School Function Assessment Research Articles

The Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA–Ch): A New Instrument for Assessing Learning Potential

To describe the development and psychometric properties of the Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch), a dynamic criterion-referenced assessment of cognitive abilities and learning potential for children with cognitive and learning difficulties. A series of studies analyzed the age standards, criterion cutoff scores, and percentage of mediation cues required for typically developing children 6-12 years of age, as well as reliability and validity. MANOVA analyses determined four age groups that best fit the outcome data: 6-6.11, 7-8.11, 9-10.11, and 11-12 years. Criterion cutoff scores of 25% for at-risk and under 10% for deficient performance were obtained for each age group. Dynamic percentage scores were determined. Significant high interrater reliability and moderate to high internal consistency reliability were found. Construct validity was supported by comparing children with traumatic brain injury and learning disabilities to typically developing children, and ecological validity of children with attention deficit hyperactivity disorder by comparing performance on the DOTCA-Ch to the School Function Assessment. The DOTCA-Ch is a reliable and valid assessment that provides learning potential and can facilitate intervention for cognitive difficulties that manifest themselves in daily functions among school-age children.

Consequential Validity of an Assistive Technology Supplement for the School Function Assessment

Educators and therapists implement assistive technology to maximize educational outcomes of students with disabilities. However, few measure the outcomes of interventions because of a lack of valid measurement tools. This study investigated whether an assistive technology supplement for the School Function Assessment demonstrates an important aspect of construct validity. Specifically, the study examined a type of consequential validity. Twenty-eight school-based therapists participated in the study. Two t tests compared a group using the School Function Assessment (n = 13) to a group using the assistive technology supplement to the School Function Assessment (n = 15). The first t test examined the difference in confidence therapists perceived in their ability to develop assistive technology interpretations. The second t test compared the number of assistive technology interpretations matching those of an expert panel. The first t test did not achieve significance (p = .998). The second (test achieved significance (p = .001). These results suggest, with certain limitations, that the assistive technology supplement for the School Function Assessment exhibits this important aspect of construct validity.

Concurrent Free Paper Sessions A

Objective: The International Classification of Functioning and Disability (ICF) centres on participation as the ultimate outcome for persons with disabling conditions. In the ICF, participation is defined as involvement within a life situation and encompasses personal maintenance, mobility, information exchange, social relationships, home life, education, work and employment, economic life and community, social, and civic life. Children's participation needs to be considered in the context of school, home, and broader community environments. This study aimed to investigate the validity, reliability, sensitivity to change, feasibility, accessibility, and practicality of use of measurements of participation of primary school children with hemiplegia. Design: A systematic review. Method: Inclusion criteria: assessments that measure primary school aged children (5-13y) with cerebral palsy or physical disabilities AND participation (at least 30% content), but may also include activity and environmental factors. Exclusion criteria: papers not published in English that assess quality of life, impairments, communication, or interpersonal relationships. Three raters independently assessed all papers and reached consensus. Results: Systematic searching identified 17 assessments. Consensus agreement was reached for the Canadian Occupational Performance Measure (COPM); School Function Assessment (SFA);' Assessment of Life Habits (LIFE-H for children 1.0);2 Children's Assessment of Participation and Enjoyment(CAPE);3 Goal Attainment Scaling (GAS); and School Outcomes Assessment. The Children Helping Out: responsibilities, Expectations and Supports (CHORES) was selected by two of the raters. The CAPE, SFA, and LIFE-H were found to have the best clinimetric properties. The LIFE-H covers 13 life habit areas. Content validity is good and test retest reliability for most areas is adequate (ICC=O.314.74).* The SFA is judgement based, with specific assessment of participation in school. It has high internal consistency (coefficient alpha=0.924.98), excellent test retest reliability (ICC=0.824.98),and adequate interrater reliability (ICC=0.624.73).' Four studies have supported content and construct validity. The CAPE measures participation in non-school mandated activities. Test development and standardization indicates sufficient internal consistency (0.42 formal domain, 0.76 informal domain), test retest reliability (ICC=0.64-0.86) and validity3 Conclusion: The most suitable measures of participation for primary school children with hemiplegia are the CAPE and LIFE-H for home and broader community environments and the SFA for the school environment. The results of this review will further inform the outcome measures for the participation domain in a randomized trial of upper limb training in children with hemiplegia.

