Combining the International Classification of Functioning (ICF) with Standardized Testing: An In-Depth Look at Squatting

Devin likes to go fishing; it’s his favorite hobby.  He is a five-year old boy with a diagnosis of bilateral cerebral palsy, GMFCS level 1.  Devin perches at the river’s edge in a deep squat in order to catch a glimpse of the trout beneath him.

Deep squatting is useful for a variety of reasons, like getting close to the floor to see something clearly, or to rest without getting on knees or bottom.  It requires adequate hip flexion range, ankle range, and postural control.  It is a developmental milestone.

When I look at the drawing of Devin, I wonder why:

  • Devin has an inverted foot position on right.
  • His low back position shows excessive lumbar flexion during a deep squat.
  • His pelvis is posteriorly tilted.
  • He is stabilizing, or limiting his degrees of freedom, by bracing his right elbow on his right knee and resting his chin firmly on his left knee.

Today, Devin is at his physical therapy re-evaluation.  As mentioned, his main activity to support his health and well-being/participation is fishing.  He beams when he mentions that every Saturday he goes to the local river to fish with his dad and a neighborhood friend.  One activity that supports this participation is his ability to perform a deep squat.  He crouches down every Saturday on a rock overlooking his favorite fishing hole.  Devin’s impairments , historically, have been tight heel cords, poor central stability (core strength), and poor postural control.

The Gross Motor Function Measure-66 will be used as a criterion measure to assess Devin’s gross motor progress over the last six months.  When looking at item 63 on the Gross Motor Function Measure-66 (GMFM-66) it focuses on deep squatting.

63. Standing: Attains squat, arms free.   0☐  1☐  2 ☐  3☐

Squat is defined as crouching close to the ground with both the hips below knee level.

In this item, Devin scores a 2 because he is using his hands on the ground or on his body for stability.

When previously tested he was scored a 1 because he couldn’t attain the hips below knees position and fell backward to sitting.

Perhaps the activity of squatting with hands free would be a good goal for the next time period of treatment.  This would be a score of 3. It would help Devin become more stable and aligned during his fishing trips.

I hope this provides a helpful example of how participation, activity, impairment and standardized testing can fit together with ease when looking at one young boy’s chosen goal.

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