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.     

Scores of typically developing children on the Peabody Developmental Motor Scales: infancy to preschool

Norms for the Peabody Developmental Motor Scales (PDMS) and the Peabody Developmental Motor Scales, second edition (PDMS-2) are based on cross-sectional data that do not provide information on how the scores of individual children vary over time. This study examined intra-individual variability of PDMS fine and gross motor scores of 77 typically developing children at 9, 11, 13, 16, and 21 months of age and PDMS and PDMS-2 fine and gross motor scores at 4 years. Correlations between scores over time ranged from .13 to .45. PDMS and PDMS-2 scores were correlated at .71 and .75 with significantly different means, indicating that the two versions are not equivalent for 4-year-old children. Most children scored above the 16th percentile, the suggested cut-off on the PDMS, at both 21-month and 4-year assessments, but their percentile ranks fluctuated considerably. Use of confidence intervals contributes to accurate interpretation of scores by differentiating true change in a child's score from change due to measurement error.     

Therapeutic Effects of Horseback Riding Therapy on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review

ABSTRACT

Purpose: This systematic review examined the efficacy of hippotherapy or therapeutic horseback riding (THR) on motor outcomes in children with cerebral palsy (CP). Methods: Databases were searched for clinical trials of hippotherapy or THR for children with CP. Results: Nine articles were included in this review. Although the current level of evidence is weak, our synthesis found that children with spastic CP, Gross Motor Function Classification System (GMFCS) levels I–III, aged 4 years and above are likely to have significant improvements on gross motor function as a result of hippotherapy and THR. Evidence indicates that 45-min sessions, once weekly for 8–10 weeks, result in significant effects. Conclusions: The current literature on hippotherapy and THR is limited. Large randomized controlled trials using specified protocols are needed to more conclusively determine the effects on children with CP. From the current evidence, it appears that hippotherapy and THR have positive effects on gross motor function in children with CP.     

Impact of Vitamin D Supplementation on Gross Motor Development of Healthy Term Infants: A Randomized Dose-Response Trial

In addition to benefits for bone health, vitamin D is implicated in muscle function in children and adults. Aims: To determine if vitamin D dosage positively correlated with gross motor development at 3 and 6 months of age. We hypothesized that higher doses would be associated with higher scores for gross motor skills. Methods: A consecutive sample of 55 healthy, term, and breastfed infants from Montreal, Canada were recruited from a randomized trial of vitamin D supplementation between 2009 and 2012. Infants were randomized to 400 International Units (IU) (n = 19), 800 IU (n = 18) or 1,200 IU (n = 18) vitamin D₃/day. Motor performance at 3 and 6 months was quantified by the Alberta Infant Motor Scale (AIMS). Plasma vitamin D₃ metabolites were measured by tandem mass spectrometry. Results: AIMS scores did not differ at 3 months. However, total AIMS scores and sitting subscores were significantly higher at 6 months in infants receiving 400 IU/day compared to 800 IU/day and 1,200 IU/day groups (p < .05). There were weak negative correlations with length and C-3 epimer of 25(OH)D. Conclusions: In contrast to our hypothesis, gross motor achievements were significantly higher in infants receiving 400 IU/day vitamin D. Our findings also support longer infants being slightly delayed.     

Measurement and Prediction of Motor Proficiency in Children Using the Bayley Infant Scales and the Bruininks-Oseretsky Test

A sample of 76 Irish girls and boys of about 9 years of age, for whom neonatal (birthweight, Apgar and Neonatal Behavioural Assessment Scale) and infancy measures (Bayley Infant Scales at 18 months) were available, were administered the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The main focus of this paper is on a longitudinal analysis of the relationships between the neonatal and infancy measures and the BOTMP administered at about 9 years. However, since the literature expresses some doubts about the basis of the division of the BOTMP subtests into fine motor and gross motor groups and about the meaningfulness of the overall battery score, an initial statistical analysis was undertaken to examine these construct validity issues with this sample of children. This analysis indicated that the division of subtests into fine motor and gross motor skills groups, as formulated by the BOTMP, is not supported. The longitudinal analysis, therefore, focused mainly on subtest scores and provided some evidence of a degree of continuity in measured motor proficiency between birth, 18 months and the prepubertal period. Continuity was more evident for female children.     

