The maturation of balance in children

Examination of sensory reception and integration abilities in children with and without Prader-Willi syndrome

BACKGROUND

Good postural stability control is dependent upon the complex integration of incoming sensory information (visual, somatosensory, vestibular) with neuromotor responses that are constructed in advance of a voluntary action or in response to an unexpected perturbation.

AIMS

To examine whether differences exist in how sensory inputs are used to control standing balance in children with and without Prader-Willi syndrome (PWS).

METHODS AND PROCEDURES

In this cross-sectional study, 18 children with PWS and 51 children categorized as obese but without PWS (without PWS) ages 8-11 completed the Sensory Organization Test®. This test measures the relative contributions of vision, somatosensory, and vestibular inputs to the control of standing balance. The composite equilibrium score (CES) derived from performance in all sensory conditions, in addition to equilibrium scores (EQs) and falls per condition were compared between groups.

OUTCOMES AND RESULTS

The CES was lower for children with PWS compared to children without PWS (M=53.93, SD=14.56 vs. M=66.17, SD=9.89, p = .001) while EQs declined in both groups between conditions 1 and 4 (F (1.305, 66.577) = 71.381, p < .001). No group differences in the percent of falls were evident in condition 5 but more children with PWS fell in condition 6 (χ2 (1) = 7.468, p = .006). Group differences in frequency of repeated falls also approached significance in conditions 5 (χ2 (3) = 4.630, p = .099) and 6 (χ2 (3) = 5.167, p = .076).

CONCLUSIONS AND IMPLICATIONS

Children with PWS demonstrated a lower overall level of postural control and increased sway when compared to children with obesity. Both the higher incidence and repeated nature of falls in children with PWS in conditions 5 and 6 suggest an inability to adapt to sensory conditions in which vestibular input must be prioritized. Postural control training programs in this population should include activities that improve their ability to appropriately weight sensory information in changing sensory environments, with a particular focus on the vestibular system. WHAT DOES THIS STUDY ADD?: This study shows that children with PWS demonstrate a lower level of postural stability. The results suggest that children with PWS show inability to adapt to sensory conditions that require prioritizing vestibular information to maintain postural control. This information can be used to help guide training programs in this population.

Child and Adolescent Manganese Biomarkers and Adolescent Postural Balance in Marietta CARES Cohort Participants

BACKGROUND

Manganese (Mn) plays a significant role in both human health and global industries. Epidemiological studies of exposed populations demonstrate a dose-dependent association between Mn and neuromotor effects ranging from subclinical effects to a clinically defined syndrome. However, little is known about the relationship between early life Mn biomarkers and adolescent postural balance.

OBJECTIVES

This study investigated the associations between childhood and adolescent Mn biomarkers and adolescent postural balance in participants from the longitudinal Marietta Communities Actively Researching Exposures Study (CARES) cohort.

METHODS

Participants were recruited into CARES when they were 7-9 y old, and reenrolled at 13-18 years of age. At both time points, participants provided samples of blood, hair, and toenails that were analyzed for blood Mn and lead (Pb), serum cotinine, hair Mn, and toenail Mn. In adolescence, participants completed a postural balance assessment. Greater sway indicates postural instability (harmful effect), whereas lesser sway indicates postural stability (beneficial effect). Multivariable linear regression models were conducted to investigate the associations between childhood and adolescent Mn biomarkers and adolescent postural balance adjusted for age, sex, height-weight ratio, parent/caregiver intelligence quotient, socioeconomic status, blood Pb, and serum cotinine.

RESULTS

CARES participants who completed the adolescent postural balance assessment (n = 123 ) were 98% White and 54% female and had a mean age of 16 y (range: 13-18 y). In both childhood and adolescence, higher Mn biomarker concentrations were significantly associated with greater adolescent sway measures. Supplemental analyses revealed sex-specific associations; higher childhood Mn biomarker concentrations were significantly associated with greater sway in females compared with males.

DISCUSSION

This study found childhood and adolescent Mn biomarkers were associated with subclinical neuromotor effects in adolescence. This study demonstrates postural balance as a sensitive measure to assess the association between Mn biomarkers and neuromotor function. https://doi.org/10.1289/EHP13381.

Static and dynamic postural control assessment in schoolchildren: Reliability and reference values of the Modified Flamingo Test and Bar Test

INTRODUCTION

Single-leg stance tests have been widely used to evaluate static balance, like the Modified Flamingo Test. The evaluation of dynamic balance on small support surfaces is the objective of some tests like the Bar Test.

RESEARCH QUESTION

How is the performance of postural control during the performance of these tests in schoolchildren between 6 and 11 years of age in both sexes? What are the reference values of these tests in this population?

METHOD

A cross-sectional study in which a total of 282 children. The evaluation included both tests.

RESULTS

The relative reliability was excellent (Intraclass Correlation Coefficient = 0.84-0.98), and the absolute reliability ranged between 4.5% and 7.1% for coefficient variation and between 0.5 and 1.5 for the standard error of measurement. The average results were 3.8 ± 2.7 floor touches for the Modified Flamingo Test and 5 ± 3.5 m for the Bar Test. The results of both tests improve progressively with the increase of age.

DISCUSSION

It can be asserted that children of different ages, as well as boys and girls of the same age, perform differently in these tests. Particularly, according to the analysis based on age subgroups, there were greater improvements in the performance of both tests between 8 and 11 years of age.

CONCLUSIONS

The girls obtained in both tests better results, although between 6 and 7 years of age the differences between sexes are not significant.

Static Postural Control during Single-Leg Stance in Endurance, Team and Combat Athletes from the Spanish National Sport Technification Program

In the context of pediatric physical exercise, the analysis of factors affecting postural control (PC) provides insight into the development of sport-specific motor skills. This study aims to evaluate the static PC during single-leg stance in endurance, team and combat athletes from the Spanish National Sport Technification Program. A total of 29 boys and 32 girls, aged 12 to 16 years old, were recruited. Centre of pressure (CoP) was measured on a force platform in standing position for 40 s under two sensorial and leg dominance conditions. Girls showed lower MVeloc (p < 0.001), MFreq (p > 0.001) and Sway (p < 0.001) values than boys in both sensorial conditions (open and closed eyes). The highest values in all PC variables were observed with eyes closed in both genders (p < 0.001). Sway values were lower in boys combat-athletes compared to endurance athletes in two sensorial conditions and with non-dominant leg (p < 0.05). Young athletes in their teens enrolled in a Sport Technification Program have shown differences in PC when comparing different visual conditions, sport disciplines and gender. This study opens a window to a better understanding of the determinants of PC during single-leg stance as a critical element in the sport specialization of young athletes.

Lifespan changes in postural control

Lifespan development of postural control shows as an inverted U-shaped function with optimal performance in young adults and similar levels of underperformance in children and older adults. However, similarities in children and older adults might conceal differences in underlying control processes. We mapped out age-related differences in postural control using center-of-pressure trajectories of 299 participants ranging from 7 to 81 years old in three tasks: stable stance, compromised vision, and narrowed base of support. Summary statistics (path length, ellipse area) replicated the well-known U-shape function also showing that compromising vision and narrowing the base of support affected older adults more than children. Stabilogram diffusion analysis (SDA) allows to assess postural control performance in terms of diffusion at short (< 1 s) and longer timescales. SDA parameters showed the strongest short-term drift in older adults, especially under compromised vision or narrowed base of support conditions. However, older adults accommodated their poor short-term control by corrective adjustments as reflected in long-term diffusion under eyes closed conditions and initiating anti-persistent behavior earlier compared with children and young adults in tandem stance. We argue that these results highlight the adaptability of the postural control system and warrant a reinterpretation of previous postural control frameworks.

