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Basic Gross Motor Assessment

Tool for Use with Children Having Minor Motor Dysfunction

JEANNE E. HUGHES, MS
and ANN RILEY, MA

Children with minor motor problems are often referred for evaluation of these
problems to physical therapists who work in educational environments. Mea
sures that therapists use to assess seriously disabled children are often inap
propriate for these children. The Basic Gross Motor Assessment was developed
after analyzing research on minor motor dysfunction. Standard procedures were
outlined and a sample of 1,260 randomly selected children aged 5 years 6
months to 12 years 5 months served for norming purposes. Validity and reliability
studies were completed with an additional 285 subjects. The Basic Gross Motor
Assessment is presented as a useful tool for evaluating minor motor problems
in children and identifying those children who require further physical therapy
assessment and perhaps direct treatment.

Key Words: Motor skills, Evaluation studies, Child development, Physical therapy.

Physical therapists who work with children in clin- higher level of performance than that expected of the
ics and in educational environments are uniquely more seriously disabled child.
prepared to evaluate the motor performance of phys-
ically handicapped and developmentally disabled PROBLEM
children. Postural reflexes, joint range of motion,
muscle strength, gait, posture, and ability to perform Since the late 1960s, large numbers of children with
activities of daily living are among the areas tradi- minor motor dysfunction have been referred to our
tionally assessed by therapists. There is a group of motor development program in the Denver Public
children often enrolled in special education programs, Schools. This situation led to our comprehensive
however, who do not have specifically diagnosed search for measurement devices to assess these chil-
physical handicaps and for whom the above-listed dren's motor problems. Criteria used to evaluate doz-
measures are not fully appropriate. Children in this ens of published tests included 1) age norms for
group walk, run, and play and seem to perform children 6 to 12 years of age, 2) standardized admin-
reasonably well, but they are referred to the physical istration procedures and directions, 3) a scoring sys-
therapist for evaluation because of clumsiness and tem that quantified the quality of movement, 4) va-
inefficient motor behaviors. Careful observation re- lidity and reliability data, 5) a minimum of equip-
veals a lack of motor skill or minor motor dysfunction ment, and 6) reasonable administration time. In ad-
in these children compared to normally functioning dition, we sought a measurement tool that might
children. An evaluation of the motor difficulties of discriminate between children whose motor aberra-
these children is necessary but should begin at a tions were probably due to experiential lags and those
whose performance indicated a need for medical
Mrs. Hughes is a physical therapist and an adapted physical referral, physical therapy evaluation, and possible
education specialist for the Denver Public Schools, Department of
Special Education, 900 Grant St, Denver, CO 80203 (USA).
treatment. Because no one test met these require-
Ms. Riley is a graduate fellow in Research and Evaluation Meth- ments, we decided to develop a test that would yield
odology, Laboratory of Educational Research, University of Colo- the desired information about a child's motor per-
rado, Boulder, CO 80309.
This article was submitted September 28, 1979, and accepted Sep-
formance. The resulting test is now known as the
tember 15, 1980. Basic Gross Motor Assessment, BGMA.1 The purpose

