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Abstracts From the Dutch Society for Pediatric Physical Therapy

doi: 10.1097/PEP.0000000000000170
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Y.P.A. van der Velden, MPPT, FYSIOplus Roermond, the Netherlands; J. van Halbeek, PPT, FYSIOplus Roermond, the Netherlands; R. van Empelen, PhD, MA, PPT, Child Development and Exercise Center, Division of Pediatrics, University Children's Hospital and Medical Center Utrecht, Utrecht University, the Netherlands and Master Physical Therapy Program, University of Applied Sciences Utrecht, the Netherlands.

Background: In the field of pediatric physiotherapy objectively measuring and recording gross motor skills is an important part of the assessment of the child. In the case of children with an intellectual disability there is often no valid and reliable measuring tool available to measure gross motor skills. The Test for Gross Motor Development - Edition 2 (TGMD-2) is a norm and criteria referenced test that can accurately measure the performance of gross motor skills in children aged between 3.0 and 10.11 years old.

In the field this test is often used in children with an intellectual disability. Scientific research on the subject has suggested that the TGMD-2 is a highly reliable and sufficiently valid way of assessing children with an intellectual disability. They do, however, score lower than children without an intellectual disability.

Purpose: In this study the TGMD-2 was used to see if significant differences could be recorded by the test in a time period of 12 weeks in children (aged 3.0-10.11 yrs) with a mild or moderate intellectual disability. This study also investigated difference in children with a mild intellectual disability compared to those with a moderate intellectual disability; and if a correlation exists between the amount of intellectual disability and the difference between the results of the first and last measurement.

Methods: In this longitudinal study children were included aged between 3.0-10.11 years and with an IQ. between 35-75. All children were treated once a week in a special education school and they all had a need for gross motor development stimulation. Their parents gave informed consent to allow the children to participate in this study. The children were divided into 2 groups. Group 1 included children functioning at a level of mild intellectual disability (IQ: 56-75); Group 2 included children functioning at a level of moderate intellectual disability (IQ: 35-55). Two measurements were taken with an interval of 12 weeks. The Gross Motor Quotient (GMQ) was determined at each test. Data were analyzed using the Wilcoxon-test, the Mann Whitney-U-test and the Spearman rank correlation-test (SPSS version 22).

RESULTS: In total 22 Dutch children were tested. Group 1 (n = 13; IQ: 56-75; age range 3.2 - 10.8 years) included 2 girls and 11 boys. Group 2 (n = 8; IQ: 35-55; age range 5.1 - 10.4 years) included 3 girls and 5 boys. Changes over time were measured in both groups. Group 1 showed significant GMQ-improvement (P = .001; median score increased from 64 (46 - 79) to 94 (73 - 109)) after 12 weeks, as did Group 2 (P = .017; median score increased from 49 (46 - 61) to 56.5 (46 - 85)). A significant difference (P = .008) was established between both groups in the recorded measures of GMQ- differences. The median score of Group 1 was 27 (21-48), the median score of Group 2 was 4.5 (0 - 30). A significant moderate correlation (rs = .522, P = .015) was found between the recorded measure of GMQ- differences and I.Q.

Conclusion: The TGMD-2 is a reliable and valid measuring tool for evaluating children with an IQ between 35-75 who have a need for gross motor development stimulation. The TGMD-2 is able to capture significant measurement differences in a time period of 12 weeks when dealing with children with a mild or moderate intellectual disability. Even children with a lower I.Q. can show high measured differences.

1. Rintala P, Loovis E. Measuring Motor Skills in Finnish Children with Intellectual Disabilities. Perceptual & Motor Skills: Motor Skills & Ergonomics. 2013;116(1):294–303.

2. Simons J, Daly D, Theodorou F, Caron C, Simons J, Andoniadou E. Validity and reliability of the TGMD-2 in 7-10 year old Flemish children with intellectual disability. Adapted Physical Activity Quarterly. 2007;25:71–82.

3. Kim Y, Park I, Kang M. Examining Rater Effects of the TGMD-2 on Children With Intellectual Disability. Adapted Physical Activity Quarterly. 2012;29:346–365.


Eline A.M. Bolster, MSc, PPT; Olaf Verschuren, PhD, PPT; Annet Dallmeijer PhD; Petra E.M. van Schie, PhD, PPT

Author Affiliations: Department of Rehabilitation Medicine, Paediatric Physiotherapy Section (Ms Bolster, Drs Dallmeijer and van Shie), VU University Medical Center, Amsterdam, The Netherlands; Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine (Dr Verschuren), University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation Medicine (Drs Dallmeijer), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Corresponding author: Eline Bolster,

Introduction: Children with cerebral palsy (CP) are known to have poor physical fitness that might be a risk factor for developing secondary health conditions. Especially for children who use a manual wheelchair for daily mobility, it is difficult to perform commonly used fitness training modes as cycling or running to improve their fitness. Training for aerobic fitness needs to be done at an appropriate intensity. For aerobic conditioning, the American College of Sports Medicine recommends to exercise at 64-96% of the maximum heart rate for moderate to vigorous aerobic training. There is a need for appropriate modes of exercise for non-ambulant children with more severe motor impairments. The racerunner holds considerable potential as a means of exercise for this group of children. The racerunner consists of a 3-wheeled frame, with handlebars, saddle and a trunk support, similar to a tricycle. Rather than using a pedalling system, children propel themselves forward by stepping their feet on the ground. The use of both legs and arms is expected to induce a higher training stimulus when training with the racerunner compared to training with a wheelchair. Moreover, the racerunner could be used to enhance an active lifestyle, for example using the device during playtime in school or after school hours. Race running could also be practised as a sport.