Concurrent validity of the Bayley Scales of Infant Development II Motor Scale and the Peabody Developmental Motor Scales in two-year-old children

Concurrent validity of the Bayley Scales of Infant Development, Second Edition (BSID II) Motor Scale and the Peabody Developmental Motor Scales (PDMS) was examined by administering both tests to 38 two-year-old Native American children. A correlation analysis of age equivalent scores indicated very good to high correlation for the BSID II Motor Scale with the PDMS Fine Motor Scale (PDFMS) (r = .87) and the PDMS Gross Motor Scale (PDGMS) (r = .83). A correlation analysis of standard scores showed poor to unacceptable correlation between the BSID II Motor Scale with the PDFMS (r = .64) and the PDGMS (r = .49); further, there was poor agreement between the classifications of significantly delayed, mildly delayed, and within normal limits performance on each test. The PDFMS tended to classify children lower than the BSID II Motor Scale. The scores of the relatively younger children within each of the PDMS 6-month age categories agreed less between the tests than did the scores of the relatively older children. In conclusion, this study provides evidence for the concurrent validity of the BSID II Motor Scale and the PDMS for age equivalent scores, but not for standard scores of 2-year-old children. Professionals must be aware of the strengths and limitations of the BSID II and the PDMS, and choose appropriately to avoid denial of or over-referral for services for young children.     

Factors Associated with Enhanced Gross Motor Progress in Children with Cerebral Palsy: A Register-Based Study

Aim: To examine associations between interventions and child characteristics; and enhanced gross motor progress in children with cerebral palsy (CP). Methods: Prospective cohort study based on 2048 assessments of 442 children (256 boys, 186 girls) aged 2–12 years registered in the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Gross motor progress estimates were based on repeated measures of reference percentiles for the Gross Motor Function Measure (GMFM-66) in a linear mixed model. Mean follow-up time: 2.9 years. Results: Intensive training was the only intervention factor associated with enhanced gross motor progress (mean 3.3 percentiles, 95% CI: 1.0, 5.5 per period of ≥3 sessions per week and/or participation in an intensive program). Gross motor function was on average 24.2 percentiles (95% CI: 15.2, 33.2) lower in children with intellectual disability compared with others. Except for eating problems (–10.5 percentiles 95% CI: –18.5, –2.4) and ankle contractures by age (–1.9 percentiles 95% CI: –3.6, –0.2) no other factors examined were associated with long-term gross motor progress. Conclusions: Intensive training was associated with enhanced gross motor progress over an average of 2.9 years in children with CP. Intellectual disability was a strong negative prognostic factor. Preventing ankle contractures appears important for gross motor progress.     

Concurrent Validity of the Bayley-III and the Peabody Developmental Motor Scales-2 at 18 Months

Aim: To determine concurrent validity between the Bayley Scales of Infant and Toddler Development, 3^rd edition (Bayley-III) and the Peabody Developmental Motor Scales, 2^nd edition (PDMS-2). Methods: Both assessments were administered to 184 preterm children at 18?months corrected age; standard scores for total score, gross motor, and fine motor were calculated for each child. Cross-tabulation and Pearson correlation coefficient (r) determined concurrent validity between the Bayley-III and the PDMS-2 motor domains. Results: High correlations were found between total motor (r?=?0.88), gross motor (r?=?0.88), and fine motor scores (r?=?0.79). Both assessments had 93% agreement on classification for motor impairment; 23 children were identified by both assessments as having motor impairments, but 12 children were identified differently on each assessment (7 as impaired on PDMS-2 but average on Bayley-III; 5 as impaired on Bayley-III but average on PDMS-2). Most children with motor impairments were identified as 1SD below the mean on the PDMS-2 (27/30) and Bayley-III (18/28); however, the Bayley-III identified more children 2SD below the mean (10/28) compared to the PDMS-2 (3/30). Conclusions: Both the Bayley-III and PDMS-2 identify motor delays in children; however, clinicians should be aware of the concurrent validity as each assessment may lead to differing results.     

