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the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2)

Understanding Physical Therapy Outcome Measurements: The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)

Previous physical therapy blogs have explained outcome measurements used to assess gross motor development in infants and children up to age 5, including the Peabody Developmental Motor Scale, second edition and the Alberta Infant Motor Scale. When children age out of either the PDMS-2 or the AIMS, one standardized assessment option physical therapists have is the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2). The BOT-2 can be used to evaluate a wide variety of fine and gross motor skills for children, teenagers and young adults 4-21 years of age. This is a test that can also be used by occupational therapists, psychologists, adaptive physical education teachers, special education teachers and educational diagnosticians.

The BOT-2 contains a total of 8 subtests that look at both fine and gross motor functioning. When certain subtests are combined, they can give more specific information regarding the child’s Fine Manual Control, Manual Coordination, Body Coordination, or Strength and Agility. Administering all 8 subtests can allow the physical therapist to obtain a Total Motor Composite looking at the child’s overall performance with fine and gross motor functioning.

Below is a description of the subtests most commonly used by physical therapists in BOT-2 testing:

  • Bilateral Coordination: This section of the BOT-2 looks at a child’s control with tasks requiring movement ofthe Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2) both sides of the body. Tasks in this section will require the child to move his arms and legs from the same and opposite sides of the body together, in sequence, or in opposition.
  • Balance: The balance subtest evaluates the child’s moving and stationary balance. Tasks are completed with a variety of challenges to the balance systems, such as while on one foot, on a balance beam, or with eyes closed.
  • Running Speed and Agility: This section of the test looks at a child’s maximum running speed, running and changing directions, as well as stationary and dynamic hopping and jumping skills.
  • Upper-Limb Coordination: This subtest is used to assess the child’s ability to coordinate arm and hand movements and visual tracking of the task. The child is required to demonstrate skills such as catching, throwing and dribbling a tennis ball with one or both hands.
  • Strength: In the strength section of testing, the child is required to perform tasks designed to evaluate strength in the core, arms and legs. Strength is assessed in both static positions as well as with dynamic movements.

Based on the child’s presenting concerns, a physical therapist may evaluate the child using just a few or all of these subtests. The child’s performance on the BOT-2 will allow the physical therapist to identify areas of strength and areas of need in regards to the child’s gross motor functioning, and can therefore help to guide treatment. Because the BOT-2 has both age and sex-specific normative data, this test will help the physical therapist determine how the child is performing compared to peers his age. The BOT-2 can be re-administered periodically in order to monitor progress in the child’s functioning and performance with gross motor skills.

If you have concerns with your child’s performance in any of the categories listed above, click here to get scheduled with one of our pediatric physical therapists!

References:
Bruininks, Robert H., and Brett D. Bruininks. Bruininks-Oseretsky Test Motor Proficiency. 2nd ed. Minneapolis: Pearson, 2005. Print.

Colleen Kearns

Colleen Kearns graduated from Marquette University with a Doctorate in Physical Therapy. She spent many years working in pediatric physical therapy at Penfield Children’s Center in Milwaukee, serving both as a volunteer and as a student PT, serving children from low-socioeconomic areas in Milwaukee with a wide variety of physical therapy needs. During her physical therapy education at Marquette, Colleen took part in the Advanced Pediatrics elective, which provided her with opportunities to observe and work with pediatric patients at a number of local inpatient and outpatient pediatric physical therapy clinics. She was also able to complete a research project on the effects of music in pediatric physical therapy, and was given the opportunity to present her findings to a group of physical therapists that work in the Milwaukee public schools.

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FitnessGram

What is the FitnessGram and Why Are These Standards Used in Schools?

 

 

 

For more than 30 years, children from 5 to 18 years old have been tested using the FitnessGram Healthy Fitness Zone standards. Parents often wonder: What are these standards and how do the calculations reflect children’s health and fitness?

The most I remember from taking part in the FitnessGram back in the day was trying to reach for my toes and then getting pinched in the back of my arm. But the FitnessGram is more than just a measure of body fat and flexibility. The test items are used to determine body composition and aerobic capacity in children. They present a multi-dimensional view of children’s health. The test items reinforce health-related fitness research. The results serve to teach students and parents that just modest amounts of physical activity can improve their performance. The program helps children and parents better understand and appreciate a physically active lifestyle. The assessment does not compare one child to another and it tests fitness, not skill.

So what are the test items in the FitnessGram and what area of fitness do they measure?

To measure Aerobic Capacity (The ability to perform big muscle group high intensity exercises for a long period of time, such as running, jumping, and walking):

  • PACER test, Progressive Aerobic Cardiovascular Endurance Run, is a multi-stage endurance test, with twenty-one levels that increase in difficulty as children run 20 meter laps that gets faster and faster with each lap.
  • 1-Mile Run tests a child’s endurance and is a great indicator of fitness
  • Walk-test also helps to measure aerobic capacity, or the body’s ability to use oxygen efficiently.

