Understanding the Functional Mobility Scale (FMS) for Children
The Functional Mobility Scale (FMS) is a clinical tool used primarily by physiotherapists and orthopaedic surgeons to classify the functional mobility of children with cerebral palsy (CP). It provides a standardized way to rate a child's walking ability based on their need for assistive devices across three distinct distances: 5, 50, and 500 meters. These distances represent different mobility environments, such as at home, at school, and in the community, respectively.
Scoring System Explained
The FMS employs a six-point ordinal scale for each distance, with scores ranging from 1 to 6. A higher score indicates greater independence in mobility.
- Score 1: Uses a wheelchair or is transported.
- Score 2: Uses a walker or gait trainer.
- Score 3: Uses crutches.
- Score 4: Uses a cane or walking stick.
- Score 5: Walks independently on level surfaces.
- Score 6: Walks independently on all surfaces.
Why the FMS is Specific to Children
The original validation studies for the children's FMS specifically targeted the age range of 4 to 18. This was done to focus on a period where functional mobility changes are more directly related to the condition and treatment rather than typical developmental milestones. Excluding younger age groups, where rapid developmental changes occur, helps ensure the scale's reliability in measuring the effects of conditions like cerebral palsy or surgical interventions.
Clarifying Confusion: The Functional Movement Screen (FMS) for Adults
It is important to distinguish the Functional Mobility Scale for children from the similarly named Functional Movement Screen (FMS). Created by physical therapist Gray Cook, this is a different assessment used for adults and athletes to evaluate fundamental movement patterns. It scores seven different movement patterns, such as the Deep Squat and Hurdle Step, on a scale from 0 to 3. It is often used to identify asymmetries and limitations that could lead to injury, forming a "movement profile" of what an individual can and cannot do. This FMS is not designed for the same population or purpose as the children's FMS.
Specialized Scales for Seniors: The Elderly Mobility Scale (EMS)
For older adults and the elderly, clinicians utilize other tools to assess mobility. The Elderly Mobility Scale (EMS), for example, measures a person's mobility based on tasks like standing, walking, and turning. The EMS helps determine the level of independence an elderly person has in their basic activities of daily living (ADLs) and whether they are at risk for falls or require long-term care. This specialized scale is a more appropriate assessment for this population than either of the FMS versions.
Comparison of Mobility Scales by Target Population
| Feature | Functional Mobility Scale (Pediatric) | Functional Movement Screen (Adult) | Elderly Mobility Scale (EMS) |
|---|---|---|---|
| Target Population | Children (4-18) with cerebral palsy | General adult population and athletes | Older adults and elderly |
| Purpose | Classify functional walking ability over specific distances | Evaluate fundamental movement patterns, identify limitations | Assess mobility for basic activities, determine care needs |
| Rating System | 6-point ordinal scale (1-6) based on device use | 4-point ordinal scale (0-3) based on movement pattern quality | 14-20 total points based on task performance |
| Scoring Details | Assesses mobility at 5m, 50m, and 500m distances | Scores seven distinct movements (e.g., Deep Squat, Hurdle Step) | Evaluates tasks like standing, stepping, and reaching |
| Key Insight | How a child moves within different environments | Identifies potential injury risks and movement deficiencies | Determines independence and care level required |
The Clinical Importance of Using the Right Tool
Using the correct scale for the appropriate age group and condition is paramount for effective treatment and tracking progress. For a child with CP, the FMS provides valuable, quantifiable data on the impact of interventions like surgery or physical therapy. This helps clinicians and families communicate about the child's abilities. For an athlete, the Functional Movement Screen gives coaches insight into how to build a fitness program that addresses underlying movement issues. For an older adult, the Elderly Mobility Scale offers a clear picture of their independence and risks, helping to plan for safe living arrangements and necessary support. The different age ranges and populations for these tools highlight the nuanced approach required for mobility assessment.
How Assessment Evolves with Age
An individual's mobility needs and challenges change significantly over a lifetime. While a child with cerebral palsy might be assessed with the FMS to understand their walking capabilities, a younger adult may be screened with the Functional Movement Screen to prevent injury during athletic training. Later in life, an older adult might be assessed with the Elderly Mobility Scale to evaluate their capacity for safe independent living. An in-depth look at these tools can be found on sites like the Shirley Ryan AbilityLab, a reputable source for rehabilitation measures. This shift in assessment tools reflects the shift in healthcare focus from developmental progress to injury prevention and, finally, to maintaining functional independence in old age.