Relevance and Effectiveness of Combined Resistance and Balance Training to Improve Balance and Muscular Fitness in Healthy Youth and Youth Athletes: A Scoping Review

BACKGROUND

Balance and resistance training applied as single-mode interventions have proven to enhance measures of balance and/or muscular fitness in youth and youth athletes. Less is known on the effectiveness of combined or sequenced balance and resistance training in youth and youth athletes.

OBJECTIVE

The objective of this scoping review was to describe the effects of concurrently performed balance and resistance training (i.e., metastable resistance training) and different sequencing schemes of balance and resistance training on measures of balance and/or muscular fitness in healthy youth and youth athletes. We additionally aimed to identify knowledge gaps in the literature.

METHODS

According to the principles of a scoping review, we followed a broad research question, identified gaps in the literature, and reported findings on the level of single studies but did not aggregate and meta-analyze outcomes across studies. For this purpose, systematic literature searches were conducted in the electronic databases PubMed (including MEDLINE), Web of Science, and SPORTDiscus from inception until August 2022. We included metastable resistance training and sequenced balance and resistance training studies in healthy youth and youth athletes aged 6-18 years that investigated the training-induced effects on measures of balance (e.g., stork balance test) and muscular fitness (e.g., countermovement jump test) in contrast to active/passive controls. The Physiotherapy Evidence Database (PEDro) scale was used to assess the risk of bias. The Strength of Recommendation Taxonomy (SORT) was applied for the whole scoping review on levels A (high strength of recommendation) to C (low strength of recommendation) and for individual studies on levels 1 (high-quality evidence) to 3 (low-quality evidence).

RESULTS

The strength of recommendation for the scoping review was level B based on inconsistent or limited-quality evidence. Eleven randomized controlled trials were eligible to be included in this scoping review and each study was rated as 'limited-quality evidence'. A median PEDro score of 6 was computed across the included studies. Four studies examined the effects of metastable resistance training (e.g., plyometric training on unstable surfaces) on measures of balance and/or muscle fitness in youth athletes. The remaining seven studies investigated the impact of sequenced balance and resistance training (e.g., blocked balance training followed by blocked resistance training) on measures of balance and/or muscle fitness in youth and youth athletes. The duration of the intervention programs ranged from 6 to 10 weeks with 2-weekly to 3-weekly exercise sessions. Participants' age range was 10-18 years (mean 15 years). Ten studies examined young male and female athletes from different sports (i.e., basketball, handball, soccer) and one study physical education students. Metastable resistance training compared with plyometric training performed on stable surfaces showed no extra effect on measures of balance and muscular fitness. Stable plyometric training appears to be even more effective to improve jump performance. Sequenced balance and resistance training in the form of a mesocycle of balance followed by plyometric training seems to be particularly effective to improve measures of balance and muscular fitness in young athletes. This scoping review identified knowledge gaps that may indicate future research avenues: (i) comparative studies should be designed to examine how sex, age, maturity status, and expertise level impact on the adaptive potential following metastable resistance training or sequenced balance and resistance training in youth and youth athletes, (ii) at least one established measure of balance and muscular fitness should always be included in study designs to allow future comparison between studies and to aggregate (meta-analyze) findings across studies and (iii) studies are needed that examine neuromuscular and tendomuscular adaptations following these exercise types as well as dosage effects.

CONCLUSIONS

According to the results of this scoping review, balance training should be an essential training component for youth that is incorporated with the resistance training exercises or introduced at least a month before resistance and plyometric training within a periodized training program. More research is needed to examine the moderating roles of age, maturity status, and sex.

Factors associated with balance ability in Duchenne and Becker muscular dystrophies

BACKGROUND

Problems such as progressive muscle function loss, postural deteriorations, and contractures seen in patients with Duchenne and Becker muscular dystrophies (D/BMD) may affect children's balance ability, and impaired balance ability may lead to limitations in children's functional level.

RESEARCH QUESTION

What factors are associated with balance ability in children with D/BMD?

METHODS

Twenty participants with D/BMD were included in the study. Participants' ages were asked; height, body weight, and body mass index (BMI) were recorded. Children's functional level was assessed with the Motor Function Measurement-32 (MFM-32), Brooke and Vignos Scales. Muscle strength of hip flexion and extension, knee flexion and extension, and ankle dorsiflexion was measured with a handheld dynamometer. Balance measurements were performed using the Balance Master System. The relationship between balance and continuous independent variables was determined using Spearman's test.

RESULTS

The mean age of the participants was 8.57 ± 3.27 years. The balance abilities of children with BMD were better than those of children with DMD (p < 0.05). The balance diminished with age (p < 0.05), while there was a positive correlation between balance and weight, height, BMI (p < 0.05). There was a positive correlation between the balance and the MFM-32 total and subsection scores. Muscle strength was positively related to balance (p < 0.05).

SIGNIFICANCE

The results showed the balance ability in children with D/BMD was affected by age, height, weight, BMI, functional level, and muscle strength. Based on the results of this study, balance and strength training should be an integral part of the rehabilitation of children with D/BMD.

Age and gender differences in static and dynamic balance of Chinese preschool children

Objectives: Balance is a crucial ability of early age, but there is conflicting evidence with regard to age and gender differences in preschool children's balance ability. Additionally, there are several tools available to measure balance, yet, wide variation in their use has restricted the capacity to synthesize the reference values. Therefore, the primary purpose of this study was to investigate the balance ability of preschool-aged children and determine how it is moderated by age and gender. The analysis pertained to determining whether different testing methods affect the results of static or dynamic balancing ability to provide a basis for normative balance ability data for healthy boys and girls between 3 and 6 years of age. Method: Six hundred and nineteen preschool children (296 boys and 323 girls) aged 3-6 years participated in the study. The static balance (SB) was assessed with children standing on one leg (OST) and in a tandem stance (TS) with respect to time. The balance beam test (BBT) and functional reach test (FRT) were used to evaluate dynamic balance (DB) by measuring the time spent and the distance reached, respectively. Result: The results revealed significant differences in OST with respect to gender (η2 = 0.037, p < 0.001), TS (η2 = 0.026, p < 0.001) and FRT (η2 = 0.016, p = 0.002); the girls performed better than boys on most balance tests except on BBT (η2 = 0.000, p = 0.596). Age had positive effects on the static and dynamic balance performance on the OST (η2 = 0.336, p < 0.001), TS (η2 = 0.205, p < 0.001), BBT (η2 = 0.367, p < 0.001) and FRT (η2 = 0.392, p < 0.001). Older children performed better than their younger counterparts. No significant interactions between age groups and sex were found. Conclusion: This study revealed that static and dynamic balance stability in preschool-aged children was affected by gender and age. Gender dimorphism is present in preschool children, older girls displayed better postural stability than boys, and balance performance improved with age. In addition, the study provides age- and gender-specific balance performance reference values for preschool children across multiple methods, which can be used to monitor static and dynamic balance development.

Facts of Vertigo in Adolescents: Controversies and Challenges – A Narrative Review

Vertigo is a common complaint in the general population affecting 5% of adults in one year. At least 29.5% of adults have referred vertigo during life. Even though the prevalence of vertigo is well known in adults the epidemiologic data in adolescents is sparse. To date, it is known that adolescent females are usually affected by vertigo and some conditions such as depression and anxiety are found in this population. However, the lack of information about the prevalence of most common types of vertigo in adolescents, predisposing factors, challenges, and controversies in clinics in the literature, present a challenge for clinicians regarding the approach and follow-up of this population. Herein, we performed a literature review including data about the prevalence, most common types of vertigo and controversial events in the approach of vertigo in adolescents over the last two decades.

