Category: T&M Tools

Archive for the ‘T&M Tools’ Category

Mar 09 2015

Scales of Independent Behavior-Revised (SIB-R)

Published by

Critical Review of Tests & Measures: Scale of Independent Behavior- Revised

Dates of Publication: 1984 and Revision: 1996

Authors: Robert H. Bruininks, Richard W. Woodcock, Richard F. Weatherman, Bradley K. Hill

Source: Riverside Publishing Company, 425 Spring Lake Drive, Itasca, Illinois 60143     phone number: 800-323-9540

Costs: Complete kit $340.00 (Includes Interview Book, Comprehensive Manual, 15 Full Scale Response Booklets, 5 Short Form Response Booklets, 5 Early Development Form Response Booklets)

Purpose: The main purpose is usually for either diagnosis or program planning. The SIB-R provides a comprehensive norm-referenced assessment of 14 areas of adaptive behavior and 8 areas of maladaptive behavior. There are 4 adaptive domains: Motor Skills, Social Interaction and Communication, Personal Living and Community Living. There are 3 maladaptive domains: Internalized, Asocial and Externalized. The SIB-R is primarily designed to measure functional independence and adaptive functioning in home, school, employment, and the community settings.

Type of Test: Questionnaire or Structured interview

Target Population and Ages: 3 months – 80+ years

Time Requirements: 45-60 minutes Full Scale, 15-20 minutes Short Form or Early Development Form Administration (and Scoring)

Test Administration: Short Form, Short Form for children and Short Form adapted for the blind

Administration: Examinee and/or Respondent (parent and/or guardian) are read statement/question as they follow along in response booklet.

Adaptive Rating Scale: Does (or could do) task completely without help or supervision:

  • 0 – Never or rarely  Even if Asked
  • 1 – Does, not well or about 1/4 of the time may need to be asked
  • 2 – Does fairly well or about 3/4 of the time may need to be asked
  • 3 – Does very well always or almost always without being asked

Maladaptive Rating Scale: Frequency or How Often?

  • 1- Less than once a month
  • 2 -One to 3 times a month
  • 3- One to 6 times a week
  • 4- One to 10 times a day
  • 5- One or more times an hour

Behavior Rating Scale: Severity or How Serious?

  • 0- Not serious, not a problem
  • 1- Slightly serious, a mild problem
  • 2- Moderately serious, moderate problem
  • 3- Very serious, severe problem
  • 4- Extremely serious, a critical problem

Scores: Age equivalents, Standard Scores: Percentile ranks; Broad Independence Score; Relative Mastery Indexes (RMI) and a Support Score

Type of information, resulting from testing: The Support Score predicts the level of support a person will require based on the impact of maladaptive behaviors on adaptive functioning. Functional limitations in adaptive behaviors may also be identified.

Environment for Testing: Quiet setting

Equipment and Materials Needed: Manual and Response Booklet (available in Spanish), Interview Easel and Software (Scoring and Reporting)

Examiner Qualifications: Trained and Certified

Evidence of Reliability: The Comprehensive Manual documents reliability through internal consistency measures, high test-retest studies, and comparison of independent raters. Please consult the manual for specifics for specific age groups.

Evidence of Validity: The Comprehensive Manual established validity as a technically sound measure standardized on 2,182 individuals nationwide. Please consult manual for specific age groups.

Summary: Although the author, Brad Hill describes SIB-R as one of the most widely used adaptive behavior assessments in the United States there were very  little research articles available to support his claim. The strengths are centered around  the usefulness and accuracy of this norm-referenced standardized tool.  The weaknesses are the time element of 45-60 minutes necessary for the administration of the full scale version and the validity of the information provided by the respondent. The clinical application would be to allow support services the information necessary to offer the appropriate level of support and supervision. The SIB-R  would also identify functional limits that could translate into therapeutic goals.

In a article written by Kerry Wells et al, three behavior scales appropriate for school aged individuals with autism were compared. The three scales were: Vineland Adaptive Behavior Scale, Scales of Independent Behavior – Revised, and the Adaptive Behavior Scale. The authors recommend including assessing adaptive behavior when evaluating individuals who present with autistic characteristics to get a more accurate diagnosis. Research showed that including a scale would improve accuracy by 9%. Wells interjected the relevance is for treatment planning. Individuals with autism typically have difficulty with communication and interactions which make it difficult to assess using standard cognitive tests. Therefore the advantage of including one of these scales would be that much of the information is provided by the respondent, someone that knows the individual very well. Wells stated that she found more research that used the Vineland Scale than the other two. However this study wanted to see how all of these scales could assess the relationship of cognitive functioning to the severity of autism.  The study revealed that the Vineland had the highest correlation with mental age than the other two scales suggesting that developmental level could be assessed better with this scale. Therefore the authors recommend using the SIB-R or Adaptive Behavior Scale when assessing this population which would focus more on the impact of the severity of autism on function.

Wells, K et al. A Comparison of Three Adaptive Behavior Measures in Relation to Cognitive Level and Severity of Autism. Journal on Developmental Disabilities.2009 vol 15 (3): 55-62.

Mar 10 2015

Pediatrics Functional Status Scale (FSS)

Published by

I. Description Information

  • Title: Pediatrics Functional Status Scale (FSS), 1st edition
  • Date of Publication: July 2009
  • Authors: Dr. Murry M. Pollack, MD, Dr. Richard Holubkov, PhD, Dr. Penny Glass, PhD, Dr. J. Michael Dean, MD, Dr. Kathleen L. Meert, MD, Dr. Jerry Zimmerman, MD, PhD, Dr. K. J. S. Anand, MBBS, DPhil, Dr. Joseph Carcillo, MD, Dr. Christopher J.L., Newth, MB, ChB, Dr. Rick Harrison, MD, Dr. Douglas F. Willson, MD, Dr. Carol Nicholson, MD.
  • Publisher: Pediatrics Journal
  • Distributor: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN)
  • Distributor Address: 295 Chipeta Way, P.O. Box 581289, Salt Lake City, UT 84158
  • Cost: accessible in Table 1 online at
  • Purpose: The purpose of this outcome measure is to measure mental status, sensory level, communication, motor function, feeding, and respiratory function to determine the dynamic state of disease and recovery.
  • Type of Test: Observational criteria listed in purpose
  • Target Population: 38 weeks gestation to 18 year-old patients at high risk for functional disability
  • Time Requirements: test administered through chart summarizing each category with estimated time of 20-30 minutes observation to score

II. Test Administration

  • Test Administration: can be subjectively observed by healthcare provider and objectively scored using scale
  • Scoring: given numerical rating of 1 (normal function), 2 (mild dysfunction), 3 (moderate dysfunction), 4 (severe dysfunction), or 5 (very severe dysfunction) in each domain
  • Environment for Testing: setting that allows focus on individual patient with adequate lighting to ensure proper observation
  • Equipment/materials: potentially source of food to measure feeding category if observer is unable to watch patient eat a meal
  • Examiner Qualifications: any clinician with expertise to observe that may include, but is not limited to, pediatrician, pediatric neurologist, pediatric nurse, pediatric developmental psychologist, pediatric physiatrist, pediatric intensivist, and/or pediatric respiratory therapist may be suitable for observation

III. Psychometric Characteristics

  • Standardization/normative Data: score of 6 in all combined categories indicates normally functioning child with increasing scores indicative of dysfunction
  • Evidence of Reliability: very good inter-rater reliability, intraclass correlation of 0.94 (weighted) which indicates high reproducibility, kappa values range from 0.52-0.89 for weight FSS components
  • Evidence of Validity: construct validity established in comparison to adaptive behavior measured by The Adaptive Behavior Assessment System (ABAS) II, discriminative validity established by receiver operating characteristic (ROC) curve analysis using dysfunction groups classified by ABAS-II, predictive validity low as outcome measure cannot predict long-term outcome of disease process
  • MCID-not provided

IV. Summary Comments

  • Strengths: time-efficient, cost-efficient, provides general score of function in child that can be documented/monitored for progress
  • Weaknesses: subjective components (inter-rater discrepancies), not descriptive of child’s complete function, limited categories that do not encompass total function of child
  • Clinical Application: when a clinician is short on time but needs to assess functional status of child and gives general progression of function that can be broken down by category

V. References

Pollack M, Holubkov R, Nicholson C, et al. Functional status scale: new pediatric outcome measure. Pediatrics. July 2009;124(1):e18-28.

