Skip to main content

About the ABI-CA

The ABI-CA is an observational measure that assesses 18 advanced gross motor skills that tap into a child's coordination, agility, balance, fitness and strength. Each of these skills is scored on a 5-point response scale (0 to 4) using item-specific response options described on the ABI-CA score form. It was designed for use with children with acquired brain injury (traumatic or non-traumatic)  who are age 7 years and up, and can walk  independently but have limitations in speed and quality of movement.

As a pre-requisite for this test, the child/youth should:

  • Display challenges in advanced gross motor skill performance (as determined by their treating physiotherapist)
  • Be medically stable; defined as the ability to participate in a full rehabilitation program without activity restriction
  • Be high functioning physically, i.e., able to hold balance for at least 3 seconds on one foot
  • Be able to walk within the 0.45cm test pathway, and follow test instructions for at least 30 minutes.

How was ABI-CA developed?

The ABI-CA was developed by Virginia Wright (PT, PhD, Senior Scientist) and Gail Kirkwood (BScPT, clinical specialist pediatric, ABI) at Holland Bloorview Kids Rehabilitation Hospital with assistance of graduate students from the Department of Physical Therapy, University of Toronto and with funding from the Bloorview Research Institute and Holland Bloorview Chair in Pediatric Rehabilitation (held by Wright) to conduct the various stages of its validation and web training material development.

How is ABI-CA administered?

The ABI-CA was designed to be administered by a pediatric physical therapist who has experience with the GMFM-88 and/or the Community Balance and Mobility Scale, and requires 45 to 60 minutes to complete depending on the abilities of the child/youth. Depending on the recovery level post-ABI, some may require that the test is split into two sessions to enable them to provide their greatest effort and concentration.

Testing is conducted on and around the ABI-CA assessment pathway following item-specific guidelines outlined in the ABI-CA manual. The ABI-CA pathway is 10 m long and 0.45 m wide. The path markings are taped to the floor in a hallway that is at least 15 m in length and 2.5 m in width. The equipment needed consists of basic gym skills items such as soccer/basketball/bouncy ball, floor level balance beam, pylons (cones), bean bags, masking tape, wobble board and a stopwatch. All test equipment should be assembled in advance to make the test flow smoothly.

For every item, the child’s therapist should do a demonstration of the task. The speed of the therapist’s performance can be kept fairly slow so the child is not discouraged at the outset by tester’s speed but needs to be 100% accurate. For the more complex skills, the child/youth is given a chance to walk through all or part of the task before testing. These are highlighted in the manual.

The child is given the two chances to perform each item. Explain that on the first trial of an item, the child should be as accurate as they possibly can, even if it takes a bit longer to do it. They will then be given one more chance to see: i) if they can be more accurate if they did not do perfectly or ii) if they did it perfectly, to try to speed up while staying accurate.

If a top score of ’4’ is achieved on the first try, no further trial is required unless child is competitive and wants to better their time (i.e. no increase in score but should record the new time if the child does it again). The child is also given the chance to say ‘no’ to doing an item or to doing the repeat trials. Some items can be discouraging for some children and it is important to keep going with testing all of the items rather than getting too frustrated with a single item. The child's test performance should be scored live (no need to videotape) using the ABI-CA worksheet. The therapist transfers the scores over to the ABI-CA excel spread sheet after the assessment is done. 

Training and certification on ABI-CA

Certification training (consisting of a one day ABI-CA course, independent review of training videos after the course, practice with several children, and finally completion of the ABI-CA criterion test) is required prior to use of the ABI-CA to ensure sufficient familiarity with the items and response options, and to optimize scoring accuracy.

We will be holding Zoom based training in Spring 2022. If you are interested, please contact Virginia Wright to discuss the possibilities.

How are ABI-CA scores used and reported?

From a goal-setting and evaluation perspective, both the item scores and ABI-CA total score are of value. We have seen a large range of ABI-CA scores among children (i.e., from 20 to 90%), and have early evidence of strong potential for score change within a child over time.

However, while helpful to use in the child's health record to monitor change over time, the total score can be somewhat discouraging to the child and parent. In contrast, the individual item scores tend to be information rich, encouraging as to the child's abilities and potential, and useful for strength and challenge identification and thus for goal setting. We suggest focusing on the items and using their scores to determine areas of strengths and challenge (e.g., related to balance, agility, speed, co-ordination) that can be discussed with the child and parent after the assessment.

What do ABI-CA items look like?

This is a sample item from the ABI-CA

ABI-CA Manual and Training Videos

The ABI-CA manual and materials are available through Flintbox, a third-party site.  

The ABI-CA training videos are available by logging in with your password on the Forms and Manuals page.

What attendees have said...

"Excellent presenting style and good mix of the info on the slides to refer to later and info around the slides to make them super relevant”

“Virginia knows her stuff but is very grounded in reality - lovely to have such a balance of expertise in academia and clinically”

"It was really nice to see that you showed us different cases and that it is possible to use the ABI-CA for children/ adolescents functioning at different levels." (Zoom course)

"I really liked the polling feature during the videos so we could all participate in scoring." (Zoom course).

"I think it is good to do as a webinar with enough time to answer questions." (Zoom course).

"Paper resources sent in advance very helpful. Content covered everything required" (Zoom course)

"I like the client videos and real examples. Came away with an understanding why ABI-CA is helpful at identifying how to get kids 'in the game'."