Review of the Bruininks-Oseretsky Test of Motor Proficiency,Second Edition (BOT-2)

The Bruininks-Oseretsky Test of Motor Proficiency (Bruininks, 1978) is a standardized, norm-referenced measure used by physical therapists and occupational therapists in clinic and school practice settings. This test recently was revised and published as the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2; Bruininks & Bruininks, 2005). The BOT-2 is an individually administered measure of fine and gross motor skills of children and youth, 4 through 21 years of age. It is intended for use by practitioners and researchers as a discriminative and evaluative measure to characterize motor performance, specifically in the areas of fine manual control, manual coordination, body coordination, and strength and agility. The BOT-2 has both a Complete Form and a Short Form. This review of the BOT-2 describes its development and psychometric properties; appraises strengths and limitations; and discusses implications for use by physical therapists and occupational therapists.     

Longitudinal Performance of Infants with Cerebral Palsy on the Test of Infant Motor Performance and on the Alberta Infant Motor Scale

Understanding the natural history of development in children with cerebral palsy (CP) is important for studying the consequences of early intervention. The purpose of this paper is to present results on the Test of Infant Motor Performance (TIMP) from 0-4 months of age and on the Alberta Infant Motor Scale (AIMS) from 3 to 12 months of age in a group of infants later diagnosed as having CP. Ages at which infants with CP were first recognized as having delayed motor performance on each instrument and the stability of performance over time are presented. Clinical implications for using both instruments are discussed.     

Responsiveness of the Test of Basic Motor Skills of Children with Down Syndrome

The aim of this study was to examine the responsiveness of the Test of Basic Motor Skills for Children with Down Syndrome (BMS). Forty-one children with Down Syndrome, 3 to 36 months of age, participated in the study. Gross motor skills were assessed three times using the BMS and the Gross Motor Function Measure (GMFM) before and after a baseline period of 2 weeks (T1-T2) and after a period of 16 weeks (T2-T3). Internal and external responsiveness of the BMS was analyzed using Guyatt's Responsiveness Index (GRI) and 2 × 2 repeated measures. Change in BMS scores was compared to change in GMFM scores and parent and physiotherapist ratings of change. The responsiveness of the BMS was large (GRI = 2.55). A significant Time × Age interaction [F(1,37) = 8.87, p < .01] indicated that BMS scores increased more for children ≤ 2 years compared with children 2 to 3 years of age. The difference in GRI between the BMS and GMFM was 0.75 (95% CI ?0.25–1.75), indicating that the BMS and GMFM did not significantly differ in responsiveness. The Time × Measure interaction was not significant, indicating that the increase in mean BMS and GMFM scores did not differ. Change in BMS scores were correlated with parent ratings of change (r = 0.65, p < .001) but not physiotherapist ratings (r = 0.36, p = .23). The results provide evidence that the BMS is responsive to change in gross motor development in children with Down Syndrome from 3 to 36 months of age.     

Predictive value of the Bayley Scales of Infant Development on development of very preterm/very low birth weight children: A meta-analysis

Background and aims

The Bayley Scales of Infant Development (BSID) is the most widely used measure to assess neurodevelopment of very preterm (gestational age ≤ 32 weeks) and very low birth weight (VLBW, ≤ 1500 g) infants in the first three years of life. This meta-analysis determines the predictive value of the Mental Developmental Index (MDI) and the Psychomotor Developmental Index (PDI)/Motor Composite, collectively referred to as Bayley motor scale, of the BSID-I, -II and Bayley-III for later cognitive and motor functioning in very preterm/VLBW children.

Methods

Cochrane Library, PubMed, PsychINFO and CINAHL were searched for English-language peer-reviewed studies published before March 2013. Studies were included if they reported odds ratios or correlations between the MDI or Bayley motor scale scores obtained in the first three years of life, and standardized cognitive or motor assessment obtained later in life in very preterm/VLBW children. Meta-analytic methods were applied to aggregate available data.

Results

A total of 16 studies met inclusion criteria. Across 14 studies (n = 1330 children), MDI scores were strongly predictive for later cognitive functioning, r = 0.61 (95%CI: 0.57–0.64), explained variance 37%, p < .001. The relationship between MDI scores and later cognitive function was not mediated by birth weight (p = .56), gestational age (p = .70), and time interval between assessments (p = .55). Across five studies (n = 555 children), Bayley motor scale scores were moderately predictive for later motor function, r = 0.34 (95%CI: 0.26–0.42), explained variance 12%, p < .001.

Conclusions

In very preterm/VLBW children, MDI scores explain 37% of the variance in later cognitive functioning, whereas Bayley motor scale scores explain 12% of later motor function. Thus a large proportion of the variance remains unexplained, underlining the importance of enhancing prediction of developmental delay in very preterm children.     