Examination of the Perceived Efficacy and Goal Setting System (PEGS) With Children With Disabilities, Their Parents, and Teachers

The Perceived Efficacy and Goal Setting System (PEGS) is an instrument and a process that enables children with disabilities to reflect on their ability to perform everyday occupations and to identify goals for occupational therapy intervention. In this study, 117 children with disabilities in grades 1-3 completed the PEGS with occupational therapists who work in school settings. Children from 6-9 years of age with a variety of disabilities were able to self-report perceptions of their effectiveness performing 24 activities that would be expected of them each day. Parents and teachers, who completed a parallel questionnaire, rated their abilities lower than the children did. The School Function Assessment, a measure of the amount and type of support required for school participation, had low correlations with the Parent and Teacher PEGS questionnaires and did not correlate with the Child PEGS. No differences in perceived efficacy were found for children across grades or gender; however, differences were found across types of disabilities. Children were able to use the perceived efficacy information to identify and prioritize goals for intervention and these goals remained stable 2 weeks later. Occupational therapists can use the PEGS within a client-centered practice to help the child set goals for therapy and to incorporate explicitly the perspectives of parents and teachers.

Personal assistance, adaptations and participation in students with cerebral palsy mainstreamed in elementary schools

Purpose. The aims of this study were to examine differences in level of participation of students with CP in full inclusion (FI group) as compared to self-contained classes (SC group), differences in the task supports provided for these two groups, the interrelationships between assistance and adaptation provided and the differential impact of physical task supports vs. cognitive/behavioural task supports on participation.Method. 148 elementary school students were divided into two groups: 100 fully included (FI) students with CP, and 48 students with CP in self-contained classes (SC). The School Function Assessment (SFA) was used as the main measurement for assessing the levels of participation and functional performance profiles.Results. Statistically significant differences (p < 0.0001) were found between the two groups on all scales (physical and cognitive/behavioural assistance and adaptations). Supports provided to the SC group were significantly greater than to the FI group and physical task supports provided to both groups were significantly greater than cognitive/behavioural supports. Pearson correlations and Smallest Space Analyses (SSA) revealed significant (p < 0.01) moderate to strong correlations (0.57 > r < 0.77) between all four task supports, and between provided task supports and participation (0.66 > r < 0.82).Conclusions. This study's focus enhances our understanding of the impact of task supports to the various factors contributing to the dimensions of the ICF, as well as their interrelationship with participation. Devises and cognitive and behavioural adaptations are required in a wider manner in addition or alternative to physical assistance by adults if we are to increase the chance of students with severe CP to become participatory for academic and social tasks required in school.

Evidence‐based physical therapy for the management of children with cerebral palsy

Developmental Medicine & Child NeurologyVolume 47, Issue 12 p. 795-795 Free Access Evidence-based physical therapy for the management of children with cerebral palsy Margaret Mayston, Margaret MaystonSearch for more papers by this author Margaret Mayston, Margaret MaystonSearch for more papers by this author First published: 13 February 2007 https://doi.org/10.1111/j.1469-8749.2005.tb01081.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Damiano DJ. (2004) Physiotherapy management in cerebral palsy: Moving beyond philosophies. In: D. Scrutton, DJ. Damiano, MJ. Mayston, editors. Management of the Motor Disorders of Cerebral Palsy. Clinics in Developmental Medicine No. 161 2nd edn. Mac Keith Press : London.p 161– 169. 2 Palisano R., Rosenbaum P., Walter S., Russell D., Wood E., Galuppi B. (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39: 214– 223. 3 Coster W., Deeney TA., Haltiwanger JT., Haley SM. (1998) School Function Assessment: User's Manual. San Antonio , TX : Therapy Skill Builders. 4 World Health Organization. (2001) International Classification of Functioning, Disability and Health. (ICF) Geneva : World Health Organization. 5 Rosenbaum P., Stewart D. (2004) The World Health Organization International Classification of Functioning, Disability and Health: a model to guide clinical thinking, practice and research in the field of cerebral palsy. Semin Pediatr Neurol 11: 5– 10. 6 Dodd KJ., Taylor NF., Damiano DJ. (2002) A systematic review of the effectiveness of strength training programs for people with cerebral palsy. Arch Phys Med Rehabil 83: 1157– 64. 7 Damiano DJ., Abel MF. (1998) Functional outcomes of strength training in spastic cerebral palsy. Arch Phys Med Rehabil 79: 119– 125. 8 Schindl MR., Forstner C., Kern H., Hesse S. (2000) Treadmill training with partial body weight support in non-ambulatory patients with cerebral palsy. Arch Phys Med Rehabil 81: 301– 306. Citing Literature Volume47, Issue12December 2005Pages 795-795 ReferencesRelatedInformation