Pollack, M, Holubkov R, Funal T, et al. Relationship between the functional status scale and the pediatric overall performance category and pediatric cerebral performance category scales. JAMA Pediatrics. July 2014;168(7):671-676.

VI. Article Summary:

The objective of this study was to determine new morbidities associated with pediatric critical care. The researchers monitored the morbidity of 5,017 randomly selected patients from eight medical and cardiac PICUs in the Collaborative Pediatric Critical Care Research Network (CPCCRN). The patient morbidities were analyzed using a comparison of baseline to hospital discharge scores of the Pediatrics Functional Status Scale (FSS). A new morbidity was defined as an increase in the patient’s FSS by greater than or equal to 3 from baseline throughout the progression of hospital stay. The authors aimed to determine whether the FSS is an appropriate objective measure to monitor whether morbidities have developed in patients ranging from newborn to 18 years of age. The baseline scores were determined through analysis of past medical history and parent report and hospital discharge scores were recorded at the end of stay. The FSS measures mental status, sensory, communication, motor function, feeding, and respiratory function of the subjects.

The results of this study found that the FSS was appropriate in determining the new morbidities of the population in this study. New morbidity was evident in 4.8% of the patients with PICU deaths in 2.0% and hospital deaths on 2.4%. It was found that the highest level of new morbidity occurs in patients with neurological diagnoses, followed by cardiovascular disease, cancer, and congenital cardiovascular disease. The categories that had the highest increase in score were the respiratory, motor, and feeding function domains. There was a clinically significant difference between the morbidity and mortality among the sites, as morbidity was significantly higher. The relevance of morbidity rates in this population relate to the outcome assessment of function in the pediatric setting. The authors of this study determined that the FSS is a functionally appropriate outcome measure to determine morbidity, which may correlate with pediatric functional outcomes and contribute to appropriate care.

Pollack, M, Holubkov R, Funal T, et al. Pediatric Intensive Care Outcomes: Development of New Morbidities During Pediatric Critical Care. Pediatr Crit Care Med. 2014;15(9):821-827.

Mar 11 2015

Children’s Assessment of Participation and Enjoyment (CAPE)

Published by

I. Descriptive Information

Title, Edition, Dates of Publication and Revision Author (s)

Children’s Assessment of Participation and Enjoyment (CAPE)

Published in 2004 by Harcourt Assessment, Inc., San Antonio TX, USA.

Authors: Gillian King, PhD, Mary Law, PhD, OT Reg (ONT), Susanne King, MSc, Patricia Hurley, BA, Peter Rosenbaum, MD, FRCP, Steven Hanna, PhD, Marilyn Kertoy, PhD, Nancy Young, PhD

Costs (booklets, forms, kit): CAPE complete kit: $133.25

Purpose: The CAPE is comprised of 55 questions that are used to look at how children and youth participate in everyday activities outside of their school classes. This assessment looks at 5 dimensions of participation, including: diversity (number of activities done), intensity (frequency of participation measured as a function of the number of possible activities within a category), enjoyment of activities, and the context in which children and youth participate in these activities (with whom and where they participate).

Type of Test: Self administered and interviewer-assisted versions of the questionnaire

Target Population and Ages: Ages 6-21 (with and without disabilities)

Time Requirements – Administration and Scoring: The questionnaire takes approximately 30-45 minutes to complete, depending on the number of activities the child does. There are 3 levels of scoring for the CAPE: overall participation scores, scores for two domains (formal and informal activities), and scale scores for five types of activities (recreational, active physical, social, skill based, and self-improvement). Scores can be calculated for these levels for each of the 5 dimensions of participation obtained from the questionnaire (diversity, intensity, enjoyment, with whom and where).

II. Test Administration

Administration: The test is either self-administered or interviewer-assisted.

Scoring: Scores for the subscales may be obtained for mean intensity (frequency) and mean enjoyment. Also, the diversity may be calculated. Total diversity scores range from 0 to 55 and intensity scores range from 1 to 7.

Type of information, resulting from testing: The CAPE examines an individual’s day-to-day participation for purpose of intervention planning or measuring outcomes.

Environment for Testing: In a setting that allows focus on individual patient with adequate lighting to ensure proper observation

Equipment and Materials Needed: Researcher needs to buy the CAPE Kit before administering.

Examiner Qualifications: Any clinician with expertise to observe/score include, but is not limited to a pediatrician, pediatric neurologist, pediatric nurse, pediatric developmental psychologist, pediatric physiatrist, pediatric intensivist, and/or pediatric respiratory therapist may be suitable for observation.

Psychometric Characteristics: enjoyment of activities and context of activities performed

Standardization/normative data:

Evidence of Reliability: Test-retest reliability range from 0.72 to 0.81

Evidence of Validity: Correlations that have been reported as evidence of construct validity were smaller in magnitude than expected (most falling in the 0.10 to 0.20 range); however, 70% of the significant correlations were predicted.

Strengths: The CAPE directly measures participation and does not confound participation with competence or amount of assistance.

Weaknesses: costly, administration depends on the child’s ability to fill out a questionnaire

Clinical Applications: This measure can be used to examine the influence of skill, support, and opportunity-based interventions on children’s participation, as well as the influence of impairments and environmental factors.

References of Review:

King G, Law M, et al. Children’s Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC). Harcourt Assessment, Inc., San Antonio, TX, USA. 2004.

King G, Law M, et. al. Measuring children’s participation in recreation and leisure activities: construct validation of the CAPE and PAC. Child: care, health and development: 33 (1) 28-39.


In the study performed by Majnemer, et. al, the purpose was to characterize participation in leisure activities in the specific population of children with cerebral palsy, and to also identify determinants of greater involvement. The authors obtained results from sixty-seven of ninety-five children with CP who were recruited (average age 9.7 years, SD 2.1 years). Most of the children had mild motor dysfunction (Gross Motor Function Classification System: 49% level I, 23% level I, 18% levels III-V) and had a spastic subtype of CP (23 hemiplegia, 17 diplegia, 16 quadriplegia, 11 other).

Results from this study showed that these children were actively involved in a wide range of leisure activities and experienced a high level of enjoyment. However, the involvement was lower in skill-based and active physical activities as well as community-based activities. It was found that mastery motiviation adn involvement in rehabilitation services enhanced involvement (intensity and diversity) in particular leisure activites, whereas cognitive and behavioral difficulties, activity limitations, and parental stress were obstacles to participation.

Reference for Summary:

Majnemer A, et. al. Participation and enjoyment of leisure activities in school-aged children with cerebral palsy.  Developmental Medicine and Child Neurology. 2008, 50: 751-758.

Mar 11 2015

Hawaii Early Learning Profile (HELP)

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Descriptive Information

  1. Title and date of publication: Hawaii Early Learning Profile (HELP), first published in 1995
  2. Author : Unknown (VORT Corporation)
  3. Source: VORT (
  4. Costs (booklets, forms, kit): According to the website, the HELP requires these kits/components for accurate family-centered, curriculum based assessment: Inside HELP($64.95), HELP Strands 0-3 ($3.50) or HELP Strands 0-3 Plus ($3.75), HELP at Home ($89.95) for a total of $158.40
  5. Purpose: HELP is a comprehensive, on-going, family centered curriculum based assessment process for infants and toddlers (ages 0-3) and their families. It is used when creating goals and tailoring developmentally-appropriate interventions to meet the specific needs of children.  Another source for further explanation states HELP is a flexible curriculum-based assessment tools that identify needs, monitor growth and development, and establish a plan to address assessment results. Play-based activities and intervention strategies are utilized to encourage, support, and facilitate a wide variety of developmental skills and address specific needs. The test examines 6 specific skill categories that are observed through play: cognitive, communication (expressive and receptive), gross motor, fine motor, social-emotional (how child relates to others), and adaptive/self-help (sleeping, eating, dressing, toileting, etc.).
  6. Type of Test: Evaluative assessment performed by observation in natural environment/multiple settings
  7. Target Population and Ages: Birth to 3 years (0-3)
  8. Time Requirements – Administration and Scoring: Implementation time varies. An initial direct assessment is 45 to 90 minutes; however, this assessment may be completed in 15 to 20 minutes. Another source states it is an ongoing observation summarized periodically.