Prediction of gross motor development and independent walking in infants born very preterm using the Test of Infant Motor Performance and the Alberta Infant Motor Scale

Background

One objective of a neonatal follow-up program is to examine and predict gross motor outcome of infants born preterm.

Aims

To assess the concurrent validity of the Test of Infant Motor Performance (TIMP) and the Alberta Infant Motor Scale (AIMS), the ability to predict gross motor outcome around 15 months corrected age (CA), and to explore factors associated with the age of independent walking.

Methods

95 infants, born at a gestational age < 30 weeks, were assessed around 3, 6 and 15 months CA. At 3 months CA, correlations of raw-scores, Z-scores, and diagnostic agreement between TIMP and AIMS were determined. AIMS-score at 15 months CA and parental-reported walking age were outcome measures for regression analyses.

Results

The correlation between TIMP and AIMS raw-scores was 0.82, and between Z-scores 0.71. A cut-off Z-score of − 1.0 on the TIMP had 92% diagnostic agreement (κ = 0.67) with an AIMS-score < P10. Neither TIMP- nor AIMS-scores at 3 months CA were associated with the gross motor outcome at 15 months CA. The AIMS-scores at 6 months CA predicted the AIMS-scores at 15 months CA with an explained variance of 19%. Median walking age was 15.7 months CA, with which only the hazard ratio of the AIMS at 6 months CA and ethnicity were significantly associated.

Conclusions

Prediction of gross motor development at 15 months CA and independent walking was not possible prior to 6 months CA using the AIMS, with restricted predictive value. Cultural and infant factors seem to influence the onset of independent walking.     

642例矫正胎龄38～58周婴儿运动表现测试结果的分析

目的探讨基于重庆3所医院矫正胎龄38~58周婴儿的运动表现测试(TIMP)数据与美国常模数据的差异,为TIMP在国内的引进及应用提供参考。方法使用TIMP对2016年1~12月在陆军军医大学第二附属医院、重庆市沙坪坝区妇幼保健院、重庆市妇幼保健院早产儿随访门诊或儿保门诊就诊的642例矫正胎龄38~58周婴儿进行评估测试,统计评估得分并与美国常模数据进行比较。结果该组婴儿TIMP得分随婴儿矫正胎龄的增加而升高,从38~39+6周龄组的37±5分,增加至56~57+6周龄组的83±12分。但各周龄组平均得分均低于美国常模,差异有统计学意义(P0.001)。结论 TIMP评估得分可反映不同矫正胎龄婴儿的运动能力。基于重庆3所医院门诊矫正胎龄38~58周婴儿的TIMP数据与美国常模相比差异较大,提示在国内使用TIMP评估小婴儿运动能力前建立中国TIMP常模非常必要。     

Effects of Modified Instructions on Peabody Developmental Motor Scales,Second Edition,Gross Motor Scores in Children with Typical Development

Aims: The current study assessed whether modifying instructions on the Peabody Developmental Motor Scales, Second Edition (PDMS-2) affected scores in children with typical development. Methods: The gross motor portion of the PDMS-2 was administered twice, 2–10?days apart, to 38 children. Age- and gender-matched groups received instructions in both standard and modified formats, with order depending on group assignment. Results: Gross Motor Quotient results showed an effect for instruction type (p?=?.03) and an interaction between instruction type and order (p?=?.02). Improved scores for those given modified instructions during the second session indicated the interaction favored modifications. Stationary scores showed an effect for instruction type (p?=?.01) and an interaction between instruction type and age (p?=?.02). Object Manipulation scores showed an interaction between instruction type and order only (p =.002); Locomotion scores showed no significant changes (p?=?.25). Percentile rank changes ranged from 9% to 22% across subtests. Conclusions: Findings suggested instruction modifications may change PDMS-2 gross motor scores, even in children with typical development. Findings also suggested normative scores should not be reported if modifications were used during testing. Research is needed to determine optimal cues for the best representation of true motor ability during standardized assessment.     

Validity of the Fine Motor Area of the 12-Month Ages and Stages Questionnaire in Infants Following Major Surgery

ABSTRACT

The Ages and Stages Questionnaires (ASQ) are parent-report screening tools to identify infants at risk of developmental difficulties. The purpose of this study was to examine validity and internal reliability of the fine motor developmental area of the ASQ, 2nd edition (ASQ2-FM) for screening 12-month-old infants following major surgery. The ASQ2-FM was completed by caregivers of 74 infants who had cardiac surgery in the first 90 days of life, 104 infants who had noncardiac surgery in the first 90 days of life, and a control group of 154 infants. The Rasch item response analysis revealed that the ASQ2-FM had poor ability to discriminate among levels of fine motor ability. Sensitivity was poor (20%) and specificity was good (98%) when compared with the scores for the fine motor subscale of the Bayley Scales of Infant and Toddler Development. The ASQ2-FM under-identified infants at risk for fine motor delay; internal reliability and construct validity do not support use as a screening tool of fine motor development of infants aged 12 months who have undergone major surgery.     

