Movakic, motor abilities in children with severe multiple disabilities; - small steps, big changes -

This thesis describes all relevant steps in the development of Movakic, an instrument for physiotherapists to evaluate and follow-up over time motor abilities, specifically in children with severe multiple disabilities (SMD). The main reason for developing a new instrument named Movakic (__mo__tor e__va__luation of __ki__ds with multiple and __c__omplex disabilities) is the need for a practical instrument. Furthermore, based on our systematic review none of the existing instruments, evaluating motor disabilities in children with disabilities, are suitable for children with SMD. In the development procedure the starting point was the experience and knowledge of an expert group, consisting of physiotherapists with longstanding specialist expertise treating this group of children. This expert group addressed/formulated the suitability criteria and designed the construct of the new instrument, resulting in a high feasibility and content validity. After the construction of Movakic a longitudinal study in 60 children with SMD was performed. We can conclude that the test-retest and inter-rater reliability were very high (range ICC=.72-.98).
Furthermore, the construct validity (r= .50-.71) and responsiveness for changes after meaningful events were satisfying. The study where the relationship between motor abilities and quality of life was explored showed that higher scores in motor abilities were moderately associated with increased quality of life scores.
Our main finding is that Movakic is a suitable instrument for the evaluation of motor abilities in children with SMD. It is recommended for implementation in care-organizations where persons with SMD live or receive day-care. Movakic is provided on-line through a secure internet site and after completion of the questionnaire physiotherapists receive a report with the scores for each child. The report is suitable for adding to the electronic client dossier. Based on our experience during the development process we can conclude that training of physiotherapists is required before Movakic reliably can be used in clinical practice.