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Japanese Journal of Comprehensive Rehabilitation Science (2017)

Original Article

Differences in evaluation of functional skills of the PediatricEvaluation of Disability Inventory (PEDI) between normallydeveloping children and children with cerebral palsy
Keiko Onogi, MD, PhD,1 Izumi Kondo, MD, PhD,2 Yoshimi Asagai, MD, PhD,3Eiichi Saitoh, MD, DMSc4
Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
3
Shinano Iryofukushi Center, Suwa, Nagano, Japan
4
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
1
2

Abstract
Onogi K, Kondo I, Asagai Y, Saitoh E. Differences in
evaluation of functional skills of the PediatricEvaluation of Disability Inventory (PEDI) between
normally developing children and children withcerebral palsy. Jpn J Compr Rehabil Sci 2017; 8: 37-43.
Objective: The Pediatric Evaluation of Disability
Inventory (PEDI) provides functional skills scales
based on the data obtained from normally developingchildren. In the present study, we performed ananalysis of children with cerebral palsy using the same
methodology as set originally to examine differencesin discrete skill items between the two groups ofchildren.
Methods: Six hundred and two children with cerebral
palsy were divided into groups based on the severityof disorder as described in the Gross Motor Function
Classification System (GMFCS). The scaled scores for
the PEDI functional skills were computed by Raschanalysis.
Results: Correlation coefficients between the scaled
scores of children with cerebral palsy and thosepresented in the PEDI original data were r = 0.890 for
self-care, r = 0.795 for mobility, and r = 0.943 forsocial function. In children in GMFCS level I, discretescores increased with age, whereas in children inlevels III, IV, and V, scores for mobility almost reached
the plateau in the age band of 4 to <6 years.
Discussion: In the difficulty level of functional skills,
Correspondence: Keiko Onogi, MD, PhD
Faculty of Rehabilitation, School of Health Sciences, Fujita
Health University, Toyoake, Aichi 470-1192, Japan.
E-mail: keionogi@fujita-hu.ac.jp
Accepted: February 25, 2017.
No benefits in any form have been or will be received fromany commercial party related directly or indirectly tosubjects of this manuscript.
©Kaifukuki Rehabilitation Ward Association 2017
doi.org/10.11336/jjcrs.8.37

the greatest difference was observed in mobility,
suggesting the need to establish a difficulty level offunctional skills that is adapted to the abilities ofchildren with cerebral palsy.
Key words: cerebral palsy, Pediatric Evaluation of
Disability Inventory (PEDI), functional skills, Raschanalysis
Introduction
Pediatric rehabilitation programs should reflect theevaluation of motor and mental functions—whichchange as the child grows up—and set appropriate
goals. In addition, the goals should be clear to all
stakeholders including parents/guardians andcaregivers as well as health care professionals. To
make a scientific assessment of the severity of disorderand motor function, a universal scale that meets thecriteria such as reliability and validity is needed [1].
Although various scales differing by institution andcountry have traditionally been used in pediatricrehabilitation, in recent years, standardized scales
including the Gross Motor Function Measure(GMFM), the Pediatric Evaluation of Disability
Inventory (PEDI), and the Functional Independent
Measure for Children (Wee FIM) have been used asendorsed by the Japanese Guidelines for Rehabilitationof Cerebral Palsy [2].
Among the above, the PEDI [3] is a scale for
evaluating both the capability and performance ofchildren in functional activities in daily living. In theevaluation of capability, functional skills (specificdaily life skills) that the child has already mastered are
confirmed and assessed. The evaluation of performanceassesses the extent to which the child needs assistancefrom a caregiver, or the level of environmental
modifications required to master the functional skills.
This helps avoid an effect on the child’s capability by
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Onogi K et al.: Differences in evaluation of functional skills of the PEDI between normally developing children and children with CP

