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Indian Journal of Physiotherapy and Occupational Therapy

Applicability of Peabody developmental Motor Scales (PDMS) -2 As a Developmental Assessment Scale for Indian Children

Author(s): Parmar Sanjay, Kiran S

Vol. 2, No. 1 (2008-01 - 2008-03)

Parmar Sanjay٭, Kiran S٭٭
٭ Lecturer, ٭٭ Reader and Vice Principal, SDM College of Physiotherapy, Dharwad, Karnataka,

Background and objectives: There is a growing need to have the developmental assessment scales for Indian children. Many literature reviews show that have difference in cultural, ethnic factors, socioeconomic status will change the developmental score. As majority of scales are developed in foreign countries their applicability to Indian children is not known. Peabody Developmental Motor Scales-2 gives in depth assessment of gross and fine motor development. Hence PDMS-2 is taken for its applicability. Methodology: Total 400 children boys and girls of age 0-5 years were taken for assessment after parent consent and pediatricians declaration that the child was normal. All children were assessed on PDMS-2 and all the items used as per the instructions in the manual. Statistical analysis done by using SPSS-11.0 and t-test used for the comparison between boys and girls in Dharwad population, PDMS-2 standard scores and quotients were compared with Dharwad population. Result: PDMS-2 is valid for 0-5 yrs of children. The girls of Dharwad population scored more than boys. Dharwad (urban) children scored lower than PDMS-2 scores. In locomotion and object manipulation (p<0.01). There is significant change in Gross Motor Quotient (GMQ) and Total Motor Quotient (TMQ) as compared to PDMS-2 scores Interpretation and Conclusion: Study to be carried out on larger population with various ethnic groups and environmental, cultural factors need to be considered. Modification in original scale may be needed.

Keywords: PDMS-2, 0-5 year normal children, Dharwad (Urban)

INTRODUCTION

The study of development is the study of how and why human organism grows and changes throughout life. Development is defined as orderly and relatively enduring changes overtime in physical and neurological structure, thought and process and behaviour1. There are various areas of development of that motor development is the process of change in motor behaviour that is related to the age of the individual. The focus on the relationship between age and motor behaviour makes the study of motor development unique. Motor development includes age related changes in both posture and movement. This may be studied as a process and a product. Since physical therapists are important members of the professional team working with developmentally delayed children. They must have the skill and knowledge to contribute to the assessment process. It is important for the therapists to base their treatment recommendation on appropriate tools of assessment2. Developmental assessment refers to a more detailed investigation of developmentally delayed children diagnostic in scope. In order to facilitate the early identification process, valid and reliable instrument should be used to assess the childs level of motor functioning. However there are several factors affecting rate of development in individual child which are internal and external.

Cintas HL et al (1995) observed that there is a difference in motor development among various ethnic group. The cultural relevance of standardized developmental test must be examined such project is specially important because these tests are useful to determine whether a child is developing typically or in some way delayed requiring special services. Catherine MC Claine et al – cultural relevance of the BSID-2 is questioned in typically developing two year old native American children who score lower than the normative3.

Terry K Crowe has cautioned about the interpretation of the results when comparing motor performance of 2 year old native American children against PDMS normative data4.

There are number of scales available for developmental assessment which normed in western countries5.

Name of the Scale Validity & reliability Test content Disadvantages Studies in India
(1) Bayley Scales of Infant Development (0-42 months) Mental, Motor and Behaviour Small no. of items
(2) Revised Gesell and Amatruda Developmental and Neurological Examination Scale (4 weeks – 36 months). Motor, Language Adaptive Standard scores are not available
(3) Alberta – Infanta Motor Scale (0 -18 months) </td > Postural Only gross motor
(4) Early Intervention Developmental Profile (0-36 months) Motor, Cognition, Language, Emotional, Self care Sample size very small, no standardization
(5) Bruininks – Oseretsky Test of Motor Proficiency (4½ – 14½ year Gross motor, Fine motor Space requirement is more, not for early age group
(6) Pediatric Evaluation of Disability Inventory (6 months – 7.5 years) • </td >Self care, Mobility, Social function Does not give age related gross fine motor activities
(7) Denever – Development Screening Test/Denever II (0-6 years). Motor, Language, Personal-Social Only screening tool

Indian population were taken in for normative data in Baroda developmental screening test which is derived from infant development scale and Trivendrum screening chart which is derived from Baroda developmental screening test. These are the only tests which have normative data from Indian population.

Name of Scale Description
Baroda Developmental Screening
test (0-2 yrs) 14
It is only screening test. Number of items are very less
does not give motor quotientDesigned from Bayley’s scale
Trivendrum Screening chart15 It is also only screening test
Developed from Baroda Developmental screening test
Does not give in depth assessment of Motor Development.

