Sonja Mensch

14 Chapter 1 need direct support of other persons to execute certain motor skills (Putten van der, Bossink, Frans, Houwen, & Vlaskamp., 2016). Despite the lack of internal motivation or initiation of these children (Munde & Vlaskamp., 2015), motor stimulation will help them (to a certain extent) to influence their surroundings such as care-givers or parents, change their position, reach or shift towards a toy, actively participate in eating and other activities and ease personal hygienic care for their parents or other caregivers. So, motor abilities provide children with SMD with a degree of control over their own life and as such may positively influence their quality of life. In the example of Jeroen, the discovery to the fact that he could raise his head with the proper support of his arm rest resulted in being able to actively participate in feeding. Moreover, by stimulating motor abilities development of (painful) contractures such as scoliosis or hip luxation may be delayed, and bowel function and respiration stimulated. ICF-CY: Environmental factors and personal factors. In children with SMD all of the processes needed for motor learning are disturbed due to their severe intellectual disability. Motor learning emerges froma complex set of processes includingperception, cognition and action. Motor learning needs to be trained in the needed specific skills and in the specific environment that requires using these skills (Shumway-Cook & Woollacott., 1995). Therefore, especially in children with SMD, intervention needs to be implemented in all functional activities of daily life involving parents and other care- givers in order to create a maximize repetition and in turn learning. Measurement It is understandable that signs of psychomotor development and effects of treatment in this group will frequently be difficult to observe and may be very subtle or will develop over a lengthy period. Therefore it is possible that subtle, but nevertheless meaningful motor development or effects of intervention might be missed; the same applies to recognizing gradual deterioration. Even parents may not recognize or misinterpret subtle, gradual changes. Moreover, in clinical practice working with children with SMD there is a lack of knowledge about the relevance and importance of motor abilities for these children. Therefore, sincemany years, there is a need to objectivelymeasuremotor function during a longer time frame as a basis for treatment plans, collaboration with parents, but also to obtain objective insight into the quality and results of professional care. In the example of Jeroen, an instrument feasible for these children should help us focus on his relevant motor abilities, evaluation of changes and treatment goals enabling him to reach a degree of control in his own life and as such have a positive influence on the quality of his life.