Volume 61 / Number 4, April 1981 503


of this paper is to describe the development of this a child's gross motor problems rather than investigate
measure. these controversies.
One reason for the evaluation of motor perform-
REVIEW OF LITERATURE ance problems and development of remedial pro-
grams for children having minor motor dysfunction
Essential to the development of the BGMA was a
may be found in the fact that these children are
description of the nature of the disability to be eval-
vulnerable to the social-emotional pressures of family
uated. An investigation of the theoretical positions,
and peers. This problem is summarized by Stewart
definitions, and terminology associated with motor
and Old's comment that "the cruelest problem facing
development and dysfunction made apparent the
an ungainly child is social failure."8
great breadth of the topic of minor motor dysfunction.
The massive amount of literature on this subject has Gross motor development has been operationally
been generated by professionals in several different defined by Hoskins and Squires as the sequential
areas of medicine, education, and psychology. Our integration of automatic, stereotyped, reflex phenom-
major concerns were to describe the types of children ena leading to the emergence of voluntary, discrete,
for whom the BGMA would be most appropriate, to nonobligating motor behaviors concerned with pos-
define the concept of gross motor abilities, and to ture and locomotion.9 Elaboration of the gross motor
determine a rationale for choosing tasks to be in- concept by Arnheim and associates details a universe
cluded in the assessment. of 45 gross motor behaviors.10 The movements listed
range from crawling and walking to catching and
The available evidence indicates that educable and
throwing.
trainable mentally retarded children often lag behind
children of normal intelligence in motor development A theory important to the development of the
and performance and that these defects range from BGMA and supported by a number of studies is that
minor to severe.2 In addition, there are children with essential gross motor abilities develop during the first
motor problems in the absence of mental retardation five years of life and stabilize at the end of the fifth
or physical disability who are described as having year.
developmental clumsiness,3 perceptual motor prob- The neurodevelopmental techniques developed by
lems,4 or sensory integrative difficulties.5 The term the Bobaths for the treatment of cerebral palsy pa-
clumsy is imprecise and possibly pejorative, but it is tients derive in part from the development of normal
used by many concerned with children having minor children. The Bobaths state that the normally devel-
motor dysfunction. oping child has good control of his balance by about
Gubbay made a detailed study of the clumsy child the age of five years.11 He can jump, play games, and
syndrome, including the range of possible causes.3 coordinate selective and precise movements of his
Two distinct approaches to defining the subject were hands for manual skills. From this age, motor devel-
identified in his careful review of relevant literature. opment slows down and no drastic or rapid changes
Some writers, he found, view the clumsy child syn- take place, although coordination and skills continue
drome as a precise entity that may be unrelated to to improve during the rest of school life.11
intelligence, behavior, or learning. Others have re- The five- to six-year period in a child's develop-
garded developmental clumsiness as one characteris- ment is regarded by Williams as the end of a major
tic of minimal cerebral damage, grouping it with growth epoch.12 Although many refinements in gross
hyperkinesis, emotional lability, specific learning dis- motor behavior are likely to occur in the years that
ability, perceptual problems, and equivocal neuro- follow, by the end of the fifth year the child can
logic signs.3 perform most simple gross motor patterns with nearly
The concept that minor motor dysfunction is one as much fluency as a skilled adult can.12
condition often found in children having learning The remainder of this paper will present three
disabilities can be traced to the classic studies by studies conducted during the development of the
Strauss and Lehtinen, who described behaviors, in- BGMA. The first study was done to establish admin-
cluding clumsiness, in children with a history of brain istration procedures and age norms for the various
damage.6 A number of approaches to the remediation tasks. The second study collected various estimates of
of learning disability place emphasis on visual-motor reliability of the BGMA. Documenting the validity
and perceptual-motor evaluation and programming. of the BGMA was the purpose of the final study.
Theories regarding the relationship between efficient
motor performance and academic achievement and STUDY 1
claims for the efficacy of various treatment methods
have been subjected to considerable scrutiny and The BGMA was developed to evaluate gross motor
criticism.7 We have chosen to focus on the nature of performance of children aged 5 years 6 months to 12

