Sonja Mensch

124 Chapter 6 (Schoenmakers et al. 2005). The conclusion of a study of Raz-Silbiger et al. was that gross motor skills of children with Developmental Coordination Disorders do appear to be somewhat related to the physical and school dimensions of their QoL (Raz-Silbiger et al. 2015). In a study of Petry et al. (2009), where the association between QoL, motor function, personal characteristics and characteristics of care settings were studied in people with SMD, the authors, surprisingly, found no significant relation betweenmotor limitation and QoL scores. However, the absence of such a relationship was insufficiently discussed in the study since motor limitations were operationalised by the number of physical limitations in body parts, muscle tone and deformities and not by measuring the level of motor abilities. Adding to this body of knowledge, the results of our study underline the importance of stimulating motor abilities in this severely disabled group of children. Moreover, small changes in motor ability in this specific population do matter since we found such an important positive relationship between motor ability and the QoL domain of physical well-being. We should realise that motor abilities of children with SMD are severely compromised and support is often needed in order for them to complete daily activities. This was an important fact in the development of Movakic. The expert group concluded that motor abilities in this group of children are mostly based on support by other persons through facilitation of movement and support through assistive devices in combination with activity of the child itself (Mensch et al. 2015c). As shown in this study, other existing tests evaluating motor abilities, applicable to children with motor disabilities, do not allow for manual support. Therefore, change in motor abilities, as measured by Movakic, is to a great extent dependent on change in level of support or facilitation, but also on change in level of activity of the child itself. This again supports our statement that active participation of the child during all activities of daily life, i.e. by stimulating motor abilities, is a prerequisite to be more active in controlling parts of the environment of these children, which influences their QoL. A limitation of our study was the small sample size, which may influence the correlation analyses. As a result standard deviations for both scores seem large; this is likely due to a combination of a low number and heterogeneous composition of respondents. This usually causes a lower chance of a significant result. There is thus a chance that e.g. moderate relationships could have been significant in higher numbers and / or a more homogeneous group. Despite the small size of the study population, children of nine different care organizations were included which makes the results more representative of the Dutch population. Another issue is that motor abilities of these children were measured in a body position that is relevant to the individual child. The total score and the body