To measure Muscle Strength (the ability of muscles to exert an external force) and Muscle Endurance (muscles’ ability to repeatedly exert an external force without fatigue):

  • Pull-ups are a measure of upper body strength and endurance
  • Push-ups are a measure of upper body and trunk strength and endurance
  • Curl-ups are a measure of abdominal strength and endurance
  • Trunk lift is a measure of back muscle strength and endurance

To measure Flexibility (the range of motion across a joint and the ability for muscles to stretch):

  • Sit and reach tests for flexibility of the trunk.
  • Shoulder stretch tests for the flexibility of one the shoulder, which is one of the most flexible joints in the body.

To measure for Body Composition (the makeup of the body and the ratio of fat tissue to non-fat tissue such as muscle and bone):

  • Body Mass Index (BMI)
  • Skinfold Measurement
  • Bioelectric Impedance Analyzers

The results of the test classify children’s performance as Healthy Fitness Zone (HFZ) or Needs Improvement (NI) zone. Children who score in the Needs Improvement zone receive reports that let them and their parents know that their currently at risk for future health problems. Some children may even score in the Health Risk category of the Needs Improvement zone. If they continue to live a sedentary lifestyle, there will be clear and potential health problems. Overall, The FitnessGram has been widely accepted in schools as a great educational tool for parents, teachers, and coaches. It builds a strong healthy foundation in children as young as elementary school. The program teaches them, through a hands-on approach, that being physical active in childhood pays off later on in life.

Click here for more great fitness related posts!

References:
Plowman, S.A. Muscular Strength, Endurance, and Flexibility Assessments. In S. A. Plowman & M.D. Meredith (Eds.), Fitnessgram/Activitygram Reference Guide (pp. Internet Resource). (2014) Dallas, TX: The Cooper Institute.
Plowman, S.A. & Meredith, M.D. (Eds.). Fitnessgram/Activitygram Reference Guide. (2014) Dallas, TX: The Cooper Institute.

Judy Wang, PT, DPT

Judy attained both her Bachelor of Arts and Doctor of Physical Therapy degrees from Washington University in St. Louis. Her pediatric clinical experiences include the Neonatal Intensive Care Unit at St. Louis Children’s Hospital, Texas Scottish Rite Hospital for Children, and Athens Regional Hospital outpatient pediatric clinic. Before joining the NSPT team, Judy worked at University of Chicago and Rehabilitation Institute of Chicago in a variety of inpatient and outpatient settings. Judy is especially passionate about working with children. Her interests include but are not limited to: cerebral palsy, NICU follow-up, spinal cord injury, brain injury, developmental delay, pediatric vestibular rehab, wound care, chronic pain, and adolescent orthopedic injuries. During her 8 years at Washington University, Judy took part in research across the age spectrum: from long term effects of neonatal/perinatal hypoxic brain injuries, to cognitive changes of Alzheimer’s disease on the elderly and their children, to progression of wounds/ulcers in diabetes and their effect on walking patterns.

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Gross Motor Skills and Dance

Dance has always been a fun and exciting recreational activity for children of all ages. Along with the enjoyment of dancing to upbeat music and the social experience, dance is also a great way to help develop your child’s gross motor skills. Read on for 4 aspects of your child’s motor skills that can be facilitated with dance lessons and performance of any style.

4 Gross Motor Benefits to Dance:

  1. Balance-Many dance moves incorporate balancing on one leg, standing with feet right next to each other or standing with one foot in front of the other. All of these positions are challenging for your child’s balance systems, which help to strengthen her balancing abilities.
  2. Coordination-While learning to dance, your child will begin by learning different dance moves and positions. Most positions involve different placement of all 4 limbs, which requires a lot of coordination. Also, once your child learns a dance routine with multiple dance positions sequenced together, she will need to coordinate the entire routine. Read more

Colleen Kearns

Colleen Kearns graduated from Marquette University with a Doctorate in Physical Therapy. She spent many years working in pediatric physical therapy at Penfield Children’s Center in Milwaukee, serving both as a volunteer and as a student PT, serving children from low-socioeconomic areas in Milwaukee with a wide variety of physical therapy needs. During her physical therapy education at Marquette, Colleen took part in the Advanced Pediatrics elective, which provided her with opportunities to observe and work with pediatric patients at a number of local inpatient and outpatient pediatric physical therapy clinics. She was also able to complete a research project on the effects of music in pediatric physical therapy, and was given the opportunity to present her findings to a group of physical therapists that work in the Milwaukee public schools.

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Sample Activities to Increase Oral Awareness!

