Daily activities of school-age children with cerebral palsy: development and learning. Dirk-Wouter Smits

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1 Daily activities of school-age children with cerebral palsy: development and learning Dirk-Wouter Smits

2 Cover Op eigen benen, Kees Verkade Cover design Kitty van der Veer, Proefschrift.nu Layout Renate Siebes, Proefschrift.nu Printed by Labor Grafimedia BV, Utrecht ISBN D.W. Smits All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage or retrieval system, without permission in writing from the author.

3 Daily activities of school age children with cerebral palsy: development and learning Dagelijkse activiteiten van kinderen met cerebrale parese: ontwikkeling en leren (met een samenvatting in het Nederlands) Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof.dr. J.C. Stoof, ingevolge het besluit van het college voor promoties in het openbaar te verdedigen op donderdag 13 januari 2011 des middags te uur door Henricus Waltherus Smits geboren op 23 mei 1977 te Made en Drimmelen

4 Promotoren: Co-promotoren: Prof.dr. E. Lindeman Prof.dr. M.J. Jongmans Dr. M. Ketelaar Dr. J.W. Gorter De totstandkoming van dit proefschrift werd mede mogelijk gemaakt door financiële steun van de Stichting Wetenschappelijk Fonds De Hoogstraat te Utrecht, George In der Maur orthopedische schoentechniek, Allergan en de Dr. W.M. Phelps Stichting voor spastici. De PERRIN CP 5-9 studies beschreven in dit proefschrift werden mede mogelijk gemaakt door de financiële steun van ZonMw (projectnummer ). De PROMOVE-CP studies beschreven in dit proefschrift werden mede mogelijk gemaakt door de Dr. W.M. Phelps Stichting voor spastici (projectnummer ).

5 Contents Chapter 1 General introduction 7 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Selective motor control of the lower extremities in children with cerebral palsy: inter-rater reliability of two tests Relationship between gross motor capacity and daily-life mobility in children with cerebral palsy Development of non-verbal intellectual capacity in schoolage children with cerebral palsy Development of daily activities in school-age children with cerebral palsy Chapter 6 Introducing the concept of learning styles to rehabilitation 93 Chapter 7 Classifying learning styles for motor activities in children and adolescents with cerebral palsy: an explorative study 101 Chapter 8 General discussion 117 Summary 131 Samenvatting (Summary in Dutch) 135 Dankwoord (Acknowledgements) 141 About the author 147

6

7 General introduction 1

8 Chapter 1 General introduction Introduction Cerebral palsy (CP) is a neurodevelopmental condition beginning early in life and persisting throughout the lifespan. 1 It is one of the most common causes of disability in children. The prevalence is around 2 per 1000 live births 2,3 and is reported to be stable over the past two decades in western countries. 4 CP is defined as a group of permanent disorders of the development of movement and posture, causing activity limitation, which are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems. 1 There is general agreement that CP is a heterogeneous condition, both in its etiology and in its clinical manifestation. 1 The etiology of CP can be described as prenatal (e.g., congenital malformation), perinatal (e.g., birth asphyxia), or postnatal (e.g., meningitis during the first year of life). Currently, the etiology is often not known and, therefore, it is not a common part of the classification of CP. The classification of CP is above all characterized by the clinical manifestation, in terms of subtypes and functional abilities 1 (Table 1.1). Subtypes relate to the predominant type of the motor impairment (i.e., spastic, dyskinetic, and ataxic) and within the spastic subtype to the limb distribution (i.e., unilateral and bilateral). 5 Spastic CP is characterized by at least two of the following features: abnormal pattern of posture and/or movement, increased muscle tone (not necessarily constant), and pathological reflexes (hyper-reflexia or pyramidal signs). Spastic CP can be either unilateral if the limbs on one side of the body are involved or bilateral if the limbs on both sides of the body are involved. Dyskinetic CP is described by both abnormal pattern of posture and/or movement and involuntary, uncontrolled, recurring, and occasionally stereotyped movements. Ataxic CP is defined by both abnormal pattern of posture and/or movement and loss of orderly muscular Table 1.1 Clinical manifestation of CP Subtype Spastic CP Dyskinetic CP Ataxic CP Unilateral Bilateral Functional ability GMFCS MACS Level I Level II Level III Level IV Level V Level I Level II Level III Level IV Level V GMFCS, Gross Motor Function Classification System; MACS, Manual Ability Classification System. 8

