Symposium IIIpostprintThe 3rd HKASMSS Student Conference on Sport Medicine, Rehabilitation and Exercise Science, Hong Kong, 19 June 2010. In Conference Proceedings, 2010, p. 30-3

Abernethy, B

Capio, CM

Sit, CHP

HKU Scholars Hub

Title Process-oriented evaluation of fundamental movement skills inchildren with cerebral palsyAuthor(s) Capio, CM; Sit, CHP; Abernethy, BCitationThe 3rd HKASMSS Student Conference on Sport Medicine,Rehabilitation and Exercise Science, Hong Kong, 19 June 2010.In Conference Proceedings, 2010, p. 30-32Issued Date 2010URL http://hdl.handle.net/10722/127885Rights Creative Commons: Attribution 3.0 Hong Kong LicenseSYMPOSIUM IIIProcess-oriented evaluation of fundamental movement skills in children with cerebral palsyCatherine M. CAPIO, Cindy HP SIT, Bruce ABERNETHYInstitute of Human Performance, The University of Hong KongIntroductionFundamental movement skills (FMS) are considered the essential basis for the development of more advanced and specific sporting skills1. High levels of FMS compe-tence have been considered to be prerequisites to suc-cessful participation in sports and physical activities2. Since the ability to perform FMS has been identified as a potential factor that influences the physical activity be-havior of children3-7, it is important that this be measured using valid and reliable instruments7 for both typically developing children and children with disabilities. The biological factors associated with a physical disabil-ity may retard the development of FMS in early child-hood. The largest diagnostic group treated in pediatric rehabilitation is made up of children with cerebral palsy (CP)8. CP refers to a group of disorders that is caused by non-progressive disturbances in the developing brain, and is known to manifest in problems of movement and posture9. While the hallmark of CP is a delay in the de-velopment of gross motor function10, low levels of par-ticipation in physical activities and recreation have also been observed11-13. FMS that are performed in an upright position include lo-comotor skills and object control skills14. Locomotor skills require overall movement of the body such as running and jumping1,15. Object control skills are more static in na-ture and involve applying force to or receiving force from objects such as kicking, catching, and throwing16. FMS may be measured using product-oriented or process-oriented approaches14. Product-oriented assessments are based on time, distance, or number of successful at-tempts resulting from the performance of a skill, while process-oriented assessments are concerned with how the skill was performed rather than the product result of the movement. Product-oriented measures appear to be more appropriate for children with CP since they empha-size an individual’s output rather than their manner of performance based on a “normal” standard17.A product-oriented FMS testing strategy is crucial in fur-ther research that will examine the FMS proficiency of children with CP. As we target FMS training, validated testing procedures will be highly useful in providing out-come measures that directly relate to sports and activi-ties that children engage in. This study aimed to validate a product-oriented measurement procedure that tests specific FMS among children with CP.  MethodsParticipants Participants included a convenience sample of 30 chil-dren with CP (17 female, 13 male) aged between 6 to 14 years (M = 9.83 years, SD = 2.5 years). Inclusion criteria were children with CP who were able to walk with or with-out walking aids and follow 2-step commands. Exclusion criteria included neurologic disease and any other medi-cal conditions that limited participation. Parents provided written consent, and children gave verbal assent prior to study involvement. Ethical approval was granted by the Institutional Review Board (IRB) of the university. FMS AssessmentProduct-oriented scores The testing procedures for the FMS assessment were adapted and modified from the protocols of the second edition of the Test of Gross Motor Development – 2nd Edition (TGMD-2)15. Performances of two locomotor skills and three object control skills were measured using prod-uct outcomes based on duration, distance, and number of successful attempts14. Process-oriented scoresTGMD-2 components that evaluate the five FMS being examined were used for process-oriented measurement. Each skill is performed for two trials, and skill perfor-mance is rated on a scale of 3-5 based on a number of qualitative criteria. The presence or absence of a criterion is scored 1 or 0. Developers of the tool have established high reliability, including internal consistency of items in the tool15. Criterion measure Gross Motor Function Classification System (GMFCS) levels were used as the criterion measure. GMFCS is a classification system designed for children with CP us-ing 5 levels that are based on differences in self-initiated movement and locomotion10. Level I denotes the ability to walk without any restrictions, while level II refers to walking with limitations when outdoors in the community. Level III refers to walking with assistive mobility devices, while levels IV and V describe mobility patterns where the children are in supported sitting and powered assis-tive technology are used.ProceduresIndividual testing sessions included the performance of the following tasks: catching, throwing, kicking, jumping for distance, and running. The sessions were conducted outdoors, on surfaces with non-slip rubber mats. Verbal instructions were given using a maximum of 2-step com-mands, followed by demonstrations. Five trials were done for catching, throwing, and kicking. Three trials were done for jumping and running. The data were analyzed using linear regression analysis, with GMFCS as the criterion reference. Alpha level was set at p<0.05.30SYMPOSIUM IIIResultsEight product-oriented measures were taken to assess five FMS, and six were found to have a significant linear association with GMFCS levels (p<0.05). Table 1 shows the correlation coefficients (r) and the coefficients of de-termination (R2) between the product-oriented measures and GMFCS levels. It was found that product-oriented scores for catching, jumping, and running were able to predict a substantial variance in GMFCS levels. Three product-oriented scores were taken for kicking: number of successful attempts considering contact, number of successful attempts considering distance, and duration of performance from initiation to contact. Only the latter two measures were found to account for sizeable GM-FCS variance in the participants.  The product-oriented score for throwing was not found to predict the variance in GMFCS levels. The fit of the regression models were also assessed using analysis of variance (ANOVA) and were found to be significant for catching, running, two kicking measures (distance and duration), and one jumping mea-sure (distance). Table 2 shows the correlation coefficients and coefficients of determination that were observed for the process-ori-ented scores and GMFCS levels. Only the two process-oriented scores for locomotion (running and jumping) were found to have significant positive associations (p<0.05) and accounted for a substantial variance in GMFCS lev-els. The fit of the regression models were also found to be significant for these locomotion skills.DiscussionOne goal of outcome measurement is to evaluate the ef-fects of interventions. However, rubrics for measurement of function and outcomes in children with CP are still inad-equate18. GMFCS has been established as the principal classification system of functional ability in children with CP, and it has been used as the criterion measure for testing the validity of measures19. Measurement scales for spasticity20, manual dexterity21, and motor ability10 have been developed and validated against GMFCS, but no scale has been found to be adequate to measure FMS. Similar to other validation studies, we used the GMFCS as the criterion measure to test the validity of product-oriented measures for throwing, catching, kick-ing, jumping, and running skills. Our results showed that six of the product-oriented measures predicted a signifi-cant amount of variance in GMFCS, providing evidence that valid product scores have been identified in four skills for children with CP. Process-oriented scores were found to predict significant variance in GMFCS only in locomotor skills, and demon-strated weaker associations with our criterion measure than those of product-oriented scores. This supports our proposition that product-oriented assessment may be more applicable in children with CP. However, it appears that further studies are needed to identify a valid mea-surement score for throwing skills. Neither product nor process scores were found to have significant associa-tions with GMFCS, indicating the need to further examine valid methods of measuring this skill. ConclusionIt has been argued that what an individual is able to do is more important than how the task is performed against a standard on which function is judged17. We used outcome measures that directly measured the task outcomes with explicitly observable data. Our findings demonstrated valid product-oriented measures for catching, kicking, jumping, and running. In the context of research, the use of tests is highly dependent on the purpose of a study22. The FMS measures that were validated in this study are geared for further research that would examine associa-tions of FMS and physical activity levels of children with CP. As such, we emphasize that the measures depict the skills that children use in physical activities that may be in the form of sports and recreation.References1. Payne VG, Isaacs LD. Human motor development: A lifespan approach. 