Motor Planning and Gait Coordination Assessments for Children with Developmental Coordination Disorder

Aims: The purposes were to examine construct validity of the Motor Planning Maze Assessment (Maze) and three items from the Functional Gait Assessment (FGA) that were modified for children (pediatric modified FGA, pmFGA), by comparing performance of children with DCD and age matched peers with typical development (TD); the construct validity of total scores of the Dynamic Gait Index (DGI) and the FGA. Methods: Twenty pairs of children with DCD and TD, age from 5 to 12 years, participated in this study. Children in both groups were tested on the Maze, pmFGA, DGI, and FGA. Paired t-tests and agreement tables were used to compare the motor performances between two groups. Results: The DCD group showed higher summary scores in the Maze (p < 0.001) and demonstrated significantly fewer steps (p ≤ 0.001) while doing the pmFGA items than the TD group. However, the FGA quality scores demonstrated minimal differences between the two groups on all three items. Children with DCD showed significantly lower DGI and FGA total scores (p < 0.001) than the TD group. Conclusion: The Maze, DGI, and FGA tests are easily applied in clinical settings and can differentiate motor planning and gait coordination between children with DCD and with TD.     

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.     

孤独症谱系障碍儿童的运动技能障碍

孤独症谱系障碍(autism spectrum disorders, ASD儿童的运动技能障碍常表现为早期运动落后、协调障碍、体能下降及视动整合障碍等,在不同程度上影响了他们的生活、学习及社会交往。由于ASD儿童的核心症状相对明显,故其运动技能障碍常常会被忽视。ASD儿童应早期进行运动功能的监测,选择合适方法进行运动评估,针对其运动技能障碍特点进行相应训练,以促进其运动技能的发育,从而辅助改善其核心功能障碍。运动干预在改善ASD儿童功能的证据日益增加,临床上不应该忽视ASD儿童的运动技能障碍及其康复干预,而应得到更多关注。     

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.     

按摩疗法对痉挛型脑性瘫痪患儿运动功能动态变化的影响

目的探讨按摩疗法对痉挛型脑性瘫痪(CP)患儿运动功能和肌张力动态变化的影响。方法随机选择本院符合痉挛型CP诊断的54例住院患儿(男31例,女23例;平均年龄5.18岁),对其进行24周40 min.d-1的按摩疗法治疗,治疗过程未予药物及其他治疗。分析其运动功能的动态变化。采用SPSS11.01软件进行统计学分析。结果痉挛性CP患儿在24周的按摩过程中,基本粗大运动能力呈逐步提高趋势,治疗前后比较差异有统计学意义(P<0.01);按摩8周时,患儿臂近端的肌张力有轻-中度降低(P<0.05),而在14周时出现明显升高,与治疗8周时比较差异有统计学意义(P<0.05),但在18周时再次下降。同时在上、下肢的远端评价,下肢的近端评价中也出现类似情况;按摩4周时,患儿肌力有轻-中度降低,但按摩10周后均出现明显提高(P<0.05),按摩14周后,患儿颈、上肢近端和下肢近端的肌力也显著提高(P<0.05)。结论按摩疗法治疗可提高痉挛型CP患儿基本粗大运动能力,相应提高其生活能力。     

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.     

Concurrent Validity of Two Standardized Measures of Gross Motor Function in Young Children with Autism Spectrum Disorder

Aims: This study provides information on how two standardized measures based on different theoretical frameworks can be used in collecting information on motor development and performance in 4- and 5-year-olds with autism spectrum disorder (ASD). The purpose of the study was to determine the concurrent validity of the Miller Function and Participation Scales (M-FUN) with the Peabody Developmental Motor Scales, Second Edition (PDMS-2) in young children with ASD. Methods: The gross motor sections of the PDMS-2 and the M-FUN were administered to 22 children with ASD between the ages of 48 and 71 months. Concurrent validity between overall motor scores and agreement in identification of motor delay were assessed. Results: A very strong correlation (Pearson's r =.851) was found between the M-FUN scale scores and the PDMS-2 gross motor quotients (GMQs). Strong agreement in identification of children with average motor skills and delayed motor skills at 1.5 standard deviations below the mean was also found. Conclusions: This study supports the concurrent validity of the M-FUN with the PDMS-2 for young children with ASD. While both tests provide information regarding motor delay, the M-FUN may provide additional information regarding the neurological profile of the child.     

