Stanbridge - T4 - Peds - W4 - Assessments and Overview

• PTA 1011, Power Point #4 covers assessments and interventions through the lifecycle.

Assessments Ch. 2

• After studying the chapter, students will be able to differentiate between norm- and criterion-referenced assessments
• Students will also be able to discuss psychometric properties of different assessments
• Students will be able to determine the purpose and design of each assessment tool
• Students will be able to appreciate that one assessment is not appropriate for all testing purposes and all children

Purpose Of Assessments

• Assessments are administered to complete an initial evaluation
• They also screen for delays or abnormalities
• Can provide a "clinical diagnosis
• Used to evaluate outcomes and progress
• Assessments document change over a period of time and be standardized (uniform testing)
• Collect data/information- which helps classify children for program placement
• Assessments determine a prognosis
• Can be used as on-going assessments and re-evaluations
• Measure benchmarks and progress over time

Important Key Terms

• Age equivalent score represents the mean chronological age of a certain score and is useful for describing/assessing developmentally delayed kids.
• Percentile score represents the percentage of children at the same age/grade level who perform at a lower level.
• Percentage score represents the percentage of items passed on a scale.
• Raw score represents actual points earned or total items passed (baseline/basal and ceiling/cutoff).
• Responsiveness represents the ability to detect minimally significant clinical change.
• Standard score is the average score for a group, or deviations from the mean
• Standard tests include a set of tasks or questions intended to assess a behavior when presented under standardized conditions, with uniform testing results.
• Validity determines whether the assessment tool accomplishes its intended purpose and its accuracy.
• Reliability determines if the tool is an accurate measure of what it claims to measure
• Reliability is measured via the consistency of test item agreement between multiple observers or administrators and its repeatability

Standardized Assessment Tools

• Standardized assessment tools can be Norm-Referenced or Criterion-Referenced.

Norm-Referenced Assessments

• These are standardized on a normal population
• Allow standard scores, percentiles, and age-equivalent calculations
• These are based on comparisons with a normative, typical-developmental sample (peers)
• Helpful to determine eligibility for services
• Refer to Table 2-1 (O'Shea, pg. 21).
• Examples:
  • Bayley Scales of Infant Development, Third Edition (BSID-III)
    • Assesses the development of children from 1 to 42 months
    • Standardized
    • Includes 5 scales:
      • cognitive- problem solving, perception, early verbal communication
      • language
      • social-emotional
      • motor- fine and gross motor skills and body control
      • adaptive behavior
  • Peabody Developmental Motor Scales -2nd edition (PDMS-2)
    • Folio and Fewell published the original PDMS in 1983
    • Initially to give physical education instructors a tool with which to assess and program motor patterns/skills within PE for kids up to age 6
    • Currently assess gross/fine motor of children birth to 6 yrs. of age
    • Assesses motor competence relative to child's peers
    • Determines great differences in motor abilities
    • Assesses qualitative and quantitative aspects of individual skills
    • Includes a 3 point scale (0, 1, 2)
    • Include age equivalents, % rankings, and standard scores for each kid
    • Gross motor scale assesses reflexes, stationary, locomotion, and object manipulation (ball skills)
    • Fine motor assesses grasping and visual-motor integration
    • Test manual describes the admin process for each item
  • Test of Gross Motor Development, 2nd edition (TGMD-2, 2000)
    • Intended for ages 3-10 yrs. old
    • Identifies children who may be eligible for special services due to significantly delayed gross motor skills
    • Includes 2 scales with 6 subtests
    • Locomotor scale includes run, gallop, hop, leap, horizontal jump
    • Object control scale includes kicking, catching, throwing
    • Easily administered in 30 minutes
  • Test of Infant Motor Performance, (TIMP, 1995)
    • Designed to assess functional motor performance of infants between 32 weeks gestational age and 16 weeks post-term
    • Includes 2 sections- elicited and observed
    • 59 items
    • Elicited-assesses infant's motor response to placement in various positions, and to visual and auditory stimulation.
    • Observed-used to rate the infants exhibited spontaneous movement
  • Alberta Infant Motor Scales (AIMS, 1994)
    • Provides an observation tool, administered by a healthcare provider
    • Observational format w/ emphasis on the quality of a movement, and are easy and quick to admin
    • Uses a representative infant population sample between 1990 and 1992 from Alberta, Canada
    • Includes four subscales (58 items) assessing prone, supine, sit, and stand
    • Each item has descriptors for weightbearing, posture, and anti-gravity movements
    • Scores are presented as percentiles
  • Bruininks-Oseretsky Test of Motor Proficiency 2nd Edition (BOT-2, 2005)
    • Is an assessment designed for ages 4 to 21 years old
    • Assesses motor skills and discrimination in children with severe motor dysfunctions
    • 8 subtests (short scoring form is about 30 mins; long form is about 60 mins)
    • Covers a wide range of unique aspects of motor development
      • Running speed and Agility (shuttle run, one-legged hopping)
      • Balance (standing on one leg, walking on line)
      • Strength (push ups, sit ups)
      • Bilateral coordination (jumping jacks, touch index finger to nose)
      • Upper-limb coordination (catching a tossed ball, dribbling)
      • Dexterity and fine motor (copying a circle, connecting dots)
    • Includes photos to accompany simple instructions
    • Child friendly tasks
  • Home Observation Measurement of the Environment (HOME)
    • Measures the quality and quantity of stimulation in the home environment (from the child's vantage point)
    • Involves systematic data collection; interview or observation -birth-10 years old
    • Assesses toys, routines, discipline/interaction, learning materials, language stimulation, and physical environment
    • Easy to administer; takes about 45 mins
  • Pediatric Evaluation of Disability Inventory (PEDI)
    • Assesses functional skills in children aged 6 months to 7.5 years
    • Includes three content areas of self-care , ability, and social function
    • Records amount of caregiver assistance the child needs to complete the skill and any equipment or object modifications needed
    • Allows therapist assesses performance over time
    • Scores are obtained through parent/caregiver interview and observations