Neuroimpairments, activity performance, and participation in children with cerebral palsy mainstreamed in elementary schools

Participation and activity performance (motor and cognitive or behavioural) were examined in 148 children with cerebral palsy (CP; 87 males, 61 females; mean age 9y 8mo, SD 1y 11mo; range 6y 1mo to 13y 7mo), mainstreamed in fully inclusive (n=100) and in self‐contained classes (n=48) within general schools in Israel, using the School Function Assessment. Differences in participation within these groups were analyzed in relation to the type of CP (mainly spastic hemiplegia, spastic diplegia, and spastic tetraplegia), the level of impairment according to the Gross Motor Function Classification System (GMFCS; level II55%, level III 37%, and level IV 8%), and additional neuroimpairments. Univariate analyses of variance revealed significant differences in levels of participation and levels of activity performance between different types of CP and GMFCS levels. With regard to additional neuroimpairments, significant differences in participation were found for fully included children with speech and language impairments and those with learning disability within the self‐contained group. Physical activity performance partly accounted for differences in participation between children with different types of CP and different levels of motor impairment. These findings suggest that within the mainstreamed environment, participation and activity performance increase as motor disability and/or additional neuroimpairments (speech and language impairments and learning disability*) decrease.

Neuroimpairments, activity performance, and participation in children with cerebral palsy mainstreamed in elementary schools

Participation and activity performance (motor and cognitive or behavioural) were examined in 148 children with cerebral palsy (CP; 87 males, 61 females; mean age 9y 8mo, SD 1y 11mo; range 6y 1mo to 13y 7mo), mainstreamed in fully inclusive (n=100) and in self-contained classes (n=48) within general schools in Israel, using the School Function Assessment. Differences in participation within these groups were analyzed in relation to the type of CP (mainly spastic hemiplegia, spastic diplegia, and spastic tetraplegia), the level of impairment according to the Gross Motor Function Classification System (GMFCS; level II 55%, level III 37%, and level IV 8%), and additional neuroimpairments. Univariate analyses of variance revealed significant differences in levels of participation and levels of activity performance between different types of CP and GMFCS levels. With regard to additional neuroimpairments, significant differences in participation were found for fully included children with speech and language impairments and those with learning disability within the self-contained group. Physical activity performance partly accounted for differences in participation between children with different types of CP and different levels of motor impairment. These findings suggest that within the mainstreamed environment, participation and activity performance increase as motor disability and/or additional neuroimpairments (speech and language impairments and learning disability) decrease.