Test Administration

  1. Administration: Observation in multiple settings
  2. Scoring: It is scored; Manual suggests approximate age-based levels of development in each strand or area based on the pattern of credit received on individual items in all areas except for regulatory/sensory organization. Number of atypical responses in the regulatory/sensory organization area can be used to cluster children into 3 groups (typical, over-reactive, or under-reactive), rather than associating skills with a specific developmental age range. Either giving credit for a skill (+), not giving credit (-), skill is atypical/dysfunctional (A), not appropriate (NA), hyper-responsive (A+), or hypo-responsive (A-). How this is all interpreted in the end is very vague in the resources found. Need to purchase manual and/or take a class to learn in-depth scoring analysis.
  3. Type of information, resulting from testing: There are no standardized scores. It is used for identifying needs, tracking growth and development, and determining ‘next steps’(target objectives).
  4. Environment for Testing: Multiple natural settings preferred
  5. Equipment and Materials Needed: Pen, HELP required items, toys/items in natural environment.
  6. Examiner Qualifications: One or more interdisciplinary pediatric/early childhood specialists (e.g., teacher, nurse, occupational therapist, physical therapist) that have taken a one-day course (offered through publisher’s website).
  7. Psychometric Characteristics: No research available to provide information.
  8. Standardization/normative data: None for test, however, skills and behaviors that are assessed in this assessment have normative data for age groups.
  9. Evidence of Reliability: Not available.
  10. Evidence of Validity: Not available.
  11. Discriminative: Unknown
  12. Predictive: Developmental age level
  • Summary Comments
    • Strengths: Monitoring progression of child by ongoing constantly assessing progress towards goals, involves parents and natural environment of family, very thorough tool seeing as it assesses over 600 skills/behaviors of a developing child.
    • Weaknesses: There is no peer-reviewed evidence to support its effectiveness, no inter-rater reliability provided even though multiple health professionals can provide this assessment to a child, costly and time consuming to administer, need to be trained to administer and very extensive grading/assessing.
    • Clinical Applications: It is used in early intervention situations of the atypically developing child. HELP also supports federal requirements for part C of IDEA and Early Head Start programs.


**No MCID available**No Research articles available using HELP as primary outcome measure, or as an ancillary outcome measure**




Mar 12 2015

Sensory Organization Test

Published by

I. Descriptive Information

Title, Editions, Versions: Sensory Organization Test (SOT) was created in 1982. Head-Shake SOT (HS-SOT) was developed for patients who performed within normal ranges on the SOT, but were still symptomatic of vestibular dysfunction. The Clinical Test of Sensory Interaction on Balance (CTSIB) (’86) & modified CTSIB (’93) were created for clinical assessment of balance, and do not have the technology & monetary requirements like the SOT.

The specific protocol for the SOT was written in 1997.

Author (s) LM Nashner created the idea of SOT computerized dynamic posturography (CDP) for clinical assessment in 1982.

Source (publisher or distributor, address) NeuroCom is the creator of the CDP that is utilized to perform the SOT.

Costs (booklets, forms, kit): $80,000-$180,000 (equipment)

Purpose Assess quantitative data about visual, proprioceptive and vestibular cues in order to maintain postural stability in stance

Type of Test (eg, screening, evaluative; interview, observation, checklist or inventory) Posturography assessment is used to evaluate postural stability in stance.

Target Population and Ages Patients with peripheral and/or vestibular deficits, head injuries, patients with fall risks (elderly, mobility disorders), CNS movement disorders (Parkinson’s) are the primary population, although normal healthy individuals can be assessed for postural stability with the SOT.

Time Requirements ~15 minutes, but up to ~30 (with the actual testing time consisting of 6 minutes)

Administration and Scoring Patient stands on a dual forceplate system, and undergo 6 different conditions. Scoring and objective values are recorded through a computerized system connected to the forceplates.

II. Test Administration

Administration Subjects stand on dual-force plates in a 3 sides surround posturography CDP system. Degree of anterior-posterior sway is recorded. 6 independent sensory conditions are tested, with each condition consisting of three twenty second trials.

The 6 conditions include:
-Eyes open on firm surface
-Eyes closed on firm surface
-Eyes open with sway referenced visual surround (altered vision)
-Eyes open on sway referenced support surface (unsteady surface)
-Eyes closed on sway referenced support surface
-Eyes open on sway referenced support surface and surround (unsteady surface and altered vision)


Equilibrium scoring: COG & postural sway are measured under each condition, and a composite equilibrium score is computed from the weighted average of the sway measured with each of the sensory conditions. Sway and equilibrium scores are calculated as a percentage based on degree of sway from vertical (100% perfect equilibrium & 0% results in a fall).

Sensory analysis is used to determine how much the patient relies on each of the systems contributing to balance (somatosensory, visual, and vestibular systems). This is analyzed through ratios of individual equilibrium scores (i.e. condition 2 score/condition 1 score)
-COG alignment: reflection of the patient’s COG position relative to center of BOS at start of each trial of the SOT
-A strategy analysis produces quantitative data about relative amount of movement about the ankles & the hips that the patients used to maintain balance during each trial. This determines how much of an “ankle strategy” and “hip strategy” is used, and can be compared to the type of condition in which one strategy predominantly occurs over the other (i.e. ankle strategy is used more often with unsteady surface).

Type of information, resulting from testing (e.g. standard scores, percentile ranks) Quantitative data about patients’ ability to maintain COG over BOS and maintain balance under varying conditions. What types of systems play a predominant role in postural stability can be determined. It can be specifically determined how much of a role the visual, vestibular, and somatosensory systems play in controlling postural stability.

Environment for Testing: Lab setting with computerized dynamic posturography equipment

Equipment and Materials Needed: NeuroCom Balance Master, Equitest, or Smart Equitest. All equipment is made by NeuroCom.

Examiner Qualifications Training suggested, but not required. Use of device manual.

Psychometric Characteristics 

-Standard Error of Measurement (SEM): composite score SEM (calculated) = 2.81
-Minimal detectable change (MDC): composite score change of greater than 8 points would indicated change secondary to rehab (tested with healthy young adults)
-MCID not established

Standardization/normative data: SOT composite scores and conditions 2-6 significantly decreases with increased age in healthy individuals: ANOVA and SOT equilibrium score has shown a main effect of age F(3.90) = 23.34 and test condition F(5.90) = 355.91

Evidence of Reliability:

Test-retest: Healthy non-institutionalized older adults (n = 40): Tested at a one week interval: Composite score: Good test-retest reliability (ICC 0.66, SOT average of three trials ranged from poor (Condition 3: ICC = 0.68) to fair test-retest reliability (condition 5: ICC = 0.68, condition 6: ICC = 0.64); Adequate composite score reliability ICC = 0.67; individual equilibrium scores ranged from poor to adequate ICC = 0.35
-Interrater/Intrarater: not established

Evidence of Validity:

-Content validity: not established
-Face validity: Sensitivity and specificity of the SOT to detect otolith disorders, as measured by VEMP & Subjective Visual Vertical tests (n=22 patients and controls); sensitivity solely in condition 3,5, & 6 is it higher than 50%; specificity decreases with increasing difficulty of the condition


SOT, Timed up and Go(TUG), Dizziness Handicap Inventory (DHI) scores of people with unilateral (n = 41) and bilateral (n = 44) vestibular hypofunction: bilateral vestibular hypofunction: Adequate correlation (-0.31) between DHI emotional score and  mean SOT sway in condition 3, and in unilateral vestibular hypofunction clients an adequate correlation (-0.35) may be found between mean sway in condition 3 and the physical DHI score; TUG scores are not correlated to any SOT scores for both groups
-The composite score and self-reported falls history within the past 6 months may be significantly related (F3 5.81, p < 0.01) (n = 100 vestibulopathic individuals)


SOT vestibular condition (condition 5/1) has moderately high sensitivity (85%) and specificity (77%) in identifying vestibulopathies (n = 40 adults, 40 adults with vestibular impairments)
-The review article by Di Fabio (1995) reports that many studies on sensitivity and specificity of using the SOT to identify people with vestibulopathy, most studies found low to moderate sensitivity and specificity. The responsiveness increases when the SOT is combined with rotary chair or caloric test results.
-Basta et al 2005 investigated the influence of pure otolith disorders on SOT scores in 33 adults with minor head injury with utrical or sacculo-utricalar disorders, finding SOT were abnormal in 76.9% of the people with combined sacular-utricular involvement, while the scores were only abnormal in 45% of utricular disorder group.