Peabody Developmental Motor Scales-2 (0-60 months)6

٭ It contains 6 sub test:

  1. Reflex (8).
  2. Stationary (30).
  3. Locomotion (89).
  4. Object manipulation (24)
  5. Grasping (26)
  6. Visual motor (72)

PDMS-2

Quotient

  • Gross Motor Quotient (Reflex, Stationary, Locomotion, Object manipulation)
  • Fine Motor Quotient (Grasping, Visual motor)
  • otal Motor Quotient

It gives in depth assessment of gross and fine motor development so it was selected for the study.

Peabody Developmental Motor Scale second edition (PDMS-2) which is normed on Western population is valid and reliable assessment scale, which assesses childs through 0-60 months and provides in depth assessment of (Gross and Fine) motor development as compared to other norm referenced scales. In India there is no evidence of PDMS-2 norms for any part of Indian population. Due to environmental, cultural and ethnic group variations, examination of PDMS-2 on Indian children is necessary. Hence the purpose of this study is to use the Peabody Developmental Motor Scales, Second Edition (PDMS-2) for assessment of Motor Development of normal children in Dharwad (Urban).

Objectives:

1. Assessment of motor development score of normal children in Dharwad (Urban) on Peabody Developmental Motor Scales, Second edition (PDMS-2).

2. Comparison of the PDMS-2 score of Dharwad children to that of PDMS-2 score given in the manual.

MATERIAL AND METHODOLOGY:

Source of Data

Children (0-60 months) residing in Dharwad (Urban) were selected for study.

Material

Peabody Developmental Motor Scales, Second Edition (PDMS II) used with all items contained in it.

Image Image Image

List of manuals:

1) Peabody Developmental Motor Scales, 2nd Edition, Examiner’s Manual – M. Rhonda Folio, Rebecca R. Fewell.7
2) Peabody Developmental Motor Scales, 2nd Edition, Guide to Item Administration – M. Rhonda Folio, Rebecca R. Fewell.8

Inclusion criteria:

  • Children of 0-60 months age group of either sex.
  • Child normal and typically developing declared by pediatrician. Exclusion criteria:
  • Incomplete assessment of PDMS-2 after inclusion

Study design: Cross sectional study.

RESULTS

The data was tabulated and analyzed using Statistical Package SPSS-11.0.

The tests used were: 1) Students t-test.

Procedure:

The study was conducted after taking the clearance from the Ethical Committee of S.D.M. College of Medical Science and Hospital. Dharwad (Urban) is divided into 23 wards. 10 wards were selected randomly out of 23 wards. The census was provided by the District Health and Family Welfare Office, Dharwad. 400 children were taken for the study considering 35-45 children from each ward. The parent consent was taken. The child was evaluated by the pediatrician after the declaration by the pediatrician that the child is normal and typically developing, the child was taken for the assessment on the Peabody Developmental Motor Scale-2.

For administration of PDMS-2 Guide to Item Administration was used.

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Table-1: Distribution of sample by age and sex

Age Groups (in months) Boys % Girls % Totals %
0—12 2 0.50 0 0.00 2 0.50
13—24 3 0.75 3 0.75 6 1.50
25—36 59 14.75 56 14.00 115 28.75
37-48 69 17.25 38 9.50 107 26.75
49-60 120 30.00 50 12.50 170 42.50
Totals 253 63.25 147 36.75 400 100.00

Table-2: Distribution of sample by caste and sex

Caste Boys % Girls % Totals %
Hindu 231 57.75 134 33.50 365 91.25
Jains 16 4.00 13 3.25 29 7.25
Muslims 6 1.50 0 0.00 6 1.50
Totals 253 63.25 147 36.75 400 100.00

Above table explains the distribution of sample by cast and sex. Maximum population evaluated are Hindu (365-91.25%) followed by Jain (29-7.25%) and Muslims (6-1.5%).

Table-3: Boys and girls Mean age and Standard

Sex Mean Std. Dev.
Boys 45.7036 10.6228
Girls 42.1224 10.6975

The above table explains the mean age of boys (4.70±10.02), (42.12 ±1.69).

Table-4: Showing the education and income per

Education of parent Frequency
>Bachelor Bachelor 350
> PUC 24
<Bachelor 26
Income per month (Rupees)
15000 to 18000 296
12000 to 15000 24
10000 to 12000 80

The above table states that maximum population was educated and having upper middle class socioeconomic status.

Table-5: Standard scores of PDMS-2 and frequency and percentage of Dharwad (Urban) children.

