Free Practice PTA Exam Questions
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Your Free NPTE-PTA Practice Question
A patient is classified as level 4 on the Gross Motor Function Classification System (GMFCS). Which of the following is the MOST appropriate intervention for this patient?
A) Ambulation in parallel bars with assistance from physical therapist assistant to improve standing tolerance and ambulation distance
B) Use of standing frame to provide weight bearing through the lower extremities and encourage upright head posture
C) Ambulation without an assistive device with close guarding by the physical therapist assistant to increase independence with ambulation
D) Basic agility drills without an assistive device to promote coordination
Correct Answer and Explanation
Did you get it right? The correct answer is A.
The Gross Motor Function Classification System (GMFCS) is a 5-level classification system that has been developed to specifically describe the functional abilities of children with cerebral palsy. Children classified as level 1 have the least functional restrictions, while children classified as level 5 are most severely limited.
Gross Motor Function Classification System for Cerebral Palsy in Children
| Level | Functional Abilities |
| Level 1 | ambulation without restrictionhas difficulty with advanced balance and coordination activities |
| Level 2 | does not require an assistive device for ambulation, but is limited outdoors and in the community for ambulation |
| Level 3 | ambulates with assistive device, is limited outdoors and in the community for ambulation and may require wheelchair |
| Level 4 | limited self-mobilitymay use powered mobility |
| Level 5 | severely limited self-mobilitytransported in manual wheelchair |
A child classified as level 4 on the GMFCS is typically able to walk short distances with physical assistance and device usage, but may require powered mobility outdoors and for community distances. A patient at this level would need to work on standing tolerance and ambulation distance in a safe, supported environment.
Therefore, the best answer is ambulation in the parallel bars. With the support of the parallel bars and a physical therapist assistant closely guarding the patient, this would be an appropriately challenging activity for most children at a level 4 on the GMFCS.
Incorrect Answers and Explanations
Answer B: A child with cerebral palsy who has limited weight-bearing opportunities through the lower extremities and presents with poor head control would most likely have severely limited self-mobility and be classified as a level 5 on the GMFCS. Standing frame intervention would be appropriate for this patient at level 5 but may not be advanced enough or appropriately challenging for treating a patient at level 4.
Answer C: A child classified as level 3 requires an assistive device for indoor mobility. This child would be challenged appropriately by working on ambulation without an assistive device with close guarding by the physical therapist assistant. This would be too advanced of an intervention for a patient at level 4 on the GMFCS.
Answer D: A child classified as level 1 ambulates without difficulty but is challenged by advanced balance and coordination activities. Basic agility drills would be appropriate for this patient but would be too advanced of an intervention for a patient at level 4 on the GMFCS.
Bottom Line
The GMFCS is a 5-level classification system that has been developed to specifically describe the functional abilities of children with cerebral palsy.
- Level 1 – ambulation without restriction; has difficulty with advanced balance and coordination activities
- Level 2 – does not require an assistive device for ambulation, but is limited outdoors and in the community for ambulation
- Level 3 – ambulates with assistive device, is limited outdoors and in the community for ambulation and may require wheelchair
- Level 4 – limited self-mobility; may use powered mobility
- Level 5 – severely limited self-mobility; transported in manual wheelchair
Children at each level should be provided with interventions that are appropriately challenging and safe based upon the child’s current abilities.
For more information, see:
Evidenced-Based Decision Making in Pediatric Physical Therapy; Cerebral Palsy. In: Campbell SK, Palisano RJ, Orlin MN. Physical Therapy for Children, 4th ed. St. Louis, MO: Saunders Elsevier; 2012. Chapter 1; Chapter 18.
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