III. Summary Comments

Strengths: It provides an objective measure, helps to possibly identify small differences & changes in those who are higher functioning in balance, etc.

Weaknesses: It has a high cost, and requires use of technology that is not easy to access in many clinics. The research that provides clinically important differences in score changes, was done in normal healthy adults. More research may be needed to determine significant changes in pathological populations.

Clinical Applications: The Neurology Section of the APTA’s task forces for Parkinson’s disease, SCI, stroke, TBI, & vestibular rehab have made recommendations for utilization of the SOT. Recommendations were based on acuity level of patient, level of care (i.e. acute, OP), ambulatory status after brain injury, and vestibular diagnosis (i.e. peripheral, central, etc.). Most, if not all, recommendations were either not recommended or had reasonable use due to limited studies.


Article References:

Basta, D., Clarke, A., et al. (2007). “Stance performance under different sensorimotor conditions in patients with post-traumatic otolith disorders.” Journal of Vestibular Research 17(1): 25-31.

Basta, D., Todt, I., et al. (2005). “Postural control in otolith disorders.” Human movement science 24(2): 268-279.

Clendaniel, R. A. (2000). “Outcome measures for assessment of treatment of the dizzy and balance disorder patient.” Otolaryngologic Clinics of North America 33(3): 519-533.

Cohen, H., Heaton, L. G., et al. (1996). “Changes in sensory organization test scores with age.” Age Ageing 25(1): 39-44.

Cohen, H. S. and Kimball, K. T. (2008). “Usefulness of some current balance tests for identifying individuals with disequilibrium due to vestibular impairments.” Journal of Vestibular Research 18(5): 295-303.

Di Fabio, R. P. (1995). “Sensitivity and specificity of platform posturography for identifying patients with vestibular dysfunction.” Physical Therapy 75(4): 290-305.

Ford-Smith, C. D., Wyman, J. F., et al. (1995). “Test-retest reliability of the sensory organization test in noninstitutionalized older adults.” Arch Phys Med Rehabil 76(1): 77-81.

Gill-Body, K. M., Beninato, M., et al. (2000). “Relationship among balance impairments, functional performance, and disability in people with peripheral vestibular hypofunction.” Physical Therapy 80(8): 748-758.

Pedalini, M. E., Cruz, O. L., et al. (2009). “Sensory organization test in elderly patients with and without vestibular dysfunction.” Acta Otolaryngol 129(9): 962-965.

Whitney, S. L., Marchetti, G. F., et al. (2006). “The relationship between falls history and computerized dynamic posturography in persons with balance and vestibular disorders.” Archives of physical medicine and rehabilitation 87(3): 402-407.

Wrisley, D. M., Stephens, M. J., et al. (2007). “Learning effects of repetitive administrations of the sensory organization test in healthy young adults.” Arch Phys Med Rehabil 88(8): 1049-1054.



Article Summary: Learning Effects of Repetitive Administrations of the Sensory Organization Test in Healthy Young Adults

The objective of this study was to determine the learning effect of multiple trials of the sensory organization test (SOT), and what type of score change would indicate a minimal change in performance secondary to rehab treatment. The researchers in this study performed a descriptive case series in which all subjects performed the SOT with the SMART EquiTest 5 separate times over 2 weeks, and 1 month following the 5 tests. The participants included 13 healthy male and female subjects with a mean age of 24, plus or minus 4 years. Degree of postural sway was measured with the SMART EquiTest, and was measured under 6 varying conditions, with 3 trials performed under each condition. Conditions consisted of changes in the participants’ vision relative to sway in their environment, the stability of the support surface, and whether or not their eyes were open or closed. An equilibrium score was calculated based on an average of the 3 scores of each of the conditions. A composite score was then taken for each of the 6 conditions, which averaged all 6 equilibrium scores. A repeated-measures ANOVA was used to analyze differences in equilibrium and the composite scores.

This study found that there were significant differences between equilibrium and composite scores among all 6 sessions for multiple conditions, indicating a learning effect when administering the SOT. Different recommendations have been made, including the administration of many baseline SOT tests prior to administering an intervention. Researches acknowledged that this idea may not be supported in the clinical setting though, and that multiple SOT tests may also act a balance training program for patients with balance dysfunction. Based on this study, an 8 point improvement in score is indicated to be a result of rehab intervention versus learning. Since this score was determined with younger healthy patients, more research may be indicated in order to determine clinically relevant changes in older patients and those with balance dysfunction. More research is also indicated in order to determine changes in function. Although, these finding in healthy young adults may be a guide for future research in determining clinically relevant SOT score changes in patients of varying ages and with varying balance altering pathologies.

Wrisley, D. M., Stephens, M. J., et al. (2007). “Learning effects of repetitive administrations of the sensory organization test in healthy young adults.” Arch Phys Med Rehabil 88(8): 1049-1054.


Mar 12 2015

Pediatric Quality of Life Inventory (PedsQL)

Published by

Title: The Pediatric Quality of Life Inventory (PedsQL)

Date of Publication: 1998

Author: James W. Varni, Ph.D.

Source (publisher or distributor, address):

Mapi Research Trust

27, rue de la Villette

69003 Lyon



  • Not funded academic research = Free of charge
  • Funded academic research = license per study: $990 including delivery of 1 module + $330 per additional module
  • Large non-commercial organization research & evaluation: can be based per study or based on yearly contract for unlimited evaluation
    1. License per study:
      Owner’s Royalty Fees: $1,322.50.  Mapi Research Trusts’ processing Fees: $1,080 including delivery of 1 module + $360 per additional module.
    2. Annual license fee (unlimited use for 1 year):
      • Author’s annual royalty fee: 3 centers or less = $6,647, 4-10 centers = $13,260, 11-15 centers = $19,872, 16+ centers = $26,485
      • Mapi Research Trust’s Processing Fees: $1,080 including delivery of 1 module + $360 per additional module
  • Commercial Use:
    1. License fee per study:
      1. Owner’s Royalty Fees: 3 centers or less = $6,647, 4-10 centers = $13,260, 11-15 centers = $19,872, 16-20 centers = $26,485, 21-25 centers = $33,097
      2. Mapi Research Trust’s Processing Fees: $1,600 per module + $500 for cost per translation per module
    2. Annual license fee (unlimited use for 1 year):
      1. Owner’s Annual Royalty Fees: 3 trials or less/year = $33,097, 4-6 trials/year = $39,710, 7-9 trails/year = $46,322, 10-12 trials/year = $52,935, 13-15 trials/year = $59,547, 16 trials/year = $66,160
      2. Mapi Research Trust’s Annual Processing Fees: 3 trials or less/year = $3,510, 4-6 trials/year = $5,590, 7-9 trails/year = $8,515, 10-12 trials/year = $11,440, 13-15 trials/year = $14,365, 16 trials/year = $16,315

Purpose: “To measure health-related quality of life (HRQOL) in healthy children and adolescents and those with acute and chronic health conditions. The PedsQL measurement model integrates seamlessly both generic score scales and disease-specific modules into one measurements system.”1

Type of Test: Inventory

Target Population and Ages: Ages 2-18

Time Requirements: Less than 5 minutes to complete.