Standard scores of PDMS-2 Reflex % Stationary % Locomotion % Object manipulation % Grasping % Visual motor%
17-20 (Very superior) 0 0.0 0.00 0.00 0.00 4.50
15-16 (Superior) 0 0.0 0.00 1.26 1.25 4.00
13-14 (Above average 0 6.5 1.00 7.04 7.00 1.50
8-12 (Average) 2 81.0 62.75 55.28 77.25 80.25
6-7 (Below average) 0 12.5 34.00 33.67 7.00 5.50
4-5 (Poor) 0 0.0 2.25 2.76 6.00 4.25
1-3 (Very poor) 0 0.0 0.00 0.00 1.51 0.00
Total 2 100.00 100.00 100.00 100.00 100.00

Above table explains the frequency and percentage of Dharwad (Urban) children. This shows that maximum population falls in the category of average and below average.

Table-6: Frequency and percentage of subtest (GMQ, FMQ and TMQ) of Dharwad (urban) children

Table-6

The above table explains the GMQ, FMQ and TMQ with quotient scores of PDMS-2. This shows that maximum population falls in the category of average and below average.

Table-7: Comparison of Standard scores of Dharwad (Urban) boys and girls

Variable Sex Mean Std.Dev. p Signi.
Reflex Boys 0.0791 0.8873 0.2810 NS
Girls 0.0000 0.0000
Stationary Boys 9.5771 1.7748 0.0000 S
Girls 10.5986 1.5731
Locomotion Boys 8.0000 1.5405 0.0049 S
Girls 8.4966 1.9245
Object manipulation Boys 8.7470 2.6154 0.3247 NS
Girls 9.0000 2.2083
Grasping Boys 9.8972 2.5113 0.2885 NS
Girls 10.1701 2.4111
Visual motor Boys 9.9249 2.5507 0.0074 S
Girls 10.6395 2.5748

The above table explains the standard scores of subtests in boys and girls. The results show that girls have scored significantly higher than boys in Stationary, Locomotion and Visual Motor.

Table-8: Results of t-test between Boys and Girls with respect to GMQ, FMQ, TMQ scores of

Variable Sex Mean Std. Dev. p Signi.
GMQ Boys 91.2925 11.8741 0.0000 S
Girls 96.7143 9.3457
FMQ Boys 99.4901 13.4107 0.5301 NS
Girls 100.4150 15.4440
TMQ Boys 94.3241 10.7462 0.0104 S
Girls 97.1293 10.0739

Above table explains that there is a statistical significant difference in score between Boys and Girls which shows that in GMQ (p=0.00) and in TMQ (0.0104) Girls are having higher score compared to Boys.

Table-9: Comparison of Standard scores between Dharwad and PDMS-2 scores

Variable Study Mean Std.Dev. p Signi.
Reflex Dharwad 10.0000 0.0000 -
PDMS-2 10.0000 3.0000
Stationary Dharwad 9.9525 1.7715 >0.05 NS
PDMS-2 10.0000 3.0000
Locomotion Dharwad 8.1825 1.7063 <0.01 S
PDMS-2 10.0000 3.0000
Object Manipulation Dharwad 8.8400 2.4738 <0.01 S
PDMS-2 10.0000 3.0000
Grasping Dharwad 9.9975 2.4754 >0.05 NS
PDMS-2 10.0000 3.0000
Visual motor Dharwad 10.1875 2.5795 >0.05 NS
PDMS-2 10.0000 3.0000

graph 1

The above table and graph depicts that there is a significant difference in subtest score of standard scores when compared with PDMS-2 standard score. The statistical difference is there in locomotion (p<0.01) and object manipulation (p<0.01) where Dharwad children have scored less than the PDMS- 2 scores.

Table-10: Comparison of quotients between Dharwad and PDMS-2 scores

Variable Study Mean Std.Dev. p Signi.
GMQ Dharwad 93.2850 11.3074 <0.01 S
PDMS-2 100.0000 15.0000
FMQ Dharwad 99.8300 14.1797 >0.05 NS
PDMS-2 100.0000 15.0000
TMQ Dharwad 95.3550 10.5785 <0.01 S
PDMS-2 100.0000 15.0000

graph 2

The above table explains that there is a significant change in GMQ (<0.01) and TMQ (<0.01) as compared to PDMS-2 scores, Dharwad children scored lower than the normative sample.

DISCUSSION

The purpose of the study was to assess the motor development scores of normal children in Dharwad (urban) on Peabody Developmental Motor Scale second edition (PDMS-2) and also compare the PDMS-2 score of Dharwad children to that of PDMS-2 score given in the manual. The sample of 400 children, Hindu community population was major followed by Jains and Muslims. The sub caste was not taken into consideration. Table-4 shows that parents of childrens in the study had education more than PUC income ranging from 12-18 thousand per month as per their information. Hence they can be considered as educated upper middle socioeconomic status. The sample was more of homogeneous with reference to socioeconomic status.