504 PHYSICAL THERAPY


years 5 months who seem to have motor problems. phart19; the Frostig Movement Skills Test Battery,
We hypothesized that if basic gross motor abilities Orpert20; the Test of Motor Impairment (Revised,
stabilize during the fifth year, as reported in the Oseretsky), Stott, Moyes, and Henderson21; and Neu-
preceding studies, then the test should contain tasks rological Examination of Child with Minor Motor
representative of gross motor abilities normally mas- Dysfunction, Touwen and Prechtl.22
tered by this age. Further, these basic tasks should be Nine gross motor tasks were finally selected for
accomplished with ease by normal children from inclusion in the BGMA. Good performance and pos-
kindergarten through grade six. sible deviations were defined for each. An example
of the deviation model is given in the description of
Method Task 1. For the other tasks only brief descriptions of
performance are provided here.
The first step in developing the BGMA was to Task 1, standing balance on one leg, eyes open.
choose the tasks to be included and decide how to The child was instructed to look at a point at his eye
score them. In addition to the examination of the level while standing first on the left leg, then on the
literature previously described, the process of item right, each for 10 seconds. While performing the
selection included extensive observations of the motor tasks, the child's arms were at his sides and the
performances of both regular and special education opposite leg flexed to 90 degrees. The task was then
children in physical education classes at all grade repeated with the child holding his arms crossed over
levels. Considerable attention was also given to these his chest, which added mild stress to balance mecha-
children during their participation in spontaneous nisms. Good performance with a grade of 3 was
play. After specific tasks were chosen for the test, achieved when the child held each of these four
children of various ages were videotaped as they positions separately without any of the following
performed these tasks. These tapes were carefully deviations: 1) leaning the flexed leg against the sup-
reviewed to determine the elements of good perform- porting leg, 2) excessive flailing of the arms protec-
ance. tively, 3) excessive swaying of the body, or 4) jumping
Although the quality of any individual's motor about on the supporting leg to maintain balance.
performance will vary from one observation to the Task 2, standing balance with eyes closed. The
next,13 Safrit argues that aspects of good performance requirements for this task were exactly as for the first
can be defined and measured accurately.14 In her task, except that the eyes were closed.
model, the most important components of the ability Task 3, stride jump. This movement began with the
are identified and a scale is then devised to measure child standing feet parallel in body alignment. He
performance against the components.14 An example then jumped up to land with his feet about 12 to 18
of this method is the judging of gymnastic perform- in (30.5-45.7 cm) apart and then jumped again to
ance.15 Zausmer has suggested that information about return to the starting position. These two movements
how a child with a motor disturbance performs a task constituted one stride jump. Ten jumps were observed
is more important than an indication of whether he while the child followed the examiner's rhythmical
can or cannot do the task.16 count.
Following the concept of measuring performance Task 4, tandem walking. The child was asked to
quality, we devised a system for quantifying perform- walk forward and backward. He walked the length of
ance based on deviations from good performance. a 10-foot (304.8-cm) line taped on the floor, touching
Good performance was defined for each of the tasks heel to toe with each step.
later selected and given a score of 3. Each deviation Task 5, hopping on one foot. The child was in-
observed in a child's performance of a task subtracted structed to hop first on the left leg and then on the
one point from the score for that task. This resulted right while proceeding between two lines taped on
in the following possible point scores for each item: the floor, 18 in (45.7 cm) apart.
3 = good (no deviations), 2 = fair (one deviation), 1 Task 6, skipping. The child was instructed to skip,
= poor (two deviations), 0 = (unable to perform task which required hopping first on one foot and then the
or more than two deviations). other while making rhythmical forward progression.
To assist in defining the quality of gross motor Experience and training probably have some effect
performance and the selection of criteria for scoring, on skipping. Older children, especially boys, were
six well-known tests containing gross motor tasks sometimes able to skip but reluctant to do so because
were reviewed. These tests were the Southern Cali- they apparently viewed the task as "childish."
fornia Perceptual Motor Test, Ayres17; the Six Cate- Task 7, target throwing with bean bags. The child
gory Gross Motor Test, Cratty and Martin18; The was instructed to throw bean bags with a simple
Purdue Perceptual-Motor Survey, Roach and Ke- underhand toss, one at a time, into the 18-in (45.7-

Volume 61 / Number 4, April 1981 505


TABLE 1 child's age. The child was required to swing the ball
Ages of Subjects on the string, toss it, and catch it in the container.
Group (mo) S
Task 9, ball handling. Catching, throwing, and
bouncing or dribbling a ball were included. Several
6-year-olds
aspects of the task were varied according to the child's
Boys 72.83 3.52
Girls 72.94 3.63 age: size of the ball, distance between the examiner
7-year-olds throwing the ball and the child catching it, and
Boys 84.78 3.76 bounce or dribble of the ball. Although experience is
Girls 84.92 3.51 necessary for ball-handling skills, school-aged chil-
8-year-olds
Boys 96.53 3.21
dren in nearly every culture have had some experi-
Girls 97.44 3.53 ence with ball play. Skill involved in control of the
9-year-olds ball was considered to reveal motor dysfunction quite
Boys 109.01 3.66 clearly.
Girls 109.04 3.82
10-year-olds
The second step in this study was to determine the
Boys 120.93 3.45 typical performance of 6- to 12-year-old children on
Girls 121.34 3.79 the nine tasks described above. To ensure standard-
11 -year-olds ized administration of the BGMA, the area to be
Boys 134.20 3.57 designated for testing, equipment to be used, and
Girls 133.80 3.72
12-year-olds
specific directions to the child were detailed.
Boys 145.65 3.63 A sample of 1,260 children was selected from the
Girls 145.25 3.48 population of children in Denver Public Schools. This
population was stratified by race and socioeconomic
status, sex, and grade level. First, the city was divided
cm) square taped on the floor. Distance from the into four quadrants that contained different racial
target was increased the greater the child's age. and socioeconomic status groups. From these four
Task 8, yo-yo. This was a novel task that used a quadrants, 18 schools were selected, so as to provide
plastic container with a handle, to which a ball was equal representation of racial and socioeconomic sta-
attached by a string. The size of the container and tus groups. Five boys and five girls from each of
the weight of the ball were changed according to the seven grades (kindergarten through sixth grade) were