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.     

Developmental Progression of Motor Skills in Children Prenatally Exposed to Cocaine

This study tested the motor development of 73 infants who were prenatally exposed to cocaine using the Peabody Developmental Motor Scales at 6, 12, 18, and 24 months of age. Repeated measures MANOVA found a main effect for age with scores decreasing as children increased in age. The significant interactive effect between age and skill type indicated that fine motor quotient scores decreased more than the comparable gross motor scores. T-tests showed significant differences between the two skill types: fine motor skills were higher at the first two testing periods and lower at the last two periods. This article discusses the nature of the delays at specified age periods and the implications for future assessment and programming.     

Development and Pilot Testing of the Challenge Module: A Proposed Adjunct to the Gross Motor Function Measure for High-Functioning Children with Cerebral Palsy

ABSTRACT

The aim was to develop a Challenge Module (CM) as a proposed adjunct to the Gross Motor Function Measure for children with cerebral palsy who have high-level motor function. Items were generated in a physiotherapist (PT) focus group. Item reduction was based on PTs’ ratings of item importance and safety via online surveys. The proposed CM items were pilot-tested with children in Gross Motor Function Classification System Level I. The focus group identified 35 items for consideration. The first item-reduction survey (n = 86 PT respondents) resulted in 20 items. A second survey yielded two additional items. Seven pilot-test participants (6–14 years) had a CM total mean score of 74.5% (SD = 19.4). Three easy items were subsequently removed and two items combined. Of seven additional items suggested by the children during testing, two were accepted in a third item-reduction survey. The final result was a 20-item CM to evaluate advanced motor skills. The CM requires refinement through Rasch scaling and formal validation.     

The Effect of Therapeutic Horseback Riding on Gross Motor Function and Gait Speed in Children Who Are Developmentally Delayed

The purpose of this study was to measure the effects of a seven-week therapeutic horseback riding program and to determine if changes were retained after therapeutic riding was discontinued. A repeated-measures within-participants design was used to assess performance on the Gross Motor Function Measure and timed 10-meter walk in seven developmentally delayed children. A statistically significant improvement in gross motor function was found in post-intervention measures. Improvements were maintained seven weeks after therapeutic riding had ended. No considerable difference in gait speed was noted. This study indicates that therapeutic riding may lead to improvement in gross motor function in developmentally delayed children and that these improvements remain once therapeutic riding ceases.     

Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review

Aims: To review the literature on the effects of aquatic intervention on gross motor skills for children with cerebral palsy (CP). Data sources: Six databases were searched from inception to January 2016. Review methods: Aquatic studies for children aged 1–21 years with any type or CP classification and at least one outcome measuring gross motor skills were included. Information was extracted on study design, outcomes, and aquatic program type, frequency, duration, and intensity. Quality was rated using the Centre of Evidence-Based Medicine: Levels of Evidence and the PEDro scale. Results: Of the 11 studies which met inclusion criteria, only two used randomized control trial design, and the results were mixed. Quality of evidence was rated as moderate to high for only one study. Most studies used quasi-experimental designs and reported improvements in gross motor skills for within group analyses after aquatic programs were held for two to three times per week and lasting for 6–16 weeks. Participants were classified according to the Gross Motor Function Classification System (GMFCS) levels I–V, and were aged 3–21 years. Mild to no adverse reactions were reported. Conclusions: Evidence on aquatic interventions for ambulatory children with CP is limited. Aquatic exercise is feasible and adverse effects are minimal; however, dosing parameters are unclear. Further research is needed to determine aquatic intervention effectiveness and exercise dosing across age categories and GMFCS levels.