Participation and activity performance of students with cerebral palsy within the school environment

Purpose. The aims of this study were to investigate the levels of participation and activity performance of students with cerebral palsy within the inclusive school context, to explore the relationships between these two aspects of function and to identify predictors of participation among the various school activities.Method. Two hundred and forty-eight elementary school students were divided into three groups: 100 fully included (FI) students with CP, 100 matched by class and gender typical students (TS) and 48 students with CP in self-contained classes (SC). The School Function Assessment (SFA) was used as the main measurement for assessing the levels of participation and functional performance profiles.Results. Significant differences (P < 0.0001) in levels of participation were evident across the three study groups using MANOVA and ANOVAs analyses, where the TS level was the highest and the SC was the lowest. Comparison of the mean score of the physical and the cognitive/behavioural tasks performance revealed similar results among the three groups. Positive Pearson correlations were obtained between participation and both motor and cognitive/behavioural activity performance in the FI and the SC groups. Regression models for the FI and the SC groups were found significant (P < 0.0001) and explained above 69% of the participation variance with physical activity performance as the most predictive variable.Conclusions. Significant differences exist between participation and activity performance of typical students and students with CP included in regular schools. Moreover, activity performance limitations were found to impact on school participation. These findings stress the continuing need to provide rehabilitative intervention towards removing existing barriers within the inclusive environment.

Exploring the comparative responsiveness of a core set of outcome measures in a school‐based conductive education programme

Conductive education (CE) is a holistic educational system that uses an active cognitive approach to teach individuals with motor disorders to become more functional participants in daily activities. While CE's popularity continues to grow in North America and Europe, its effectiveness has not been established. The lack of definition of responsive outcome measures for evaluation of CE programmes has limited the interpretability of conclusions from earlier studies evaluating effectiveness. To determine which measures from a core set were most responsive to physical, functional and psychosocial changes associated with a school-based CE programme. This was a one-group before and after data collection design using an 8-month follow-up period. We enrolled a referral sample of nine children with cerebral palsy in Kindergarten or Grade 1 (Gross Motor Function Classification System levels 3, 4 or 5). The study took place within a school-based CE programme at a Canadian children's rehabilitation centre. Children participated in a CE full-day class for an entire school year. Physical, functional, psychosocial and participation measures included: Gross Motor Function Measure (GMFM), Quality of Upper Extremity Skills Test (QUEST), Peabody Developmental Motor Scales, Paediatric Evaluation of Disability Inventory (PEDI), Pictorial Scale of Perceived Competence and Social Acceptance for Young Children, Individualized Educational Plan, and Goal Attainment Scaling (GAS). Four children from the study's second year were also evaluated on the Impact on Family Scale (IFS), GAS and School Function Assessment. The Gross Motor Function Measure, QUEST, PEDI (Caregiver Assistance) and IFS were most responsive to change. GAS was useful in documenting and quantifying goals. Problems were encountered in evaluating self-esteem and school participation. Several strong measures of outcome were identified. Further work is needed to find valid and sensitive psychosocial and school participation measures for these young children.

The Reliability and Validity of the School Function Assessment—Chinese Version

The purpose of this study was to examine the reliability and validity of the School Function Assessment (SFA)-Chinese version. The data drawn from the standardization sample of the instrument (N = 320) were used in the analyses. Using internal consistency procedures, Cronbach's alpha for each scale ranged from .94 to .98. The test—retest study reported intraclass correlation coefficients from .87 to .98 among the scales. Content validity of the SFA—Chinese version was confirmed by the overall high content validity indices (85% to 100%) determined by educational experts. Construct-related validity based on an exploratory factor analysis revealed two correlated functional domains of the SFA—Chinese version, “cognitive/behavioral” and “physical,” which were consistent with the theoretical construct hypothesized in the instrument. The known groups method demonstrated different patterns of the SFA scores among three different diagnostic groups. Moreover, discriminant analysis of the scores showed a high percentage of children correctly classified into their diagnostic groups. The overall results supported the psychometric properties of the SFA—Chinese version.

School function assessment: performance of icelandic students with special needs

The purpose of this study was to determine the performance of a sample of Icelandic students, aged 6 to 12 years, with various impairments, on the School Function Assessment (SFA). The SFA was administered to 75 Icelandic students with identified special needs, 35 with physical impairments and 40 with cognitive/behavioral impairments. Both diagnostic groups demonstrated most participation in mealtime/snack time but had low scores on the school playground. Differences were found between the two study groups on all three parts of the instrument, with higher performance and participation scores for the students with cognitive/behavioral impairments. The findings raise the awareness of some of the challenges encountered by Icelandic students with special needs and indicate the importance of adapting Icelandic school settings to promote social participation of all students.

