Low Motor Assessment: A Comparative Pilot Study with Young Children With and Without Motor Impairment.

Most of the developmental instruments that measure cognitive development in children rely heavily on fine motor skills, especially for young children whose language skills are not yet well developed. This is problematic when evaluating the cognitive development of young children with motor impairment. The purpose of this study is to assess the need for a Low Motor adapation of a standardized instrument when testing children with motor impairment. To accomplish this, we have adapted the procedures, item instructions and play material of a widely used and standardized instrument, the Bayley Scales of Infant Development-Second Edition (BSID-II, Bayley 1993). The Original and the Low Motor versions were administered to 20 children experiencing typical development and 19 children with motor impairment within a period of two weeks. Results showed that children with motor impairments scored significantly higher on the Low Motor version of the Bayley Mental Scale than on the Original version: a difference of between 5 and 10 points when the score is expressed in terms of a developmental index score. Results from children with typical development support the assumption that item content and difficulty remain unchanged in the Low Motor version.

Needs, problems and rehabilitation goals of young children with cerebral palsy as formulated in the rehabilitation activities profile for children.

OBJECTIVE: To describe the content of needs, problems and goals of 41 Dutch children with cerebral palsy using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a classification system. To evaluate the adherence of formulations of needs, problems and goals to specifications of the Rehabilitation Activities Profile for Children. METHODS: Raw text data were extracted and organized. Two raters independently weighed the entries' quality against the specifications and linked the extracted content to ICF-CY categories. RESULTS: In 12% of the reports no needs, and in 24% no principal goals, were formulated. Needs mostly pertained to the activities-and-participation domain (65%), whereas problems and goals covered all 3 ICF-CY domains. None of the needs were prioritized and 79% met the quality criterion of description of a problem/desire. Twenty-four percent of the problems were described in the activity-and-participation domain and 83% referred to a treatable problem. Fifty-six percent of the goals were formulated in terms of intended result/effect and 63% as child/parent actions. CONCLUSION: Insight is provided into the content of rehabilitation programmes for children with cerebral palsy. To optimize the quality of the reports, research on reasons for non-adherence to specifications of the Rehabilitation Activities Profile is needed.

Goal setting in Dutch paediatric rehabilitation. Are the needs and principal problems of children with cerebral palsy integrated into their rehabilitation goals?

OBJECTIVE: To evaluate whether the needs and principal problems of children with cerebral palsy (CP) as formulated in their interdisciplinary rehabilitation reports are integrated into the goal descriptions and whether this depends on the nature of the needs and problems. DESIGN: Descriptive multiple-case study. SETTING: Five Dutch paediatric rehabilitation facilities. SUBJECTS: The rehabilitation profiles of 41 children with cerebral palsy aged between 4 and 8 years. METHODS: The raw text data were extracted and organized, after which two raters independently linked the extracted content to the categories of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). Matches between needs, problems and goals were identified by ICF-CY code comparisons. RESULTS: The Cohen's kappas for ICF-CY encoding were all in the range of "fair to good" (0.52-0.78). For five children (12%) no needs had been formulated and the reports of 10 (24%) were excluded from further analyses as they lacked a principal goal. In the 31 reports analysed, 29 (23%) need constructs and 46 (46%) problem constructs were incorporated into the goals. Of the total of 95 goal constructs 49 (52%) were not related to either a need or a problem construct. No clear relationship could be established between the type of needs and problems and their inclusion or exclusion in the principal goals. CONCLUSION: Overall, the integration of the needs and principal problems of children with their rehabilitation goals was not optimal. However, integration was difficult to objectify because needs, problems and goals were poorly documented.