environmental adaptations.
The evaluation domains of the PEDI are divided
into three subdomains, i.e. self-care, mobility, andsocial function, which are scored using the functional
skills scale (capable/unable to). In line with a detailed
manual, the scoring is done according to the diagnosis
based on what was found from the interviews withparents/guardians or the observations made bytherapists/educators who have daily contact with thechild. The scores by domain are transformed into
normative standard scores and scaled scores by Raschanalysis based on the data obtained from 412 normallydeveloping children in the northeastern region of theUnited States. The normative standard scores, set toyield a mean of 50 (standard deviation of 10), indicatesthe relative positions to the functional status presumed
from the age. Ninety-five percent of normallydeveloping children in each age group are distributedin the range of 30–70, which indicates that a child’s
normative standard score below 30 means his/herfunctional status is poorer than expected for his/herage. The scaled scores are ratings obtained bytransforming raw scores measured on an ordinal scale
into values indicated on an interval scale considering
the difficulty level of discrete items, and they vary
within the range of 0–100. The higher the score is, thehigher the difficulty level of the task that the children
can perform. The scaled scores enable the comparisonof children’s abilities on the same scale regardless ofage [4,5].
In the PEDI, the data used to calculate the scaled
scores for the discrete items and create maps illustrating
the difficulty levels is that obtained from normallydeveloping children. Therefore, there may be a gap
between the difficulty level for disabled children andthe one for normally developing children. The purposeof the present study was to assess the functional skillsof children with cerebral palsy in Japan using the
PEDI and analyze the results by the same methodology
used in the PEDI in order to examine the differencecompared to the original data.
Subjects
The study included 602 children with cerebral palsy(351 males, 251 females) who underwent assessmentby the PEDI at 46 of the 63 facilities for children withdisabilities in Japan. The mean and median ages were
8.6 years (0–18 years) and 9 years, respectively. To
compare the data on the 602 children based on theseverity of disorder, they were divided into groups by
the Gross Motor Function Classification System(GMFCS).
GMFCS is a discriminant scale developed by
Palisano et al. Based on gross motor function focusing
on sitting and transfer abilities, it classifies the final
stage achieved at age 6 years or older into the following
five levels: I, Walks without Limitations; II, Walks
with Limitation; III, Walks Using a Hand-Held
Mobility Device; IV, Self-Mobility with Limitations;
May Use Powered Mobility and V, Transported in a
Manual Wheelchair.
Taking into account the change in motor function
with age, the GMFCS has age bands of under 2 years,
2 to <4 years, 4 to <6 years, 6 to <12 years, and 12 to<18 years, providing separate descriptions of motor
function corresponding to each age band for eachlevel. The rater classifies the severity of motor
impairment assuming, for each age, how the child isgoing to develop to the final level to be achieved [6].
The children included in the present study wereclassified as follows: GMFCS I, 52 (8.6%); II, 69(11.5%); III, 161 (26.7%); IV, 176 (29.2%); and V, 144(23.9%) (Table 1).
Methods
The functional skills (73 items for self-care, 59
items for mobility, and 65 items for social function)
were scored in accordance with the PEDI manual; for
institutionalized children, the scoring was performedby discussion among the staff who are familiar withthe daily activities of the respective children, and for
non-institutionalized children, by interview with theparents/guardians. To ensure the validity of scoring, atleast one person representing each facility participatedin the PEDI training prior to data collection to hear alecture and take the subsequent test.
We calculated the scaled scores for discrete
functional skills by Rasch analysis and computed thecorrelation coefficients compared to the “scaled scoresfor discrete functional skills on the basis of the data

Table 1. Children divided into groups by GMFCS.

(num.)GMFCS Level

I

II

III

IV

V

Sum

Under 2 years
2 to < 4 years
4 to < 6 years
6 to < 12 years
12 to < 18 years

0
7
14
26
5

2
6
11
38
12

1
22
22
79
37

0
14
17
89
56

6
37
18
55
28

   9
86
82
287
138

Sum

52

69

161

176

144

602

Jpn J Compr Rehabil Sci Vol 8, 2017

Onogi K et al.: Differences in evaluation of functional skills of the PEDI between normally developing children and children withCP
39

obtained from normally developing children” shownin the original PEDI. The Rasch analysis was
performed using Winsteps ver. 3.62.1 (Linacre JM,
Winsteps Com).
Next, in children with cerebral palsy, scaled scoresfor the discrete skills specified in the PEDI werecomputed for each level defined in the GMFSC, fromwhich mean scores by age were calculated to examine
the relationship between the scores for discrete skills
and age using multi-way analysis of variance.
The present study was carried out under the approvalof the Ethics Committee for Epidemiological andClinical Research of the university with which theauthor is affiliated.
Statistical analyses were performed by JMP 9.0.2
for computation of correlation coefficients and by
IBM SPSS Statistics ver. 23 for multi-way analysis ofvariance.
Results
Correlation coefficients between the scaled scores forfunctional skills computed by Rasch analysis of the dataon children with cerebral palsy and those on normallydeveloping children shown in the original PEDI were r =0.890 for self-care, r = 0.795 for mobility, and r = 0.943
for social function, demonstrating a low correlation in

