A quick and qualitative assessment of gross motor development in preschool children

  • Tanja H. KakebeekeEmail author
  • Aziz Chaouch
  • Elisa Knaier
  • Jon Caflisch
  • Valentin Rousson
  • Remo H. Largo
  • Oskar G. Jenni
Original Article


There is a need for a quick, qualitative, reliable, and easy tool to assess gross motor development for practitioners. The aim of this cross-sectional study is to present the Zurich Neuromotor Assessment-Q (ZNA-Q), which assesses static and dynamic balance in children between 3 and 6 years of age in less than 5 min. A total of 216 children (103 boys; 113 girls; median age 4 years, 4 months; interquartile range 1 year, 3 months) were enrolled from day-care centers, kindergartens, and schools, and were tested with 5 different gross motor tasks: standing on one leg, tandem stance, hopping on one leg, walking on a straight line, and jumping sideways. All ordinal measures (consisting of qualitative measures and scales) featured a marked developmental trend and substantial inter-individual variability. Test-retest reliability was assessed on 37 children. It varied from .17 for tandem stance to .43 for jumping sideways for the individual tasks, and it was .41 and .67 for the static and dynamic balance components, respectively. For the whole ZNA-Q, test-retest reliability was .7.

Conclusion: Ordinal scales enable practitioners to gather data on children’s gross motor development in a fast and uncomplicated way. It offers the practitioner with an instrument for the exploration of the current developmental motor status of the child.

What is Known:

Measurement of gross motor skills in the transitional period between motor mile stones and quantitative assessments is difficult.

Assessment of gross motor skills is relatively easy.

What is New:

Supplementary and quick gross motor test battery for children for practitioners.

Normative values of five gross motor skills measured with ordinal scales.


Zurich Neuromotor assessment Quick and qualitative version Gross motor skills 



Contralateral associated movements


Dynamic balance


Fine motor


Pure motor


Poor man’s data augmentation


Standard deviation score


Static balance


Zurich Neuromotor Assessment


Zurich Neuromotor Assessment second edition



We gratefully acknowledge the support of the presidents’ conference of the public schools in Zurich and the educators and teachers of the child care centers and Kindergartens for their help with recruitment.

Authors’ contributions

THK: Designed the study, acquired funding, performed data collection, coded and analyzed the corresponding data, and wrote the manuscript

AC: Performed statistical analysis and modeling

EK: Performed data collection and coded the corresponding data

JC: Performed data collection and corrected the manuscript

VR: Assisted in statistical data analysis

RHL: Contributed to the draft and gave advice on the assessment tools

OGJ: Designed the study, acquired funding, corrected final draft of the manuscript

All authors reviewed and edited the manuscript


This study was supported by the Swiss National Science Foundation, grant no. 32003B_153273, the Largo, Maiores and Giedion Risch Foundation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study. Parents provided written informed consent for their participating child and children consented orally.


