1
Children with Disabilities Rating Scale (CDRS)
Orphanage: ______Ward: ______HTS: Yes _____ No ____
Date of Observation: ______Pre ____ Post____ FUp ______Assessor: ______If Reliability Other Assessor: ____________
Contexts
Behavior / Feeding / Bathing/Dressing/Toileting / Free Play / Average
Score
Positioning
1. / Children appear uncomfortable, Children appear comfortable,
stressed, stiff, or awkwardly relaxed, properly
placed placed
0 1 2 3 / 0 1 2 3 / 0 1 2 3 / 0 1 2 3
2. / Children sedentary or in one Children in varied positions during position most of observation most of observation and/or and/or during activities during activities
0 1 2 3 / 0 1 2 3
3. / Children isolated from activities Children placed to see, listen,
(facing away) and participate in activities
0 1 2 3 / 0 1 2 3
Handling
4. / Children dangling, flailing, or Children lifted, carried,
stiffening arms, head, moved w/ appropriate
or legs support
0 1 2 3 / 0 1 2 3 / 0 1 2 3 / 0 1 2 3
Care Routines
5. / Daily activities are Daily activities are performed
hurried or pushy sensitively , accommodating
without regard to children’s limitations
children’s limitations
0 1 2 3 / 0 1 2 3 / 0 1 2 3
Equipment
6. / No adaptive equipment used Appropriate adaptive equipment
(or is used inappropriately) used for positioning, feeding,
for positioning, feeding, or moving children
or moving children
0 1 2 3 / 0 1 2 3 / 0 1 2 3 / 0 1 2 3
CDRS Definitions
Definition: Children with Multiple disabilities - These children have a combination of disabilities that vary in intensity and severity but together make independence in everyday tasks difficult. They may include a variety of problems in vision, hearing, speech, motor, sensory, behavior, and social/emotional domains.
Children with Disabilities / 0 = No / 1 / 2 / 3 = YesChild’s Positioning
1. Children w/ multiple/severe disabilities are positioned comfortably, not stressed, stiff, or in awkward orientations. / Uncomfortably positioned: Children appear abnormally aligned (head floppy, body contorted, limbs drawn up toward body, etc.). Head and trunk are not aligned in midline, arms and hands are restricted, no support to pelvis and legs. Limbs contorted and at awkward angles. / Comfortably positioned: Children should appear as normally aligned and flexed as appropriate to the position he/she is in (sitting, lying down, etc.). Normal alignment: Head and trunk in midline (supported if necessary), arms and hands free to move, support to the pelvis and legs if needed.
2. Positions of children w/ multiple/severe disabilities are varied throughout the day and from one activity/context to the next. / Lack of repositioning: Most of children are left in the same positions throughout the day. There is no attempt to reposition them. Limbs are drawn in towards the body, increased spasticity, lack of head and trunk control, lack of body symmetry, head flattening, and possibly bedsores. / Varied positions: Children with multiple/severe disabilities are re-positioned throughout the day to promote control of head and torso, encourage independent body extension, facilitate symmetry and postural control, decrease muscle spasms, and create sensori-motor experiences for the child.
3. Children are placed in the room where they can see, listen, and participate in activities. / Apparent isolation: Children with severe/multiple disabilities are isolated from other children or cut-off from activities (sitting away from group or facing a wall). They are left indoors when other children are taken outside to play. They may be physically near the group but cannot see or hear what’s going on. / Appropriate placement: Children are placed in room where activities are conducted. Children with severe/multiple disabilities are facing other children, are proximal to the activity thereby able to see and hear what is going on. Integrated or included by sitting if others are sitting, outdoors if others are outdoors, etc.
Handling
4. Children w/ multiple/severe disabilities are lifted, carried, moved w/ appropriate support; no dangling, flailing, or stiffening of arms, head, legs. / Poor handling: Children are carried without support to the limbs, head, and trunk and appear uncomfortable. Children may stiffen or slump, head or limbs are hanging down unsupported. Children may demonstrate increased spasticity. / Correct handling: This is the act of lifting, carrying, and moving children with severe muscle and motor disabilities. Proper handling provides support to the limbs, head, and trunk so that children appear comfortable (see above) and are not stiffening or slumped abnormally nor do they have dangling limbs or present uncontrolled movements. Abrupt, sudden, movement by the caregiver may cause abnormal movement in children.
CDRS Definitions (cont’d.)
0 = No / 1 / 2 / 3 = YesCare Routines: Mealtime (feeding), dressing, toileting/diapering, bathing
5. Activities of daily living are done sensitively, accommodating to children’s limitations; not hurried or pushy. / Insensitive or improper care routines: Care routines done without proper handling or regard for children’s limitations. Caregiver movements are indifferent, rushed, or forceful and do not normalize the child’s muscle tone. / Sensitive and proper care routines: Care routines are done with proper handling and positioning techniques and with sensitive caregiver facilitations that normalize the child’s muscle tone as much as possible.
Equipment
6. Appropriate equipment is used for positioning, feeding, moving about, daily living. / Lack of or inappropriate equipment: Lack of adaptive equipment (or is used inappropriately) or lack of any apparent modifications that would assist children with independence. Absence of modified toys, wheelchairs, prone boards, speech boards, dowels, or Velcro© for dressing. No pads in chairs to support head or body. / Use of Adaptive equipment: Caregiver appropriately uses modifications (such as grips and dowels) to toys, routine utensils like toothbrushes, spoons, etc. Or modified products that assist children with independence in developmental areas such as speech, motor, self-help, etc.(i.e., wheelchair for mobility, prone board for arm movement, corner chair for sitting, standing board for standing, speech boards for communication, dowels, and Velcro© for dressing, etc.).
3/4/10