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10 Dankwoord Bijna bij het einde wil ik nog een paar mensen bedanken die hun kritische licht hebben laten schijnen met betrekking tot dit proefschrift: Paul Westers voor de statistische adviezen, Jan Klerkx voor de Engelse correcties, Rosanne Faber voor de leesbaarheid van de samenvattingen, Renate Siebes en Kitty van der Veer voor de totale layout en de leescommissie bestaande uit Prof. Dr. Gerben Sinnema, Prof. Dr. Frank Backx, Prof. Dr. Ria Nijhuis en Prof. Dr. Bert Steenbergen voor de kwalitatieve beoordeling. Een paar dagen geleden: Thuis stel ik twee gasten aan elkaar voor die elkaar daarvóór nog nooit gezien hadden. Altijd leuk als er een klik tussen mensen blijkt te ontstaan. Olaf en Stef, met jullie als paranimfen kan ik mijn verdediging nu met vertrouwen tegemoet zien. Dat kon weleens een mooie dag gaan worden! Ik ga de cirkel rond maken. Mijn hoofd is soms wel erg veel met onderzoek bezig geweest. Daniëlle, jij weet daar alles van. Je zorgde er dan voor dat ik af en toe ook naar mijn hart luisterde. Daar, in mijn hart, was en is er altijd ruimte voor jou. 146

11 * About the author

12 Curriculum vitae CURRICULUM VITAE Dirk-Wouter Smits werd op 23 mei 1977 geboren te Made en Drimmelen. Hij behaalde in 1995 zijn VWO-diploma aan het Newman College in Breda. Van 1995 tot 2000 studeerde hij Pedagogische Wetenschappen (specialisatie Sport, Bewegen en Gezondheid) aan de Universiteit Utrecht. Binnen deze studie nam hij in 1999 deel aan het European Master s Degree in Adapted Physical Activity (EMDAPA) programma aan de Katholieke Universiteit Leuven. Van 2000 tot 2003 volgde hij de (verkorte) opleiding Fysiotherapie aan de Hogeschool Utrecht. In 2003 werkte Dirk-Wouter enkele korte periodes als fysiotherapeut. Daarna was hij een jaar werkzaam bij de opleiding Fysiotherapiewetenschap aan de Universiteit Utrecht en vervolgens een jaar bij de opleiding Fysiotherapie aan de Hogeschool Utrecht. Bij beide opleidingen was hij medewerker in het ontwikkelen van wetenschappelijk onderwijs en was hij tevens betrokken bij onderzoek en onderwijs rond het thema motorisch leren. Vanaf 2004 combineerde hij zijn werk in het onderwijs met een functie als onderzoeksassistent in het Kenniscentrum van Revalidatiecentrum De Hoogstraat in Utrecht. In deze functie heeft hij zich gedurende een jaar gericht op het plannen en uitvoeren van metingen in het kader van het Pediatric Rehabilitation Research in the Netherlands (PERRIN) CP 0-5 project, een longitudinale studie naar het beloop en determinanten van het dagelijks functioneren van kinderen met CP van 0 tot 5 jaar. Vanaf de zomer van 2005 werd het PERRIN CP 5-9 project opgestart en begon Dirk-Wouter zijn werk als junior-onderzoeker op dit project. In het PERRIN CP 5-9 project lag voor hem de kans promotieonderzoek te doen. In 2007 schreef hij een subsidieaanvraag voor een onderzoek naar leerstijlen voor het leren van motorische vaardigheden bij kinderen met CP: het Praktijkonderzoek Motorische Vaardigheden Educatie bij CP (PROMOVE-CP). Vanaf 2008 kon hij zich naast het PERRIN CP 5-9 project dus ook richten op het PROMOVE-CP project. Hiermee ging een wens van hem in vervulling om zich als onderzoeker te kunnen verdiepen in het thema motorisch leren bij kinderen. 148

