Motor Development of Egyptian Children on the Peabody Developmental Motor Scales-2-Juniper Publishers
Juniper Publishers-Journal of Pediatrics
Abstract
Background: Peabody developmental
motor scale (PDMA-2) is considered one of the most commonly used tests
to assess motor development in preschool children. It provide useful and
comprehensive information for early assessment. It remains unclear if
the standard measured established and currently used are applicable to
Egyptian children.
Objectives: To establish normative data for fine motor developmental skills that can be applicable to Egyptian children.
Methods: 195 Egyptian children
attending nursery schools in Greater Cairo, throughout Egypt were
randomly identified, based on their chronological age (from 36 to 42
months). Each child needed to achieve a screening score of at least 80%
using the Portage Scale to participate in this study. If eligible, and
consent was obtained, each child was subsequently evaluated monthly
using the PDMS-2 for six months, longitudinally.
Results: There are significant
differences for measured subtest items of fine motor development for
Egyptian children when compared with the currently available PDMA-2
normative data, using Z-scores.
Conclusion: Confirmation and
acknowledgement of the differences which may exist among children from
Egypt vs. those used to establish “normative standards” for diagnostic
tools, such as the PDMA-2, illustrates the importance of establishing a
range of different “normative values” as needed, so developmental tests,
such as these, can be applicable to a wider range of geographic areas,
globally. Development of standard measures of motor development for
Egyptian children is needed, so as to serve as a national reference for
all health care staff working in pediatric physical therapy.
Keywords: Egyptian children; fine motor development; portage scale; Peabody Developmental motor scaleIntroduction
The field of study concerned with the description and
explanation of changes in motor performance and motor control, across
the life span, is typically called motor development. While the study of
motor development has historically focused on the period from
conception through to adolescence, and the changes and stages through
which the developing human progresses in attaining adult levels of motor
performance, researchers in this field are now also increasingly
interested in the deterioration of motor skills apparent in the elderly
population. Such a broadened focus is important given aging populations
worldwide and given that many changes in the performance and control of
motor skills are age related and occur throughout the entire life span
[1].
Children are the biggest promise for the nation’s
future. The family, community, and government are responsible for their
survival, development, and protection. The Egyptian government took
successful steps in saving children’ life through promoting diarrheal
disease control, vaccination and Integrated Management of Childhood
Illnesses (IMCI). It now focuses on child development programs aiming
creation a more physically and mentally productive generation. The long
term progress of any nation depends on how much it cares about its
children [2].
Fine motor skills are the collective performances
that involve the hands and fingers. That is, fine motor skills are those
performances that require the small muscles of the hand to work
together to perform precise and refined movements. Fine motor
skills typically develop in a reasonably consistent and predictable
pattern in the early years of childhood (from birth through to mid
primary school). They include reaching, grasping, manipulating
objects & using different tools like crayons & scissors. But
because
tasks such as printing, coloring & cutting are not emphasized
until a child is of preschool age, fine motor skill development is
frequently overlooked when the child is an infant or toddler [3].
The Peabody Developmental Motor Scales-2 (PDMS-2) is the
most commonly used pediatric motor outcome measurement
tool. The PDMS-2 was designed to assess motor development
in children from birth to 72 months of age to measure fine and
gross motor skills. The possible uses of the PDMS-2 include;
Determination of motor competency relative to a normative peer
sample, assessment of qualitative and quantitative capacities
of individual gross motor and fine motor skills, evaluation of
progress over time and determination of efficacy of interventions
in research [4].
The motor development of children is a critical developmental
and an important area for scientific research. We believe that
despite its importance to children, the field of motor development
and physical therapy has remained disappointingly neglected and
we believe that we need to confirm that the current standards
being used are appropriate and applicable to Egyptian children,
and if not that a standardized scale which measures the normal
development of Egyptian children be created and used.
The PDMS-2 is one of the most popular used scales all over
the world, however it only examined children from western
populations, and as such it is not clear if the populations used
to create the normative values are broadly applicable to those
of all children, and in particular those from Egypt. The need to
establish a fine motor scale that is representative to the fine motor
development in Egyptian children is needed. There has been no
study conducted to check the applicability of the PDMS-2 in Egypt.
