transition, audit and clinical research.Journal of Children s Orthopaedics 04/2014; 8(3). DOI:10.1007/s11832-014-0569-0