Infant Neuromotor Assessment Instruments:

The goal of this article is to review infant neuromotor assessment instruments which are of particular interest to pediatric therapists. A brief history of early neurological assessment protocols is presented followed by a discussion of measurement issues important in the critical evaluation of assessment instruments. Measurement terminology such as reliability, validity, and standardization are defined and examples are provided from recent neuromotor assessment literature. In the major section of this article, six recently published neuromotor assessment instruments are described and critiqued. Relevance of these tools for use by pediatric physical and occupational therapists is discussed. Finally, the importance of early identification of neuromotor deficits is presented, briefly followed by directions for future research in the area of infant neuromotor assessment.     

Reliability and validity of the mother-child neglect scale

The current study offers a new way to ascertain information about child neglect by evaluating a self-report measure of neglectful behaviors, the Mother-Child Neglect Scale (MCNS). The scale was modified from an existing self-report measure, the Neglect Scale (NS), which was originally designed to measure personal histories of neglect. One hundred adolescent mothers were administered the MCNS and NS in two occasions via phone interviews. In addition, maternal abuse potential and the quality of mother-child interactions were assessed when children were age 3 and 5 years. The MCNS had high internal consistency and moderate test-retest reliability. Convergent validity was found between the MCNS and maternal histories of neglect as well as observed parenting behaviors and child abuse potential; those relationships remained after social desirability was controlled. This research tool may prove useful, in conjunction with existing assessment instruments, in determining the type and severity of past neglectful behaviors.     

Reliability and validity: Part II

Determining measurement reliability and validity involves complex processes. There is usually room for argument about most instruments. It is important that the researcher clearly describes the processes upon which she made the decision to use a particular instrument, and presents the evidence available showing that the instrument is reliable and valid for the current purposes. In some cases, the researcher may need to conduct pilot studies to obtain evidence upon which to decide whether the instrument is valid for a new population or a different setting. In all cases, the researcher must present a clear and complete explanation for the choices, she has made regarding reliability and validity. The consumer must then judge the degree to which the researcher has provided adequate and theoretically sound rationale. Although I have tried to touch on most of the important concepts related to measurement reliability and validity, it is beyond the scope of this column to be exhaustive. There are textbooks devoted entirely to specific measurement issues if readers require more in-depth knowledge.     

Reliability and validity of health status measurement by the TAPQOL

Background: In addition to clinical measures in the evaluation of paediatric interventions, health related quality of life (HRQoL) is an important outcome. The TAPQOL (TNO-AZL Preschool children Quality of Life) was developed to measure HRQoL in preschool children. It is a generic instrument consisting of 12 scales that cover the domains physical, social, cognitive, and emotional functioning. Aims: To evaluate the feasibility, score distribution, internal consistency, test-retest reliability, and discriminative and concurrent validity of the TAPQOL multi-item scales in preschool children, aged 2–48 months. Also to evaluate the feasibility, reliability, and validity separately for infants (2–12 months old) and toddlers (12–48 months old). Methods: Parents of a random general population sample of 500 preschool children were sent a questionnaire by mail. A random subgroup of 159 parents who participated received a retest after two weeks. Results: The response rate was 83% at the test and 75% at the retest. There were few missing answers. Six scales showed ceiling effects. Nine scales had Cronbach''s alphas >0.70. In general, score distributions and Cronbach''s alphas were comparable for infants and toddlers. Test-retest showed no significant differences in mean scale scores; two scales had intra-class correlations <0.50. Five scales showed significant differences between children with no conditions versus children with two or more parent reported chronic conditions. Conclusion: Results showed that the TAPQOL is a feasible instrument to measure HRQoL and support the reliability and discriminative validity of the majority of its scales for infants as well as toddlers.     

Reliability and validity of health status measurement by the TAPQOL.

BACKGROUND: In addition to clinical measures in the evaluation of paediatric interventions, health related quality of life (HRQoL) is an important outcome. The TAPQOL (TNO-AZL Preschool children Quality of Life) was developed to measure HRQoL in preschool children. It is a generic instrument consisting of 12 scales that cover the domains physical, social, cognitive, and emotional functioning. AIMS: To evaluate the feasibility, score distribution, internal consistency, test-retest reliability, and discriminative and concurrent validity of the TAPQOL multi-item scales in preschool children, aged 2-48 months. Also to evaluate the feasibility, reliability, and validity separately for infants (2-12 months old) and toddlers (12-48 months old). METHODS: Parents of a random general population sample of 500 preschool children were sent a questionnaire by mail. A random subgroup of 159 parents who participated received a retest after two weeks. RESULTS: The response rate was 83% at the test and 75% at the retest. There were few missing answers. Six scales showed ceiling effects. Nine scales had Cronbach's alphas >0.70. In general, score distributions and Cronbach's alphas were comparable for infants and toddlers. Test-retest showed no significant differences in mean scale scores; two scales had intra-class correlations <0.50. Five scales showed significant differences between children with no conditions versus children with two or more parent reported chronic conditions. CONCLUSION: Results showed that the TAPQOL is a feasible instrument to measure HRQoL and support the reliability and discriminative validity of the majority of its scales for infants as well as toddlers.     