TABLE 2
BGMA Total Scores and t Values for Difference Between Mean Total Scores by Sex

n Total s SE t
Score
6-year-olds
Boys 90 32.7 5.3 2.36 - .33
Girls 90 32.9 4.6 2.17
7-year-olds
Boys 90 46.9 6.1 3.09 - .47
Girls 90 47.3 5.7 3.04
8-year-olds
Boys 90 49.1 6.8 2.89 .52
Girls 90 48.6 5.0 2.77
9-year-olds
Boys 90 50.2 4.9 2.65 .78
Girls 90 49.6 5.1 2.78
10-year-olds
Boys 90 51.5 4.2 2.21 2.70 a
Girls 90 49.7 4.7 2.73
11 -year-olds
Boys 90 52.5 3.8 1.89 2.10 b
Girls 90 51.2 4.8 2.33
12-year-olds
Boys 90 52.6 3.8 2.17 -1.33
Girls 90 53.3 2.6 1.94
a
p<.01.
b
p < .05.

506 PHYSICAL THERAPY


then randomly selected from each school. Children Discussion
in special education had been excluded before the Three major conclusions were drawn from this
sample was drawn. The study was conducted for four study. First, although normal six-year-olds performed
months during the second semester of the school year. well on most of the tasks selected, three tasks were
The mean and standard deviation of the ages of the difficult for some, indicating that we had chosen tasks
children in the sample are reported in Table 1. The that were harder than anticipated. Second, standing
nine BGMA tasks were administered to each child in balance with eyes closed is probably not a task that
the sample by the same examiner. discriminates between aberrant and normal motor
performance. Third, a number of conditions and be-
Results haviors need to be considered in assessing motor
performance.
The mean score for each of the nine tasks was
calculated for each age group. Based on these results, STUDY 2
two minor changes were made in the assessment. No
group received a mean score above 2.64 for Task 2 In addition to age norms and standardized proce-
standing balance with eyes closedalthough the dures, we wished to estimate the reliability of the
scores did improve from 1.84 for the 7-year-olds to BGMA. Three estimates were obtained: one compar-
2.64 for the 12-year-olds. When compared to mean ing the same children's scores at different times, one
scores for the other tasks at each age level, this task comparing several raters' scores of the same children's
seemed difficult for most of the subjects and was performances, and the last comparing the items for
dropped from the final battery on the assumption internal consistency.
that if standing balance with eyes closed was difficult
for normal children then it was not a good discrimi- Method
nating task for identification of children having motor
problems. Inasmuch as motor task performance is not exactly
Three tasks proved to be too difficult for the aver- the same on all occasions,13 the first source of varia-
age six-year-old children and these were eliminated bility was that within the performers themselves. A
for this age group only. These tasks were 1) standing coefficient of stability was estimated using a test-retest
balance with eyes open and arms crossed over the procedure. The subjects were 48 students chosen from
chest, 2) stride jump, and 3) yo-yo. special education and physical education classes. The
The descriptive statistics of total scores for each age BGMA was administered to these subjects twice, with
group and the results of a t test comparing boys' and a two-day interval between sessions.
girls' scores are presented in Table 2. In the total The scoring of the BGMA is also dependent upon
scores, the only sex differences that were significant the consistency with which different raters observed
(p < .05) were for the 10- and 11-year-olds in favor performance. The consistency of different raters' us-
of boys. Subtest scores were also analyzed, using a t ing the BGMA was determined using a measure of
test comparison of boys' and girls' scores. Eleven- interrater reliability. The BGMA was administered to
year-old boys were better at catching and throwing 10 children, whose performance was observed and
the ball than 11-year-old girls were; girls at all ages rated by five different professionals: a kindergarten
were better at skipping than boys were. These findings teacher, a special education teacher, a physical edu-
should be considered in test interpretation. cation teacher, an occupational therapist, and a phys-
In addition to the deviations for each specific task, ical therapist. The subjects were chosen from a pop-
conditions and behaviors of a more general nature ulation of children enrolled in a regular physical
were observed with some children in the sample. Of education class who had been referred by their
these, 32 are listed on the BGMA protocols. The teacher as having possible motor performance diffi-
examiner can use this list to help structure observa- culties.
tions of the child's behavior and account for some The final estimate of reliability was calculated us-
conditions during the administration of the test. The ing all the data from the original norming group
list is also used in determining the need for further (1,260 subjects). An internal consistency coefficient
physical therapy evaluation. Examples of conditions was calculated for each age level.
or behaviors that were noted during the children's
participation in the assessment included 1) unusual Results
size for age, particularly obesity, 2) poor posture, and
3) tendency to switch hands during the execution of The results of the reliability study are summarized
a task. in Table 3. The test-retest reliability coefficient sup-