mobility and high correlations in self-care and social
function (Figure 1).
In the scaled scores for mobility, the items thatexhibited higher scores in children with cerebral palsy
compared to normally developing children, namely theitems that were evaluated as being more difficult forchildren with cerebral palsy than for normally developingchildren were “Indoor locomotion–distance/speed: Item
29, Moves within a room with no difficulty, and Item 31,
Moves between rooms with no difficulty,” “Indoor
locomotion methods: Item 27, Walks without support,”and “Outdoor locomotion methods: Item 39, Walks
without support.” Meanwhile, normally developingchildren showed a higher score for “Toilet transfers: Item
1, Sits if supported by equipment or caregiver” compared
to children with cerebral palsy. In the scaled scores for
self-care, the items that exhibited higher scores in children
with cerebral palsy than in normally developing children
were “Use of drinking containers: Item 10, Holds bottleor spout cup” and “Use of utensils: Item 5, Finger feeds,”
while the item for which normally developing children
presented a higher score was “Hair brushing: Item 23,
Manages tangles and parts hair.” In the scaled scores forsocial function, children with cerebral palsy showed ahigher score for “Peer interactions: Item 31, Notices
presence of other children, may vocalize and gesture
toward peers” compared to normally developing children

CP: scaled scores of children with cerebral
palsy
Original: scaled scores of normally developingchildren
SC: Self-Care, M: Mobility, SF: Social
Function
Figure 1. Scaled scores of normally developing children (original data in the PEDI) andchildren with cerebral palsy.
Distribution of the scaled scores of normally developing children (original data in thePEDI) and the scaled scores of children with cerebral palsy are illustrated by self-care,mobility, and social function.


Jpn J Compr Rehabil Sci Vol 8, 2017

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Onogi K et al.: Differences in evaluation of functional skills of the PEDI between normally developing children and children with CP(Table 2).
In testing the difference between correlation
coefficients, z-scores were 1.420 for self-care, 1.084
for mobility, and 1.767 for social function. The values
transformed into standard normal distribution(z-scores) were 1.88 between self-care and mobility,
3.71 between mobility and social function, and 1.99
between self-care and social function, exhibiting asignificant difference only between mobility and social
function (p < 0.001) based on the standard normal
distribution.
In calculating the mean of the scaled scores by age
for each level of the GMFCS in children with cerebral
palsy, those aged under 2 years were excluded fromthe statistical analysis because of too few subjects. In
every age band in GMFCS group I, the scaled scoresfor the mobility domain were higher than the other two
domains, whereas in groups III, IV, and V, the scaled
scores for the mobility domain were lower than theother two domains. Additionally, in groups IV and V,
while the scaled scores for the mobility domain
scarcely changed from ages 4 to <6 years and beyond,the scores for social function and self-care maintainedmoderate increases (Figure 2).
The multi-way analysis of variance showed nosignificant difference in interaction between each skill
and age in GMFCS group I, exhibiting an F-value of0.987 and p = 0.439. The F-value and p-value for theother groups were: F-value 2.267 and p = 0.041 forgroup II, F-value 7.817 and p < 0.0001 for group III,F-value 3.982 and p = 0.001 for group IV, and F-value
2.551 and p = 0.02 for group V, showing significant
differences in groups II and V with p < 0.05 and ingroups III and IV with p < 0.01. In a multiple
comparison between the PEDI skills in each GMFCS
level, group I showed no significant difference between
self-care and social function, and group II exhibited nosignificant difference between any factors. Meanwhile,

Tabel 2. Copmarison of the scaled scores between normally developing children and children with cerebral palsy.
Mobility

SelfCare

Skill

No.