Biological Maturation Predicts Dynamic Balance and Lower Limb Power in Young Football Players

Biological maturation has an increasingly important role in youth sports. The aim of the study was to evaluate the relationship between dynamic balance and lower limb power and biological maturation in young football players. Seventy-two healthy, young male elite football players (age: 10 ± 2) participated in the study. Dynamic balance was assessed using a modified Star Excursion Balance Test (mSEBT). Power of the lower limbs was examined by a Countermovement Jump test (CMJ) and Single Leg Hop for Distance (SLHD). Furthermore, anthropometry and biological maturation (age, peak height velocity, and maturity offset) were assessed. There was a strong positive correlation between vertical jump (r = 0.75), distance long jump (r = 0.84), and biological maturation. A moderate positive correlation was found between dynamic balance (mSEBT COM, PL, and PM) and maturity offset. There was a significant association between mSEBT, CMJ, and SLHD (p < 0.05). Moreover, maturity offset explained 75% of vertical jump and 74% of distance long jump performance, respectively, and 12% of dynamic balance. Biological maturation should be considered when assessing athletic performance, establishing rehabilitation, and sports training in youth football players.

Does 8 Weeks of Integrated Functional Core and Plyometric Training Improve Postural Control Performance in Young Rhythmic Gymnasts?

It has been suggested that core stability and plyometric training (CPT) can enhance athletes' postural control. Nevertheless, the effects of an integrated core and plyometric training program on rhythmic gymnastics (RG) performance are unclear. This study aimed to evaluate the effects of an integrated functional CPT program on young rhythmics gymnasts' postural performance. A sample of 44 young female rhythmic gymnasts from a competitive team (age = 10.5 ± 1.8 years) participated in the study. The subjects were randomly divided into a control group and an experimental group. Pre- and posttest design was used. Postural control was assessed using single-leg stance tests and RG-specific balances over a force platform and evaluated by expert RG judges. The experimental group (n = 23) completed an 8-week functional CPT program based on RG technical requirements. Meanwhile, the control group (n = 21) received their usual training sessions. A mixed model of analysis of variance was applied to evaluate the effects of an intrasubject factor and an intersubject factor on each of the dependent variables. After 8 weeks, the experimental group obtained significant better results in some variables of the right support leg with eyes open and left support leg with eyes open single-leg support (p < .01), improvements were also found in some specific RG balances: Arabesque measured on the force platform (p < .01) and the side leg with help balance scored by the judges (p < .01). In conclusion, an integrated functional CPT program improved postural control in young rhythmic gymnasts. Coaches should consider using this CPT to improve RG performance.

Relationship between static balance and gait parameters in preschool children

BACKGROUND

Postural sway while standing reflects the degree of sensory integration function. The relationship between static balance and gait parameters in preschool children is essential for understanding which component of gait function is linked to the sensory integration function.

RESEARCH QUESTION

We aimed to clarify the relationship between static balance and gait in children, aged 2-6 years, with typical development METHODS: A total of 105 children (48 girls, 57 boys) participated in this study. Static balance parameters were computed using positions at the center of pressure (COP) while standing (COP length, velocity, and sway area). Spatiotemporal parameters during gait were analyzed for stride length, step width, stance time, cadence, coefficient of variation (CV) of step length, and CV of stance time as gait variability. Pearson correlation coefficients were estimated to explore the relationship between age and static balance or gait parameters. Partial correlation analysis controlling for age was also performed to examine the relationship between static balance and gait parameters.

RESULTS

A moderate association between age and static balance parameters and between age and gait parameters was found. Partial correlation analysis revealed that the variability parameters of gait were associated with the static balance parameters. No relationship was found between both spatial and temporal gait parameters and static balance parameters.

SIGNIFICANCE

Among the gait parameters that are considered to develop in early childhood, gait variability was associated with COP sway while standing, whereas stride length with increasing age was independent of any static balance parameters. Of the spatial, temporal, and variability parameters of gait, only gait variability maybe associated with the development of sensory integration function.

Decreased Balance Function in School-Aged Children with Behavioral Problems

Children with behavioral problems have a high risk of impaired motor performance. However, the characteristics of balance functions and their associations with behavioral traits are unclear in this population. This study aimed to evaluate balance functions and their relationships with the degree of behavioral problems in school-aged children. A total of 209 children, aged 6–10 years, were divided into two groups, those with and those without behavioral problems, using the Strengths and Difficulties Questionnaire (SDQ). Physical assessments included the one-leg standing test (OLST), the two-step test, and the five-times-sit-to-stand test. We compared the data between groups and assessed for correlations in terms of total difficulties and the SDQ subscale scores. Children with behavioral problems showed significantly reduced the OLST results (p < 0.001) and the two-step test results (p = 0.008). The five-times-sit-to-stand test results did not show significant differences between groups. The OLST results were significantly correlated with emotional symptoms (r = −0.22, p < 0.001), hyperactivity/inattention (r = −0.29, p < 0.001), peer relationship problems (r = −0.22, p < 0.001), and total difficulties (r = −0.32, p < 0.001). Meanwhile, the two-step test results showed no significant correlation with the SDQ scores. Children with behavioral problems have poor balance function, thereby increasing the risk for instability. This suggests that the balance function of children with behavioral problems needs to be considered.

Feasibility and Preliminary Effects of a 1-Week Vestibular Rehabilitation Day Camp in Children with Developmental Coordination Disorder

AIM

This pilot study investigated the feasibility and preliminary effects of an intensive 1-week day camp program for children with Developmental Coordination Disorder (DCD) that focused on vestibular rehabilitation.

METHODS

Ten participants (6-10 years) were assessed twice pre-intervention, post intervention, and at 8-week follow-up. Videonystagmography, Video Head Impulse Tests (vHIT), and Modified Emory Clinical Vestibular Chair Test (m-ECVCT) test were assessed at baseline. Outcomes measures were gaze stability (Dynamic Visual Acuity; DVA), functional gait (Functional Gait Assessment; FGA), balance (Sensory Organization Test), motor function (Bruininks-Oseretsky Test), and participation (Miller Function and Participation).

RESULTS

No abnormal results were detected from the videonystagmography, vHIT and m-ECVCT. There was a 100% attendance rate at the camp and assessment sessions. FGA scores significantly improved following intervention and changes were maintained at follow-up. The number of children with abnormal DVA scores decreased from 3 to 1 to 0 between pre-intervention, post-intervention, and follow-up. There were no significant changes in any of the other outcomes following intervention.

CONCLUSIONS

Intensive vestibular rehabilitation delivered in a day camp format is feasible and show positive preliminary effects on functional gait and dynamic visual acuity in children with DCD.

Prevalence of Pediatric and Adolescent Balance Disorders: Analysis of a Mono-Institutional Series of 472 Patients

(1) Background: To assess the prevalence and frequency distribution of balance disorders in children and adolescents to delineate the planning of a targeted clinical and instrumental diagnostic work-up; (2) Methods: Retrospective analysis of the clinical documentation of patients under 18 years suffering from balance disorders from 2010 to 2019. Detailed collection of clinical history, accurate clinical examination, including both nystagmus and vestibulospinal signs examinations, and specific instrumental testing were the basis of the diagnostic process. (3) Results: A total of 472 participants were included in the study. Vestibular loss (26.1%) was the most frequent cause of vertigo in children, followed by vestibular migraine (21.2%) and benign paroxysmal positional vertigo (10.2%). In 1.1% of patients, the cause of vertigo remained undefined; (4) Conclusions: The diagnostic process applied was effective in understanding the cause of balance disorders in most cases and prevents more complex and expensive investigations reserved for only a few selected cases.

