Rajiv Gandhi University of Health Science, Karnataka

Curriculum Development Cell Conformation for Registration of Subjects for Dissertation

Registration No :-

Name of the Candidate :- Mr. NITESH KUMAR PANDE

Address :- Village and Post –Hariharpur, Dist-Jaunpur UP

Name of the Institution :- SDM college of physiotherapy, Dharwad

Course of study and subject :- MPT (Physiotherapy in Pediatrics)

Date of admission to course :- 15/07/2013

Title of the topic :- APPLICABILITY OF PEABODY DEVELOPMENTAL

MOTOR SCALE-2 (PDMS-2) TO QUANTIFY GROSS

MOTOR DEVELOPMENTAL DELAY IN CHILDREN WITH

MOTOR DEVELOPMENTAL DELAY

Brief resume of the intended work :- Attached

Signature of the student :-

Guide name :- DR. PARMAR SANJAY

Remarks of the guide

Signature of the guide :-

Co-Guide name :-

Signature of the co-guide :-

HOD Name :- DR. RAVI SAVADATTI

Signature of HOD

Principal Name :- DR .RAVI SAVADATTI

Principal mobile no. :- 9845051209 E-mail ID :-

Principal signature :-

Remarks of the Principal :-

A) / BRIEF RESUME OF THE STUDY
INTRODUCTION
The study of development is study of how & why human organism grows & changes throughout life. Development defined as orderly & relatively enduring changes overtime in physical & neurological structure, through process & behavior.1
Motor development is defined as the process of changes in motor behavior that is related to the age of individual. Physical therapists are important member of the professional team working with developmentally delayed children.2
Gross Motor Quotient (GMQ) is a composite of the indices of the subtest that measure the use of the large muscle systems. Three of following four subtests form this composite score:3
Reflex (birth to 11 month only)
Stationary (all age)
Locomotion (all age)
Objective Manipulation (12 month and older)
During the past 20 years, physical therapists have had considerable interest in the development and evaluation of health status outcome measure.4 Outcome measures are used by researchers and clinicians to assess changes in patients’ abilities before and after health care to promote the accountability of health care services.5 Outcome measures must have the psychometric properties of reliability & responsiveness.6-8 The low intra subject variation in stable subject reflects the test-retest reliability of measure.5 Only measure with high test-retest reliability can detect the real change & reduce the bias caused by measurement error. The responsiveness of a measure is defined as the ability to assess clinically important change over time.9 Thus, evidence supporting the test-retest reliability & responsiveness of an outcome measure must be established before its use in research or clinical setting.
Developmental disabilities are a group of related chronic disorders of early onset estimated to affect 5% to 10% of children.10,11 Global developmental delay is a subset of developmental disabilities defined as significant delay in two or more of the following developmental domains: gross/fine motor, speech/language, cognition, social/personal, and activities of daily living.12-16
Developmental delay can have many different causes, such as genetic causes like Down syndrome, or complications of pregnancy and birth (like prematurity or infection). Often, however, the specific cause is unknown. Some cause can be easily reversed if caught early enough, such as hearing loss from chronic ear infection, or lead poisoning.17
There are number of scales available for development assessment which normed in western countries like Balyley Scale of Infant Development (BSID) that measures development during first 30 months, revised BSID (birth- 42 months), Revised Gesell and Amatruda Development and Neurological examination scale (4 week- 36 months), Battelle Development Inventory: (1 month – 9 month)18 and in India there are Baroda Development screening test (Developed by selecting items from the Bayley scale of Infant Development)19, Trivendrum Development Screen Chart designed by selecting by selecting 17 test items from BSID (Baroda Norms)20 .
As stated earlier, use of reliable and valid instrument which will give the motor development assessment in depth is necessary. Peabody Development Motor Scales, second edition (PDMSP-2) which is normed on western population is valid and reliable assessment scale, which assess child through 0-60 months and provides in depth assessment of (Gross and Fine) motor development compare to other norm reference scale.18 This scale has been applicable in Indian scenario for its applicability, researcher has questioned as out its cultural variance, In Dharwad urban population, In normal children as well as In rural children.21
NEED FOR THE STUDY:
Peabody Developmental motor scale – 2 has been widely studied for its cultural variable and questioned regarding its reporting. The studies have been conducted In India in region like, Manglore, Dharwad (urban and rural) which reported the same21. This scale given in depth assessment regarding motor development. As physical therapist its more important to document regarding delay if it is present and also quantification, As on routine basis we get cases for therapy mentioning only delay but not the quantified in specific area. The study conducted on cerebral palsy children aged 2 to 5 year by using PDMS-2 stated that scale can be used for motor measures regarding its responsiveness. Here we are under taking study to see whether the scale diagnosis motor developmental delay in specific sub category on patients who referred for therapy having gross motor developmental delay. As there is scarcity of literature review regarding same in India, Dharwad. For the applicability as whether the scale will show children delay or not. Hence study is under taken for its applicability to quantify gross motor development delay in children who are referred to paediatric physical therapy.
RESEARCH HYPOTHESIS:
Null Hypothesis (H0):
The Peabody developmental motor scale second edition (PDMS-2) score of gross motor will not be applicable to quantify the gross motor developmental delay.
Alternative Hypothesis (H1):-
The Peabody developmental motor scale second edition (PDMS-2) score of gross motor will be applicable to quantify the gross motor developmental delay.
REVIEW OF LITERATURE:
After birth change occurs at a relatively rapid rate particularly during 24 months of life is the acquisition of and changes in gross and fine motor skills. Motor development is at first reflex in nature. Studying the typical sequence of motor developmental reveals a developmental direction.2
A study recommends valid and reliable instrument of child`s level of motor function which will facilitate early detection process in detecting motor deficit. An evaluation check list is generated for assessing the quality and appropriateness of a motor behavior scale for specific decision application.22
A Study Prevalence of Developmental Delay and participation in Early Intervention Services for young children as result indicate that ~13% of children in the sample had developmental delay that the prevalence of developmental delay that make children eligible for part C services in much higher than previously thought. Moreover, the majority of children who are eligible for Part C services are not receiving services for their developmental problems. Strategies need to be developed to monitor patterns of enrollment in early intervention services and reach out to more minority children, particularly black children.23
Developmental delay occurs when a child exhibits a significant delay in acquisition of milestones or skills, in one or more domains of development ( i.e., gross motor, fine motor, speech/language, cognitive, personal/social, or activities of daily living ). A significant delay has been traditionally defined as discrepancy of 25 percent or more from the expected rate, or a discrepancy of 1.5 to 2 standard deviation from the norm. As estimated by the World Health Organization (WHO), about 5% of the world`s children 14 year of age and under have some type of moderate to severe disability24. In the United States, developmental and/ or behavioral disorder occur in 16-18% of children under 18 years of age25,26. Other reported childhood disability prevalence includes Jamaica-15%, Pakistan -15%, and Bangladesh -8% 27. In India, sources have found prevalence of 1.5-2.5% of developmental delay in children under 2 years of age.28,29 These impairment impact not only the child and the family, but also society, in term of the cost of providing health care, education support, and treatment services. Evidence support that early treatment of developmental disorders leads to improved outcomes for children and reduced costs to society.30,31 However, studies in the US have shown only about 1/3 of children are identified prior to school entrance, and as a result, miss out on the proven long term benefits of early intervention.32-33
In Neuromotor and Developmental assessment in Physical Therapy Assessment In Infancy, gives brief description about the norm referenced development assessment.
The PDMS provides the most in- depth assessment of motor development and is recommended over the Bayley motor scale and the Gessell and Amartuda developmental and neurologic examination as it has greater number of items, 3 point scoring scale, to obtain separate scores for the gross motor and fine skill categories within each scale are desirable feature.18
As stated in examiners manual of Peabody Developmental Motor Scale second edition-PDMS-2 is an early childhood motor development program that provides both in depth assessment of gross and fine motor scale from birth to 5 years of age. Reliability and validity have been determined empirically. The assessment is composed of 6 subsets that measures inter related motor abilities that develop early in life. The PDMS-2 can be used by occupational therapist, physical therapist, diagnosticians, early intervention specialists, adaptive physical education teachers, psychologist, and other who are interested in examining the motor abilities in young children.3,35,36
