Child’s Nervous System
Preliminary Reliability and Validity of a Battery for Assessing Functional Skills in Children with Sturge-Weber Syndrome
Teressa Garcia Reidy*1, Stacy J. Suskauer*1,2, Cathy D. Bachur1, Charles E. McCulloch3, Anne M. Comi1,4
*Co-first authors who contributing equally
1. Kennedy Krieger Institute; 707 North Broadway, Baltimore, MD 21205, USA
2. Johns Hopkins University School of Medicine, Departments of Physical Medicine and Rehabilitation and Pediatrics
3. University of California San Francisco School of Medicine, Division of Biostatistics; UCSF Box 0560, San Francisco, CA 94107-1762, USA
4. Johns Hopkins University School of Medicine, Departments of Neurology and Pediatrics
Corresponding Author:
Stacy Suskauer, M.D.
Phone: 443-923-9440
Fax: 443-923-9445
Online Resource 1
Standardized task presentation developed for items from the Erhardt Developmental Prehension Assessment (EDPA) and Modified House Functional Classification (MHC)
Child’s Initials:
Rater’s Initials:
Date of evaluation:
Time of evaluation:
Child’s age:
Child’s dominant hand:
Child’s non-dominant hand:
Any other pertinent information:
Set-up and scoring:
Position child/adjustable table so that child’s elbows are above the table.
The child’s nose is considered midline; shoulder is considered side position.
Present all items at midline; if child unable to complete, then present to side.
-Use stickers to mark, on the table, the positions of midline and side.
For Erhardt DevelopmentalPrehension Assessment (EDPA) items:
*mark as present (+), absent (-), or surpassed (++)
*score both hands
For Modified House Functional Classification (MHC) items:
*mark as present (+) or absent (-)
*score only NON-DOMINANT hand
- Verbal cue: “Pick up the Cube and show me the sticker”
(sticker positioned on bottom surface of cube)
*Score EDPA item 2.e. Grasp of Cube
*Score the following items from MHC (Non-Dominant hand only)
___Active opening of fingers, but may have adducted thumb on approach to and grasp of object
___Rakes and has gross grasp of small block (1x1), but has no pad-to-pad or tip-to-tip finger prehension)
___Has functional shoulder, elbow, or hand movement towards an object in front of patient
___Consistent volitional shoulder, elbow or hand movement towards an object in front or to side of patient
___Some volitional shoulder, elbow or hand movement to aid in dressing or to move towards an object in front or to side of patient.
- Verbal cue: “Simon Says, touch your nose with the block”
(if hand is pronated to hold the cube, then ask the child to touch his/her nose with his/her finger)
*Score the following items from MHC (Non-Dominant hand only)
___Can bring item in hand to mouth with forearm supination
___Brings hand to mouth if other hand is blocked, but does not have to reach mouth with fingers (pronated forearm)
- Verbal cue: “Put the cube in the container”
(Give 3 trials with small box before moving to larger box, if unable to put cube in container, then ask to transfer to other hand)
*Score EDPA item 2.h. Release of the Dowel or Cube
*Score the following items from MHC (Non-Dominant hand only)
___Has some wrist extension during release in space
___Has voluntary release in space
___Has voluntary release, but may use surface to release object
___Attempts release, but other hand may assist by pulling object out of grasp
- Verbal cue: “Pick up the bean like this”
(Demonstrate using finger and thumb fine pincer grasp)
*Score EDPA item 2.f. Grasp of the pellet
*Score the following items from MHC (Non-Dominant hand only)
___Tip-to-tip pinch
___Thumb able to oppose somewhat to pick up small items in a tip-to-tip pinch
___Can perform pad-to-pad pinch to pick up Cheerios one at a time but may have adducted thumb
___Can rake small beans and grasp
- Verbal Cue: “Put the bean in the container”
*Score EDPA item 2.i. Release of the pellet
- Verbal cue: “Pick up the beans one at a time, and hold them in your hand”(Demonstrate)
*Score the following item from MHC (Non-Dominant hand only)
___ Able to pick up dry beans from a surface one at a time and hold in ulnar side of hand while picking up other beans with radial side of hand
- Verbal Cue: “Hide this coin in your hand.”
(demonstrate)
“Bring it to your fingers like this.”
(demonstrate coin translation)
“Now hide it in your hand again.”
(demonstrate)
*Score the following item from MHC (Non-Dominant hand only)
___ Able to pick up, stabilize, and translate coins in and out of the hand.
- Verbal cue: “Put the pegs in the pegboard”
(Place board at midline, demonstrate if child does not initiate)
*Score the following item from MHC (Non-Dominant hand only)
___ Fine graded movements present to put small pegs into a pegboard unilaterally.
- Verbal cue: “Button and unbutton one of these buttons “
(Prompt use of both hands – needs to grip button or area immediately around button with non-dominant hand to count as bimanual use)
*Score the following item from MHC (Non-Dominant hand only)
___ Able to un/fasten a button bimanually.
- Verbal cue: “Take the marker.”
(Present the marker oriented vertically)
*Score the following item from MHC (Non-Dominant hand only)
___Has some supination to reach for a vertically oriented object.
- Verbal cue: “Take the marker again, like this”
(Now present the marker horizontally and demonstrate a tripod grasp)
*Score EDPA item 2.d. Grasp of the Dowel
- (If the child is unable to grasp the marker, hand it to them.)
*Score the following item from MHC (Non-Dominant hand only)
___ Attempts to relax or open palm for observer to place an object in the hand, but may not be able to fully make an open, flat palm.
- Verbal cue: “Rotate the marker like this.”
(demonstrate 180 degree rotation, then 360 degree rotation)
*Score the following item from MHC (Non-Dominant hand only)
___ Able to perform complex rotation with an object – shows isolate finger movements
___Can perform simple rotation of an object, turning it over ½ revolution with thumb, index, and long fingers
- Verbal cue: “Take the cap off” (of the marker)
*Score the following item from MHC (Non-Dominant hand only)
___Can retain object against moderate resistance while other hand manipulates (i.e. remove lid from marker)
___Uses body to help stabilize object against resistance while other hand manipulates (remove lid from marker)
___Retains item long enough for other hand to attempt interaction/manipulation.
- Verbal cue: “Draw a circle with each hand”
(Present paper for drawing, demonstrate if necessary)
*Score EDPA item 3.a. Crayon or Pencil grasp
*Score the following item from MHC (Non-Dominant hand only)
___Can write or draw with a mature grasp. (*Defined for study use as age-appropriate grasp)
- Verbal Cue: “Point to the circle you will cut out.”
(Alternatively, “Point to your nose/face.”)
(Goal is to elicit finger isolation)
*Score the following item from MHC (Non-Dominant hand only)
___Can point with an extended finger (at least partial isolated while other fingers are out of the way).
- Verbal Cue: “Cut out the circle.”
(Present child safety scissors – right-handed vs left-handed model depending on child’s dominant hand).
(if they do not pick the paper off the table for cutting, give Verbal prompt: “Pick up the paper and rip it in half”)
*Score the following item from MHC (Non-Dominant hand only)
___Can hold paper to cut out a circle with the other hand.
___Able to grade grasp with lightly resistive media such as paper or clothing without crushing while other hand manipulates.
___Makes fist and uses arm to stabilize objects like paper or toys on a surface while the other hand manipulates.
- Verbal Cue: “Lay on the floor and push up on both hands like this. Can you be a cat? A Dog?”
(Provide demonstration for weightbearing through both arms.)
*Score the following item from MHC (Non-Dominant hand only)
___Attempts to push or hold up body for anti-gravity positions/transitions with upper extremity.