Inter-rater reliability in assigning ICF codes to children with disabilities

Purpose: The purpose of this study was to determine if independent raters would arrive at similar decisions about which codes from the Activities and Participation component of the International Classification of Functioning, Disability, and Health (ICF) to assign to children with disabilities based on the results of standard paediatric functional assessment measures.Method: Children (N = 60), 9 months to 17.75 years old, with a range of disabilities were assessed using either the Vineland Adaptive Behavior Scales (n = 20), the Pediatric Evaluation of Disability Inventory (PEDI) (n = 20), or the School Function Assessment (SFA) (n = 20). Two raters independently determined which of 40 codes from the Activities and Participation component of the ICF applied to each child based on items and standard scores from the assessment measure. The Cohen's kappa statistic was used as the measure of inter-rater reliability.Results: The kappa statistic was ⩾ 0.70, the criterion for good agreement in this study, for 23/40 codes using the Vineland, 17/40 codes using the PEDI, and 17/40 codes using the SFA. The mean kappa statistic reached ⩾ 0.70 for the Self care domain, using all three tools. The mean kappa statistic also reached ⩾ 0.70 for Learning and Applying Knowledge and Mobility using the Vineland.Conclusions: Independent raters reached high rates of agreement when assessment test items were structured developmentally and corresponded to a single ICF code. For domains other than Self care, alternative assessment strategies may be necessary to improve assigning ICF codes to children with disabilities.

The development of the School Function Assessment Chinese version for cross-cultural use in Taiwan.

The primary purpose of this research project was to translate and adapt the School Function Assessment (SFA), a standardized criterion-referenced instrument that measures school-related functional skills, for its cross-cultural use in Taiwan. The project consisted of four study phases: translation, cultural adaptation, pilot testing, and field testing for standardization. A series of rigorous procedures including the method of translation and back-translation, team consensus for cultural adaptation, and Rasch modelling techniques were used to address various dimensions of cross-cultural equivalence and psychometric properties of the translated SFA. The protocols that were developed as well as technical issues that were addressed in this project provide useful guidelines for international occupational therapists who are interested in translating and adapting instruments for cross-cultural use.

Social—Behavioral Skills of Elementary Students with Physical Disabilities Included in General Education Classrooms

In this study, the authors examined strengths and limitations in the social—behavioral skills of elementary students with physical disabilities included in general education classrooms. The sample consisted of 62 special education students with physical impairments (25 girls &amp; 37 boys) attending kindergarten through Grade 6 in public schools. Students with cognitive or sensory impairments were excluded. Teachers and related services personnel rated these students' skills using Part III, Activity Performance, of the School Function Assessment. On 6 of the 7 scales, more than 40% of the students performed below the grade-expected level. Findings were similar for the exploratory composite scales examining initiative and social problem-solving. Low total scores reflected more frequent ratings of inconsistent performance on skill items rather than an inability to perform. Although these difficulties are subtle, they may limit effective school participation.

Validity and Reliability of the School Function Assessment in Elementary School Students with Disabilities

This study examined validity of the School Function Assessment (SFA) and interrater reliability of occupational therapist and teacher ratings of students' school function. The validity of the SFA was examined using the known-group method in 35 participants in kindergarten through 7th grade attending elementary schools; 15 students with learning disabilities (LD), 11 students with autism, and 9 students with traumatic brain injury (TBI). The SFA criterion scores for the 23 individual scales were clustered into five distinct parts for the validity analyses. Significant differences in SFA scores among the 3 groups of students were found using Kruskal-Wallis analyses (χ2 ranged from 9.28 to 20.55, p< .01). Two discriminant analyses demonstrated high correct classification of students with autism and LD, but showed less accurate classification of students with TBI, indicating that the SFA scores of students with TBI did not fall into a systematic pattern for classification. For the interrater reliability study, 16 students' ratings by their teacher and occupational therapist were analyzed. Intraclass correlations resulted in moderate relationships between teacher and occupational therapist ratings for the average criterion scores for the three main sections of the SFA: participation, .70; task supports, .68; and activity performance, .73. Results of this study are discussed in terms of validity of score interpretation and the reliability of different team members completing the SFA questionnaire.

