Sonja Mensch

136 Chapter 7 children with SMD we know the difficulties in formulating clear, achievable and relevant goals containing small steps. Movakic can help physiotherapists by identifying relevant goals on the domain of motor abilities. Especially in the intervention of children with SMD, intervention needs to be implemented in all functional activities of daily life involving parents and other care-givers in order to maximize repetition and in turn learning. Formulating achievable goals will help motivate working on goals. In addition, parents and care-givers reacted very positively on the fact that knowledge of possibilities in motor abilities, instead of what the disabilities of their child are, helped them focus on relevant aspects of stimulating their child. As mentioned before, the limitations of other observational instruments such as relevance of items and big steps in scores which were hard to achieve (Mensch et al., 2015a) demotivated physiotherapists, parents and care-givers. It is generally acknowledged that physical activity is relevant for prevention of health issues such as cardio-vascular diseases, poor physical fitness and cognitive problems (Hartman, Houwen, Scherder, & Visscher., 2010) (Houwen, Putten, & Vlaskamp., 2014), (Nederlandse Hartstichting., 2017) (Bartlo & Klein., 2011). We assume that this applies to people with SMD too. Moreover, it demonstrates the importance of measurement of motor abilities and quantifying activity of the child with SMD. Unfortunately, due to the budget cuts in the Dutch care system, the number of professional care-givers is rapidly declining. Children with SMD need help from other people in all activities of daily life (Putten et al., 2016). By the decrease in number of qualified care-givers the burden of care is increasing exponentially, resulting in for example less time for the children. Children with SMD have significant lower reaction time so reduction of qualified care-givers in our care systemmay directly influence their quality of life (QoL). A recent study onmotor activation in people with profoundmultiple disabilities showed that motor activation in persons with PMD in daily practice by support of persons is rather limited. The consequences can be extensive and related to nearly all domains of human functioning and as it is on their QoL (Putten et al., 2016). In addition, interesting is the relation we found between motor abilities and QoL (Mensch et al., submitted) because maximizing QoL of children with SMD is often the most important objective of treatment and care. A range of health problems often threatens QoL of these children and care or treatment concentrate on the prevention and relief of suffering. Although problems in motor abilities are not the most important aspect children with SMD have to deal with, stimulating motor abilities instead of accepting inactivity can help these children in alertness and being active during the day (Houwen et al., 2014), (Putten, Vlaskamp, Reynders, & Nakken., 2005).