# Item-level measurement properties of the pediatric awareness and sensory motor assessment in children with medical complexity

## TL;DR

The study evaluates a new assessment tool for children with complex medical needs to better measure their sensory awareness and motor responses.

## Contribution

The study validates the Pediatric Awareness and Sensory Motor Assessment (PASMA) as a reliable and unidimensional tool for children with medical complexity.

## Key findings

- The PASMA is unidimensional and effectively measures sensory awareness and motor response in children with medical complexity.
- The assessment has high item reliability and successfully stratifies participants into distinct awareness levels.
- Differential item functioning suggests potential for reducing the number of PASMA administrations per individual.

## Abstract

Children with medical complexity (CMC) are medically fragile with severe brain damage and chronic conditions, necessitating daily care. Their neurological impairments often limit participation in childhood activities, affecting quality of life. Current assessment tools fail to detect subtle abilities in CMC, hindering development of effective rehabilitation goals and interventions. The Pediatric Awareness and Sensory Motor Assessment (PASMA) was created to fill this gap, providing sensitive measurement of sensory awareness and motor response across five domains (i.e., olfactory, visual, auditory, gustatory, and tactile).

In this retrospective study, a Rasch analysis was conducted on PASMA data for CMC. The PASMA was administered five times over ten weekdays to each child, reflecting its intended clinical use to gain a reliable sense of each child's awareness.

Analysis of data from 36 CMC revealed that the PASMA is sufficiently unidimensional, effectively measuring sensory awareness and motor response as a single construct. Its rating scale structure was validated without modifications, and the item hierarchy matched clinical expectations. High item reliability (0.97) was observed, with one item (V2 blink in response to light) slightly misfitting, but without affecting overall measures. Adequate person reliability was observed (0.81), with 15% person misfit. Person misfit did not degrade item measures or model statistics. Differential item functioning (DIF) was noted for the three easiest items on specific days. The PASMA successfully stratified participants into three distinct awareness levels (low, medium, and high awareness), without floor or ceiling effects.

The PASMA is a valid unidimensional measure of sensory awareness and motor response in CMC. Rating scale characteristics, item hierarchy, and person separation measures all support the PASMA's measurement properties within this heterogeneous sample of CMC. DIF findings support a potential reduction in the recommended number of PASMA administrations per individual. Future research will focus on establishing rater reliability and external validity. Additional efforts will support health professionals to utilize the PASMA for baseline assessments, guiding personalized interventions, and tracking progress.

Clinical use of the PASMA could provide new opportunities to detect subtle abilities, preferences, and changes in CMC, to promote meaningful participation and improve quality of life.