Validation of School Function Assessment with Elementary School Children

The present study was conducted to examine the validity of the School Function Assessment (SFA). The study sample consisted of 64 children: 29 in general education (GEN) without disabilities, 18 with learning disabilities (LD), and 17 with cerebral palsy (CP). Convergent validity was supported by the significant correlation (r values ranged from .56 to .72) found between the scores on the Vineland Adaptive Behavior Scales (classroom edition) to comparable scales of the SFA. Construct validity of the SFA using the known groups method was also supported. Significant differences in SFA scores among the 3 groups were found using the Kruskal-Wallis analysis of variance and multiple comparisons. The GEN group differed from the LD group in cognitive/behavioral subtests, the CP group differed from the GEN group in all areas of the SFA, and the LD and CP groups differed on the physical domain of the SFA. Finally, the discriminant analysis of scores on the SFA showed the high percentage of participants being correctly classified in the respective groups (93.1% for GEN, 55.8% for LD, and 88.2% for CP). These results provide new evidence for the validity of the SFA using methodologies not previously reported in the literature. Given the unique features as well as the provided psychometrical properties of the SFA, this recently developed functional assessment should be considered a valid instrument for use in school settings.

Measuring Assistive Technology Outcomes in Schools Using Functional Assessment

Assistive technology is used to help maximize the educational outcomes of students with disabilities. However, few schools or districts effectively measure the outcomes of assistive technology. This article describes activities of Project OATS (Outcomes of Assistive Technology in the Schools), including identification and piloting of existing assessment instruments for possible use as an outcome measure; examining the validity of an existing instrument called the School Function Assessment (SFA), and field testing the School Function Assessment-Assistive Technology Version, an adaptation of the SFA.

Predicting elementary school participation in children with disabilities

Objective: To identify predictors of participation in school activities from two sets of functional variables using classification and regression tree analysis.Design: Relational study.Participants: A nationwide sample of 341 children with various disabling conditions, including physical and cognitive/behavioral types of impairment and various severity levels. Children attended public elementary school in 40 states in the United States.Main Outcome Measure: Overall participation in elementary school, combining children's participation in six different environments (transportation, transitions, classroom, cafeteria, bathroom, and playground), as measured by the newly developed School Function Assessment. The children were dichotomized into full (n = 117) and limited (n = 224) participation categories.Results: Two classification trees were developed identifying a small set of predictors from variables measuring performance of functional tasks and discrete activities. Final predictive models included physical and cognitive-behavioral variables, suggested important interactions among predictors, and identified meaningful cut-off points that classified the sample into the outcome categories with about 85% accuracy.Conclusions: Limited participation was predicted by information about children's physical capabilities. Full participation was predicted by a combination of physical and cognitive-behavioral variables. Findings underscore the relative utility of functional performance compared with impairment information to predict the outcome, and suggest pathways of influence to consider in future research and intervention efforts.

Factor Structure of the School Function Assessment

The School Function Assessment (SFA) was developed to provide information on students’ abilities to meet functional demands of the elementary school program. This judgment-based, criterion-referenced assessment supports a comprehensive, detailed examination of the extent to which students with a variety of disabilities are performing important school-related functional tasks and activities such as moving around the school, using classroom materials, interacting with peers, and caring for personal needs. The factor structure underlying the SFA Activity Performance scales was investigated using data from two heterogeneous national samples of students with disabilities ( n = 266 and n = 341). Analysis with the principal axis technique and oblique rotation identified two factors, a Cognitive/Behavioral Function dimension and a Physical Function dimension. These factors were moderately correlated, which is congruent with definitions of the function construct that emphasize the integration of physical, cognitive, and social abilities in the performance of daily activities in the natural environment.