Volume 61 / Number 4, April 1981 507


TABLE 3 reliability, is usually not easily or directly estimable.
Results of BGMA Reliability Studies During the development of the BGMA, a three-step
Calculation
study was conducted to provide evidence concerning
Type of Reliability Used
Value the content, construct, and concurrent validity of the
instrument.
Stability Pearson r .97 (n = 48,
p<.001)
Interrater Hoyt .97 (n - 5, Method
p<.001)
Internal consistency Hoyt .71 (n = 180,
P<01)
Content Validity. The tasks chosen to represent the
universe defined as gross motor performance did not
include physical fitness, fine motor, or sports skill
ports the conclusion that children's performance does tasks. The BGMA was presented to a panel of six
not vary significantly from day to day. professionals for review and for suggestions for task
The interrater reliability was estimated at .994. The improvement before the tests were administered to
reliability of one rater was calculated using the Spear- the norming sample population.
man-Brown formula to adjust the reliability given Construct Validity. A construct is described as a
five raters. This estimate was .97 (Tab. 3). theoretical idea developed to explain and to organize
The internal consistency coefficient is the median some aspects of existing knowledge. In the review of
value obtained. These were calculated for each age literature, much evidence was found supporting the
level and ranged from .59 to .79. The estimates of construct of gross motor abilities. Our investigation
internal consistency are considerably lower than the of construct validity involved two procedures. We
other reliability coefficients. This was anticipated for predicted that special education children referred by
two reasons. First, the domain of gross motor skills is their teachers for evaluation of suspected motor dif-
probably heterogeneous. A child with good balance ficulties would not perform as well as the children in
may or may not have good ball-handling skills. This the sample drawn for norming purposes. Further, we
is supported in the literature on specificity of motor predicted that certain tasks in the BGMA would be
skills.23 Secondly, the reliabilities are probably atten- related because of the communality of skills required.
uated, particularly at the upper grade levels because To investigate the first prediction, BGMA scores
of a ceiling effect. The BGMA was meant to identify were compared for 81 special education and 81 age-
children with motor dysfunction and place them in matched children selected randomly from the appro-
order in terms of severity. It will not discriminate priate age group of the norming study sample. The
between an outstanding athlete and a normal child. children ranged in age from 6 to 12 years old. The
Most normal children can perform the tasks well special education children were from classes for ed-
enough to get nearly perfect scores. The result is a ucable mentally retarded, learning disabled, and
negatively skewed distribution that lowers the relia- emotionally disturbed children. An additional group
bility estimate. An additional study is currently being of trainable mentally retarded children had also been
conducted with special education students to estimate referred, but only one child in this group of 16 pupils
the test's reliability with this population. was able to score even 50 percent of the expected
average score. In fact, motor responses of these chil-
Discussion dren on the BGMA tasks with the quality criteria
were virtually unscoreable, which led to the conclu-
When tests are used to make decisions about indi- sion that the BGMA is probably inappropriate for
vidual children, high reliability is important. All of use with most severely retarded children.
the reliability estimates calculated for the BGMA are The comparison between the special education and
high enough to warrant confidence in the obtained normal children's scores at each grade level was done
scores. Total scores were used in all of the calcula- using a t test for the mean total scores of each group.
tions. The reliability of subtest scores will be much The second analysis of data to confirm the con-
lower, and therefore the scores on single subtests struct of gross motor ability was a factor analysis.
should never be used in isolation to make decisions Factor analysis is a statistical procedure used to de-
about children's needs. termine 1) how many factors (groupings) are needed
to account for intercorrelations among a set of test
STUDY 3 scores, 2) which factors determine performance on
each test, and 3) how much variance in test scores is
One of the most neglected aspects of test construc- accounted for by the factors. Tests that share common
tion is the determination of validity. Validity, unlike variance thus measure the same factor. The propor-