Reliability and validity of the injury prevention project home safety survey

OBJECTIVE: To evaluate reliability and validity of The Injury Prevention Project Safety Survey (TIPP-SS) of the American Academy of Pediatrics in measuring injury prevention practices. DESIGN: Reliability was measured using the test-retest method. Validity is measured comparing results of parent-completed TIPP-SSs and a home safety audit conducted in the participants' homes at the time of survey. SETTING: Two Chicago Public School Early Childhood Education program sites. PARTICIPANTS: Eighty-eight families (44 English speaking and 44 Spanish speaking) with a child aged 3 to 5 years attending a site A or B Chicago Public School Early Childhood Education program. Participants were split evenly between sites. INTERVENTION: For the reliability study, primary caregivers completed TIPP-SS twice, 14 to 24 days apart. For the validity study, primary caregivers completed TIPP-SS during a home visit in which a research assistant completed a home safety audit. A total of 44 home visits were completed, 22 in Spanish and 22 in English. OUTCOME MEASURES: Test-retest reliability and validity of TIPP-SS. Results are compared for agreement of individual items and the whole survey. RESULTS: The Injury Prevention Project Safety Survey is reliable but not valid. The Injury Prevention Project Safety Survey is a good measure of the concept of injury prevention knowledge and practice (Cronbach alpha = 0.869). External reliability was statistically supported as well (P = .40). The Injury Prevention Project Safety Survey is not a valid measure of injury prevention behaviors. Validity was poor for items based on observed data (Pearson r = 0.287, in English; Pearson r = - 0.449, in Spanish). Validity was much stronger for parent report data (Pearson r = 0.689, in English; Pearson r = 1.00, in Spanish). CONCLUSIONS: Results suggest that TIPP-SS measures knowledge and attitudes rather than behavior. Parents are often aware of the desired behavior or condition and report those instead of actual conditions or behaviors. This suggests that the quest to develop a valid home-based, injury prevention, behavior assessment tool should continue and be done in a way that carefully addresses potential instruments' validity and reliability.     

Neuromotor development in infants with cerebral palsy investigated by the Hammersmith Infant Neurological Examination during the first year of age.

BACKGROUND: The Hammersmith Infant Neurological Examination (HINE) is a simple and scorable method for assessing infants between 2 and 24 months of age. AIMS: The purpose of this retrospective study was firstly, to evaluate the neuromotor development of infants with cerebral palsy (CP) by the HINE, during the first year of age; secondly, to correlate the scoring of this neurological tool with levels of the Gross Motor Function Classification System (GMFCS). METHODS: A cohort of 70 infants with a diagnosis of CP at 2 years of age was evaluated by the HINE at 3, 6, 9 and 12 months of corrected age and by GMFCS at 2 years of age. RESULTS: The main results indicate that at 3-6 months, infants with quadriplegia (IV and V levels of GMFCS) and those with severe diplegia (III level) scored below 40, whereas those with mild or moderate diplegia (I-II level) and hemiplegia (I-II level) mainly scored between 40-60. Interestingly, the 26% of infants with hemiplegia scored > or =67 at 12 months. We observed a strong (r=-0.82) and significant (p<0.0001) negative correlation between the scores of the neurological examination and the levels of GMFCS. CONCLUSIONS: Our results point out that the HINE can give additional information about neuromotor development of infants with CP from 3-6 months of age, strictly related to the gross motor functional abilities at 2 years of age.     

Reliability and Validity of the Standing Heel-Rise Test

ABSTRACT

A standardized protocol for a pediatric heel-rise test was developed and reliability and validity are reported. Fifty-seven children developing typically (CDT) and 34 children with plantar flexion weakness performed three tests: unilateral heel rise, vertical jump, and force measurement using handheld dynamometry. Intraclass correlation coefficients (ICC) varied from 0.85–0.99 for reliability analyses in both participant groups. Construct validity analysis revealed a significant difference between groups (F = 44.57, p < .05) and age-related differences among CDT; 5- to 8-year olds (mean = 15.2, SD = 5.4) performed fewer repetitions compared to 9- to 12-year olds (mean = 27.7, SD = 11.7) (p < .05). Age explained 41% of the variance in the number of heel-rise repetitions. Correlations between the three tests (r = 0.56 to 0.66) provide evidence of convergent validity. The results indicate that the standardized protocol is both reliable and valid for use in 5- to 12-year-old children with and without plantar flexion weakness.     