Vertigo and Dizziness in Children: An Update

Background: Vertigo and dizziness are relatively infrequent in paediatric patients, but specific data on the prevalence of these disorders are limited and influenced by various factors, including the age of the examined population. These conditions often have a significant impact on patients’ and parents’ quality of life. The aim of this paper is to investigate the prevalence of different aetiologies of vertigo in the paediatric population through a systematic review. Methods: According to PRISMA guidelines, a systematic review of the literature was performed. Medline and Embase were searched from January 2011 through to 10 September 2021. The search yielded 1094 manuscripts, which were reduced to 7 upon the application of inclusion criteria. Results: A total of 2470 paediatric patients were evaluated by the selected papers. Vestibular Migraine was the most frequently diagnosed condition, occurring alone or in association with other diseases. Overall, audio-vestibular disorders represented the second cause of vertigo, and the prevalence appears to increase according to age growth. Over the years, even though we assisted in the amelioration of diagnostic rates, partially related to an improvement in diagnostic tools, the aetiology of vertigo remains still unclear in a variable percentage of patients. Conclusion: Vertigo in children, despite being an uncommon symptom, requires a multidisciplinary approach, often involving Paediatricians, Neurologists and Otorhinolaryngologists. A comprehensive evaluation of children suffering from vertigo is crucial for establishing a successful therapy and reducing parental worries.

Development of postural stability in children with autism spectrum disorder: a cross-sectional study

The purpose was to investigate the effects of age on postural stability for children with autism spectrum disorder (ASD). Twenty-nine children with mild ASD were assigned into one of the three groups: 6–8 years (U8), 9–11 years (U11) and 12–14 years (U14). Participants stood barefoot with both feet on a force platform and maintained stationary for 15 seconds during eyes-open and eyes-closed conditions. Center of pressure data were collected and variables were calculated, including displacements, total distances, sway areas, and sample entropy. The variables were compared among the three groups using a mixed-model ANOVA. The age group effect was significant for mediolateral center of pressure displacement (p = 0.04) and sway distance (p = 0.02). Post-hoc comparisons revealed that U8 exhibited greater mediolateral displacement and total distance compared to U14, regardless of test conditions. The U14 group exhibited improved mediolateral postural stability compared to U8, whereas no differences were found between U8 and U11 or between U11 and U14. This may suggest that children with ASD could slowly develop postural stability but only demonstrate significant changes over a long period of time. Early intervention programs aimed to improve complexity of postural control could be beneficial.

Vestibular, Oculomotor, and Balance Functions in Children With and Without Concussion

OBJECTIVE

The main objective of this study was to assess whether objective vestibular, oculomotor, and balance functions were impaired in children with a current diagnosis of concussion with vestibular and/or ocular symptoms.

SETTING

Data were collected in a vestibular/ocular clinical laboratory. Patient participants were recruited from a concussion clinic in a children's hospital.

PARTICIPANTS

Thirty-three children aged 8 to 17 years with a current diagnosis of concussion and vestibular and/or ocular symptoms and 30 children without concussion.

DESIGN

Cross-sectional single-visit study.

MAIN OUTCOME MEASURES

Eye-tracking rotary chair oculomotor and vestibular measures, vestibular evoked potentials, and static posturography.

RESULTS

There were no statistically significant differences on any clinical measure between children with concussion and children without concussion. Younger children without concussion performed significantly worse on several rotary chair and balance measures compared with older children without concussion.

CONCLUSIONS

No vestibular, oculomotor, or balance measures were significantly different between children with concussion and children without concussion, suggesting these measures may not be useful in the evaluation of a child with concussion and vestibular and/or oculomotor symptoms. Future research should investigate age effects and other vestibular and oculomotor tests to identify objective findings that better relate to vestibular and/or ocular symptoms in children with concussion.

Sex differences in postural control under unstable conditions in schoolchildren with accelerometric assessment

BACKGROUND

Although the effects of balance training on unstable surfaces have been widely studied, the impact of exposure to an unstable surface in static balance throughout childhood has not been described to date.

RESEARCH QUESTION

How does postural stability vary between sexes in children 6-12 years of age during single leg static support on unstable surface? What are the normative values of centre of mass acceleration in the mentioned age range during such test? Is the postural stability on an unstable surface in the postural control of children aged 6-12 years during static single-leg stance. Secondarily, the normative acceleration values of the gravity centre, recorded during such tests and throughout the mentioned age range, were also provided.

METHODS

Descriptive, transversal study conducted with a total of 316 school children (girls = 158). The analysed variables were the mean and maximum values obtained in each of the three body axes and their root mean square during static single-leg support test on an unstable surface (a mat).

FINDINGS

Accelerations decreased in magnitude with the increasing age of the participants. The highest accelerometric values were recorded in the medio-lateral axis in both sexes and throughout the entire age range studied. Between sexes, the greatest differences were obtained between 8 and 11 year-olds. The regression models revealed significant values about the influence of sex on the accelerometric variables (girls were more likely to obtain less accelerations in postural adjustments with increasing age).

INTERPRETATION

Boys depend more on somatoaesthetic information, whereas girls would use more visual and vestibular information. In the age range of 8-11 years, the postural control system is significantly different between sexes regarding the hierarchy of the efferent information of the available postural control subsystems. Moreover, the reactions of straightening and postural control on single-leg stance are, fundamentally, flexion-extension movements.

Balance dynamics are related to age and levels of expertise. Application in young and adult tennis players

In tennis, coaches consider balance fundamental for the acquisition of skilled motor performance. However, the potential relationship between balance and tennis expertise and performance has not been explored yet. Therefore, this study assessed the relationship between balance and tennis performance using linear and non-linear parameters through 1) the comparison of tennis players of different ages and levels of expertise, and 2) analyzing the relationship between balance and tennis serving speed and accuracy. One hundred and six recreational and expert male tennis players took part in the study (age range 10-35 years old). Temporal dynamics of postural control during a balance task on an unstable surface were analyzed through the mean velocity and the detrended fluctuation analysis (DFAV) of center of pressure (COP). Tennis serve performance was quantified by measuring accuracy and speed. Traditional variables measuring balance performance only showed differences according to age but not to sport performance. COP showed a reduction of auto-correlated variability (reflected by DFAV) with age but mainly in expert players. COP dynamics was the only balance parameter discriminating sport expertise and it was related to age. Balance dynamics exhibited by expert tennis players DFAV results support the idea that, along the years, sport experience induces balance adaptations characterized by a higher ability to perform postural adjustments. These results also reinforce the use of non-linear analysis to reveal subtle balance adaptations produced by sport practice. Finally, the lack of correlations suggests that balance, measured with scattering variables, in a non-specific task is not a main determinant of sport performance in tennis serve.

Influence of Visual Information and Sex on Postural Control in Children Aged 6-12 Years Assessed with Accelerometric Technology

The performance of postural control is believed to be linked to how children use available sensory stimuli to produce adequate muscular activation. Therefore, the aim of the present study was to thoroughly explore postural stability under normal conditions and without visual information in postural control in children aged 6–12 years during static single-leg support. A descriptive cross-sectional study was conducted with 316 children (girls = 158). The analyzed variables were the mean and maximum values obtained in each of the three body axes and their root mean square during two static single-leg support tests: one with eyes open and one with eyes closed. Girls showed lower magnitudes in the recorded accelerations at all ages and in all the variables of both tests. Accelerations during the tests showed progressively lower values from 6 to 12 years of age. The sex had a significant influence on the magnitude obtained in the accelerations recorded during the tests. Improvements in balance with increasing age were greater with visual information than without visual information. The tests of single-leg support showed preferential sensorimotor strategies in boys and girls: boys tend to rely more on visual inputs, and girls process somesthetic information in a preferential way.

