INSIGHT INTO DAILY ACTIVITIES OF CHILD WITH MULTIPLE DISABILITIES 113 5 Introduction In pediatric health care there is increasing attention for a child-centered approach, also referred to as personalized care (Coyne, Hallstrom, & Soderback, 2016). In this care it is essential to assess personal relevant functioning, hence, to explore which activities are important for a child and to assess the quality of performance of these meaningful activities (Coster & Khetani, 2008; Rodger & Kennedy-Behr, 2017). Therefore, we need to ask children what they do or want to do and then assess the performance in their own context. However, how can we ask children with multiple disabilities how they feel on the meaningfulness of activities? Effective communication about wants and needs is important for personalized care, particularly for “communication vulnerable people” (Stans, Dalemans, de Witte, & Beurskens, 2013). Several assessment tools to explore meaningful activities in children are available, such as the Children’s Assessment of Participation and Enjoyment (CAPE) (Imms, 2008; King, Law, King Hurley, Hanna, Kertoy, et al, 2000), the Preferences for Activities of Children (PAC) Imms, 2008; King, Law, King, Hurley, Hanna, Kertoy, et al, 2000) and the Pediatric Activity Card Sort (PACS) ( Mandich, Polatajko, Miller, & Baum, 2004). Although these measures may be applicable to children with some restrictions in communication and/or cognition, children with more severe limitations will not be able to provide reliable answers on these measures. An alternative method is Talking Mats® (TM) (Murphy & Cameron, 2006), a pictorial framework that has been used as a tool for people with communication difficulties (Germain, 2004). It has been used also as an effective communication resource for people with intellectual difficulties and can support conversations between professionals and communication vulnerable people and help people with intellectual disabilities to express their views by increasing both the quantity and quality of information communicated (Murphy & Cameron, 2008; Stans, Dalemans, de Witte, & Beurskens, 2019). Therefore, TM might be a suitable method to explore meaningful activities in children with limited communication and cognitive abilities. To address meaningful activities as part of the treatment, measuring the quality of performance of activities is required. Brink et al. (2021) suggested the Perceive, Recall, Plan and Perform (PRPP) System of task analysis (Chapparo & Ranka, 1996) as the most suitable assessment for quality of performance in children with multiple disabilities. In this observational instrument, the performance level is not compared to others’ (Anastasi, 1988) but shows an overall personalized performance mastery score as well as how well information processing strategies are applied during occupational performance. The PRPP-Assessment can be used in direct observation
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