Development of oral facial muscles is important for a child to accurately produce speech sounds. Poor coordination and strength of articulators can adversely affect skill development for speech sound production. When looking at oral development it is important to ensure the child is provided a variety of movement opportunities to build a variety of oral skills. Movements should include movements of the jaw, tongue, and cheeks to build strength and coordination.

Father practicing oral awareness with child

Below are sample activities to do at home to increase oral awareness and movement

  1. Gather two sets of 5 items varying in size, texture, shape, and temperature. For example; ice, a tongue depressor, straw, teething toy, and straw. Encourage your child to use each of the objects in oral-exploratory play. Imitate your child’s movements and comment on what your child is doing and how it makes the mouth feel.
  2. Mirror play! Have your child sit with you in front of a mirror. Explain that you will be playing a “clown” game. Feel free to dress up in silly hats or clothes to play the game! Instruct your child that you will be taking turns making silly faces in the mirror and copying each other. With your models, make sure you do a variety of tongue movements. Stick your tongue out, move it side to side, lift up the tip up to touch your nose. Have your child practice the movement 2-3 times before it is his or her turn to put the clown hat on.
  3. Play musical “chairs”. Choose objects around the house that include a target sound. For example if the target sound is “b” you could find a book, bear, bottle, bread, and bowl. Place pieces of paper on the floor, with the item on the paper, in a circle. Have the child walk from sheet to sheet until the music stops. Once the music stops, have your child say the target word they land on. You can also write the word on the pieces of paper to increase print sound awareness.
  4. Cut an egg carton in half lengthwise, turn it upside down, and color or paint each of the 6 protruding sections a different color. Next, find a puppet or an animal with a large mouth. Find small “food” items to feed the puppet. These could be marbles or pretend food. Tell your child that you are going to sing silly songs to help feed the very hungry animal! Model a sequence of three sounds varying in intonation tapping the egg cartons to pace each sound as they are sung. Different intonation patterns can include rising/falling pitch or increase/decreased loudness on individual sounds. For example, “ ba BA ba”. Think of the NBC studio signature tone. Once the silly song is imitated you can feed the hungry animal! Using rhythm and a singsong voice has been proven to help facilitate speech output.

These activities will encourage oral motor development in a fun and exciting way. Your child will be learning and exploring and improve his oral awareness in the process!




Allison Raino

Allison Raino M.A., CF-SLP is a pediatric speech language pathologist who earned her masters degree from University of Central Florida. Allison has augmented her educational experience with relevant work experience both abroad and domestically. She has experience with auditory oral rehabilitation, elementary school settings, autism, feeding difficulties, and oral motor speech disorders. Allison is certified in Debra Beckman Oral Motor Assessment and Intervention as well as the Oro-Facial Deep Tissue Release. She is committed to enhancing the strengths of children to help them achieve their maximum potential.

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Using the Fall Season to Work on your child’s Developmental Skills!

The weather is changing and children are back to school.  The Fall season provides opportunities for many activities to address your child’s occupational therapy needs.Children playing with autumn leaves

The activities listed below work on a variety of developmental skills and are appropriate for children of all ages:

  1. Rake leaves- provides heavy work and builds strength and endurance
  2. Carve pumpkins- addresses hand strength and fine motor skills
  3. Roll in a pile of leaves- provides heavy work and vestibular input
  4. Fall cooking and baking- decorate cupcakes or bake an apple pie by stirring the batter or placing sprinkles on the frosting. These activities work the small muscles of the hands and enhance fine motor precision.
  5. Leaf rubbing (place a leaf under a piece of paper, rub a crayon over the leaf until the image appears on the paper)- addresses visual skills and fine motor skills

Your children and whole family will be eager to engage in these fun Fall activities!

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Dana Pais

Dana Pais

Dana Pais, OTD, OTR/L is an occupational therapist who obtained her Masters of Occupational Therapy (MS) and Doctorate of Occupational Therapy (OTD) at the University of Illinois at Chicago. During her doctoral studies, she spent time working in Lima, Peru at the Centro Ann Sullivan del Peru (CASP), a center for families and their children with cognitive and physical disabilities, where she provided intervention for many children and their families in the areas of low vision accessibility, independent living, school inclusion and supportive employment. Her interests include sensory processing and its impact on daily life and managing visual deficits. She is passionate about helping children reach their full potential in every aspect of their lives.

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Swimming- A Fun and Beneficial Sport

Swimming is a great sport and pastime, particularly for children with sensory processing difficulties, as the waterBoy in swimming pool provides a multi-sensory experience for the body. Swimming also addresses a variety of skills, ultimately improving your child’s sensory processing, strength, endurance and coordination.

Proprioceptive/tactile processing: The feel of water on the body gives proprioceptive input, the input to the muscle and the joints, and gives a sense of where the body is in relation to other body parts. The constant sense of the water against the skin provides deep proprioceptive input and helps with developing body awareness.

