Pediatric Assessment/Atypical Development Flashcards
Purpose of discriminative test
identifies children with developmental delay
Does discriminative, evaluative or predictive consist of screening tools or diagnostic evaluations determining the etiology of the problem?
Discriminative
Does discriminative, evaluative or predictive determine appropriate placement or services?
Discriminative
Does discriminative, evaluative or predictive assess current skill level and document change over time
evaluateive
Does discriminative, evaluative or predictive allow you to select effectiveness of intervention?
evaluative
Is discriminative, evaluative or predictive NORM referenced?
Discriminative: whether or not a problem exists
Is discriminative, evaluative or predictive CRITERION referenced?
Evaluative: determines appropriate plan and goals and measures change over time
what does test-retest tell you
reliability in a test over a period of time (the other kind of reliability is inter-rater)
what is inter-rater reliability
the degree to which DIFFERENT raters obtain the same score
construct, concurrent and predictive are all parts of psychometric property?
validity
what is construct validity
does the test measure what it claims to measure
what is concurrent validity
the score correlates with that of another valid test that is administered at the same tim
what is predictive validity
predicting the performance on a future measure (two measures are taken at different times)f
what does a highly sensitive test find in terms of positives and negatives
true positives
avoid false negatives
good at ruling out
what does a highly specific test find in terms of positives and negatives?
avoids false positives
is specificity or sensitivity probably a better measure for making sure you don’t miss someone who needed intervention?
Sensitivity: avoiding false negatives and therefore not missing someone who needed PT
what kind of things in PT would you want to be super specific about?
fractures, surgical decision making
want to avoid false positives
detectors at airports are specific or sensitive?
Sensitive: rules out, if you go through and it doesn’t beep you can be pretty certain nothing is on them
For PT are we more concerned with specificity or sensitivity?
sensitivity: avoiding false negatives, making sure we’re getting to everyone we should
Norm referenced you compare against what?
you compare against other children in a given population (whether that is a “normal” child or a disordered population)
Criterion referenced you compare against what?
you compare against the child to themselves down the road.
how can you expect to administer a norm referenced test?
standardized items
rules to follow
you get a booklet
norm referenced test is discriminative or evaluative?
discriminative
criterion referenced test is discriminative or evluative?
evaluative
can you provide age equivalent values for a norm or criterion referenced test?
norm referenced
what is the big thing criterion referenced test does?
look at changes within an individual child overtime
which test can you NOT compare to a group
criterion referenced
PDMS2 is criterion or norm referenced?
norm
BOT2 is criterion or norm referenced?
norm
GMFM is criterion or norm referenced
criterion
If you’re doing a norm referenced test can you use the parent saying “yes ive seen them do that before?
no! Its super standardized you have to see them do it
criterion or norm referenced tests are you thinking about% nd SD?
norm referenced bc these are all about comparing performance to others
50% correlates to what on a standard bell curve?
the mean
Within how many SD’s of the mean is generally considered “normal”
= or - 2 SD
if a kid is within 2 SD of normal are they going to qualify for therapy?
no they are considered normal
below 2SD will qualify for therapy
percentile rank gives what information?
relative position within normative samples and rate of change over time
what does it mean if percentile rank decreaes?
they are not progressing at the same rate their peers are
Standard scores vs age equivalent?
standard score doesn’t have units
what is a scaled score?
who is it good for?
scaled score: performance as it relates to the ENTIRE RANGE of scores on the test
good for individuals <1 percentile of the measure. It will show performance overtime
What is age equivalents?
age which a score obtained correlates with tehe AVERAGE performance
criterion referenced scoring will not have what two kinds of data associated it
age equivalents, percentile ranks
age equivalents and percentile ranks can be found for criterion or norm referenced tests?
norm referenced
true or false: only doing a standardized assessment is a good examination
FALSE: standardized testing should only be a part of your full exam and eval
What is the point of neonate tests?
you want to catch it early and intervene
what are the two tests we talked about for infants/toddlers?
AIMS
PDMS2 (goes all the way until 6 years old)
what are the three school age tests we talked about?