Concurrent and discriminant validity of Nintendo Wii Fit exergame for the assessment of postural sway

[Purpose] The purpose of this study was to determine the concurrent validity of Wii Fit center-of-pressure parameters with Clinical Test of Sensory Integration for Balance and to evaluate the discriminant validity of the Wii Fit center-of-pressure parameters for adults and the elderly for the assessment of postural sway. [Participants and Methods] This study used an observational cross-sectional correlational design. All 70 participants were required to complete a questionnaire for eligibility screening, followed by a center-of-pressure assessment using three Wii Fit balance activities (snowboard slalom, ski slalom, and balance bubble) and Clinical Test of Sensory Integration for Balance using a force platform. [Results] For center-of-pressure assessment, our results showed there was concurrent validity of Wii Fit ski slalom and balance bubble with Clinical Test of Sensory Integration for Balance conditions 6 and 4, respectively. Our results also demonstrated that the three Wii Fit balance activities selected in this study could be used to discriminate between adults and the elderly. [Conclusion] Our results suggest that Wii Fit is a viable and affordable alternative method for center-of-pressure assessment.

Relationships between types of balance performance in healthy individuals: Role of age

BACKGROUND

Balance is considered to be task-specific as indicated by studies reporting only small-sized and non-significant correlations between types of balance (e.g., static, dynamic). However, it remains unclear whether these associations differ by age and the comparability of studies is limited due to methodological inconsistencies.

RESEARCH QUESTION

Are associations between types of balance performance affected by age in children, adolescents, and young adults?

METHODS

Static, dynamic, and proactive balance performance was assessed in 30 children (7.6 ± 0.6 years), 43 adolescents (14.7 ± 0.5 years), and 54 young adults (22.8 ± 2.8 years) using the same standardized balance tests. Pearson's correlation coefficients (r) were calculated for associations between types of balance and statistically compared to detect differences between age groups.

RESULTS

Except for the association between static (i.e., medio-lateral [M/L] sway) and proactive (Y-balance test) balance performance in young adults (r = .319, p < .05), our analyses revealed small-sized and non-significant associations between measures of static, dynamic, and proactive balance performance in children (-.302 ≤ r ≤ .245, p > .05), adolescents (-.276 ≤ r ≤ .202, p > .05), and young adults (-.120 ≤ r ≤ .161, p > .05). Significant differences between age groups were observed for associations between dynamic and proactive balance, which were lesser in young adults (r = .161) compared to adolescents (r = -.276, p = .017) and children (r = -.302, p = .023) and for associations between static (i.e., M/L sway) and proactive balance, which were larger in young adults (r = .319) compared to adolescents (r = -.131, p = .029).

CONCLUSIONS

Practitioners (e.g., PE teachers) should be aware that associations between types of balance performance are small and hardly affected by age in youth. Therefore, they should be trained and tested individually in children, adolescents, and young adults.

Maturation of the postural control in adolescent girls: A 3-year follow-up study

BACKGROUND

Stable posture is a manifestation of the appropriate functioning of the neuromuscular system that is essential for proper motor development and control. Balance and stability of the erect posture are shaped during the entire childhood to culminate in its full efficiency in adolescent subjects.

METHODS

In this 3-year follow-up study, the process of the postural control maturation has been assessed in a group of 18 girls at the transition period between childhood to adolescence. Their balance and postural stability control were assessed using standard static posturography supplemented by two postural stability tests: the rising-on-toes (ROT), and the maximum forward lean (MFL), all performed with (EO) and without vision (EC). Balance control was analyzed with the sway vector (SV) and sway directional indices, whereas the anteroposterior trajectories of the center-of- pressure (COP) during forward-leaning and the raise-on-toes tests were used to determine changes in postural stability control.

RESULTS

The study documented that stability control in girls aged 11-13 is shaped according to their own pace of development. Their postural sway was characterized by the lower COP velocity but very sensitive to visual input. The directional sway measures remained at the same level for the entire period of observation. MFL and ROT tests provided similar information on postural stability and its dependence on visual input. These tests allow for more thorough assessment of postural stability to compare with quiet stance testing.

SIGNIFICANCE

Subtle changes in postural control in adolescents could be assessed based on the results of combined static and dynamic tests. In particular, the ROT test can be recommended for the assessment of postural stability.

Analysis of dynamic balance in preschool children through the balance beam test: A cross-sectional study providing reference values

BACKGROUND

dynamic balance (DB) is a complex ability at an early age and balance deficits are related to numerous disorders. There are several balance measures but wide variation in their use has restricted the capacity to synthesise references values. The main purpose of this study was to analyse the performance of the Balance beam test (BBT) in preschool children, according to age and sex providing BBT reference values, and also to analyse its reliability and validity.

RESEARCH QUESTION

could the BBT be a reliable test for measuring dynamic balance in preschool children?

METHODS

593 preschool children (3-6 years) participated in this study. The BBT was used to evaluate DB by measuring distance reached, time spent, and number of steps. Differences between sex and age groups were analysed using the Mann-Whitney U and Kruskal-Wallis tests. Test-retest reliability analysis was performed using intraclass correlation coefficients and the Bland-Altman graphic. Convergent validity was investigated with the Stork Balance stand test (SBST).

RESULTS

no significant differences were found for sex in any components of the BBT. Age had positive effects on BBT performance in distance (χ² = 63.474, p < 0.001), time (χ² = 46.441, p < 0.001), and step numbers (χ² = 40.967, p < 0.001). Younger children performed more poorly than older children. No significant interactions between age groups and sex were found. The BBT showed adequate validity and reliability.

SIGNIFICANCE

the reference values established for Spanish preschool children in the current study could be used to monitor DB development. It is necessary to take into account distance reached, time spent, and the steps taken to obtain a more precise measure of DB in this population.

Changes in the Sensory Weighting Strategies in Balance Control Throughout Maturation in Children

BACKGROUND

 The central nervous system integrates information from different sensory inputs (vestibular, visual, and somatosensory) to maintain balance. However, strategies for weighing sensory information change as maturation occurs.

PURPOSE

 The purpose of this study was to: (1) evaluate postural control development in a large sample of healthy children aged 5 to 17 years old, (2) analyze changes in sensory weighting strategies as maturation occurs, and (3) determine the extent to which anthropometric characteristics (height, weight, body mass index [BMI]) influence postural control.

SAMPLE SIZE

 This study recruited 120 healthy children, equally distributed in gender and number, into four age groups (5-8 years, 9-11 years, 12-14 years, and 15-17 years) and compared them to a control group of 20 healthy adults (aged 20-25 years).

RESEARCH DESIGN

 The sensory organization test (SOT) was used to assess overall balance and the use of specific sensory inputs to maintain postural control. All children underwent the six SOT conditions: (1) eyes open, surround and platform stable, (2) eyes closed, surround and platform stable, (3) eyes open, sway-referenced surround, platform stable, (4) eyes open, sway-referenced platform, (5) eyes closed, sway-referenced platform, and (6) eyes open, sway-referenced surround and platform.

DATA ANALYSIS

 Condition-specific equilibrium scores (ES), composite equilibrium scores (CES), and sensory analysis ratios were analyzed to determine whether the performance was related to age, gender, or specific anthropometric characteristics (height, weight, and BMI).

