The use of the brunet lezine scale for the cognitive and motor assessment of patients with profound and multiple disabilities
Dr Marie-Christine ROUSSEAUa, Mr Tanguy LEROYb, Prof Pascal AUQUIERb, Prof Thierry BILLETTE DE VILLEMEURc
a Hôpital San Salvadour, b EA 3279 Santé Publique et Maladies Chroniques, (Aix-Marseille Université), c Hôpital Trousseau (Assistance Publique Hôpitaux de Paris)
Objectives: To date, there is no validated tool allowing the assessment of cognitive and motor capacities of patients with polyhandicap (PLH) because of their profound and multiple disabilities because of their severe mental deficiencies and motor handicaps, as well as their extremely low possibilities to communicate. However, as these patients hardly ever reach the cognitive and motor development of infants older than two years, we hypothesized the level of their development may be assessed by means of an adapted version of the Brunet-Lézine (BL) scale. Therefore, the aim of this study is to estimate the relevance of the use of the Brunet-Lézine scale among PLH patients.
Patients: Forty patients (21 males and 19 females aged 4 to 54) were enrolled in two specialized French rehabilitation centers. They were all PLH patients with a combination of motor (pyramidal, extra pyramidal, cerebellar, neuromuscular) deficiencies and a profound mental retardation (IQ could not be assessed); they fully depended on caregivers for their everyday needs (FIM < 30) and they had a very restricted mobility (GMFCS II to V).
Methods: The relevance of the use of Brunet-Lézine scale among PLH patients was first assessed by describing the distribution of patients’ scores on the four dimensions of the scale. Then the structure of the scale was verified and the convergence of the scores at this scale with other relevant - while not sufficient - scores was assessed: FIM, GMFCS, and a clinical evaluation of sociability and verbalization by another independent caregiver.
Results: PLH patients tend to present low scores on the Brunet-Lézine scale, which correspond to early developmental stages. Among PLH patients, it sounds more relevant to group the four dimensions of the Brunet-Lézine into two factors: motor activity (posture and coordination) and social interactions (language and sociability).
Discussion/conclusion: Convergence analyses suggest that the motor and social development of PLH patients may be reliably estimated by means of the Brunet-Lézine scale.
Keywords : Profound and multiple disabilities, polyhandicap, cognitive assessment, motor assessment, Brunet-Lézine.