BOT2
GMFM
PDMS2 (done up until six)
what is the one participation measure we talked about
CAPE/PAC
is AIMS criterion or noms referenced?
norms referenced
is AIMS elicited or observational?
observational
validated age range for AIMS
best age range?
birth to 18 months
3-9 months
what does AIMS do in the discriminative category
identifies gross motor delay
describe aims
48 GROSS motor skills
4 positions: supine, prone, sitting, standing
OBSERVE
how long does AIMS take?
can you continue in another session if you don’t finish in the first?
20-30 minutes
can complete across sessions if they’re less than one week apart
infants should be naked or in diaper
Observation of spontaneous movement
can present toys, auditory prompts etc
Items can be completed in any sequence
Which test is this?
AIMS
AIMS
number of trails per task
unilateral or bilateral?
unlimited number of trials
doesn’t look at laterality, just if they can do it
how does scoring work for aims
items marked as O or NO (observed or not observed)
find “motor window” items btwn least mature and most mature skill observed in each position
score each item in the window: 1 for observed, 0 for not observed
Give a point for everything below the window
is parental reporting accepted for AIMS?
no! has to be observed
where do you start working with the kid during AIMS
start with what they’re showing you then try to elicit harder motions, all to find the window
what is the major numeric data you are trying to get for AIMS?
percentile rank
what percentile rank is
normal
suspicious
abnormal
for AIMS?
normal: >16th percentile
suspicious. bwn 5th percentile and 16th percentile
abnormal: <5th percentile
explain the limitation in AIMS
once you get to ~15 months the difference in AIMS score is basically nothing. There’s a ceiling effect
is GMFM discriminative or evaluative?
evaluative: assess motor performance in children with CP
is GMFM criterion or norm referenced?
criterion
age range for GMFM
5 months to 16 years: appropriate for children whos motor skills are at or below those of a normal 5 yr old child
Explain GMFM levels
I: walks without limitations
II: walk with limitations
III: walks with hand held mobility device
IV: self-mobility w/limitations, may use powered mobility
V: Transported in WC by another, dependent
compare and contrast GMFM 88 and 66
88: all items must be scored
66: For higher functioning kids bc it takes out some of the some items can be NT
what population is GMFM item set validated in?
CP
what does the item set of the GMFM give you?
minimum number of items that need to be administered to get an accurate GMFM 66 score
how do you score GMFM
0-3:
0: couldn’t attempt
3: independent
How is GMFM for other neurologic populations?
good reliability and validity
Does GMFM score sides when its appropriate?
yes!
how much time does full GMFM take to administer?
what can be done about this?
45-60 min
can complete the test over one week: DO NOT RETEST ITEMS ALREADY ADMINISTERED
How much time does it take GMFM 66 to administer?
10-20 min
true or false: GMFM you can hands on assist or facilitate the kid
false
true or false: GMFM you can put the kid in the starting position
true: but you cannot assist or facilitate
Do you get a trial test with GMFM
yes!
what should the child be wearing for GMFM
NO SHOES
comfortable clothes
how many trials does kid get in GMFM for each item?
max of 3
what about Orthoses or AD for GMFM?
repeat and document
is there a manual for GMFM?
yes! (even though its criterion referenced)
GMFCS
gross motor function classification
higher score on GMFM means what?
closer to level I, independence
what kind of motor motion does PDMS2 look at
gross and fine
is PDMS norm or criterion referenced?
norm!
what is the age range for PDMS2?
birth to 6 years(ends on their 6th birthday)
What are the three major categories for PDMS that you can test separately but cannot test the categories within the categories separately?
gross motor
fine motor
total motor
what are the two things with the gross motor composite of the PDMS2 which change depending on the age you’re testing a child
reflexes you test 0-11 months
object manipulation you test 12 months and older
what are the three things you would test under gross motor composite in PDMS for a child that was 10 months old
reflexes
locomotion
stationary: balance and postural control
in someone older than 11 months you would test object manipulation instead of reflexes
does PDMS2 have a test kit?
yes!
how long does PDMS2 take to administer
how many days can you do it accross
45-60 min
complete within 5 days
how do you administer PDMS, where do you start
determine their age and start in the dark bracket
scoring for PDMS
2
1
0
2: according to criteria
0: cannot or will not attempt
how to establish basal and ceiling level of PDMS2
basal level: score a 2, 3 times in a row
ceiling: score a 0 on three items IN A ROW
everything before basal level they get full credit for, everything above ceiling they get 0
how many trials does a child have on PDMS2
3
is the BOT2 norm or criterion referenced
norm!
what does the BOT look at?
various domains of motor skills
what is the age range for BOT2?