13 PUBLICATIONS Scientific, peer-reviewed publications Smits DW, Ketelaar M, Gorter JW, Van Schie PE, Dallmeijer A, Jongmans M, Lindeman E. Development of daily activities in school-age children with cerebral palsy. Research in Developmental Disabilities (in press). Smits DW, Van Groenestijn AC, Ketelaar M, Scholtes VA, Becher JG, Gorter JW. Selective motor control of the lower extremities in children with cerebral palsy: interrater reliability of two tests. Developmental Neurorehabilitation 2010; 13(4): Smits DW, Verschuren O, Ketelaar M, Van Heugten C. Introducing the concept of learning styles in rehabilitation. Journal of Rehabilitation Medicine 2010; 42(7): Zwier JN, Van Schie PE, Becher JG, Smits DW, Gorter JW, Dallmeijer AJ. Physical activity in young children with cerebral palsy. Disability and Rehabilitation 2010; 32(18): Smits DW, Gorter JW, Ketelaar M, Van Schie PE, Dallmeijer A, Lindeman E, Jongmans M. Relationship between gross motor capacity and daily-life mobility in children with cerebral palsy. Developmental Medicine and Child Neurology 2010; 52(3): e60-e66. Publications Professional publications Noordstar J, Smits DW, Gorter JW. Het zelf-concept bij kinderen met cerebrale parese. Beweegreden 2009; 5(3): Smits DW, Van Schie PE. Revalidatieonderzoek bij kinderen met cerebrale parese; PERRIN CP 5-9. BOSK Magazine 2009; 1: 35. Gorter JW, Smits DW, Van Schie PE. PERRIN 5-9: Onderzoek bij schoolgaande kinderen met cerebrale parese. BOSK Magazine 2007; 1: 17. Gorter JW, Smits DW, Van Schie PE. PERRIN 5-9: Onderzoek bij schoolgaande kinderen met cerebrale parese. BOSK Magazine 2006; 1: 35. Gorter JW, Nijnuis M, Smits DW. Multidisciplinair onderzoek bij jonge kinderen met cerebrale parese: PERRIN CP 0-4 en PERRIN CP 5-9. Kinderfysiotherapie 2005; 17: 37. Smits DW, Vermeer A, Jansen W, Baumann, BJ. De Nederlandse Platenschaal voor Zelf- Waargenomen Competentie en Sociale Acceptatie voor jonge kinderen met cerebrale parese: een analyse van karakteristieke scoreverdelingen. Bewegen en Hulpverlening 2000; 17:

14 Publications Abstracts Smits DW, Ketelaar M, Gorter JW, Van Schie PEM, Becher JG, Lindeman E, Jongmans MJ. De ontwikkeling van het denkvermogen van kinderen met CP (PERRIN CP 5-9). Abstract boek, pp Presentation 4 th PERRIN symposium CP in ontwikkeling: over ontwikkeling en prognose van kinderen, jongeren en jongvolwassenen met CP. Utrecht, the Netherlands, 18 June Gorter JW, Ketelaar M, Smits DW, Dallmeijer A. Workshop Mobiliteit en Motorische ontwikkeling. Workshop 4 th PERRIN symposium CP in ontwikkeling: over ontwikkeling en prognose van kinderen, jongeren en jongvolwassenen met CP. Utrecht, the Netherlands, 18 June Smits DW, Van Schie PEM. Florisson D, Post I. Workshop School en cognitie. Workshop 4 th PERRIN symposium CP in ontwikkeling: over ontwikkeling en prognose van kinderen, jongeren en jongvolwassenen met CP. Utrecht, the Netherlands, 18 June Smits DW, Verschuren O, Gorter JW, Lindeman E, Jongmans MJ, Ketelaar M. Classifying learning styles is relevant for teaching daily motor activities in children and adolescents with cerebral palsy: a mixed-methods study. Developmental Medicine & Child Neurology 2010; 52 (Suppl. 4): Presentation European Academy of Childhood Disability (EACD). Brussels, Belgium, May Smits DW, Verschuren O, Gorter JW, Ketelaar M. Classifying learning styles in pediatric rehabilitation practice: first experiences in children and adolescents with cerebral palsy. Abstract book, p. 33. Presentation International Symposium A global status quo on cerebral palsy, with a view to the future. Utrecht, the Netherlands, 5-7 November Smits DW, Gorter JW, Ketelaar M, Van Schie PEM, Dallmeijer A, Lindeman E, Jongmans MJ. The relationship between gross motor capacity and performance of daily life mobility in children with cerebral palsy at primary school age. Conference proceedings, p. 74. Presentation Third International Cerebral Palsy Conference. Sydney, Australia, February Van Schie PEM, Zwier N, Becher J, Smits DW, Gorter JW, Dallmeijer A. Physical activities in 5 and 7 years old children with cerebral palsy. Conference proceedings, p Presentation Third International Cerebral Palsy Conference. Sydney, Australia, February Rentinck ICM, Smits DW, Van Schie PEM. PERRIN 0-5 en PERRIN 5-9. Workshop BOSK Landelijke informatie- en ontmoetingsdag Cerebrale Parese en onderzoek. Utrecht, the Netherlands, 21 June

15 Smits DW, Van Groenestijn AC, Becher JG, Van Schie PEM, Dallmeijer AJ, Ketelaar M, Gorter JW. Clinical assessment of selective motor control in children aged 5-7 years with cerebral palsy. Abstract book p. 51. Poster presentation European Academy of Childhood Disability (EACD). Groningen, the Netherlands, June Smits DW, Van Schie PEM, Ketelaar M, Dallmeijer AJ, Becher JG, Gorter JW. A longitudinal study on the course and determinants of daily functioning in primary school aged children with cerebral palsy. Revista de Neurologica 2006; 43 (Suppl. 2): S Poster presentation European Academy of Childhood Disability (EACD). Barcelona, Spain, October Publications 151

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