Thus, the regional relevance of the PDMS-2 must be examined,
specifically when scores are used to determine whether a child is
“normal” or delayed. Therefore; it was very important to establish
norms for the Egyptian children in fine motor developmental skills
to find a way of assessment that might be more clinically relevant
for Egyptian children.
Methods
Sample
An estimated cluster sample of three governorates from the
total governorates represented in the Greater Cairo Area, Egypt
was studied; reaching a total of 195 participants. Children of either
gender with ages from 36 to 42 months were included. Children
were excluded if they failed the screening test (scoring a value of
< 80% on the Portage Scale), or had active medical conditions or
were uncooperative on 3 trials.
Instruments
The Portage checklist has been introduced successfully into
countries across the world and translated into different languages,
Arabic version. It focuses on the role of daily contact with the child
recognizing the critical importance of the interactions taking
place between parent/care and child in promoting the early
development of the young child. The Portage kit is an Activity Card
File that consists of 580 developmentally sequenced questions
from birth to age nine, it contain five domains: Socialization, Self-
Help, Language, Cognition, and Motor.
PDMS-2 norm-referenced and standardized motor skill test
that consists of 6 subscales of which the scores from 4 subscales
that combined to give a gross motor quotient (GMQ) and 2
subscales combined to give a fine motor quotient (FMQ). For each
item, the manual describes the child’s beginning position, the
materials needed, and directions for administering the item and
the criterion for scoring. The criterion for scoring each response
is written in a behavioral objective format which specifies the
number of trials permitted or the time allotted. Each response is
scored on a 3-point scale (0 _ unsuccessful, 1 _ clear resemblance
to item criterion but criterion not fully met, 2 _ successful
performances, criterion met). The administration of both Gross
Motor Scale and Fine Motor Scale takes approximately 45 to 60
minutes [5].
Procedure
Subjects were recruited for the study from nursery schools
and play schools in Egypt. Screening was done by administering
the Portage Checklist as per the guidelines given in the scale. The
child was included in the study if they achieved a score of at least
80% according to the portage motor checklist.
The PDMS-2 was then administered according to guidelines
provided in the manual, using the floor and ceiling rules to
minimize the administration time. The data were recorded in
the examiner record booklets. The obtained raw scores for visual
motor integration subtest of the scale were converted to age
equivalent, percentile, and standard scores. All the values were
recorded on the summary score sheet. The standard scores and
the quotients were converted to z-scores for analysis were used
for comparison with the normative mean values in the PDMS-2
manual.
Data Analysis
Data analysis was done using SPSS ver.14.0 and Arcos software
packages. The mean and standard deviations were calculated for
the raw scores, standard scores, for age group (36–42 months).
The z-scores for the standard scores for fine motor scale were
calculated and compared with the normative z-scores provided in
the manual.
Results
The three groups of Egyptian children from Greater Cairo Area
(Cairo, Giza, and Kaliobia) were homogenous in mean age. Mean ages of Greater Cairo Area were calculated in one group. The mean
age (in months), the mean, and standard deviations for the raw
scores of selected items for both boys and girls were according to
the child’ chronological age (36 to 42 months) presented in Table1.
The measurable items for this age were two items of grasping
subtest of PDMS; 22- G: Grasping marker, 23- G: Unbuttoning
button and seven items of visual motor integration subtest; 57- V:
Cutting paper with blunt scissor, 58-V: Lacing string into 3 holes,
59-V: Copying cross, 60-V: cutting on the line drawn, 61-V: Copying
cross in the middle, 62-V: Dropping 10 food pellets, and 63-V:
Tracing line drawn, With taken into consideration the basal and
the ceiling level of scoring according to the Illustrated Guide for
Administering and Scoring of the PDMS-2 Items.
The sample of this age includes 195 children, 71 of them are
boys and 124 are girls and we report here the statistical analysis
of all data collected. Descriptive analysis for the mean values of
Egyptian children development during this study for this age was
shown to have a significant statistical difference between boy and
girl groups in 22-G, 57-V, and it highly significant in 63-V items.
The statistical analysis of the Z-score and percentile rank of
the standard scores for this age group indicated that there was
a significant difference between the three groups of Egyptian
children from greater Cairo area (Cairo, Giza, and Kaliobia) and
the normative sample in favor of Egyptian children in grasping
items and in favor of European sample in visual motor integration
items; were presented in Table 2 and shown in Figure 1.