Item

Indoor locomotion: Distance/Speed
Indoor locomotion: Distance/Speed
Toilet transfers
Indoor locomotion: Methods
Outdoor locomotion: Methods
Tub transfers
Outdoor locomotion: Surfaces

29
31
1
27
39
21
47

Outdoor locomotion: Surfaces
Indoor locomotion: Methods

49
26

Upstairs
Bed mobility/Transfers
Indoor locomotion: Pulls/Carries
objects
Downstairs
Tub transfers

54
16
36
59
20

Outdoor locomotion: Surfaces
Outdoor locomotion: Surfaces
Outdoor locomotion: Methods

46
48
38

Moves within a room with no difficulty
Moves between rooms with no difficulty
Sits if supported by equipment or caregiver
Walks without support
Walks without support
Sits unsupported and moves in tub
Rough, uneven surfaces (lawns, gravel
driveway)
Up and down curbs
Walks, but holds onto furniture, walls,
caregivers or uses devices for support
Walks up entire flight with no difficulty
Raises to sitting position in bed or crib
Carries objects large enough to require two
hands
Walks down full flight with no difficulty
Sits if supported by equipment or caregiverin a tub or sink
Slightly uneven surfaces (cracked pavement)
Up and down incline or ramps
Walks, but holds onto objects, caregiver, or
devices for support

Skill
Use of drinking containers
Hairbrushing
Use of utensils
Food textures
Shoes/Socks

Socialfunction

No.
10
23
5
2
54

Item
Holds bottles or spout cup
Manages tangles and parts hairFinger feeds
Eats ground/ lumpy foods
Removes socks and unfastened shoes

Original(score)CP(score)Difference*

28
35
52
46
49
32

57
64
24
74
75
55

-29
-29
28
-28
-26
-23

48

69

-21

59

78

-19

35

54

-19

68
23

86
41

-18
-18

44

61

-17

70

86

-16

7

23

-16

44
53

60
69

-16
-16

41

56

-15

Original(score)CP(score)Difference*

8
99
16
37
33

35
77
34
20
50

-27
22
-18
17
-17

Skill

No.

Item

Original(score)CP(score)Difference*

Peer interactions (Child of similar age)

31

6

27

-21

Fuctional use of communication

11

Notices presence of other children, may
vocalize and gesture toward peers
Names things

30

45

-15

CP, scaled scores of children with cerebral palsy; Original, scaled scores of normally developing children.
*Items which absolute value is more than 15 are shown subtracting the scaled scores of children with CP from those of normally developingchildrenJpn J Compr Rehabil Sci Vol 8, 2017

Onogi K et al.: Differences in evaluation of functional skills of the PEDI between normally developing children and children withCP
41

Figure 2. Scaled scores by level/age band defined in the GMFCS.
Children with cerebral palsy were divided into groups as defined in the GMFCS. Each group
was further divided into five age bands based on the assessment method of the GMFCS andthe means of the scaled scores for discrete domains are indicated. Children aged under 2
years were excluded from the calculation because the number of these children was too small.
in groups III, IV, and V, significant differences were
found between all factors.
Discussion
In children with cerebral palsy, improvement ingross abilities is considered to peak at age 4 andthereafter, and almost come to an end at age 6 andbeyond [7]. Conversely, certain abilities in daily life
such as locomotion and transfers are considered tokeep improving thereafter by mastering alternativemeans. Accordingly, goals for functional assessment
should also be set on achieving the skills required indaily activities, for which the PEDI has gained wide
use as an assessment tool to observe the changes withtime and evaluate the effectiveness of the treatment[8,9].
However, the PEDI was developed and designed
based on the data on normally developing children in
the United States. As has been reported in the Dutch
version of the PEDI, cultural differences are assumed
to have a certain influence on the daily activities ofchildren and hence the issue has been examined inGermany, Saudi Arabia, and Norway [10-12].
Additionally, because the PEDI was designed fornormally developing children, some movements thatthese children can perform easily may constitute an
item of a high difficulty level for children with cerebral
palsy, which may decrease their rating for some items.
On the other hand, since the order of the difficultylevel of the items is different between children withcerebral palsy and normally developing children,score inversion phenomena, wherein the scaled scoresof normally developing children are higher than thoseof children with cerebral palsy, may occur.
In the present study, we performed the analyses forchildren with cerebral palsy using the same
methodology as described originally and compared
the differences. The results showed that with respect tothe difficulty level of performing functional skills, thegreatest difference in scaled scores was observed in
mobility, which was followed by self-care, and thedifference in social function was the smallest. In termsof correlation coefficients, a significant difference wasfound between the functional skills in mobility andthose in social function.
Motor function of children with cerebral palsy
involves impairments ranging from very mild paralysis
to severe paralysis in the trunk/limbs. The Medical
Survey Report on Prognosis of Children with Severe
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Onogi K et al.: Differences in evaluation of functional skills of the PEDI between normally developing children and children with CP