Criterion-Referenced:

• Judgment-based with a comparison of a child's performance to criteria that have been defined w/in the test
• Based on milestones of motor skills performed by typically developing children
• Most useful when developing a treatment plan or curriculum for a child
• Refer to Table 2-1 (pg. 21 O'Shea)
• Examples
  • Gross Motor Function Measure (GMFM, 1994)
    • Can measure change in motor function over time in a child with cerebral palsy
    • Focuses on how much activity the child can accomplish (quantity), not the quality
    • 88 items assess motor function through: lying, rolling, sitting, crawling, kneeling, standing/walking, running and jumping
    • Includes also a GMFM-66 (shorter, only 66 items)
    • GMFM specifically for children with Cerebral Palsy (CP) and Down syndrome
  • School Functional Assessment (SFA, 1998)
    • Guides program planning for students with disabilities
    • Tests children K- 6th grade with disabilities and skills such as, participation, task support, activity performance, cognitive, physical and behavioral tasks
    • Specific to children with sensory and physical impairments
    • Clinical judgment based on typical performance
    • Requires collaboration with all team members/teacher; time-consuming
  • Hawaii Early Learning Profile (HELP, 1997)
    • Comprehensive and developmentally sequenced
    • Curriculum based, cross-disciplinary and integrated approach
    • Focuses on whole child
    • Birth to 6 years
    • Includes six domains of- cognitive, language, gross motor, fine motor, social, and self-help
  • Infant/Toddler Sensory Profile (ITSP)
    • Judgment-based questionnaire that characterizes a child's behaviors/performance regarding sensory processing
    • A 48-item questionnaire. Measures sensory modulation abilities in children aged 7-36 months
    • Parents rate the frequency of child's behavior on a 5-point scale from 1 (almost always) to 5 (almost never)
    • The questions are grouped into 5 sections i.e. auditory processing (10 questions), visual processing (7 questions), tactile processing (15 questions), vestibular processing (6 questions), and oral sensory processing (7 questions)

Additional Assessment Tools:

• Developmental Assessment of Young Children(DAYC)
• Neurological Assessment of the Preterm and Full-term Newborn Infant (NAPFI)- covered in Ch. 17 O'Shea
• Denver Developmental Screening Test
• Diagnostic instruments to assist in screening/evaluating a child for autism (Ch. 12), includung:
  • The Ages and Stages Questionnaire (ASQ)
  • The Autism Screening Questionnaire
  • Childhood Autism Rating Scale (CARS)
  • The Checklist for Autism in Toddlers (CHAT)

Overview Of Physical Therapy Interventions Ch. 3

• Student will identify the difference between intervention philosophies, be able to recognize which interventions would be most appropriate for a given situation, and understand why one intervention may not be appropriate for all situations and all children
• PT Interventions varies as per child's age, pathology, family structure, living situation, past medical history, and prognosis
• Master clinicians use a variety of techniques/interventions that can be modified
• Research has not proven any intervention better or worse
• A PTA's must have clinical knowledge and expertise, and must rely on sound clinical knowledge to make clinical decisions in selecting appropriate activities
• Must have overall good understanding of the pathology, as well as the medical treatment for patients with acute conditions
• Clinicians need understand how pathology may affect functional skills
• Important to know precautions and contraindications, to be able to chose exercises and activities.
• Many clinical decisions for pediatric patients is the same as adult population
• For patients with neurological problems, PTA must understand the initial evaluation, be familiar with assessment tool used, and be able to comprehend the results
• PTA's need sound understanding of primitive reflexes, postural reactions, muscle tones and typical development. This is only achieved through fully understanding normal/typical development and it is only then that the clinician can assess/recognize abnormal development
• Once able to observe abnormal movement/function, clinical reasoning begins.
• The goals should start before any treatment begins, they should be measurable and relevant to a child's lifestyle
• Goals should be functional and realistic, can be met/ modified/revised, frequent reassessments should also occur

Intervention Plan

• Should reflect needs and capabilities
• It should consider child’s age and pathology (acute and chronic)
• In addition to this, the home program should embed daily routine
• Be family centered up to 3 years of age, and then switch to education centered
• Educate family and/or caregiver to allow child to do more on their own
• It should be fun and engaging
• Finally, in order for it to be effective, all systems need to be assessed and monitored: physiologic, sensorimotor, musculoskeletal systems.
• Examples of Appropriate Toys and Intervention Strategies per age group (infants-school age included in document

Learning Assessment Questions

• Norm-referenced assessments:
  • a. Are standardized tests
  • b. Are based on comparisons with typical development of peers
• It is important for a PT/PTA to understand typical development in order to recognize the following:
  • b. Atypical development