The study done to compare normal motor development scores of children in Mangalore, India, on the Peabody Developmental motor scales-2 (PDMS-2) with the normative scores provided with the instrument. It was observed that there were significant differences in the scores of the children from this sample, compared with the normative data given in the manual of PDMS-2. It indicates that cultural differences do significantly affect the scores of the children on the scale. The study concluded that it is necessary to evaluate the cultural sensitivity of such tests for use in a particular region and ethnic group, especially when these assessment tools are being used to diagnose and plan treatment for a child.37
Assessment of Dharwad rural normal children on Peabody developmental motor scales, second edition (PDMS-2) concluded that most of the children were categorized in average and below average group as compared to PDMS-2 norms. Item wise analysis with heterogeneous sample need to be undertaken with PDMS-2 and interpreting their score in dharwad( rural) children, examiner should be caution and also use of PDMS-2 on motor developmental delay on Indian population need to be explored.38
The study done on Reliability, Sensitivity to change, and Responsiveness of Peabody Developmental motor scales- second edition for children with Cerebral Palsy states that the psychometric properties of Peabody Developmental motor scale second edition (PDMS-2), a revised motor test to assess both gross motor and fine motor composites in children with cerebral palsy (CP), are largely unknown. The purpose of this study was to examine the test-retest reliability and the responsiveness of the PDMS-2 for children with CP. The composite scores on the PDMS-2 have good sensitivity-to-change coefficient ranged from 1.6 to 2.1, and the responsiveness coefficient ranged from 1.7 to 2.3. The results provide strong evidence that the 3 composites of PDMS-2 had high test-retest reliability and acceptable responsiveness. The PDMS-2 can be used as an evaluative motor measure for children with CP.39
A study done using Rasch model to validate the Peabody Developmental Motor Scales-second edition in infants and pre-school children states that the measurement properties, including dimensionality, scoring scales, and item hierarchies of PDMS-2 have been validated with the Rasch model to facilitate its clinical usage for infant and preschool children.40
Study on assessment of motor development function in preschool children, Neurodevelopmental assessment of pre age school age children (18 month to 4 year ) include examining motor development and function. Selection of an appropriate measure will depend on the purpose of testing and characteristics of child. This study discusses as out measure of motor developmental that are commonly used.21
Increased intensity of physical therapy for a child with gross motor developmental delay, the intensity of physical therapy provided for children in early intervention (EI) program may be influenced by a number of factors. In an individualized program, however, some children and families may benefit from an increased frequency of services. The purpose of this case report was to systematically document and describe an increase in physical therapy frequency over a 4-week time frame for a child receiving EI physical therapy services. Improvement was noted on the Gross Motor function Measure and goal attainment scaling. Her age-equivalent score on the Peabody gross motor scales did not change.41
OBJECTIVES OF THE STUDY:
1. To study the applicability in quantifying the gross motor developmental delay in motor developmental delayed (Gross motor) children.
B) / PROCEDURE, MATERIALS AND METHODS:
SOURCE OF DATA COLLECTION:
Sri Dharmasthala Manjunatheshwara College of Medical Science and Hospital, Physiotherapy Out Patient Department, Dharwad.
METHOD OF COLLECTION OF DATA:
MATERIAL:
Peabody developmental motor scales, second edition (PDMS-2) will be used with all items contained in it as per instruction in manual3.
Material included in the PDMS-2 kit is as follow:
-One black shoelace.
-Six square beads.
-Twelve cubes.
-One bottle with screw-on-top.
-One pegboard.
-One large button strip.
-Three pegs.
-One form board.
-Three forms.
-One lacing card.
-One measuring tape.
-One rolls 2-inch wide masking tape.
-Blackline masters.
-Three shape cards.
Items which were not provided in the kit were prepared as per the instruction in the manual and were used. Items are as follow.
-Rattle.
-Soft plush toy.
-Small tray on string.
-Empty soft drink can.
-8-inch ball.
-Tennis ball.
-Spoon.
-Wash cloth.
-10-15 sheets of paper (81/2×11 inch).
-Pencils, crayons and markers.
-Blunt scissors.
-Large pull toy(e.g. wagon)
-book with thick cover pages.
-Food pellets.
-4 to 5 feet of heavy string or rope.
-Stairs with 7-inch rise.
-Stop watch.
-Mat.
-Study object (16 to 21 inches high).
INCLUSION CRITERIA:
1. Children of either sex from 1 year to 5 years.
2. Diagnosed cases of developmental delay by pediatrician.