Neuromotor development of preterm and full-term infants

The Neuromotor Behavioral Inventory (NBI), a 16-category measure of muscle tone, developmental motor abilities, quality of movement, neurological reflexes and reactions, and neuromotor outcome was used with 38 infants divided into three groups: healthy preterm (HPT), sick preterm (SPT), and healthy full-term (HFT) infants. Infants were tested at five time points: 40 weeks postconception (newborn) and 3, 6, 9 and 12 months of age post-term. The intent of the study was two-fold: to determine whether there are developmental differences among the groups of infants and whether the differences persist during the first year of life. Results indicate that HFT and HPT infants score higher than SPT infants in the neuromotor categories of: muscle tone, upper extremity development, head control, and neuromotor outcome rating. HFT infants scored higher than both preterm groups in: trunk rotation, reaction to movement, visual and auditory attention, and fixing. Differences persisted among the groups during the first year of life in the following: the developmental motor ability of trunk rotation, fixing, adaptability, and the neuromotor outcome rating. It appears that neonatal health status is a contributing factor to infant neuromotor development, particularly in the quality of movement reactions.     

Reliability, sensitivity and responsiveness of the Infant Behavioral Assessment in very preterm infants

Aim: The aim of this study is to investigate the reliability, sensitivity and responsiveness of the Infant Behavioral Assessment (IBA) to evaluate neurobehavioural organization in very preterm infants. Methods: Videotaped assessments of very preterm infants participating in a recent trial served to evaluate a standardized IBA observation. Inter‐rater reliability was based on 40 videos scored by two independent observers, using percentage agreement and weighted Kappa’s. Sensitivity was evaluated by comparing the IBA results of 169 infants at 35–38 weeks postmenstrual age, dichotomized according to two developmental risk factors. For responsiveness, the effect size (ES) was calculated between 0 and 6 months corrected age in all intervention and control infants and in subgroups of high‐risk intervention and control infants with oxygen dependency ≥28 days. Results: Inter‐rater agreement was 93% in the total assessment; Kappa agreement was moderate to good in the behavioural categories. Significant differences were found between groups with or without risk factors. Larger differences between ESs in the randomized groups with oxygen dependency ≥28 days than in the total randomized groups reflect the responsiveness of the IBA. Conclusion: In this study, we found satisfactory to good clinimetric characteristics of the IBA in very preterm born infants.     

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.     

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.     

The Minneapolis-Manchester Quality of Life instrument: Reliability and validity of the Youth Form

OBJECTIVE: Improvements in survival after childhood cancer have increased emphasis on health-related quality of life (HRQoL) of survivors. We developed the Minneapolis-Manchester Quality of Life-Youth Form (MMQL-YF) as a standardized patient self-report instrument designed to assess HRQoL in childhood cancer survivors between the ages of 8 and 12 years. STUDY DESIGN: To validate the instrument, the MMQL-YF was administered to 643 children (481 healthy, 162 with cancer). Factor analysis was conducted to refine the instrument, and Cronbach's alpha coefficient was used to measure its internal reliability. Known-groups validity was determined by comparing healthy children with those with cancer. Construct validity was studied by a comparison of similar domains in the MMQL-YF and the Child Health Questionnaire (CHQ). Stability was tested by re-administration of the MMQL-YF 2 weeks later. RESULTS: Internal consistency reliability was in the acceptable range for this instrument. The MMQL-YF was able to distinguish between known groups, and its scales correlated highly with similar CHQ domains. Test-retest reliability showed that the instrument was extremely stable in all scales tested. CONCLUSION: Data provide evidence for the validity and reliability of the MMQL-YF as a comprehensive, multidimensional, self-report instrument for measuring HRQoL among childhood cancer survivors.     