Discussion
Development is influenced by heredity and environment. One
of the environmental factors that affect development is culture
which may affect performance of a child on a developmental test
that does not reflect typical cultural experiences for a specific
population. Because differences in motor development have been
found among various ethnic groups, the cultural relevance of
standardized developmental tests must be examined [6].
Uses of scales that are developed for western populations
are not always applicable to all the diverse cultural groups and
regions of the world, so that the cultural and regional relevance of
a scale must be checked before using. Such a project is especially
important because these tests are used to determine whether a
child is developing typically or is in some way delayed, requiring
special services [7].
Motor assessments designed for children of the dominant or
mainstream culture are not always appropriate for those from
diverse ethnic backgrounds. This study was undertaken to compare
the scores of children from one ethnic group with the scores of the
children on whom the test was normed. It was observed that there
were significant differences in the scores of the children from our
sample, compared with the normative data given in the manual of
PDMS-2. It indicates that cultural differences could significantly
affect the scores of the children on the scale [8].
The ages of the study population ranged from 36 to 42 months.
It contains two items of grasping subtest of PDMS; Grasping marker
which develop earlier in Egyptian children around 34 months than
in the normative western-derived sample around 41 months and
Unbuttoning button which develops in Egyptian children around
40 months and in the normative sample around 41 months, along
with seven items of visual motor integration subtest; Cutting
paper with blunt scissor which develops in Egyptian children
around 37 months as in the normative sample, Lacing string into 3
holes which develops in Egyptian children around 39 months as in
the normative sample, Copying cross which develops in Egyptian
children around 39 months as in the normative sample, cutting
on the line drawn, Copying cross in the middle, Dropping 10
food pellets, and Tracing line drawn which develops in Egyptian
children around 41 months as in the normative sample.
The grasping and the visual motor integration skills that were
to have a highly significant difference in the mean standardized
(Z) score of the third group, in favor of Egyptian children for
grasping items and in favor of European children for visual motor
integration items. Growth potential in preschool children is similar
across developing countries, and stunting in early childhood is
caused by poor nutrition and infection rather than by genetic or
geographical differences. Patterns of growth retardation are also
similar across countries. Faltering begins in utero or soon after
birth, is pronounced in the first 12–18 months, and could continue
to around 40 months, after which it levels off [9].
The higher performance in grasping subtest is seen from the
age of 36 months and is maintained until the age of 54 months,
reaffirms the findings of another study that suggested that the
increase in maximal isometric grip strength during childhood and
in preadolescence stages has two components; The first is muscle
growth, which takes a gender-specific course during puberty,
indicating that it is influenced by hormonal changes. The second
increase in grip strength per muscle cross sectional area (CSA)
[10].
While the lower performance of visual motor integration
subtest, seen from the age of 36 months, could be better understood
applying the findings from another study which reported that the
hand represents an excellent model in which to study one of the
most intriguing issues in motor control: simultaneous control of
a large number of mechanical degrees of freedom. The complex
apparatus of the human hand is used both to grasp objects of all
shapes and sizes through the linked action of multiple digits and
to perform the skilled, individuated finger movements needed
for a large variety of creative and practical endeavors, such as
handwriting, painting, sculpting, and playing a musical instrument
[11].
Conclusion
In general, the findings reported here confirm several
significant differences between the scores of children 36 to 42
months from the Greater Cairo Area, Egypt, and those of the
western-generated normative sample used as a standard or
normative comparator in the currently available version of the
PDMS-2.
It is not always practical to develop assessment tools which are
culturally sensitive across the totality of regions and environments
where they may be needed and used, but it is necessary to evaluate
the cultural and geographical differences that may be evident
for standardized tests for a particular region and ethnic group,
especially when these instruments are being used to assess areas
of motor development of Egyptian children and serve as a means
of access to important and needed therapeutic resources. We may
be unknowingly limiting access to children who would benefit
from therapeutic help, and providing to others who are less
likely to need or benefit from it. Applicable standards for motor
development that are relevant to Egyptian children are needed.
Acknowledgment
Thank you to Prof. Dr. Faten Abdelazeim and Prof. Dr. Amany
Mousa for their review of the manuscript. The authors thank
the children and the families who participated in this study; the
staff of the various nursery schools and baby class members for
assistance in recruitment and use of their facilities for the support
of this study.
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