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Background: Standardized, norm-referenced tests, such as The Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) and the Pediatric Balance Scale (PBS) are commonly used examination measures to assess progress of gross motor skills in pediatric patients. However, there is limited evidence to support the use of these measures in patients with chronic neurological conditions. Case Description: The patient is an 8-year-old girl. She has a medical diagnosis of Unilateral (left) Perisylvian Syndrome, a variant of neuronal migration disorder. The malformation of the left hemisphere has contributed to the following impairments: cognitive, motor, sensory and the gastrointestinal system, as well as occurrences of petit mal and atonic drop seizures. The patient has demonstrated minimal progressions, as well as regressions, of certain gross motor skills based on standardized testing. Outcome Measures: The main outcome measures utilized to determine patient progress were the BOT-2 and the PBS. A parent reported outcome measure, the Pediatrics Quality of Life Inventory Short Form (PedsQL 4.0 SF15) and parent interviews were also used to determine quality of life and participation levels of the patient. Discussion & Outcome Considerations: The purpose of this case report is to consider the discrepancies of standardized testing of pediatric patients with neurological disorders when compared to observed goal attainment in physical therapy, as well as parent reported participation and quality of life measures.