Aim: To assess whether the racerunner is a suitable training device for improving aerobic fitness. Therefore heart rate and distance covered during the 6-minute test performed with the racerunner (6-minute racerunner test) and wheelchair (6-minute push test1) in children with CP who use a manual wheelchair in daily life was assessed.

Method: Eight children with CP (5 boys, 3 girls) with a mean age of 11 y 8m (range 6y 2m to 16 y 1m) participated. They were classified as Gross Motor Function Classification System (GMFCS) level II (n = 1), III (n = 2) and IV (n = 5). All participants performed the 6-minute racerunner test and 6-minute push test within 1 week. The instructions for both tests were the same: try to walk or ride as far as possible in 6 minutes, but do not start speeding. During the tests the children wore a flexible heart rate monitor (Polar FT7, Kempele, Finland) to register heart rate. Heart rate was defined as the mean heart rate during the last 2 minutes of the test. Differences in heart rate and distance covered of both tests were analysed using a paired t-test with α<.05.

Results: Heart rate of the test with the racerunner was 175 beats per minute (range 128-192), which was significantly higher (t = −5.455, df = 7, P = .01) than at the end of the wheelchair test, where heart rate was 121 beats per minute (range 84-159). Heart rate when performing the test with the racerunner was higher in all children compared to the wheelchair test.

The mean distance covered in 6 minutes with the racerunner was 312 meters (range 90-725) and with the wheelchair 263 meters (range 43-528), which was not a significant difference (t = −0.991, df = 7, P = .355).

Conclusion: At het end of the 6-minute racerunner test, the children reached a higher heart rate than at the end of the 6-minute push test. Distance covered in both tests was comparable.

Interpretation: Although the size of the group is small, it seems that children more easily reach a higher heart rate with the racerunner. When we use 194 bpm as an estimate of HRmax as previously suggested,2 this means that all children are in the required training zone for increasing aerobic fitness at the end of the 6-minute racerunner test (between 64% and 96% of their estimated HRmax). For most children, the racerunner might be more suitable for training purposes, because the children reach a higher training stimulus. For daily living the wheelchair seems more efficient, because the children covered the same distance in the wheelchair as with the racerunner, but with a lower heart rate.

Acknowledgements: We would like to thank the paediatric physical therapists, especially Els Tempelaars, of Heliomare in Wijk aan Zee, the Netherlands for their help.

1. Verschuren O, Ketelaar M, de Groot J, Vila Nova F, Takken T. Reproducibility of two functional field exercise tests for children with cerebral palsy who self-propel a manual wheelchair. Dev Med Child Neurol 2013;55:185–90.

2. Verschuren O, Mailtais DB, Takken T. The 220-age equation does not predict maximum heart rate in children and adolescents. Dev Med Child Neurol 2011;3:861–4.


Schamper J.E. Pediatric physical therapist FysioPoll, Struytse Hoeck 92C, 3224HB Hellevoetsluis; Drs. Duiser I.H.F., Tutor, Academy for Pediatric Physical Therapy, University of Applied Science Rotterdam, Rotterdam, the Netherlands; Hartman J.E.M. PhD, Senior Tutor, Academy for Pediatric Physical Therapy, University of Applied Science Rotterdam, Rotterdam, the Netherlands

Background: To determine possible underlying factors causing handwriting problems in children, pediatric physical therapists use the Beery Developmental Test of Visual-Buktenica-Motor Integration (Beery-VMI). The Beery-VMI was developed in the United States. Norm values for the most recent version (the sixth edition, 2010) were obtained from 1737 American children aged 2-18 years from various ethnic groups. To date, only American norm values of the Beery-VMI have been published.

Aim: The aim of this study was to determine whether norm values need to be developed for Dutch primary school children aged 7-10 years, or whether the American norm values of the Beery-VMI can be used.

We examined whether there is a significant difference between the average standard scores on the Beery-VMI of Dutch children and the American norm values, and whether average standard scores of boys and girls on the Beery-VMI differ.

Methods: The longitudinal study started in 2010 and was completed in 2013. The Beery-VMI test was performed yearly with Dutch children in 6 different primary schools.

The average standard scores of Dutch children between 7 and 10 years old on the 3 subtests, Visual Motor Integration (VMI), Visual Perception (VP) and Motor Coordination (MC), were calculated. A one-sample t-test was used to determine if a significant difference exists between the average standard scores on the Beery-VMI of Dutch children and the American standard scores.

An independent t-test was used to determine if a difference exists between the average standard scores of boys and girls on the Beery-VMI.

Results: Beery-VMI results from a total of 276 children (130 boys and 146 girls) were collected. Dutch children scored significantly higher on the VP subtest than American norm values, but significantly lower on the VMI and MC subtests. The standard deviations of the norm values of the Dutch children on the VMI, VP and MC subtests are significantly smaller than of the American standard norm values (P<.001). Girls scored significantly higher than boys on the VMI subtest at ages 8-9 years, on the VP subtest at age 9 years and on the MC subtest at ages 7-10 years.

Conclusion: This study shows that the American norm values of the Beery-VMI are not applicable to Dutch school children aged 7-10 years. The American norm values should therefore be used with caution. Based on this study, we recommend that Beery-VMI norm values in this age range are developed for Dutch children. In addition we also recommend examining whether a significant difference exists in Dutch children aged 2-6 and 11-18 years in relation to the American norm values.

A last recommendation is that the reason for the boys' consistent lower scores on the MC subtest needs to be examined.

Copyright © 2015 Academy of Pediatric Physical Therapy of the American Physical Therapy Association