复旦中文版沟通功能分级系统的信度和效度研究

目的确定复旦中文版沟通功能分级系统(CFCS)的信度和效度。方法以2017年5月至2017年10月在复旦大学附属儿科医院康复中心和上海董李凤美康健学校中2~18岁脑瘫和具有沟通障碍的学龄前儿童(PCCD)为研究对象,排除具有严重听力和视力障碍者和非汉语沟通的家庭。由研究小组多名儿童康复医师和治疗师根据英语版CFCS翻译、回译和集体讨论形成复旦中文版CFCS。在言语语言治疗师(SLP)进行现场CFCS评级的同时,照顾者根据CFCS提供的评估流程行回顾性评估,相对照顾较多的为第一照顾者,较少的为第二照顾者。通过分析SLP和照顾者、照顾者之间的评估结果的相关性,确定CFCS的评估者间信度。以能力低下儿童评定量表(PEDI)作为校标行效度检验,PEDI评估者为儿童照顾者或儿童在校的主要任课老师,通过分析SLP的CFCS分级与PEDI社会功能项目的尺度化分之间的相关性,确定CFCS的效度。结果符合本文纳入和排除标准的研究对象139名儿童,男91例,年龄2.0~15.8(4.7±3.2)岁,2~4岁74例(53.2%),~16岁65例。脑瘫儿童80例均行粗大运动功能分级系统(GMFCS)评估,行手功能分级系统(MACS)评估47例;PCCD儿童59例。同1名SLP对139个纳入对象行CFCS评估。102/139(73.4%)个家庭至少有1名照顾者参与了CFCS评估,48/102(47.1%)个家庭有2名照顾者参与了CFCS评估,总体信度SLP与照顾者、第一和二照顾者间CFCS评级Kw分别为0.83和0.85。102个参与了CFCS评估家庭中55例脑瘫儿童,其中20例有2名照顾者参与了CFCS评级,SLP与照顾者、第一和二照顾者间CFCS评级Kw分别为0.88和0.86;PCCD 47例儿童,其中28例有2名照顾者参与了CFCS评级,SLP与照顾者、第一和二照顾者间CFCS评级Kw分别为0.85和0.82。2~4岁儿童的CFCS评价在SLP和照顾者间的信度为Kw=0.77,照顾者间的信度为Kw=0.90;~16岁儿童的CFCS评级在SLP和照顾者间的信度为Kw=0.87,照顾者间的信度为Kw=0.74。139例纳入对象SLP的CFCS级别与PEDI社会功能项目的尺度化分之间的相关系数为-0.81。结论复旦中文版CFCS在脑瘫儿童和PCCD中均具有良好的评价者间信度和平行效度,可以有效地对这些儿童进行沟通功能分级。     

中文版脑瘫患儿手功能分级系统的信度和效度研究

摘要 目的 确定中文版脑瘫（CP）患儿手功能分级系统（MACS）的信度和效度。方法 通过分析现场操作评价和录像评价结果之间的关系确定MACS的重测信度;分析不同评价者间（家长、作业治疗师和康复医生）的评价结果确定MACS的评价者间信度;以CP患儿精细运动能力测试（FMFM）的分值为效标确定MACS的平行效度。结果 来自上海2家CP康复机构的124例4～18岁CP患儿参加了此项研究。男77例,女47例;平均(6.7±2.6)岁,4～7岁97例;～12岁24例,～18岁3例。其中痉挛型四肢瘫27例,双瘫48例,偏瘫38例,手足徐动型5例,共济失调2例,肌张力障碍型4例。粗大运动功能分级（GMFCS）Ⅰ级51例,Ⅱ级32例,Ⅲ级15例,Ⅳ级14例,Ⅴ级12例。2名作业治疗师的现场评价与录像评价结果显示,MACS具有良好的重测信度,ICC值分别为0.94（95%CI：0.90～0.96）和0.87（95%CI:0.80～0.92）;同时MACS具有良好的评价者间信度,作业治疗师与家长现场评价间的ICC值为0.85(95%CI：0.77~0.91),2名作业治疗师现场评价间的ICC值为0.99(95%CI：0.99~1.00),不同家长现场评价间的ICC值为0.91(95%CI：0.66~0.98),2名作业治疗师录像评价间的ICC值为0.96(95%CI：0.94~0.97),作业治疗师与康复医生录像评价间的ICC值为0.94(95%CI：0.90~0.97);MACS与FMFM分值间具有良好的平行效度,Spearman相关系数为-0.71。结论 中文版CP患儿MACS具有良好的信度和效度,适用于中国开展CP患儿的手功能分级。在进行MACS评价时应充分考虑环境因素的影响,引导家长参与到MACS的评价工作中来。     

Reliability and Clinical Significance of the Southern California Postrotary Nystagmus Test

The purpose of this paper is to review the literature related to the reliability and clinical validity of the Southern California Postrotary Nystagmus Test. Extensive research has been done on both normal and abnormal school age children and on normal land high-risk infants. Precaution for administration and guidelines for interpretation of postrotary nystagmust test scores are discussed. Alternate methods of measuring nystagmus, such as caloric and per-rotary induces nystagmus, are compared to postrotary nystagmus.