RESULTS

 Data showed a significant age-associated improvement in ES for all 6 conditions (p < 0.05) and in CES (p = 0.001). For both genders, (1) somatosensory function was adult-like by age 5 to 8 years, (2) visual function peaked around age 12 years, and (3) vestibular function reached maturity by age 15 to 17 years (p < 0.05). A moderate positive correlation (r(140) = 0.684, p = 0.01; two-tailed) between height and CES was found and a weak positive correlation (r(140) = 0.198, p = 0.01) between height and somatosensory ratio was noted. Lower vestibular ratio scores were observed in children who had a higher BMI (p = 0.001).

CONCLUSION

 The efficient use of individual sensory system input to maintain balance does not occur at the same age. Age and gender affect the changes in sensory weighting strategies, while height and BMI influence postural control in children. These factors need to be accounted for in child assessment.

Utility of the anterior reach Y-BALANCE test as an injury risk screening tool in elite male youth soccer players

OBJECTIVES

Examine growth and maturation trends in dynamic balance using the anterior reach Y-Balance test, and its utility as an injury risk screening tool.

DESIGN

Cross sectional and prospective cohort.

SETTING

Elite male youth soccer players.

PARTICIPANTS

346 players grouped as pre, circa or post peak height velocity (PHV).

MAIN OUTCOME MEASURES

Pre-season anterior reach absolute and relative Y-Balance test scores and seasonal prospective lower extremity injury monitoring.

RESULTS

Absolute reach distances were greatest post-PHV (p < 0.05). Relative to leg length, pre-PHV achieved the highest scores and increased between-limb differences. Significant associations between injury and anterior reach scores were present in pre (OR: 0.94, CI: 0.91-0.98, p < 0.05) and circa-PHV (OR: 1.05, 95% CI: 1.05-1.10, p < 0.05). Increased age (OR: 1.49, 95% CI: 1.04-2.13, p < 0.05) and height (OR: 1.06, 95% CI: 0.99-1.13, p = 0.82) were risk factors post-PHV. No differences in injury occurrence were shown between players with absolute reach difference >4 cm in any group.

CONCLUSIONS

Anterior reach scores increased injury risk, but associations were small and inconsistent. The Y-Balance should be used with caution as a screening tool in this cohort.

Body-Worn Sensors Are a Valid Alternative to Forceplates for Measuring Balance in Children

Aims

Clinical evaluation of balance has relied on forceplate systems as the gold standard for postural sway measures. Recently, systems based on wireless inertial sensors have been explored, mostly in the adult population, as an alternative given their practicality and lower cost. Our goal was to validate body-worn sensors against forceplate balance measures in typically developing children during tests of quiet stance.

Methods

18 participants (8 males) 7 to 17 years old performed a quiet stance test standing on a forceplate while wearing 3 inertial sensors. Three 30-second trials were performed under 4 conditions: firm surface with eyes open and closed, and foam surface with eyes open and closed. Sway area, path length, and sway velocity were calculated.

Results

We found 20 significant and 8 non-significant correlations. Variables found to be significant were represented across all conditions, except for the foam eyes closed condition.

Conclusions

These results support the validity of wearable sensors in measuring postural sway in children. Inertial sensors may represent a viable alternative to the gold standard forceplate to test static balance in children.

Functional Variability in Team-Handball Players during Balance Is Revealed by Non-Linear Measures and Is Related to Age and Expertise Level

Postural control is considered a key variable in team sports, such as handball, which require abilities strongly related to balance. However, postural control and its relationship to the performance of handball skills according to the players’ skill level and age has not been evaluated to date. This study analyzes the relationship between balance ability and team-handball performance according to age and expertise, applying a non-linear approach to balance assessment. Postural control from 114 male team-handball players was analyzed through the center of pressure (COP) during a balance task. Sport performance was measured by the accuracy and speed in throwing. Expert players threw faster, but not more accurately than recreational players. Balance performance was better for 18+ players (older than 18 years old) than those U12 (under 12 years old), but no differences were found according to their skill level. Players who threw with less accuracy showed slower COP velocity during the balance task and their moves were less irregular. Players who threw faster displayed more irregular and less auto-correlated COP movements. In conclusion, experienced team-handball players exhibited better balance performance, and this seems to be related to the maturation of the motor system more than to sport performance level. Nevertheless, non-linear measures of COP excursion revealed an exploratory behavior during balance in expert players, exhibiting more motion adjustments to reduce motor output error. Traditional variables measuring balance performance did not show sensitivity to this motor control process. A non-linear approach to balance assessment revealed functional variability during balance as an intrinsic characteristic of individuals’ motor control according to age and skill level.

Gender Differences in Postural Stability among 13-Year-Old Alpine Skiers

This experiment examined changes in body sway after Wingate test (WAnT) in 19 adolescents practicing alpine skiing, subjected to the same type of training load for 4–5 years (10 girls and nine boys). The postural examinations were performed with eyes open (EO), eyes closed (EC), and sway reverenced vision (SRV) in the medial-lateral (ML) and anterior-posterior (AP) planes. The displacement of center of foot pressure (CoP), range of sway (RS), mean sway velocity (MV), way length, and surface area were measured in bipedal upright stance before and after the WAnT to assess the influence of fatigue on postural balance. There were no significant differences in WAnT parameters between girls and boys. Relative peak power (RPP), relative total work (RWtot) were (girls vs. boys) 8.89 ± 0.70 vs. 9.57 ± 1.22 W/kg, p < 0.05 and 227.91 ± 14.98 vs. 243.22 ± 30.24 W/kg, p < 0.05 respectively. The fatigue index (FI) was also on similar level in both genders; however, blood lactate concentration (BLa) was significantly higher in boys (10.35 ± 1.16 mM) than in girls (8.67 ± 1.35 mM) p = 0.007. In the EO examination, statistically significant differences between resting and fatigue conditions in the whole group and after the division into girls and boys were found. In fatigue conditions, significant gender differences were noted for measurements in the ML plane (sway path and RS) and RS in the AP plane. Comparison of the three conditions shows differences between EO vs. EC and SRV in AP plane measured parameters, and for RS in ML plane in rest condition in girls. The strong correlations between FI and CoP parameters mainly in ML plane in the whole group for all examination conditions were noted. By genders, mainly RS in ML plane strongly correlates with FI (r > 0.7). No correlation was found between BLa and CoP parameters (p > 0.06). The presented results indicate that subjecting adolescents of both genders to the same training may reduce gender differences in the postural balance ability at rest but not in fatigue conditions and that girls are significantly superior in postural balance in the ML plane than boys. It was also shown that too little or too much information may be destructive to postural balance in young adolescents.

The development of postural control among children: Repeatability and normative data for computerized dynamic posturography system

BACKGROUND

The purpose of this study was to investigate the normal development of postural control in children aged 2-18 years in Tehran, and to provide normative data of computerized dynamic posturography (CDP) device variables.

METHODS

The study population included 400 boys and 400 girls aged 2-18 years (eight age groups with 2-year interval) and 100 adults aged 22-25 years. In each age group, 100 people were selected based on the inclusion and exclusion criteria. To evaluate the postural control of the subjects, the sensory organization test (SOT) was performed by using a CDP.

RESULTS

The results of this study led to the determination and presentation of normative data for the development of postural control in boys, girls and children aged 2-18 years. The results related to the repeatability of data produced by the CDP, thereby showing that this system is highly reliable. The results of an independent t-test also showed that girls across all age groups performed better than boys (p ≤ 0.05).

CONCLUSION

The results of this study demonstrated a nonlinear trend of natural development of postural control. Overall, according to the results of the present study, it seems that like adults, 14-16 year-old teens are capable of processing, integrating and organizing sensory systems information for postural control.