Cerebral Palsy published in 2011 reported that amonga total of 475 children with cerebral palsy in Okinawa
prefecture, those who were classified as GMFCS
group I, II, III, IV, and V accounted for 15.8%, 12.2%,
7.6%, 37.1%, and 27.4%, respectively [13], whereas
in the present study, there were fewer children in
GMFCS level I (8.6%) and more children in group III(26.7%). In any case, since children in groups IV and
V accounted for a high proportion in all the children
with cerebral palsy included in the present study, thedifference with normally developing children was
liable to increase in motor function.
Meanwhile, the difference in the difficulty level offunctional skills was small in terms of social function,suggesting that there is no major difference between
normally developing children and children withcerebral palsy regarding the order of mastering social
function set in the PEDI.
The self-care domain presented larger differencescompared to social function, specifically in the items“Use of Drinking Containers: Holds bottle or spoutcup,” “Use of utensils: Finger feeds,” and “Shoes/
Socks: Removes socks and unfastens shoes.” This
presumably implies that movements using fingers
such as holding a feeding bottle or finger feeding,which are relatively easy and mastered at an earlystage in normally developing children, constitutedifficult tasks for children with cerebral palsy.
The items that yielded higher scores in normallydeveloping children were “Toilet transfers: Sits if
supported by equipment or caregiver” for mobility,and “Hair brushing: Manages tangles and parts hair”
and “Food textures: Eats ground/lumpy foods” forself-care. In the PEDI original data, the items of toilet
transfers in the mobility domain showed a slightly
higher difficulty level than the items of indoor/outdoor
locomotion [14]. On the other hand, for children withcerebral palsy, the difficulty level of the items included
in indoor/outdoor locomotion is high, and hence theitem of toilet transfers with assistive equipment or
support by caregiver was positioned as an easier
movement compared to other items. Additionally,“Hair brushing: Manages tangles and parts hair” inself-care is the item of the highest difficulty level inthe original data of the self-care domain in the PEDI[14], which is likely to demonstrate the occurrence ofan inversion phenomenon referred to earlier because
movements using fingers are of a high difficulty levelfor children with cerebral palsy. Regarding “Foodtextures: Eats ground/lumpy foods,” it is likely that
normally developing children master more self-care
items than children with cerebral palsy during the time
period when they become able to take food with
textures requiring food bolus formation instead of
weaning food, which explains the higher scores
exhibited by normally developing children thanchildren with cerebral palsy.
Next, we divided the subject children in the present
Jpn J Compr Rehabil Sci Vol 8, 2017

study by the gross motor function level defined in the
GMFCS. Children in each level were divided further
by age band to evaluate the functional skills of the
PEDI. The severity of paralysis in children in GMFCS
level I is slight, and hence they were expected tofollow approximately the same tendency as normallydeveloping children. In fact, their scores for discrete
skills were found to increase with age. In contrast, inchildren in levels III, IV, and V, who have minor tosevere paralysis, their motor function almost reached
the plateau in the age band of 4 to <6. However, theirscores for self-care and social function were found toincrease slightly thereafter. This suggests that self-careand social function skills are likely to improve evenafter motor function has reached the target level.
Therefore, a rehabilitation approach to help encouragesuch skills is needed [15].
Our study has potential limitations, the first ofwhich is the uneven distribution of the subject age
groups. Specifically, the group aged under 2 years was
so small that they were excluded from the present
study. Additionally, cerebral palsy has different diseasetypes such as spastic, athetoid and mixed, and different
topographic distribution of paralysis, i.e. quadriplegia,
diplegia, and hemiplegia, which may cause a differencein the difficulty level of functional skills among groupsof different disease types and paralysis distribution.
However, we did not perform separate Rasch analysis
for each group in the present study because the numberof samples included in the respective groups would bediminished by such subdivision based on disease type/paralysis distribution. These limitations are issues thatshould be examined in the future by increasing thenumber of samples by using the pediatric rehabilitation
database [16,17].
Conclusion
We computed the scaled scores of children withcerebral palsy according to the method used to
calculate the original data of scaled scores shown in
the PEDI, and compared them with the original data.
No major difference was observed in social function
between children with cerebral palsy and normallydeveloping children, whereas many items of mobility
abilities showed large differences. It is hoped that thedifficulty levels of functional skills will be set so thatthey are adapted to the abilities of children withcerebral palsy and will be utilized for rehabilitation in
the future.

Acknowledgement

The authors thank Ms. Satomi Kawarada for her
cooperation in this manuscript.