Administration: This outcome measure should be administered before any other health data forms and before the patient sees the physician. The parent and child questionnaires should be completed separately. The administrator should not interpret the question for the patient/parent.

Scoring: Total Scale score = 23 items, Physical Health Summary Score = 8 items, Psychosocial Health Summary Score = 15 items. Each question is answered on the “5-point Likert scale from 0 (never) to 4 (almost always)”1. Then “items are reversed scored & linearly transformed to a 0-100 scale as follows: 0=100, 1=75, 2=50, 3=25, 4=0.   The mean of the scores on the 100-point scale is then calculated (sum of all items divided by number of items answered)”1 and higher scores indicate a better quality of life.

Type of information, resulting from testing: Results of the outcome measure inform the clinician of the patient’s outlook on their quality of life and inform the clinician of what the patient struggles with or performs really well. This questionnaire provides information in the physical, emotional, social, and school functioning dimensions.

Environment for Testing: No specific environment noted, but a quiet area would be best.

Equipment and Materials Needed: Writing utensil, writing surface, and a quiet environment.

Examiner Qualifications: Any clinician with capability to administer inventory survey and maintain a neutral tone if asked questions (so as not to sway any answers).

Psychometric Characteristics: If the child requires someone read the survey to him/her, then the reader’s voice should be kept in a neutral tone so as not to influence the child’s responses. If the child has trouble understanding the written statements, then they should complete the preceding age group form. If the child’s cognitive disabilities interfere with their ability to fill out the form, the parent should complete the Parent-Proxy Report form instead. If the participant does not understand the question they are informed they are allowed to not answer. If a participant is completing the PedsQL as part of a study, make sure the participant is informed their answers will be evaluated as a group, instead of individually.

Standardization/normative data: MCID = 4.5

Evidence of Reliability: Total Scale Score: Child Self-Report = 0.88, Parent Proxy-Report = 0.90

Evidence of Validity: “Distinguishes between healthy children and children with acute and chronic health conditions; distinguishes disease severity within a chronic health condition.”1

Discriminative: Unknown

Predictive: Predictive of poorly perceived quality of life.

Strengths: Translated into several languages, easy to administer, does not require a lot of time to complete, can use younger age version if patient cannot comprehend current age level survey.

Weaknesses: If a patient does not understand a question the administrator is not allowed to interpret question for him/her. Costly if using it for funded academic research.

Clinical Applications: The PedsQL can be used to assess a patient’s outlook on his/her quality of life, or assess a parent’s outlook on their child’s quality of life, specifically in children with various types of chronic diseases. Patient responses on the outcome measure can also steer the direction of physical therapy or other type of medical treatment to focus more on activities that can improve a child’s quality of life.


The study by Baggott et al. focused on using multiple outcome measures to assess quality of life in children with various types of cancer one week after receiving chemotherapy and compared their results to normative data obtained from healthy children. Most of the participants were males, all children ranged from 10 to 18 years old, and all participants completed a memorial Symptom Assessment Scale, a PedsQL (Generic & Cancer Modules), and a Karnofsky Performance Status (KPS). All participants completed the questionnaires based on the week prior when they received chemotherapy treatment. During the treatment the most common side effects that were experienced by the patients included nausea, fatigue, pain, alopecia, and drowsiness.

The results of the study showed that when compared to scores of healthy children the participants reported lower scores overall, lower physical functioning scores, and lower school functioning scores of the PedsQL. This study also looked at symptoms associated with chemotherapy and their correlation to perceived quality of life and found that nausea had the biggest impact on negative perceptions of health related quality of life (HRQOL).  This is because nausea was the symptom causing patients to be in the hospital longer. The results also demonstrated that participants did not have significantly lower emotional or social functional scores on the PedsQL. This could be due to the fact that children do not understand the severity of their diagnoses, they may not acknowledge their negative emotions, or perhaps they are very optimistic. Overall, the study found that if there are more negative side effects of chemotherapy and cancer, the HRQOL will be lower.


  1. PedsQLTM. The PedsQL Measurement Model for the Pediatric Quality of Life InventoryTM Web Site. Published 1998. Accessed March 12, 2015.
  2. Varni J, Seid M, Rode C. The PedsQL: Measurement Model for the Pediatric Quality of Life Inventory. Medical Care. 1999; 37(2):126-139.
  3. Baggott C, et al. An evaluation of the factors that affect the health-related quality of life of children following myelosuppressive chemotherapy. Support Care Cancer. 2011; 19:353-361.
  4. Vetter T, Bridgewater C, McGwin Jr G. An Observational Study of Patient versus Parental Perceptions of Health-related Quality of Life in Children and Adolescents with Chronic Pain Condition. Health and Quality of Life Outcomes. 2012;10(85)1-6.

Mar 12 2015

Timed ‘Up and Go’ in Children (TUG-IC)

Published by

Descriptive Information

Title, Edition, Dates of Publication and Revision: Timed ‘Up and Go’ Test in Children (TUG-IC), 2005, adapted from Podsiadlo and Richardson’s Timed ‘Up and Go’ Test, 1991. 4 Also referred to as a Modified Timed Up and Go Test.

Authors: Williams EN, Carrol SG, Reddihough DS et al. 4

Source: Mary P Galea, PhD BAppSc(Physio) BA, School of Physiotherapy, University of Melbourne, Austin Health, Parkville, Victoria, Australia. Correspondence at School of Physiotherapy, University of Melbourne, Parkville, Victoria 3010, Australia. E-mail:

Costs: free, however a diagram and data collection worksheet for the TUG-IC can be found in the reference book for pediatric normative values by Parrot.3

Purpose: To test functional ambulatory mobility including balance and difficulty turning during gait of children with or without physical disabilities and to monitor change over time.4

Type of Test: evaluative screening test or outcome measure

Target Population and Ages: 3-12 y/o 2

Time Requirements: unspecified


Test Administration

Administration: The structure of the TUG-IC differs from the standard TUG to increase validity in the pediatric population. The test consists of a pre-test and a timed test to familiarize the patient with the procedure. The chair used is a height that supports hip and knee flexion of 90 degrees. The child is instructed to touch the star on the wall that is at his/her shoulder height and is 3 meters from the chair. The child is not instructed on how fast to walk and the test may be restarted if the child skips or hops instead of walks during the test. The timer is started when the child’s bottom leaves the chair and is stopped when the child’s bottom touches the chair again.4

Scoring: timed in seconds and compared to normal ranges4

Type of information, resulting from testing: mean score for preschoolers is 6.7 seconds and the mean score for primary school children is 5.1.4 No MCID is established in the pediatric population. TUG(s) = 6.387-(age(y) x 0.166) + (weight (Kg) X 0.014) is an equation to find an age and weight comparable score. 1

Environment for Testing: indoor, unobstructed hallway with a wall4

Equipment and Materials Needed: stopwatch, tape, tape measure, goniometer, paper star, and a pediatric sized chair with no armrests4

Examiner Qualifications: none

Psychometric Characteristics: Inter- and intraexaminer ICC of .81-.99, Same-day retest ICC of .76-.99, Within-session ICC of .80-.992

Predictive: of age and weight1


Summary Comments

Strengths: The TUG-IC is free and easy to administer with no special equipment. The instructions are simple and understandable for the pediatric population. Multiple research studies have proven high reliability and validity for this test in the pediatric population.

Weaknesses: The methodology of the TUG may be mistakenly administered in the pediatric population rather than the TUG-IC. The TUG-IC must be used in conjunction with other tests and measures to monitor physical mobility and balance. No absolute normative value or MCID is currently determined for the TUG-IC.

