Sonja Mensch

135 General discussion This meant that Movakic data of the same child could be used in both datasets, as a child could be without events in one 3-month interval but have had surgery in the next for example. Lastly, relevance of the interpretation of changes in scores is a topic of debate for many years (Maas., 2017). In order to interpret changes in Movakic scores, there needs to be agreement on the size of impact of events on motor abilities in children with SMD. We propose to carefully record events and regularly performmeasurements using Movakic in a longitudinal study. At least, the measurement should be performed after every meaningful event to minimize the chance of another event that could introduce bias in establishing the net effect of the first recorded event. Next, we recommend an intervention study that aims to establish the net effects of physiotherapeutic interventions on motor abilities measured with Movakic, which using the data of the longitudinal study could be controlled for bias/confounding introduced by co-occurring events. Implications for clinical practice Use of Movakic might help identify change inmotor functioning, as a result of influences with negative impact on motor ability such as having pain or longer disturbances of health and fitness or influences indented to have a positive impact such as training motor abilities, the use of devices or undergoing surgery or other specific therapeutic interventions. As stated in the last paragraph of the previous section, we recommend that in clinical practice such influences should be registered with a standardised, longitudinal and preferably objective documented method. Using such a standardized method would enable objectifying the effects of interventions on motor abilities in clinical practice as well in scientific (intervention) studies. Another potential use of Movakic is systematically recording motor ability in the individual child with SMD as part of the evaluation of multidisciplinary goals. In a multidisciplinary setting all disciplines work on the same perspective of the individual child with SMD. However, all disciplines have their own specific goals often leading to discussion of which intervention could have led to the result or which intervention has the priority. By formulating clear goals with the child’s perspective in mind we can try to prevent this. Movakic consists of items on specific motor abilities clustered in relevant body positions with or without material aid, and clusters of items focussing on specific perspectives. These items on specific motor abilities on maintaining body positions, activities, changing body position and moving around can be helpful in formulating clear goals and evaluating treatment goals in multidisciplinary settings. In multidisciplinary settings such as in day-care centres, evaluating goals often follows the treatment plan cycle. Moreover, based on the practical experience in working with