Clinical Bottom Line
“How could I apply this information?”
This article uses a standardized measurement tool, the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT 2), with a sample of children with neurofibromatosis type 1 (NF1) and begins to define the body structure and functional issues that may lead to activity limitations and participation restrictions. The BOT 2 is an appropriate measurement tool and should help therapists design effective interventions for children with NF1.
The BOT 2 identified a motor proficiency delay in children with NF1, in the total motor composite score and 7 of 8 subtests. By including the BOT 2 in the PT examination of children with NF1, therapists may accurately identify children who would benefit from physical therapy services and design intervention plans for specific body structure and function impairments. The evidence provided in this article may assist school-based therapists in meeting Individuals with Disabilities Education Act requirements of (1) using technically sound instruments to confirm deficiencies that may affect academic performance and (2) basing the student's educational plan on peer-reviewed research to the extent practicable. The BOT 2 may provide information on specific components of motor proficiency that can negatively affect the child's academic performance, such as writing, keyboarding, and cutting. Deficits in strength and agility may interfere with participation in physical activity that is important for building a strong skeletal system and optimizing health over the lifespan. Children with NF1 are known to have decreased bone mineral density and increased risk for fractures and should benefit from interventions that increase participation in physical activity.
“What should I be mindful about in applying this information?”
The authors of this article caution about generalizing information to all children with NF1 because the sample size was so small and regionally specific. Therapists who do want to use the BOT 2 with this population should remember that the total motor composite score of the BOT 2 is the strongest indicator of motor performance and thus provides the most valid examination data. Even though it takes a long time to perform the entire BOT 2, it is important to complete the entire test to get the most valid examination data. Function and participation assessments such as the School Function Assessment or Pediatric Outcomes Data Collection Instrument should be used with the BOT 2 to assess the child with NF1.
Nancy L. Biedry, PT, MS, PCS Rehabilitation Services Department, Central DuPage Hospital, Winfield, Illinois
Donna J. Cech, PT, DHS, PCS Physical Therapy Program, Midwestern University, Downers Grove, Illinois