Clinical Applications: The TUG-IC is best utilized in conjunction with other tests and measures to evaluate and monitor progress of physical mobility and balance in children who are typically developing. Although no MCID is given, the score may be compared to the average normative value for the patient population. The TUG-IC has been researched in populations including typical development, cerebral palsy I-III, acute lymphoblastic leukemia, LE amputation, anorexia nervosa, developmental deficiency, cystic fibrosis, spina bifida, disabled children and adolescents, LE sarcoma, and traumatic brain injury.1



  1. Nicolini-Panisson RD and Donadio MVF. Normative values for the Timed ‘Up and Go’ test in children and adolescents and validation for individuals with Down syndrome. Developmental Medicine & Child Neurology. 2014;56(5): 490–497.
  2. Nicolini-Panisson RD and Donadio MVF. Timed “Up & Go” test in children and adolescents. Rev Paul Pediatr. 2013;31(3):377-83.
  3. Parrot A. Chapter 5: Functional ambulatory mobility test—timed ‘up and go’ test in children. In: Parrot A, ed. Normative reference values for musculoskeletal conditions and functional motor abilities in the pediatric population literature review and clinical guidelines; part 1: gait. Canada, Quebec: Wilfrid-Hamel; 2009:23-28.
  4. Williams EN, Carroll SR, Reddihough DS. Investigation of the timed ‘Up & Go’ test in children. Dev Med Child Neurol. 2005;47(8):518-24.


Summary of an article utilizing the timed up-and-go:

Collange Grecco LA, Zanon N, Malosa Sampaio LM, et al. A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial. Clin Rehabil. 2013;27(8):686-96.

The purpose of this study was to compare treadmill training and overground walking in regard to functional mobility for patients with cerebral palsy. The population consisted of patients between the ages of 3 and 12, with no cognitive or visual impairments, GMFCS Levels I-III, functional ambulation for >12 months, no orthopedic surgical procedures or neuromuscular block within 12 months, and no orthopedic deformity indicating a need for surgery. The methods were prospective and randomized with a blinded rater. The methods included an initial evaluation, intervention, post-intervention evaluation, and follow-up evaluation. The outcome measures included the 6-minute walk test, timed up-and-go test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, and the study specific treadmill walking measures. The experimental group performed treadmill training with their habitual braces for two 30 minute sessions per week for 7 weeks with therapist corrected gait components as needed. Speed was increased to patient tolerance during the first 2 sessions and 80% of this recorded tolerance level for the remainder of the sessions, with 60% of this recorded tolerance for each 5 minute warm-up and cool-down. The alternate group performed overground walking with their habitual braces for two 30 minute sessions per week for 7 weeks with therapist corrected gait components as needed. The patients were instructed to walk at a comfortable, self-selected pace for the 5 minute warm up and cool down and were encouraged to increase the speed for the rest of the treatment time. The results consisted of a significant improvement for 6 minute walk test at postintervention and follow-up for both groups, with the experimental group with significantly better results for both postintervention and follow-up. The results also consisted of a significant improvement for the experimental and overground walking groups at postintervention for the timed-up-and-go test, mobility section of the Pediatric Evaluation Disability Inventory, C and E subscales of the Gross Motor FunctionMeasure-88, Berg Balance Scale and time and velocity tolerated on the effort test. The experimental group maintained these significant improvements at follow-up: timed up-and-go test, mobility section and overall Pediatric Evaluation Disability Inventory score, subscales C, D and E and overall Gross Motor Function Measure-88 score, Berg Balance Scale, anteroposterior oscillation with eyes closed, mediolateral oscillation with eyes open and time and velocity tolerated on the effort test Overall, this study provided evidence that children with cerebral palsy retain lasting functional benefits after undergoing treadmill training for 7 weeks.

Mar 12 2015

Miller Assessment for Preschoolers (MAP)

Published by

Descriptive Information

  1. Title, Edition, Dates of Publication and Revision*
    1. Miller Assessment for Preschoolers (MAP)
    2. Published in 1982, revision in 1988
  2. Author (s)
    1. Lucy Jane Miller. PhD, OTR, FAOTA
  3. Source (publisher or distributor, address)
    1. Pearson
  4. Costs (booklets, forms, kit)*
    1. MAP manual – $160
    2. MAP drawing booklet, scoring sheets for various ages or record booklet (pack of 25) – $56
    3. MAP kit – $860
  5. Purpose*
    1. To evaluate children of preschool age for mild – moderate developmental delays. Outcome can be used to help determine individualized education plans and individual family service plan. Three core test items are tested: sensory and motor abilities, cognitive abilities and combined abilities.
    2. The test consists of 27 subtest, grouped into five developmental areas: Foundation Index (assesses basic sensory-motor abilities), Coordination Index (consists of more complex gross, fine and oral motor tasks), Verbal Index (language items testing verbal memory, sequencing, comprehension, association and expression), Non-verbal index (non-spoken items examining memory, sequencing, visualization and mental manipulations), and Complex Tasks Index (the interpretation of visual-spatial information).
  6. Type of Test (eg, screening, evaluative; interview, observation, checklist or inventory)*
    1. Evaluative, interview, observation
  7. Target Population and Ages*
    1. Preschool age children
    2. 2 years 8 months – 5 years 9 months old
  8. Time Requirements – Administration and Scoring*
    1. 30 – 40 minutes


Test Administration

  1. Administration
    1. ‘Game-like’ so the child perceives it as fun
    2. Administered by a qualified professional as mentioned above
  2. Scoring
    1. Objective
    2. A developmental score is developed/calculated from the scores obtained in five developmental areas.
    3. Each subtest is scored on a scale of 1-7 with 3-5 considered normal.
    4. Final scoring is presented as a percentile compared to normative data of the appropriate age group
      1. A child scoring in the red range is <5% of normative data and indicative of a high likelihood for developing a developmental disability
      2. A child scoring in the yellow range is between the 6th and 25th percentile indicates a risk of a developmental disability
      3. A child scoring in the green range is 26-99% of the normative sample and indicates average or above average performance
      4. The MAP is able to discriminate between mild – moderate developmental delays, but does not able to differentiate among the children that score in the higher percentiles in the green range6.
      5. ‘Examiners can establish the cutoff points most appropriate for their own purpose’4.
  3. Type of information, resulting from testing (e.g. standard scores, percentile ranks)
    1. A percentile can be determined from the score that the child receives compared to normative values in their age group
  4. Environment for Testing
    1. Educational environment normal for Preschool aged children
  5. Equipment and Materials Needed
    1. MAP complete kit à includes all necessary instructions, scoring sheets for all ages, drawing booklets, pictures and materials needed to administer the test.
  6. Examiner Qualifications
    1. Differing information: both B and C qualifications
    2. Need a masters or doctorate in psychology, education, OT, social work or a field related to assessment
    3. A degree or license to practice in the allied healthcare field
  7. Evidence of Reliability
    1. Interrater and test-retest reliabilities range from .84 – .99
  8. Evidence of Validity’
    1. Research shows that the Miller Assessment for Preschoolers is a valid tool for screening Preschool aged children for developmental delays. Articles supporting the validity of this test are referenced below.


Summary Comments

Strengths of this test include the extensive topics that are covered to rank children and how it helps create a percentile for children based off the normative data for their age group. Another strength is how you can determine a specific area/s of weakness and focus on that area for the child in therapy. The test requires higher qualifications to administer the test, which ensures the person administering the test has adequate knowledge to rate the child they are testing. The Miller Assessment for Preschoolers helps provide an outcome measure to set a child’s educational path and provides a value for educators and therapist to refer back to see if the child is progressing. The total score and complex task index is the best indicators to distinguish between differing developmental disabilities, but the vernal and non-verbal indices are the least accurate according to Daniels5. Other positives include the reported validity and reliability. Negatives about MAP include the cost; it is very expensive and requires a lot of items to be purchased. The time it takes to administer the test is equal or close to the normal time that most therapists will get in one session with their patients. Lastly it is difficult to get an idea of what a sample of the test would look like without purchasing the whole test. Overall I feel this test would not be appropriate to administer in a physical therapy clinic due to the negative factors listed above. With increasing cost of insurance and decreasing therapist visits being covered efficiency is a large deterrent for using this to screen children. It seems the exam would be more beneficial in the educational system in order to accurately place a child into a program based off of their developmental delay.