Gross motor development in full-term Greek infants assessed by the Alberta Infant Motor Scale: Reference values and socioeconomic impact

Objective

The aims of this study were to investigate gross motor development in Greek infants and establish AIMS percentile curves and to examine possible association of AIMS scores with socioeconomic parameters.

Methods

Mean AIMS scores of 1068 healthy Greek full-term infants were compared at monthly age level with the respective mean scores of the Canadian normative sample. In a subgroup of 345 study participants, parents provided, via interview, information about family socioeconomic status. Multiple linear regression analysis was performed to evaluate the relationship of infant motor development with socioeconomic parameters.

Results

Mean AIMS scores did not differ significantly between Greek and Canadian infants in any of the 19 monthly levels of age. In multiple linear regression analysis, the educational level of the mother and also whether the infant was being raised by grandparents/babysitter were significantly associated with gross motor development (p = 0.02 and p < 0.001, respectively), whereas there was no significant correlation of mean AIMS scores with gender, birth order, maternal age, paternal educational level and family monthly income.

Conclusions

Gross motor development of healthy Greek full-term infants, assessed by AIMS during the first 19 months of age, follows a similar course to that of the original Canadian sample. Specific socioeconomic factors are associated with the infants' motor development.     

Concurrent Validity and Reliability of the Alberta Infant Motor Scale in Infants at Dual Risk for Motor Delays

Concurrent validity of scores for the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Gross Motor Scale-2 (PDGMS-2) was examined with a sample of 35 infants at dual risk for motor delays or disabilities. Dual risk was defined as low birthweight (≤ 1,500 g at birth) and environmental risk (children from low-income families). Measures were administered to participants during one visit to a high-risk, follow-up program. Pearson product-moment correlation coefficients were high (r = .90 to .97), with the highest correlation between PDGMS-2 locomotion subscale and AIMS total score. Correlation coefficients were lower for infants > 9 months of age. Novice examiners' scores on both measures closely approximated those of experienced examiners (ICC range = .98 to .99). The results support concurrent validity of the AIMS and PDGMS-2 for infants at dual risk and have implications for using the AIMS in high-risk follow-up programs, particularly in relation to evaluating functional components of motor performance and ease of administration.     

Effect of Hippotherapy on Motor Proficiency and Function in Children with Cerebral Palsy Who Walk

Aims: To evaluate the effects of hippotherapy on physical capacities of children with cerebral palsy. Methods: Thirteen children (4–12 years old) with cerebral palsy classified in Gross Motor Function Classification System Level I or II were included in this prospective quasi-experimental ABA design study. Participants received 10 weeks of hippotherapy (30 min per week). Gross motor function and proficiency were measured with the Bruininks–Oseretski Motor Proficiency short form [BOT2-SF]) and the Gross Motor Function Measure-88 [GMFM-88] (Dimension D and E) twice before the program (T1 and T1′), immediately after (T2), and 10 weeks following the end of the program (T3). Results: Mean scores for dimensions D and E of the GMFM-88 Dimension scores (p = .005) and three out of the eight items of the BOT2-SF (fine motor precision (p = .013), balance (p = .025), and strength (p = .012) improved between baseline and immediately after intervention; mean scores immediately following and 10 weeks following intervention did not differ. Conclusions: Hippotherapy provided by a trained therapist who applies an intense and graded session for 10 weeks can improve body functions and performance of gross motor and fine motor activities in children with cerebral palsy.     

Validity of US norms for the Bayley Scales of Infant Development-III in Malawian children

ObjectiveMost psychometric tests originate from Europe and North America and have not been validated in other populations. We assessed the validity of United States (US)-based norms for the Bayley Scales of Infant and Toddler Development-III (BSID-III), a neurodevelopmental tool developed for and commonly used in the US, in Malawian children.MethodsWe constructed BSID-III norms for cognitive, fine motor (FM), gross motor (GM), expressive communication (EC) and receptive communication (RC) subtests using 5173 tests scores in 167 healthy Malawian children. Norms were generated using Generalized Additive Models for location, scale and shape, with age modeled continuously. Standard z-scores were used to classify neurodevelopmental delay. Weighted kappa statistics were used to compare the classification of neurological development using US-based and Malawian norms.ResultsFor all subtests, the mean raw scores in Malawian children were higher than the US normative scores at younger ages (approximately <6 months) after which the mean curves crossed and the US normative mean exceeded that of the Malawian sample and the age at which the curves crossed differed by subtest. Weighted kappa statistics for agreement between US and Malawian norms were 0.45 for cognitive, 0.48 for FM, 0.57 for GM, 0.50 for EC, and 0.44 for RC.ConclusionWe demonstrate that population reference curves for the BSID-III differ depending on the origin of the population. Reliance on US norm-based standardized scores resulted in misclassification of the neurological development of Malawian children, with the greatest potential for bias in the measurement of cognitive and language skills.     