Vestibular processing: Somersaults under water or headstands at the bottom of the pool provide vestibular input, as the body is responding to the changes in head position and assisting with balance to complete these tasks.

Auditory processing: The pool environment typically provides a loud and vibrant auditory experience, as children’s laughter and happy shrieks are heard while they play in the pool.

Strength: Moving the body against water when swimming is a workout for the muscles! The water provides natural resistance for muscles, which in the long run, builds up overall body strength.

Endurance: Not only does the resistance of the water against the body make the body stronger, it also assists with endurance. As the muscles become stronger, they will be able to endure swimming and other activities for longer periods of time.

Coordination: Swimming strokes are very complex. The brain must take in all of the sensory information from the environment and act quickly to move the arms, legs, torso and head in a coordinated fashion to produce the movement.

So many children find swimming exciting and fun, and love spending summer days at the pool. Parents can also appreciate spending time at the pool knowing that this activity is not only fun, but also good for their child!

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Dana Pais

Dana Pais

Dana Pais, OTD, OTR/L is an occupational therapist who obtained her Masters of Occupational Therapy (MS) and Doctorate of Occupational Therapy (OTD) at the University of Illinois at Chicago. During her doctoral studies, she spent time working in Lima, Peru at the Centro Ann Sullivan del Peru (CASP), a center for families and their children with cognitive and physical disabilities, where she provided intervention for many children and their families in the areas of low vision accessibility, independent living, school inclusion and supportive employment. Her interests include sensory processing and its impact on daily life and managing visual deficits. She is passionate about helping children reach their full potential in every aspect of their lives.

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6 Ways Aquatic Therapy Can Help Your Child

Aquatic therapy is a wonderful activity for children and adults of all ages. If your child likes the bath and is motivated by water, aquatic therapy is aqua therapygreat way to build their skills and confidence.

Below are 6 ways that aquatic therapy can help your child reach their full potential:

1. Gains in range of motion:

After an injury, such as a broken leg or an ankle sprain, joint movement is often limited by swelling or decreased strength to muscles. Aquatic therapy pools are generally set to a comfortable 80-90 degrees, which is warmer then a normal pool. Using the warm temperature of the water, joints will be able to be more flexible and stretch to new limits.

2. Increased strength:

Once proper range of motion is achieved at a joint, proper strengthening is needed in order for the muscle to perform well at its new length. Using the principle of resistance, muscles are able to gain strength by performing simple actions in the water, such as lifting a leg to the side of the body.

3. Achievement of gross motor milestones:

Children have an easier time completing gross motor milestones, such as rolling, walking and jumping in the water secondary to buoyancy principles. For example, a child with cerebral palsy may learn to roll in the water with the assist of a therapist and the buoyancy of the water. Once the nervous and musculoskeletal system in the child’s body learn how to roll in the water, it will be easier to learn on a mat table in the clinic and then transfer to rolling in bed at home.

4. Increased tactile input:

For kids with sensory processing disorders, the water can provide the deep pressure input that they crave. This deep pressure and overall increased tactile input will help a child who has difficulty processing sensory input transfer into a more organized, calm child.

5. Helps with breath support:

For kids with speech issues, aquatic therapy can be very helpful. By using techniques such as holding their breath under water, deep breathing and by raising their arms up and bringing them down with the resistance of water can all help with proper breath support for speaking.

6. Better social interaction:

Completing gross motor activities can often help to decrease social anxiety. Often times, jumping into the water or swimming across the length of the pool can encourage speaking in children who have anxiety. Kids can also learn a swimming stroke from watching each other, share toys and participate in fun games together in the pool setting.

Aquatic therapy can be a great way to help your child reach their full potential. Not only can it help with gross motor skills, but can also help with speech and social interaction. So, if your child is motivated by the water, encourage them to jump on in!

Have aquatic games you would like to share? Leave us a comment and let us know!

Bridget Hobbs

Bridget Hobbs, PT,DPT, is a licensed physical therapist with a passion for working with kids with special needs. She received her Bachelor of Science degree in Biomedical Sciences from Marquette University and then continued at Marquette to receive her clinical doctorate in Physical Therapy in 2006. Bridget started her physical therapy career working with adults who had orthopedic, cardiac and neurological injuries. In 2009, she began working for North Shore Pediatric Therapy to pursue working in the outpatient pediatric setting and has found her home in this setting. Areas of interest for Bridget include treating children with torticollis, orthopedic injuries, autism, gross motor delays and neuro-muscular disorders. Bridget has advanced training in neurodevelopmental therapy, aquatic therapy, treatment of torticollis and working with premature infants. She looks forward to using her experience and passion for kids to translate to great therapy with your child.

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