Research article

Leosdottir T, Egilson ST, Georgsdottir I. Performance on extremely low birthweight children at 5 years of age on the Miller Assessment for Preschoolers. Phys Occup Ther Pediatr. 2005;25(4):59-72. PubMed PMID: 16418116.

The research article I chose was comparing the MAP scores of 32 children with extremely low birth (ELBW; <1000g or 2.2 lbs) and 55 children born full-term in 1991-1995, in Iceland, to determine if there was any differences. The control group consisted of 12 boys and 43 girls born full term. The ELBW group consisted of 6 boys and 26 girls. The ELBW children were matched with one or two children from the control group; the children were matched according to date of birth and gender of the children. The selection criteria for the control group was a gestational age >/= 37 weeks, a birth weight of >/= 2500g or 5.5lbs, Apgar score of >/= 7 and no known developmental impairments upon enrollment. All children were in the fourth age group of the MAP, which is 4yrs 3 mos – 4 yrs 8 mos. Each child completed the MAP individually according the procedures outlined in the MAP manual, at the same time of day and using identical settings for each child. The results showed a significant difference in the following categories: total score, Foundations, Coordination and Complex-Tasks indices. These categories show that babies born with ELBW had decreased abilities in basic motor tasks, coordination and fine motor skills compared to the control. The authors argued that these results show that there is a need for early assessment to help the development in babies born prematurely. Strengths of this research are the number of children they tested and the detail of their procedures, which should be easily replicated. Weaknesses include how old this research is; since it was originally published in the 90s it is outdated. I can not rely on this article solely as proof that the MAP is a great outcome measure in determining developmental delays for preschool aged children, more current research is needed.



  3. Parush S, Yochman A, Jessel AS, Shapiro M, Mazor-Karsenty T. Construct validity of the miller assessment for preschoolers and the pediatric examination of educational readiness for children.Phys Occup Ther Pediatr. 2002;22(2):7-27.
  4. Banus, B. The Miller Assessment for Preschoolers (MAP): An Introduction and Review. American Journal of Occupation Therapy. 1983: 37, 333-340.
  5. Daniels, L. The Miller Assessment for Preschoolers: Construct Validity and Clinical Use With Children With Developmental Disabilities. American Journal of Occupation Therapy.1998: 52, 857-865.
  6. Leosdottir T, Egilson ST, Georgsdottir I.Performance on extremely low birthweight children at 5 years of age on the Miller Assessment for Preschoolers. Phys Occup Ther Pediatr. 2005;25(4):59-72. PubMed PMID: 16418116.

By: Tiffany Patterson

Mar 12 2015

Test of Infant Motor Performance (TIMP)

Published by

Descriptive Information:

  1. Title: Test of Infant Motor Performance (TIMP)
  2. Author: Gay Girolami , PT, PhD, C/NDT
  3. Source:
  4. Cost: 2 day workshops aerage cost are 350-400$
  5. Purpose:  Identifies infants that are high risk for poor motor performance.  Also is able to show change in motor performance over time.
  6. Type of Test: test is an assessment of the posture and movement skills needed by infants for daily life activities.
  7. Target Population/Ages: 34 weeks postconceptional age through 4 months post term
  8. Time Requirements: Unspecified


Test Administration:

  1. Administration: Testing reviews a total of 42 items. 13 items are observed during a period of spontaneous activity. 5 items on the test are all related to head control in supported sitting. The following series of items examine postural control in the supine position. There is also a series of prone items that can be evaluated together. The remaining items to be evaluated focus on righting reactions during tilting and sidelying as well as postural control in standing.
  2. Scoring: Correct scoring is explained during workshops.
  3. Type of information, resulting from testing: 
    • discriminate among infants with varying degrees of risk for poor motor outcome based on perinatal medical condition
    •  be sensitive to the effects of physical therapy provided to high risk infants in the special care nursery or home exercise programs offered to premature infants post-hospital discharge
  4. Environmnt for Testing: The TIMP can be used both in special care nursery settings and in early intervention programs.
  5. Equipment and Materials Needed: Testing forms and pen
  6. Examiner Qualifications: The test must be administered by those with experience in the TIMP attained by workshops.
  7. Psychometric Characteristics:  The test-retest reliability for 116 pairs of tests of r = .89 over 3 days; no significant difference between testers.
  8. Standardization data: Diagnose motor developmental delay from 34 weeks postconceptional age through 4 months post term based on age standards developed from a sample of 990 U.S. infants of all races/ethnicities
  9. Predictive/Discriminative: Predicts 12-month motor performance with sensitivity 92% and specificity 76% and preschool motor performance with sensitivity 72% and specificity 91% at 3 months of age.


Summary Comments

Strengths: Provides valuable predictive information on motor development of age group tested and sensitive to show effects of physical therapy provided to high risk infants in the special care nursery.

Weaknesses: Requires expensive training workshops in order to be administered.

Clinical Applications: Along with identifying infants that are high risk for poor motor performance and showing progress with motor performance over time, This test can also be used to plan and assess outcomes of intervention for babies with low scores



  • Barbosa VM, Campbell SK, Sheftel D, Singh J, Beligere N. Longitudinal performance of infants with cerebral palsy on the Test of Infant Motor Performance and on the Alberta Infant Motor Scale. Phys Occup Ther in Pediatr. 2003;23(3):7-29.
  • Campbell SK. Test-retest reliability of the Test of Infant Motor Performance. Pediatr Phys Ther. 1999;11:60-66
  • Campbell SK, Kolobe THA, Wright B, Linacre JM. Validity of the Test of Infant Motor Performance for prediction of 6-, 9-, and 12-month scores on the Alberta Infant Motor Scale. Dev Med Child Neurol. 2002;44:263-272
  • Langkamp DL, Harris SR. Predicting preschool motor and cognitive performance in appropriate for gestational age children born at <32 weeks’ gestation. Early Development and Parenting. 1992;1:89-96.
  • Washington KA, Harris SR.  Mental and motor development of low birth-weight infants with normal developmental outcomes.  Pediatric Physical Therapy. 1989;1:159-165.
  • Guimaraes CLN, Reinaux CM, Botelho ACG, Lima GMS, Cabral Filho JE. Motor development evaluated by Test of Infant Motor Performance: Comparison between preterm and full-term infants. Rev Bras Fisioter, Sao Carlos 2011;15 (5):357-362.
  • Nobel Y, Boyd R. Neonatal assessments for the preterm infant up to 4 months corrected age: A systematic review. Dev Med Child Neurol. 2012 Feb;54(2):129-39.


 Article utilizing the Test of Infant Motor Performance (TIMP)

Lee H-M, Galloway JC. Early intensive postural and movement training advances head control in very young infants. Phys Ther 2012;92:935-947.

The purpose of the study was to determine the effects of the postural and movement experiences on the head control through measurement with the test of infant motor performance beginning when infants were 1 month old.

The population consisted of 22 full-term 1 month old infants with no known sensory or motor impairments. The patients were randomly selected to training group or control group. The training group consisted of 6 males and 5 females. They were provided at least 20 minutes of daily postural training, requiring increased use of neck, shoulder girdle, and trunk muscles, and movement training, requiring increased use of arm movements for reaching. The caretakers of treatment group were also encouraged to use a front carrier (i.e. BabyBjörn) for at least 20 minutes per day. The control group consisted of 8 males and 3 females. They were provided social interaction from the care giver as they werein a supine position. Caretakers provided visual and verbal contact, but no physical contact of the infant nor the use of toys was allowed. Each session lasted for at least 20 minutes per day over a 4 week period. Testing was performed every other week from the 1 to 4 months of age.

Following analysis of the the results, it was shown that the training group had higher TIMP scores on head control–related items during the training period and after training stopped compared with the control group. After conclusion of treatment, the treatment group infants actively moved their heads forward more often and for further distances.

The author concluded that young infants can benefit from postural and movement experiences to rapidly enhance their head control as early as 4 to 6 weeks of postnatal life.  The author also concluded that improvement in TIMP scores and increase head mobility and head control was the result of infant positioning, caregiver handling, and caregiver-infant interactions.