References

1.	Kondo I. Evaluative measure and current concept of
rehabilitation for cerebral palsied children. Jpn J Rehabil

Onogi K et al.: Differences in evaluation of functional skills of the PEDI between normally developing children and children withCP
43
Med 2016; 53: 353-8. Japanese.
2.	Kondo I. Evaluation methods for cerebral palsy(Summary). Japanese Guidelines for Rehabilitation of
Cerebral Palsy. the 2nd Edition. The Japanese Associationof Rehabilitation Medicine. Tokyo: KANEHARA & CO.,Ltd.; 2014. p.50-6. Japanese.
3.	Haley SM, Coster WJ, Ludlow LH, Haltiwanger JT,
Andrellas PJ. Chapter 1, Introduction to the PEDI,
Pediatric Evaluation Disability Inventory. In: PEDI
Research Group, editor. Boston: New England Medical
Center Hospital & PEDI Research Group; 1992. p.3-9.
4.	Toikawa H. PEDI (Pediatric Evaluation of Disability
Inventory). Manual of Evaluation for Children’s
Rehabilitation. In: Takahashi H, supervisor. Toikawa H,
editor. Tokyo: Shindan to Chiiryo Sha; 2015. p.113-6.
Japanese.
5.	Kawarada S, Kondo I. Pediatric Evaluation of Disability
Inventory. Japanese Guidelines for Rehabilitation of
Cerebral Palsy. the 2nd Edition. The Japanese Association of
Rehabilitation Medicine. Tokyo: KANEHARA & CO.,Ltd.; 2014. p.62-3. Japanese.
6.	Rosenbaum PL. Prognosis for gross motor function in
cerebral palsy, creation of motor development curves.
JAMA 2002; 288: 1357-63.
7.	Kondo I. Evaluative measure for cerebral palsy. Igaku
no Ayumi 2002; 203: 729-32. Japanese.
8.	Kruijsen-Terpstra AJ, Ketelaar M, Verschuren O, Gorter
JW, Vos RC, Verheijden J, et al. Efficacy of three therapy
approaches in preschool children with cerebral palsy: arandomized controlled trial. Dev Med Child Neurol
2015; Nov 24. [Epub ahead of print]
9.	Takahashi H, Liu M: Pediatric evaluation of disability
inventory —review of clinical use—. J Clin Rehabil

2003; 12: 530-4. Japanese.
10.	Schulze C, Kottorp A, Meichtry A, Lilja M, Page J.
Inter-rater and test-retest reliability of the German
Pediatric Evaluation of Disability Inventory (PEDI-G).
Phys Occup Ther Pediatr 2015; 35: 296-310.
11.	Al-Khudair Rl, Al-Eisa E. Applicability of the pediatricevaluation of disability inventory among Saudi children.
Disabil Rehabil 2014; 36: 658-64.
12.	Berg MM, Dolva AS, Kleiven J, Krumlinde-Sundholm
L. Normative scores for the pediatric evaluation of
disability inventory in Norway. Phys Occup Ther Pediatr
2016; 2: 131-43.
13.	Japan Council for Quality Health Care (JCQHC).
Medical Report about severely disabled children withcerebral palsy. Available from: http://www.sanka-hp.
jcqhc.or.jp/documents/report/pdf/20110712igakutekityo
usahoukokusyo_fix.pdf (cited 2011 July 12). Japanese.
14.	Haley SM, Coster WJ, Ludlow LH, Haltiwanger JT,
Andrellas PJ. Chapter 2, Standardization and TechinicalDate, Pediatric Evaluation Disability Inventory. In: PEDI
Research Group, editor. Boston: New England Medical
Center Hospital & PEDI Research Group; 1992. p.27-64.
15.	Asagai Y. Rehabilitation training fitting to the physicalcondition of children with cerebral palsy. Jpn J Rehabil
Med 2016; 53: 359-64. Japanese.
16.	Kondo I, Onogi K. Database of children with cerebral
palsy in the world. J Clin Rehabil 2010; 19: 982-6.
Japanese.
17.	Haley SM, Coster WJ, Kao YC, Dumas HM, FragalaPinkham MA, Kramer JM, et al. Lessons from use of thePediatric Evaluation of Disability Inventory (PEDI):
Where do we go from here? Pediatr Phys Ther 2010; 22:
69-75.

Jpn J Compr Rehabil Sci Vol 8, 2017