The Characteristics of Feet Center of Pressure Trajectory during Quiet Standing

To investigate the level of bilateral symmetry or asymmetry between right and left foot center of pressure (COP) trajectory in the mediolateral and anteroposterior directions, this study involved 102 participants (54 females and 48 males). Ground reaction forces were measured using two Kistler force plates during two 45-s quiet standing trials. Comparisons of COP trajectory were performed by correlation and scatter plot analysis. Strong and very strong positive correlations (from 0.6 to 1.0) were observed between right and left foot anteroposterior COP displacement trajectory in 91 participants; 11 individuals presented weak or negative correlations. In the mediolateral direction, moderate and strong negative correlations (from −0.5 to −1.0) were observed in 69 participants, weak negative or weak positive correlations in 30 individuals, and three showed strong positive correlations (0.6 to 1.0). Additional investigation is warranted to compare COP trajectories between asymptotic individuals as assessed herein (to determine normative data) and those with foot or leg symptoms to better understand the causes of COP asymmetry and aid clinicians with the diagnosis of posture-related pathologies.

Understanding the impact of age, gender, height and body mass index on children's balance

AIM

This research aimed to understand the influence of age, gender, height and body mass index (BMI) on balance ability in children aged 4-12 years. The secondary aim was to develop normative values for three balance tests on the Balance Master system.

METHODS

Children were recruited in 2017 through community advertising. Balance testing occurred at three recreational centres in Frankston, Victoria, Australia. Data were collected by the Rhythmic Weight Shift, modified Clinical Test of Sensory Integration and Limits of Stability balance tests of the Balance Master equipment. Multiple regression analysis determined associations between variables including age, gender, height and BMI.

RESULTS

There were 91 children recruited and consented. Children were aged between 4 and 12 years old. Balance ability was shown to improve with age (P < .05), with girls demonstrating more mature balance strategies at earlier ages. Decreased BMI was associated with greater balance ability and postural control (P < .05).

CONCLUSION

The normative values established may be used to support clinical paediatric assessment with this equipment. Findings of this study suggest that increased BMI may be associated with poorer balance ability in children. However, further research studies are needed to explore this assertion.

Obesity Affects Postural Control in Middle Childhood and Adolescence but not in Early Childhood

Introduction: Overweight/obese children have postural control differences compared with normal-weight children. Nevertheless, there are not studies that analyze the effect of obesity during the entire period comprised between childhood and adolescence. The objective of this study was to determine the differences in postural control between normal-weight and overweight/obese participants during early and middle childhood and adolescence. Methods: 359 children were divided into six groups according to age and weight status. Each participant carried out one 30-s trial with eyes open (EO) and one 30-s trial with eyes closed (EC). Center of pressure signals were acquired using a Wii Balance Board. Mean velocity in antero-posterior (MVAP) and medio-lateral (MVML) directions and the 95% confidence interval ellipse area were calculated. Results: A Mann Whitney U-test showed significant differences between normal-weight and obese 8- to 12-year-old children in MVAP and MVML in both EO and EC. In 13- to 17-year-old adolescents, there were differences between normal-weight and overweight/obese in ellipse area and MVML, both in EO and EC condition. There were no differences in postural stability between normal-weight and overweight/obese 4- to 7-year-old children. Conclusions: Obesity reduces postural stability only in middle childhood and adolescence but not in early childhood.

Preliminary Study of the Effect of Training With a Gaming Balance Board on Balance Control in Children With Cerebral Palsy: A Randomized Controlled Trial

OBJECTIVE

A new protocol based on the use of a gaming balance board for children with cerebral palsy was tested.

DESIGN

A total of 56 children with cerebral palsy were enrolled and randomly divided into two groups: experimental and control. The children in experimental group underwent 12 wks of rehabilitation using their foot to play personal computer games with the proposed balance board, whereas those in the control group played personal computer games with a computer mouse in the standing position. Balance control was assessed before and after the intervention using the Zebris FDM System for measuring the center of pressure. The Pediatric Balance Scale and 2-min walk test were used for evaluating functional balance.

RESULTS

In the analysis of covariance, the proposed new balance board used for the personal computer games decreased the postural sway (sway path, F = 6.95, P = 0.011; sway area, F = 11.79, P = 0.001) and improved the performance of the functional balance tests.

CONCLUSIONS

This study demonstrated the possibility that this new gaming balance board can be used for balance control in children with cerebral palsy.

Three-dimensional path of the body centre of mass during walking in children: an index of neural maturation

Few studies have investigated the kinematic aspects of the body centre of mass motion, that is, its three-dimensional path during strides and their changes with child development. This study aimed to describe the three-dimensional path of the centre of mass in children while walking in order to disentangle the effect of age from that of absolute forward speed and body size and to define preliminary pediatric normative values. The three-dimensional path of the centre of mass during walking was compared across healthy children 5–6− years (n = 6), 7–8 years (n = 6), 9–10 years (n = 5), and 11–13 years of age (n = 5) and healthy adults (23–48 years, n = 6). Participants walked on a force-sensing treadmill at various speeds, and height normalization of speed was conducted with the dimensionless Froude number. The total length and maximal lateral, vertical, and forward displacements of the centre of mass path were calculated from the ground reaction forces during complete strides and were scaled to the participant’s height. The centre of mass path showed a curved figure-of-eight shape. Once adjusted for speed and participants’ height, as age increased, there was a decrease in the three-dimensional parameters and in the lateral displacement, with values approaching those of adults. At each step, lateral redirection of the centre of mass requires brisk transient muscle power output. The base of support becomes relatively narrower with increasing age. Skilled shortening of the lateral displacement of the centre of mass may therefore decrease the risk of falling sideways. The three-dimensional path of the centre of mass may represent maturation of neural control of gait during growth.

Age-related Assessment of Postural Control Development: A Cross-sectional Study in Children and Adolescents

The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4-18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant (p < 0.025) increase in surface and length, when compared to healthy adults, increased values within the low/middle frequency domain and within the high frequency domain were also observed in 4-13 and 4-7-year-old children, respectively. In conclusion, although the nature of postural control development remains largely undetermined, this study represents a first attempt to outline an age-dependent normal range of the relative contribution of inputs in typically developing children.

Age and sex differences in human balance performance from 6-18 years of age: A systematic review and meta-analysis

Background

The process of growing leads to inter-individual differences in the timing of growth, maturational, and developmental processes during childhood and adolescence, also affecting balance performance in youth. However, differences in balance performance by age and sex in youth have not been systematically investigated yet.

Objective

The objective of the present study was to characterize and quantify age- and sex-related differences in balance performance in healthy youth.

Methods

A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus. To be applicable for analysis, studies had to report at least one measure of static steady-state, dynamic steady-state, proactive or reactive balance in healthy children (6–12 years) and/or adolescents (13–18 years). Coding of the studies was done according to the following criteria: age, sex, and balance outcome. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies. Weighted standardized mean differences were calculated and classified according to their magnitude.

Results

Twenty-one studies examined age-related differences in balance performance. A large effect for measures of static steady-state balance (SMD_ba = 1.20) and small effects for proxies of dynamic steady-state (SMD_ba = 0.26) and proactive balance (SMD_ba = 0.28) were found; all in favor of adolescents. Twenty-five studies investigated sex-related differences in balance performance. A small-sized effect was observed for static steady-state balance (SMD_bs = 0.33) in favor of girls and for dynamic steady-state (SMD_bs -0.02) and proactive balance (SMD_bs = -0.15) in favor of boys. Due to a lack of studies, no analysis for measures of reactive balance was performed.

Conclusions

Our systematic review and meta-analysis revealed better balance performances in adolescents compared to children, irrespective of the measure considered. Sex-related differences were inconsistent. These findings may have implications for example in terms of trainability of balance in youth that should be investigated in future studies.

