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Pediatric Physical Therapy:
doi: 10.1097/PEP.0b013e3181eb6a5b
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Development of a Challenge Assessment Tool for High-Functioning Children With an Acquired Brain Injury

Christy, Jennifer Braswell PT, PhD; Turner, Penny H. DPT

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Author Information

Department of Physical Therapy, University of Alabama at Birmingham, Birmingham

Children's Health System, Birmingham, Alabama

Jennifer Braswell Christy, PT, PhD

Department of Physical Therapy, University of Alabama at Birmingham, Birmingham

Penny H. Turner, DPT

Children's Health System, Birmingham, Alabama

“How could I apply this information?”

Consider the following: An 8-year-old boy sustained acquired brain injury (ABI) 1 year ago and presented for physical therapy evaluation. The child obtained a perfect score on the Gross Motor Function Measure and was almost age-appropriate on the Bruininks-Oseretsky Test for Motor Proficiency, Second Edition. However, he wants to return to playing soccer and riding his bicycle and is currently unable to do these activities. It is for this type of case that the Challenge Assessment (CA) was developed. The CA is an outcome tool to assess advanced gross motor skills in school-aged youth with ABI. This article describes the content validity stage of pilot testing the items on 6 children with ABI. The authors justify the need for a new tool that is sensitive to progress and ability to return to sports in higher-functioning children with ABI. The rationale is that existing outcome tools lack real-life activities, do not include tasks performed in sports, lack multidimensional dynamic tasks, or have a ceiling effect in high-functioning children with ABI and functional limitations.

The CA was developed in the following stages:

* On the basis of review of the literature and existing outcome tools, an expert panel (n = 4) chose items (n = 78) to each represent a gross motor category.

* Items were judged by experts (n = 75) who scored each item on safety, feasibility, and importance.

* Items that met a priori criteria (n = 28 items) were chosen for pilot testing on 6 children with ABI. Table 2 provides the participants' scores for each item.

* Instructions and scoring for each item were adjusted on the basis of observations and feedback from subjects in the pilot study. The test took 1 hour to complete, children were not fatigued, and there did not appear to be a ceiling or floor effect.

“What should I be mindful about in applying this information?”

Clinicians should be mindful that the CA is in the early development stage and is not yet ready for clinical use. However, clinicians should be excited and eagerly awaiting validation and psychometric testing. The final outcome tool will be instrumental in justifying treatment of children with ABI who want to return to sports and other high-level activities.

© 2010 Lippincott Williams & Wilkins, Inc.

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