Sonja Mensch

58 Chapter 3 Nakken., 2005). The seven other instruments were developed for children with cerebral palsy, other neurologic conditions, or motor disabilities in general. Although evaluation of psychometric properties of all eight instruments appeared incomplete, one or more of them might be suitable for children with SMD after some adaptation. Therefore, an expert focus group formulated suitability criteria and systematically judged the clinical suitabilityof the identified instruments for thisgroup.Theexpert focusgroupdetermined the clinical suitability of the eight instruments based on five established criteria; 1) Low level of motor abilities, children with SMD are classified in level V (GMFCS) and can at best crawl. 2) Grading of scoring because of the subtle changes in motor abilities. 3) Manual and/or device support is a functional element in using motor abilities. 4) Non- verbal instruction, children with SMD have an Intelligent Quotient (IQ)<25 and do not understand verbal instruction. 5) Capability versus capacity and performance, which means the possibility, and not quality, of performing a motor ability is important. The suitability criteria were further specified in appendix A. As a result of the judgment, consensus was reached for all instruments; none of the selected instruments was found to be completely suitable in the target group. Therefore the focus group decided that development of a new instrument was needed. The procedure of the judgment is described in appendix A. In this study we present the development of an instrument to evaluate motor abilities of children with severe multiple disabilities. The formulated suitability criteria were the starting point of the construction of the new instrument. We tested its applicability and content validity. In a companion publication in the current issue of this journal the reliability of the new instrument will be presented. METHODS Expert focus group The joint development and application of new suitability criteria and growing insights into wishes for an ideal instrument for children with SMD led to a strong motivation of the expert focus group to proceed and design a new instrument. Members of the focus group were selected from therapists of the Ipse de Bruggen Care Organisation with ten years or more experience with the target population. The expert focus group consisted of six well-trained physical therapists and an occupational therapist, each with over 15 years [range 15-30 years] of specialist experience in working with children with SMD. They were trained in the use of different instruments such as the Gross Motor Function