4 to 21 years
PDMS2, BOT2, AIMS are all norm or criterion referenced?
norm!
how must you administer the 8 subsets of the BOT2
you have to administer them in their given pair, but they can stand alone as long as you do this
Fine manual control, body coordination, manual coordination, strength and agility are all the test items of what test?
BOT2: each of these have two subsets under them
how long does BOT2 take
60 minutes
but there is short form that takes ~15 minutes
Can you score the BOT2 on your own
no there is a kit and an administration easel that has directions, diagrams photos, scoring examples etc.
what is a scale score for BOT2
standard scores?
allows comparison btwn both subsets of the 4 domains
standard scores allow for comparison btwn the 4 domains
what is the purpose of the CAPE and PAC
assess participation
what is the age range for CAPE and PAC
6-21 years
how long does CAPE and PAC take to administer?
20-60 minutes
CAPE and PAC look at the nature of activity (formal and informal ) as well as what?
activity type: recreational, physical, social, skill based, self improvement
what tests asks you if you have done an activity in the past four months
CAPE, PAC
JUST READ THIS SUMMARY: Standardized tests can be used as a part of an examination for screening, determining the need for therapies, evaluation, and/or monitoring progress depending on the specific test
Test selection should include consideration of a child’s age and abilities as well as the purpose of test administration
Tests need to be administered in a standard method when drawing conclusions and considering change over time and understanding of norm-referenced and criterion-referenced test development is important when interpreting examination findings
Remeber there is variability and a range of typical development in the first place
what are three three balls that go into milesstone aquisition?
environment/exposure
predisposition
MSK
what are the four developmental domains that you have to think about the interplay of for development
sensory
cognitive
motor(fine and gross)
communication
what is it important to educate family on in terms of development and atypical development
there is a range of normal! Walking goes up to 18 months
first day of last menstrual period –> time of birth is what
gestational age
First day of last menstrual period –> date of assessment is what age
postmenstrual age
date of birth to date of assessment is what age
chronological age
expected date of delivery –> date of assessment is what age
adjusted age
what standardized test that we talked about might you want to look at adjusted age in?
PDMS2
adjusts until 2 years of age
full term is how many weeks when they’re adjusting for prematurity
40 weeks
what range of weeks is considered full term baby
37-42
what range of weeks is considered a preterm baby
<37 weeks
Late preterm is considered how many weeks
34-36 weeks 6 days
late preterm at a lot of risk for CP?
no, more moderately and very preterm
how many weeks is very preterm
<32
very high risk of CP
benefit and risk of adjusting for gestational age
benefit: qualm parents fears, maybe the kid just needs to work on growing
risk: miss something that can potentially be worked on
explain what CP is in as few words as possible
perminant non-progressive neuological deficit
is CP normally rule out or in diagnosis?
rule out
compare and contrast the lesion vs. the sequelle of CP
lesion: static
Sequelle: progressive
what is the most common kind of CP
spastic
characterized by slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue.
Athetosis
number of cases of CP in 1,000
1 or 2
what birth weight are you at high risk of CP?
<1,000g
1000-1499g
how many weeks of gestation does to risk of CP drastically decrease?
32 weeks and beyond
spastic vs. diskinetic vs. ataxic
spastic: stuck
diskinetic: involuntary, repetitive twisting
ataxic: unsteady, no coordination, NOT stuck
what can you see on an MRI that might point docs towards a CP diagnosis?
PVL: periventricular leukomalacia
decreased white matter (has abnormal white signal)
not direct correlation but still a risk factor
Can you treat PVL?
not the cause itself but you can maximize function
what is the GMA
who uses it?
what is it used for
gross motor assessment
Healthcare practitioners in the NICU use it.
Done to see if child is at risk of CP later in life
does PVL correlate super well with CP later in life?
no but it is a factor to consider for kids to be assessed for needs early
what is the huge concept for the NICU
there might be movement characteristics that you can observe that can cue you off to think who might need therapy before they have a true diagnosis of CP (lack of fidgetiness, only synergistic patterns of motion)
what is the one thing that kept coming back under unhelpful for treating CP
NDT