Reliability and Construct Validity of the 6-Minute Racerunner Test in Children and Youth with Cerebral Palsy,GMFCS Levels III and IV

Aim: To determine the test–retest reliability and construct validity of a novel 6-Minute Racerunner Test (6MRT) in children and youth with cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) levels III and IV. The racerunner is a step-propelled tricycle. Methods: The participants were 38 children and youth with CP (mean age 11 y 2 m, SD 3 y 7 m; GMFCS III, n = 19; IV, n = 19). Racerunner capability was determined as the distance covered during the 6MRT on three occasions. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable differences (SDD) were calculated to assess test-retest reliability. Results: The ICC for tests 2 and 3 were 0.89 (SDD 37%; 147 m) for children in level III and 0.91 for children in level IV (SDD 52%; 118 m). When the average of two separate test occasions was used, the SDDs were reduced to 26% (104 m; level III) and 37% (118 m; level IV). For tests 1 to 3, the mean distance covered increased from 345 m (SD 148 m) to 413 m (SD 137 m) for children in level III, and from 193 m (SD 100 m) to 239 m (SD 148 m) for children in level IV. Conclusions: Results suggest high test–retest reliability. However, large SDDs indicate that a single 6MRT measurement is only useful for individual evaluation when large improvements are expected, or when taking the average of two tests. The 6MRT discriminated the distance covered between children and youth in levels III and IV, supporting construct validity.     

Establishing Australian Norms for the Jebsen Taylor Test of Hand Function in Typically Developing Children Aged Five to 10 Years: A Pilot Study

Aims: The aim of this study was to present preliminary normative data for the Jebsen Taylor Test of Hand Function test (JTTHF) in Australian children. Normative data provide reference values for comparison of upper limb capacity when evaluating and planning treatment. Methods: The JTTHF administration procedures and materials were standardized. One hundred and two typically developing children aged 5 to 10 years in Brisbane, Australia, were then assessed using the JTTHF. Results: Five-year-old children were significantly different to all other groups (one year age bands), and 6-year-old children were significantly different from 9-year-old children in the dominant hand. Regression modeling showed improvements of 0.9 and 0.89 s in JTTHF total time for the dominant and nondominant hands, respectively, for every 12 months of maturation in 6- to 10-year-old children. Conclusions: This paper presents preliminary JTTHF norms for Australian typically developing children 5 years, 6 to 7 years, 8 to 9 years, and 10 years of age.     

Nutritional and socioeconomic factors in motor development of Santal children of the Purulia district, India

Aims

The aim of this study was to characterize the motor development of 5-12 year-old Santal children of the Purulia district of West Bengal, India. The effect of socioeconomic and nutritional status on motor development was also examined.

Study design

841 (427 boys and 414 girls) Santal children were examined in this cross-sectional study. The nutritional status of each child was assessed by height-for-age z-score based on WHO reference data. Socioeconomic status (SES) was measured by the updated Kuppusswami scale. Motor development was measured using the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, Short Form (BOT-2).

Results

Sex had a significant (p < 0.05) effect on children's score of running speed and agility, upper-limb coordination and strength with higher scores for boys than girls. Children with a height-for-age z-score of − 2 or less were significantly more likely to have a total BOT-2 z-score of − 2 or less compared with children at a healthier height-for-age range (Χ² = 271.136, p < 0.0001). Well-nourished children scored significantly higher (p < 0.05) than undernourished children in total BOT-2 score and in all individual motor subtests. Regression analysis showed that nutritional status, socioeconomic status and height have a significant impact on total BOT-2 score (p < 0.001). Age and sex were found to be influencing factors in motor development.

Conclusion

Santal children's motor proficiency is around the 1st percentile when compared with normative BOT-2 data. This may be, in part, a result of nutritional and economic disparities between children on who the BOT-2 was normed and Santal children, supporting the role of nutrition in motor development. Additionally, Santal children with lower SES and poorer nutritional status have lower motor proficiency compared with Santal children with comparatively higher SES and nutritional status.