The Montre ´al Rehabilitation Performance Profile: A Statistical Model for Assessing Stair Descent in Children With Cognitive Impairments Lucie C. Pelland, PhD, Patricia A. McKinley, PhD ABSTRACT. Pelland LC, McKinley PA. The Montre ´al Rehabilitation Performance Profile: a statistical model for assessing stair descent in children with cognitive impairments. Arch Phys Med Rehabil 2003;84:1813-22. Objectives: To characterize the responsiveness of the Mon- tre ´al Rehabilitation Performance Profile (MRPP); to measure the differential effectiveness of a task-specific (TS) and a task-nonspecific (TNS) motor learning format to promote al- ternating stair descent in children with cognitive impairments; and to evaluate the relevance of the MRPP to evidence-based practice. Design: Randomized comparison of 2 age-matched groups; psychometric testing of measurement tool. Setting: School for children with developmental and cogni- tive impairments. Participants: Ambulatory sample of convenience: 18 chil- dren, age 5 to 9 years, with moderate to severe cognitive impairment. Interventions: Not applicable. Main Outcome Measures: The MRPP variables measured at baseline; end of 10-week intervention; and 5 and 10 weeks postintervention. Analysis of variance for repeated measures and part-whole correlation. Results: Global stair descent performance improved for both TS and TNS groups over time (P=.001). However, a specific acquisition and retention of the alternating pattern of descent was associated with the TS format. Conclusion: The MRPP was responsive to small differences in stair descent performance that are specific to the format of the motor learning intervention. The MRPP allows clinicians to determine the timing of the intervention needed to maintain or improve stair descent ability. Key Words: Child; Cognition disorders; Evidence-based medicine; Motor skills; Rehabilitation. © 2003 by the American Congress of Rehabilitation Medi- cine and the American Academy of Physical Medicine and Rehabilitation C HILDREN WITH MODERATE to severe cognitive im- pairments are at high-risk for developmental delays 1 that will limit abilities in different spheres of daily functioning. A key concern for this population is the impact of delays in gross motor development in acquiring safe and independent mobility skills that are supportive of community participation. Safe stair descent is an important skill to consider, because falls on stairs can result in injuries that are potentially preventable. Although children generally acquire the ability to alternate feet while walking down the stairs in a safe and independent manner by 6 years of age, children with cognitive impairments typically continue to apply a tap-step strategy to stair descent 2 (this consists of stepping down onto a step with 1 foot and placing the trailing foot beside the lead foot on the same step until staircase descent is complete). Inherently, the tap-step pattern offers stability through its phase of double-support on 1 step, in contrast to single-leg support required for alternating stair descent. However, the double-support phase requires an active braking of the forward momentum of descent to allow the trailing foot to be placed on the step. This active breaking invokes additional anticipatory postural control responses that may not be available to the child with cognitive impairment. The perseverance of the tap-step pattern of stair descent there- fore predisposes these children to falls when required to in- crease the rate of stair descent. Because adaptation to an increased rate of descent is an important functional ability for community participation, it is generally considered that an intensive motor learning interven- tion will benefit children with cognitive impairments, possibly diminishing the impact of the developmental delay on overall functional capacity and promoting safe and independent stair descent. 3 Clinical practice guidelines have yet to be clearly defined concerning the motor learning format, frequency of sessions, and total duration of the intervention that would be most effective in promoting the acquisition and retention of this important mobility skill in children with cognitive impair- ments. The lack of evidence needed to establish appropriate clinical practice guidelines arises primarily from difficulty in achieving a reliable evaluation of the main effects of a motor learning intervention on skill acquisition in children with cog- nitive impairments. For example, standardized scores of motor performance obtained on motor development scales, such as the Bruininks-Oseretsky Test of Gross Motor Performance, 4 cannot be reliably interpreted for these children because it is impossible to determine if poor performance is related to a child’s difficulty in performing the task or to the child’s inabil- ity to understand the requirements of the standardized task. 5 Also, inferences made on the basis of 1 standardized score cannot be generalized to functional capacity in the community because the motor responses of these children tend to vary 6-10 and be highly influenced by the environmental context in which the task is performed, 11 and therefore are unpredictable. As a result, it is difficult for clinicians to establish measures of performance that would be reliable in terms of content validity and responsiveness and that would permit a reliable quantifi- From the Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON (Pelland); School of Physical and Occupational Therapy, McGill University, Montreal, QC (McKinley); and Constance Lethbridge Rehabili- tation Center, Montreal, QC (McKinley), Canada. Presented in part at the Canadian Physiotherapy Association Annual Congress, June 19 –23, 1997, Winnipeg, MB, and as a poster at the Society for Neurosciences Annual Meeting, October 25–30, 1997, New Orleans, LA. Supported by Les Fonds de Recherche en Sante ´ du Que ´bec (studentship) and an Eileen Peters McGill Fellowship. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Reprint requests to Lucie Pelland, PhD, Faculty of Health Sciences, Physiotherapy Program, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada, e-mail: Lpelland@uottawa.ca. 0003-9993/03/8412-8164$30.00/0 doi:10.1016/j.apmr.2003.03.008 1813 Arch Phys Med Rehabil Vol 84, December 2003