When the standard scores obtained in each sub tests were compared genderwise, the results showed, higher scores were obtained by girls than boys. Many studies have shown similar results. A study by Nancy E. Wallace, showed that girls seem to be on a faster timetable than boys all the way through their growth. Girls tends to grow more regularly and predictably than boys. In the toddler years girls are better at jumping, hopping, rhythmic movement and balance. Young boys achieve jumping, hopping, rhythmic movement and balancing skills less quickly than girls. They tend to reach certain milestones later, such as picking up a toy from the floor without sitting down first.9

Phatak (1971) in their study reported that girls from upper socioeconomic class of Baroda had consistently higher mean score than boys for all the months from the 1-30 months10. In Dharwad taluk, Dharwad district Karnataka, India, Khadi PB, Khateeb J. Patil researchers followed the development and growth of 274 infants from birth to five years. In terms of motor and mental indices at 27 months, no girl was well nourished. Between birth to 8 months, the motor development indices of the well nourished girls was slightly higher than that of boys. Well nourished girls had higher motor indices with significant difference at 24 months (p=0.01). motor capacity of malnourished infant girl was much better than their male counterparts11.

Our study also showed similar results (Table 7 and 8).

The result of our study showed that there is significant difference between Dharwad (urban) children scores and PDMS-2 score (standard scores and quotients) which is due to homogenicity in sample of our study as compared to the normative study. Items given in PDMS-2 are lacking in cultural variance environmental factors and biological factors of development would have contributed for these results. While subjecting the children to the scale, we found that certain items in gross motor like sit ups, push ups, rolling forward, hitting target. In fine motor cutting activities were relatively scored low whereas buttoning and unbuttoning were scored earlier by Dharwad children.

In our study Dharwad children had scored less on GMQ and TMQ as compared to PDMS2 scores. (Table-10).

Limitations:

  • 0-12, 13-24 months age group sample was less.
  • In our study selection of the samples was done on the basis of pediatricians assessment. No standard screening test has been taken into consideration.
  • Environmental, cultural factors of child rearing in each group were not considered.
  • Each item attained by the Dharwad children as per the age was not analyzed.
  • Group in the study was homogenous. Scope of the study:
  • 0-12, 13-24 month age group can be taken separately for evaluation.
  • Environmental, biological, cultural variance each ethnic group-wise can be taken into consideration.
  • Study can be carried out on rural population upper and lower socioeconomic group considering heterogenous group for study.

CONCLUSION

The evaluation of 400 normal children of 0-5 years age group on PDMS-2 shows:

1. Most of children were categorized in average and below average group as compared to PDMS-2 norms.
2. Girls of Dharwad (urban) population scored more than boys

Item wise analysis with heterogenous sample needs to be undertaken with PDMS-2 scale for its validity in India. Hence when using PDMS-2 and interpreting their scores in Dharwad (urban) children examiner should be cautious and certain items can be modified for their use. Studies need to be carried out in various parts of India to draw definite conclusions on the use of PDMS-2.

REFERENCES

  1. Paul Henry Musen, John Janeway Conger: Child development and personality. 7th edition, C. Harper and Row, Publishers New York.
  2. Jan Stephen Tecklin, Lippincott Williams and Wilkins: Pediatric Physical Therapy. 3rd Edition.
  3. Crave T.K., Mc Clain et al: Motor Development of Native American Children on the Peabody Developmental Motor Scales. Am J Occup Ther 1999; 53(15): 514-518.
  4. Physical Therapy Assessment in early infancy Edited by – Irma J. Wilhem, Churchill Livingstone
  5. M. Rhonda Folio and Rebecca R. Fewell: Peabody Developmental Motor Scales (PDMS-2) www.PRO-EDonline store.
  6. M. Rhonda Folio, Rebecca R. Fewll: Peabody Developmental Motor Scales, 2nd Edn, Guide to Item Administration.
  7. M. Rhonda Folio, Rebecca R. Fewell: Peabody Developmental Motor Scales, 2nd Edition. Examiner’s Manual.
  8. Nancy E. Wallace: Toddler topics, http: // westmorekind. extension. psu.edu / family.
  9. Catherine Mc Clain et al: Motor Development of Two-Year Old Typically Developing Native American Children on the Bayley Scales of Infant Development II Motor scale. Pediatr Phy Ther 2000; 12: 108-113.
  10. Pramila Phatak, Neena Mukul: Mental and Motor Growth of Indian children (1 month to 30 month). Final Report.
  11. Khadi P.B., Khateeb J: Development of rural girl children - Abias. Indian J. Motors Child Health 1996, 7(1): 24-7.
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