  1. 1.
    Anderson P (2002) Assessment and development of executive function (EF) during childhood. Child Neuropsychol 8(2):71–82. CrossRefPubMedGoogle Scholar
  2. 2.
    Barnett L, Hinkley T, Okely AD, Salmon J (2013) Child, family and environmental correlates of children’s motor skill proficiency. J Sci Med Sport 16(4):332–336. CrossRefPubMedGoogle Scholar
  3. 3.
    Barnett LM, Telford RM, Strugnell C, Rudd J, Olive LS, Telford RD (2018) Impact of cultural background on fundamental movement skill and its correlates. J Sports Sci:1–8.
  4. 4.
    Bax M, Gillberg C (2009) Development: normal/delayed/disordered. In: Aicardi J (ed) Diseases of the nervous system in childhood, 3rd edn. Mac Keith Press, London, pp 891–901Google Scholar
  5. 5.
    Bayley N (2006) Bayley scales of infant and toddler development, 3rd edn. Pearson, San AntonioGoogle Scholar
  6. 6.
    Bruininks RH, Bruininks BD (2005) Bruininks-Oseretsky test of motor proficiency - second edition (BOT-2). Pearson, MinneapolisGoogle Scholar
  7. 7.
    Burton AW, Miller DA (1998) Movement skill assessment. Human Kinetics, LeedsGoogle Scholar
  8. 8.
    Fisher RA (1936) Statistical methods for research workers, 6th edn. Oliver and Boyd, EdinburghGoogle Scholar
  9. 9.
    Folio M, Fewell R (2000) Peabody developmental motor scales-2. PRO-ED, AustinGoogle Scholar
  10. 10.
    Henderson SE, Sugden DA, Barnett AL, Petermann F, Bös K, Kastner J (2007) Movement assessment battery for children - second edition (Movement ABC-2) - Deutschsprachige adaptation. Harcourt Assessment, LondonGoogle Scholar
  11. 11.
    Jonsson E, Seiger A, Hirschfeld H (2005) Postural steadiness and weight distribution during tandem stance in healthy young and elderly adults. Clin Biomech (Bristol, Avon) 20(2):202–208. CrossRefGoogle Scholar
  12. 12.
    Kakebeeke TH, Locatelli I, Rousson V, Caflisch J, Jenni OG (2012) Improvement in gross motor performance between 3 and 5 years of age. Percept Mot Skills 114(3):795-806. CrossRefPubMedGoogle Scholar
  13. 13.
    Kakebeeke TH, Caflisch J, Chaouch A, Rousson V, Largo RH, Jenni OG (2013) Neuromotor development in children. Part 3: motor performance in 3- to 5-year-olds. Dev Med Child Neurol 55(3):248–256. CrossRefPubMedGoogle Scholar
  14. 14.
    Kakebeeke TH, Knaier E, Chaouch A, Caflisch J, Rousson V, Largo RH, Jenni OG (2018) Neuromotor development in children. Part 4: new norms from 3 to 18 years. Dev Med Child Neurol.
  15. 15.
    Kiphard EJ, Schilling F (2017) KTK - Körperkoordinationstest für Kinder. Hogrefe Verlag, BernGoogle Scholar
  16. 16.
    Largo RH, Caflisch JA, Hug F, Muggli K, Molnar AA, Molinari L (2001) Neuromotor development from 5 to 18 years. Part 2: associated movements. Dev Med Child Neurol 43(7):444–453CrossRefPubMedGoogle Scholar
  17. 17.
    Largo RH, Caflisch JA, Hug F, Muggli K, Molnar AA, Molinari L, Sheehy A, Gasser ST (2001) Neuromotor development from 5 to 18 years. Part 1: timed performance. Dev Med Child Neurol 43(7):436–443CrossRefPubMedGoogle Scholar
  18. 18.
    Largo RH, Rousson V, Caflisch JA, Jenni OG (2007) Zurich neuromotor assessment. AWE Verlag, ZurichGoogle Scholar
  19. 19.
    Logan SW, Robinson LE, Wilson AE, Lucas WA (2012) Getting the fundamentals of movement: a meta-analysis of the effectiveness of motor skill interventions in children. Child Care Health Dev 38(3):305–315. CrossRefPubMedGoogle Scholar
  20. 20.
    Morris AM, Williams JM, Atwater AE, Wilmore JH (1982) Age and sex-differences in motor-performance of 3 through 6 year old children. Res Q Exerc Sport 53(3):214–221. CrossRefGoogle Scholar
  21. 21.
    Piper MC, Darrah J (1994) Motor assessment of the developing infant. Saunders, PhiladelphiaGoogle Scholar
  22. 22.
    Rudd J, Butson ML, Barnett L, Farrow D, Berry J, Borkoles E, Polman R (2016) A holistic measurement model of movement competency in children. J Sports Sci 34(5):477–485. CrossRefPubMedGoogle Scholar
  23. 23.
    Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428CrossRefPubMedGoogle Scholar
  24. 24.
    Ulrich DA (2000) Test of gross motor development, 2nd edn. Pro-ED. Inc., AustinGoogle Scholar
  25. 25.
    Utesch T, Bardid F, Huyben F, Strauss B, Tietjens M, De Martelaer K, Seghers J, Lenoir M (2016) Using Rasch modeling to investigate the construct of motor competence in early childhood. Psychol Sport Exerc 24:179–187. CrossRefGoogle Scholar
  26. 26.
    Wei G, Tanner M (1990) A Monte Carlo implementation of the EM algorithm and the poor man’s data augmentation algorithms. J Am Stat Assoc 85(411):699–704CrossRefGoogle Scholar
  27. 27.
    Zimmer R, Volkamer M (1987) Motoriktest für vier- bis sechsjährige Kinder [Motor Test for four- to six-year-olds]. Beltz Test, WeinheimGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Tanja H. Kakebeeke
    • 1
    Email author
  • Aziz Chaouch
    • 2
  • Elisa Knaier
    • 1
  • Jon Caflisch
    • 1
  • Valentin Rousson
    • 2
  • Remo H. Largo
    • 1
  • Oskar G. Jenni
    • 1
    • 3
  1. 1.Child Development CenterUniversity Children’s Hospital ZürichZürichSwitzerland
  2. 2.Division of BiostatisticsInstitute of Social and Preventive Medicine, University HospitalLausanneSwitzerland
  3. 3.Children’s Research CenterUniversity Children’s Hospital ZürichZürichSwitzerland

Personalised recommendations