Sonja Mensch

63 Design and content validity In addition, the expert focus group decided that most of the items should include three questions; 1. Required level of manual support i.e. the level of palpable support that was given, or support by a device. 2. Level of activity of the child itself. 3. Level of manual facilitation, meaning active stimulation, i.e. provocation of the child with your hands. These questions address relevant elements in the actual use of motor abilities by these children during daily functioning. All questions could be scored using a four-point Likert scale (see Table 4). Table 4. Questions and answer categories of the items 1 How much support does the child need? 0. Complete support 1. A lot of support 2. Moderate support 3. Barely support 2 Is the child active? 0. Completely passive 1. Has intention to stand up 2. Active during part of the movement 3. Completely active 3 If you use facilitation, how much do you use? 0. In spite of full facilitation there’s no intention 1. A lot of facilitation 2. Variable facilitation 3. Only during start of movement The expert focus group decided that the instrument should take the form of a questionnaire instead of an observational test. This was decided because execution of motor abilities of children with SMD may vary considerably under the influence of attention, fatigue, health,medicationuse, or unfamiliar circumstances.Thequestionnaire has to be completed by a therapist that has long-lasting experience with the child in a naturalistic setting instead of a therapist that does not know the child and uses the instrument in an isolated testing situation. Most other observational instruments are based on using a specific testing situation. Based on the difficulty to test execution of motor abilities in standardized situation, the judgment on being able to perform the motor ability in whatever shape or form in spontaneous situations during the last three months will be used to measure the motor abilities of the children with SMD. A score-form was added to the questionnaire, containing separate pages for each specific situation and an overview page with total situation scores. The maximum total scores of the 12 situations will differ because of a different cluster of items. Because all children have different abilities or disabilities and different therapeutic goals, only situations that are relevant to the child need to be scored. Therefore, on the score-form, individual scores for evaluated situations have to be converted into percentages of