508 PHYSICAL THERAPY


tion of total variance in test scores that is attributable TABLE 4
to the factor can be used as an index of construct Mean Score Differences Between Referred Special
validity.24 Education and Norming Sample Children
The search for factors was initiated using the SPSS n X ta
Factor program.25 The principal factoring method
with iterations was used, and the initial factor solution AgeSpecial
6
education 11 17.72 -5.19
was rotated using Varimax criterion to achieve simple Norms 11 33.36
structure. Separate factor analyses were performed Age 7
for the seven age groups. When highly similar factor Special education 23 27.17 -7.98
structures were found for the individual age groups Norms 23 47.60
of 7 through 12 years, the data for those 1,080 children AgeSpecial
8
education 9 28.77 -7.05
were pooled to derive an overall principal factor Norms 9 50.22
structure. Age 9
Concurrent Validity. The third type of validity that Special education 7 29.85 -3.83
was considered was concurrent validity, which indi- AgeNorms 10
7 51.14
cates the extent to which a test may be used to Special education 17 34.05 -7.42
estimate an individual's current performance on a Norms 17 52.82
selected criterion. Age 11
The first estimate of concurrent validity was a Special education 6 34.66 -4.10
Norms 6 53.16
comparison of physical education teachers' ratings of Age 12
children's class performance with scores of the same Special education 8 38.37 -3.46
children on the BGMA. One girl and one boy at each Norms 8 53.62
grade level, one through six, were chosen at random a
p<.01.
from the class lists of teachers in the 12 schools where
teachers had agreed to participate in the study. The (low) on their ability in gymnastics, soccer, ball han-
teachers then rated the children from 5 (high) to 1 dling, physical fitness tasks, and agility. The same

TABLE 5
Initial Factor Loading Matrix, Ages 6 Years 6 Months Through 12 Years 5 Months Combined
Factor Factor Factor Factor Factor Factor Factor
1 2 3 4 5 6 7
Standing balance
Arms at sides, eyes open
Left leg .73
Right leg .83
Arms crossed, eyes open
Left leg .81
Right leg .84
Ball catch .83
Ball throw .79
Ball bounce .54
Standing balance
Eyes closed, arms at sides
Left leg .86
Right leg .86
Hopping left .75
Hopping right .92
Skipping .38
Yo-yo
Accuracy score .90
Form .82
Target
Accuracy score .79
Form .80
Dynamic balance
Walking forward .76
Walking backward .68
Eigenvalues 4.85 2.80 1.82 1.55 1.32 1.12 1.0
% of total variance 25.6 14.7 9.6 8.2 7.0 5.9 5.1