5th ed. Boston: Mc-Graw Hill; 2002. 2. Stodden D, Langendorfer S, Roberton MA. The associ-ation between motor skill competence and physical fitness in young adults. Res Q Exerc Sport. Jun 2009;80(2):223-229.3. Barnett LM, van Beurden E, Morgan PJ, Brooks LO, Beard JR. Childhood motor skill proficiency as a predic-tor of adolescent physical activity. J Adolesc Health. Mar 2009;44(3):252-259.4. Foweather L, McWhannell N, Henaghan J, Lees A, Stratton G, Batterham AM. Effect of a 9-wk. After-school multiskills club on fundamental movement skill proficien-cy in 8-to 9-yr.-old children: An exploratory trial. Percept Motor Skill. Jun 2008;106(3):745-754.5. Okely AD, Booth ML, Patterson JW. Relationship of physical activity to fundamental movement skills among adolescents. Med Sci Sport Exer. Nov 2001;33(11):1899-1904.6. Williams HG, Pfeiffer KA, O’Neill JR, et al. Motor skill *statistically significant at p<0.05*statistically significant at p<0.05Table 1. Correlation coefficients, coefficients of determi-nation, and regression model fit between product-orient-ed scores and GMFCS levelsTable 2. Correlation coefficients, coefficients of determi-nation, and regression model fit between process-orient-ed scores and GMFCS levels.31SYMPOSIUM IIIperformance and physical activity in preschool children. Obesity (Silver Spring). Jun 2008;16(6):1421-1426.7. Wrotniak BH, Epstein LH, Dorn JM, Jones KE, Kondilis VA. The relationship between motor profi-ciency and physical activity in children. Pediatrics. Dec 2006;118(6):e1758-1765.8. Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: Incidence, impairments and risk fac-tors. Disability and Rehabilitation. Feb 2006;28(4):183-191.9. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol Suppl. Feb 2007;109:8-14.10. Rosenbaum P, Walter SD, Hanna SE, et al. Prog-nosis for gross motor function in cerebral palsy: cre-ation of motor development curves. JAMA. Sep 18 2002;288(11):1357-1363.11. Bjornson KF, Belza B, Kartin D, Logsdon R, McLaugh-lin JF. Ambulatory physical activity performance in youth with cerebral palsy and youth who are developing typi-cally. Phys Ther. Mar 2007;87(3):248-257; discussion 257-260.12. Engel-Yeger B, Jarus T, Anaby D, Law M. Differences in Patterns of Participation Between Youths With Cere-bral Palsy and Typically Developing Peers. Am J Occup Ther. Jan-Feb 2009;63(1):96-104.13. Hurvitz EA, Green LB, Hornyak JE, Khurana SR, Koch LG. Body mass index measures in children with cerebral palsy related to gross motor function classifica-tion: a clinic-based study. Am J Phys Med Rehabil. May 2008;87(5):395-403.14. Burton A, Miller D. Movement skill assessment. .Champaigne , IL: Human Kinetics; 1998.15. Ulrich D. Test of Gross Motor Development. . 2nd ed. Texas: Pro-Ed; 2000.16. Jaakkola T, Kalaja S, Liukkonen J, Jutila A, Virtanen P, Watt A. Relations among physical activity patterns, lifestyle activities, and fundamental movement skills for Finnish students in grade 7. Percept Mot Skills. Feb 2009;108(1):97-111.17. Rosenbaum P, Stewart D. The World Health Organi-zation International Classification of Functioning, Disabil-ity, and Health: a model to guide clinical thinking, practice and research in the field of cerebral palsy. Semin Pediatr Neurol. Mar 2004;11(1):5-10.18. Adams JV. Understanding function and other outcomes in cerebral palsy. Phys Med Rehabil Cli. 2009;20:567-575.19. Morris C, Bartlett D. Gross motor function classifica-tion system: impact and utility. Developmental Medicine and Child Neurology. Jan 2004;46(1):60-65.20. Nordmark E, Andersson G. Wartenberg pendulum test: objective quantification of muscle tone in children with spastic diplegia undergoing selective dorsal rhizo-tomy. Developmental Medicine and Child Neurology. Jan 2002;44(1):26-33.21. Beckung E, Hagberg G. Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Developmental Medicine and Child Neu-rology. May 2002;44(5):309-316.22. Cools W, De Martelaer K, Samaey C, Andries C. Movement skill assessment of typically developing pre-school children: A review of seven movement skill as-sessment tools. Journal of Sports Science and Medicine. Jun 2009;8(2):154-168.32

Process-oriented evaluation of fundamental movement skills in children with cerebral palsy

http://hub.hku.hk/bitstream/10722/127885/1/Content.pdf

Process-oriented evaluation of fundamental movement skills in children with cerebral palsy

Abstract

Similar works

Full text

Available Versions

HKU Scholars Hub