Mar 13 2015

Gross Motor Function Measure

Published by

Title: Gross Motor Function Test (GMFM-88, and most recent the GMFM-66), Date published, December 2002. Second edition, December 16, 2013

Authors: Dianne J. Russell, Peter L. Rosenbaum, Lisa M. Avery, Mary Lane

Source: Published by Mac Keith Press, ISBN for GMFM-88 # 1 89868329 8 and ISBN for GMFM-66 # 1 89868329 8)

Costs: $119 for User’s Manual, 2nd Edition through Wiley Blackwell Publishing. CanChild grants permission for printing, but does not allow the sale of the GMFCS. Go to the following website to learn more,

Purpose: To evaluate change in motor function over time or with intervention for children with cerebral palsy. It has also been validated with children who have Down syndrome.

Type of test: Standardized observational test

Target Population and Ages: The original validation sample included children 5 months to 16 years old. The GMFM-88 is appropriate for children or adolescents with cerebral palsy or Down syndrome whose motor skills are at or below those of a 5 year old without a motor disability. The GMFM-66 has only been validated for children with cerebral palsy.

Time requirements-Administration and scoring: Administering the GMFM-88 may take approximately 45-60 minutes for someone familiar with the measure, depending on the skill of the assessor, the ability level of the child, and the child’s level of cooperation and understanding. This time will increase if the assessor wants to evaluate the use of ambulatory aids and/or orthotics in addition to an unaided assessment. Sometimes 2 sessions are required to complete all of the items. Item scoring is completed at the time of test administration. Calculation of dimension and total scores takes approximately 5 minutes with a calculator. The GMFM-66 should take less time to administer, as there are fewer items.

Administration: Items may be tested in any order and verbal encouragement or demonstration is permitting. There is a maximum of three trials allowed for each item and any spontaneous performance is acceptable. Toys and incentives can be used to motivate the child to perform a specific task.

Scoring: There is a 4-point scoring system for each item on the GMFM.

0 Does not initiate task
1 Initiates task (<10%)
2 Partially completes task (10-99%)
3 Completes task (100%)
NT Not tested

Scores range from 0-3, with higher scores denoting better performance. The test assesses 5 gross motor dimensions: lying and rolling, crawling and kneeling, sitting, standing and, walking, running and jumping. The score is given based on the best performance of the three trials. If undecided, choose the lower of the possible scores. The item scoring is the same for the GMFM-88 and the GMFM-66. The GMFM-88 scores can be summed to calculate raw and percent scores for each of the five dimensions, selected goal areas and a total GMFM-88 score. The GMFM-66 requires a user-friendly computer program to enter the individual item scores and convert them to an interval level total score.

Type of information: The GMFM-88 provides a percentage score and the GMFM-66 provides an interval-level total score.

Environment for Testing: The testing environment should be comfortable to the patient and large enough to hold the necessary equipment and allow the child to move freely. One item on the test requires the child to run 15 feet and return. The floor surface should me smooth and firm. Since the test was designed to measure change over time, the testing environment should be kept consistent.

Equipment for Testing: If using the GMFM-66, a computer must be accessible.

Equipment and Materials Needed: Mat, adjustable bench, tape lines, stairs with at least 5 steps, and toys.

Examiner Qualifications: The GMFM was designed for use by pediatric therapists who are able to assess motor skills in children. There is a GMFM Self-Instructional CD ROM that provides training tips and allows the therapist to work through examples of each item. For the GMFM-66, it takes a minimum of 3 hours to read through the manual and an additional 3 or more hours to work through the CD ROM training. Learning how to score and interpret the GMFM-66 using the GMAE (Gross Motor Ability Estimator, a computer-based scoring system) will require additional training.

Psychometric Characteristics: Reliable, valid, and responsive to change. MCID for the GMFM-66 is .8-1.3

Adair B, Said C, Rodda J, Morris M. Psychometric properties of functional mobility tools in hereditary spastic paraplegia and other childhood neurological conditions. Dev Med Child Neurol. 2012 April; 54(7): 596-605

Standardization/normative data: Yes, see graph

Evidence of Reliability: ICC for inter-rater reliability in this study was found to be 0.93 and the ICC for intra-rather reliability in this same study was found to be 0.99-1.0.

Mahasup N, Sritipsukho P, Lekskulchai R, Keawutan P. Inter-rater and intra-rater reliability of the gross motor function measure (GMFM-66) by Thai pediatric physical therapists. J Med Assoc Thai. 2011 Dec; 94:S139-44.

Evidence of Validity: The GMFM-88 has been validated on children 5 months to 16 years with cerebral palsy or Down syndrome whose motor skills are at or below those of a 5-year old child without any motor disability. The GMFM-66 has only been validated for children with cerebral palsy.

Palisano R, Hanna S, Rosenbaum P, et al. Validation of a Model of Gross Motor Function for Children With Cerebral Palsy. Phys Ther. 2000; 80:974-985.

Discriminative: Yes

Predictive: The motor growth curves describe patterns of gross motor function for children with CP over time. They can be used to predict a child’s future motor capabilities.

Growth Motor Curves

Strengths: The test has normative data, is predictive, valid and reliable. It shows change over time and the GMFM-66 provides information of level of difficulty of each item, which can help the therapist set realistic goals. The test is also accepted internationally.

Weakness: The test requires the assessor to have some practice with the test before administering it, and if utilizing the GMFM-66, the online training can take several hours. The test has only been validated for cerebral palsy and Down syndrome. The test can also take up to two sessions to complete. If using the GMFM-66, the use of a computer is required and therapist must be able to interrupt results.

Clinical Applications: The test has good clinical application in that it is designed to assess motor function change over time or with intervention in children with CP or Down syndrome if using the GMFM-88. The gross motor function curves can assist parents and health care professionals to make evidence-based management decisions more effectively. The curves can also assist in determining whether a child’s gross motor function is comparable to expectations for children with CP of the same age.

Summary of article utilizing the GMFM

Article: Christovão T, Pasini H, Grecco L, Ferreira L, Duarte N, Oliveira C. Effect of postural insoles on static and functional balance in children with cerebral palsy: A randomized controlled study. Braz J Phys Ther. 2015 Jan-Feb; 19(1):44-51.


The purpose of this randomized, controlled, double-blind, clinical trail was to determine the effect of the combination of postural insoles and ankle-foot orthoses on static and functional balance in children with cerebral palsy. Twenty children ages 4-12 years old were randomly allocated to either a control group (n=10) that used placebo insoles or the experimental group (n=10), which used postural insoles. The patients were instructed to wear the insoles for three months, 6 hours a day. The BBS, TUG, 6-minute walk test and GMFM-88 were used to assess balance as well the determination of oscillations from the COP in the anteroposterior and mediolateral directions with eyes open/closed. The participants were evaluated immediately after placement of the insoles, after three months of use of the insoles and one month after suspending use of the insoles. The results demonstrated no significant differences immediately after placement of the insoles except that the experimental group had shorted TUG times. After three months of insole use, no significant differences were found in any of the variables except again, the experimental group demonstrated significant reductions in TUG time and reduction in sway in the anteroposterior and mediolateral directions with eyes open.


Palisano R, Hanna S, Rosenbaum P, et al. Validation of a Model of Gross Motor Function for Children With Cerebral Palsy. Phys Ther. 2000; 80:974-985.

Mahasup N, Sritipsukho P, Lekskulchai R, Keawutan P. Inter-rater and intra-rater reliability of the gross motor function measure (GMFM-66) by Thai pediatric physical therapists. J Med Assoc Thai. 2011 Dec; 94:S139-44.

Adair B, Said C, Rodda J, Morris M. Psychometric properties of functional mobility tools in hereditary spastic paraplegia and other childhood neurological conditions. Dev Med Child Neurol. 2012 April; 54(7): 596-605

GMFM. CanChild Centre for Childhood Disability Research. Available at: Assessed March 10, 2015.