Volume 61 / Number 4, April 1981 509


TABLE 6
Correlations Between Teacher Observations and BGMA Total Scores
Physical
Gymnastics Soccer
Agility Rhythm Ball Fitness
Observation Observation
Scores
Grade 1
7-year-olds
total score .59 .63 c .55* .42 a .60 c .56*
Grade 2
8-year-olds
total scores .46 a .60 c .41 a NS .64 c .41 a
Grade 3
9-year-olds
total score .64 c .70 c .72 c .72 c .64 c .65 c
Grade 4
10-year-olds
total score .73 c .67 c .56* .63 c .54 b .43 a
Grade 5
11 -year-olds
total score .47 b NS .56* .69 c .43 b .60*
Grade 6
12-year-olds
total score .79 c .60 c .47 b .49* .44 b NS
a
p < 0.5 and >.01.
b
p < .01 and >.001.
c
p < .001.

children were also given the BGMA. The total scores input is primarily proprioceptive, visual, and vestib-
on the BGMA were correlated with each of the ular.
teacher's ratings. Factor 2: Elementary ball handlingability to or-
A second estimate of concurrent validity was made ganize perceptual motor responses required for simple
from the data previously collected from the interrater functions of ball control.
reliability. The mean scores given by the five raters Factor 3: Static balance, eyes closedequilibrium
were tested for significant difference using a repeated-reactions as in Factor 1 except without visual input.
measures ANOVA. Factor 4: Leg strength and balanceincorporation
of strength to elevate body on one foot with ability to
Results maintain balance on same foot when landing and
while making rhythmical forward progression.
Content Validity. The suggestions and comments Factor 5: Object controlability to initiate smooth,
made by the professional reviewers were incorporated rhythmical hand and arm movements to control an
into the final test items. object moving through a restricted range, using visual
Construct Validity. The comparison between the and proprioceptive feedback.
special education and norming sample children re- Factor 6: Aimingability to focus on a target
sulted in significant differences in means favoring the visually and to project an object through space with
normal children at each level (Tab. 4). proper force, accuracy, and coordination to hit a
The factor analysis resulted in seven factors with target.
eigenvalues of 1.0 or greater and together accounted Factor 7: Dynamic balancepostural stability in
for 76 percent of the total variance. Inspection of the motion, with equilibrium control constantly keeping
data shows seven readily interpretable factors for 7- body center of gravity over changing base of support
to 12-year-old children (Tab. 5). The group of six- in movement.
year-olds had the same general factor structure except Task 3, stride jump, did not correlate with any
for static balance with eyes closed, a task that had other task in the BGMA group and thus did not
been eliminated from the battery for this age group. emerge as a factor. However, the task was retained in
The seven factors were named and defined as follows: the assessment for its value in discrimination of motor
problems.
Factor 1: Static balance, eyes openequilibrium Concurrent Validity. The results of comparison
reactions that maintain the body in an upright posi- between BGMA scores and teacher ratings for 7- to
tion but without movement through space. Sensory 12-year-olds are reported in Table 6.

510 PHYSICAL THERAPY


The correlations are significant in 33 of 36 cases. the groups also supports the construct validity of the
The repeated-measures ANOVA of the interrater re- BGMA.
liability data provides no reason to believe that the The evidence for concurrent validity is also sup-
total scores given by the five raters were different in portive. The scores on the BGMA correspond very
any important way (F = 1.375, df = 4, p < .26). well to the observations made by the physical edu-
Although they came from different professional dis- cation teachers, and different raters gave approxi-
ciplines, the BGMA structured the raters' observa- mately the same score to children on the BGMA.
tions so that the scores they gave were essentially the
same. CONCLUSIONS

Discussion Physical therapists are being employed or con-


tracted to work in educational environments in ever-
The evidence of the factor structure supports the increasing numbers since the passage of Public Law
construct validity of the BGMA. The factors were 94-142. Handicapped children from several categories
predictable and interpretable from the theory upon of special education who have minor motor dysfunc-
which the test was based. tion are being referred to these therapists for assess-
Using the scores on the BGMA, children having ment of gross motor performance. We believe the
minor motor dysfunction can be identified from nor- BGMA meets the requirements of a good assessment
mal children. The special education children in the tool and can be used with confidence for making
study were expected to score lower because of the program decisions for these children.
motor problems generally associated with other hand- Acknowledgment. We wish to acknowledge the
icaps and because this group had been referred spe- cooperation of the children, teachers, and administra-
cifically for evaluation of suspected motor difficulties. tors of the Denver Public Schools in making this
This confirmation of the expected differences between project possible.

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