A Review of Field-Based Assessments of Neuromuscular Control and Their Utility in Male Youth Soccer Players

Read, PJ, Oliver, JL, Croix, MS, Myer, GD, and Lloyd, RS. A review of field-based assessments of neuromuscular control and their utility in male youth soccer players. J Strength Cond Res 33(1): 283-299, 2019-Lower-extremity injuries in male youth soccer are common and equate to a substantial time loss from training and competitions during the course of a season. Extended periods of absence will impact player involvement in skill and physical development activities, as well as participation in competitive match play. Neuromuscular risk factors for lower-extremity injury in male youth soccer players can be categorized into quadriceps dominance, leg dominance, ligament dominance, trunk dominance, and reduced dynamic stability. Valid screening methods to identify risk factors that are practically viable are needed for youth athletes who may be at a greater risk of injury in soccer. Although field-based tests of neuromuscular control provide a reliable option for the assessment of injury risk in adults and females, less data are available in male youth soccer players, and further research is required to examine their ability to predict injury risk. This article provides a review of the current literature pertaining to field-based screening tests and critically appraises their suitability for use with male youth soccer players. Currently, the only method that has been validated in male youth soccer players is the landing error scoring system. Asymmetrical anterior reach measured during the Y-Balance test may also be considered because of its strong predictive ability in male youth basketball players; however, further research is required to fully support its use with soccer players.

Utilization of the Pediatric Modified Dynamic Gait Index: Issues Related to Child Development

Aims: This cross-sectional study investigated how typically developing children performed on a version of the Dynamic Gait Index, modified for children (Pediatric Modified DGI). Methods: Seventy-four typically developing children, ages 7-18 years, were evaluated using the Pediatric Modified DGI. Scores were analyzed in three age groups using descriptive statistics for age-related performance. The Kruskal-Wallis and Mann-Whitney U tests were used to evaluate group differences. Results: Children performed differently on the Pediatric Modified DGI between the three groups (Kruskal-Wallis H(2) = 18.819, p < .05). Mann-Whitney U post hoc testing identified significant differences between the 7 to 10 and the 15 to 18-year-old groups (U = 128.5, p = .000, r = -.54) and between the 11 to 14 and the 15 to 18-year-old groups (U = 139, p = .001, r = -.46). Pediatric modified DGI scores were notably different between the three age groups on three of the items: horizontal head turn, vertical head turn, and pivot turn. Conclusions: Children's age appears to impact performance on the pediatric modified DGI, which should be considered when using this tool to examine functional mobility. Future studies should explore functional mobility assessments that consider sensory system development.

The influence of biological maturity on motor performance among habitually barefoot versus habitually shod adolescents

Biological maturation is associated with physiological changes which in turn affect motor performance. No study has assessed the association between growing up habitually shod versus habitually barefoot and motor performance in the context of maturation, so this approach is unique. The purpose of this study was to examine the influence of biological maturity on motor performance dependent on the participants' footwear habits. Sixty-five German habitually shod (mean age 13.28 ± 0.83 years) and fifty-five South African habitually barefoot (mean age 13.38 ± 0.87 years) participants were included. Dynamic postural control was determined via backward balancing, explosive strength by standing long jump and sprinting performance based on a 20-m sprinting test. All tests were performed barefoot and shod. Biological maturation was calculated by using the maturity offset value. Linear mixed models were used to analyse interactions between the maturity offset value, footwear habits and motor performance. Throughout maturation, there was a significant difference between habitually barefoot and habitually shod balance performance (P = 0.001). Maturation led to balance improvements in habitually barefoot adolescents, but not in habitually shod adolescents. No such differences could be observed for standing long jump and 20-m sprint performance. Maturity offset was a significant predictor for jumping and sprinting performances (P < 0.001), independent of being habitually barefoot or habitually shod. Better performances could be observed in more mature subjects. Biological maturation seems to be a relevant predictor for motor performance characteristics for the jumping and sprinting performance in adolescents.

Characterizing postural oscillation in children and adolescents with hereditary sensorimotor neuropathy

Charcot Marie Tooth disease (CMT) has negative functional impact on postural control of children; however, it has not been widely studied. Stabilometry can provide insights about postural control and guide preventive interventions in immature perceptual and musculoskeletal systems as those seen in children with CMT. This cross-sectional study aimed to identify and interpret stabilometric variables that reflect the postural control of children with CMT. 53 subjects (age 6-17) were assigned to one of the two groups: CMT (15 males and 14 females with CMT) or Control (13 males and 11 females healthy). Quiet standing was tested in different conditions: with open and closed eyes on regular surface (open-regular, closed-regular) and foam surface (open-foam, closed-foam) using a force platform. The minimum of 2 and maximum of 3 trials of 30 seconds for each test condition provided the classical stabilometric variables and Romberg Quotient (RQv). CMT group showed increase of confidence ellipse area, mean velocity, mediolateral and anteroposterior velocities associated with decreased mean body oscillation frequency, as the complexity of tasks increased. CMT postural deficit was identified by greater and faster sway associated with these lower frequencies, when compared to Control.

Validation of Posturographic Measurements in Adolescents

OBJECTIVE

The objectives of the present study were to validate the test-retest reliability of static posturography in healthy adolescents aged 13 to 16 years, to identify the most reliable and least variable measurements.

PATIENTS

Thirty-two healthy pupils from Skåde Skole participated in this study.

INTERVENTION

Static posturography.

OUTCOME MEASURES

Subjects were tested for 32 seconds in eight trials (eyes open/eyes closed, on stable ground/foam pads, head neutral/head turned) by using a Tetrax platform. Testing included two rounds of trials and postural regulation was assessed by measuring sway during the eight trials.

RESULTS

We found statistically significant lower sway scores during round two in position NO; a similar trend was seen for position NC, PO, HR, HL, and HB, but was not statistically significant. For position PC and HF an increase was seen, but not statistically significant.

CONCLUSION

The most reliable and least variable measurements include position NO, NC, PO, and PC. Influence of all three systems involved in maintaining balance is tested in these positions. Static posturography can easily be implemented in a clinical setting as the equipment does not take up much space and is easy to use and instruct the test subjects about. Finally, the costs related to the static posturography are considerably lower compared with dynamic posturography equipment. However, static posturography might not be challenging enough when testing athletic individuals.

Evidence of balance training-induced improvement in soccer-specific skills in U11 soccer players

The present study aimed to determine the role of balance training improving technical soccer skills in young players. Two U11 soccer teams were randomly assigned one to either balance training (BT; n = 22) or control group (Ctrl; n = 21). At the end of their habitual soccer training (identical in BT and Ctrl), BT underwent additional balance training for 12 weeks (3 sessions/week, 20 minutes per session), while Ctrl had a 20-minute scrimmage. Before and after the intervention, BT and Ctrl underwent two soccer-specific tests (Loughborough Soccer Passing, LSPT, and Shooting, LSST, Tests), and bipedal and unipedal balance evaluations. After intervention, both groups decreased the trials time and improved passing accuracy, with larger improvements in BT than Ctrl (LSPT penalty time [CI_95% ]: -2.20 seconds [-2.72/-1.68]; ES [CI_95% ]: -2.54 seconds [-3.34/-1.74]). Both groups improved balance ability, with BT showing larger increments in bipedal tests than Ctrl (static balance: -29 mm [-42/-16]; ES: -1.39 [-2.05/-0.72]; limit of stability: 4% [3/5]; ES 3.93 [2.90/4.95]; unipedal quasi-dynamic balance: 0.07 a.u. [0.03/0.11]; ES: 1.04 [0.40/1.67] and active range of motion: -5% [-8/-2]; ES -0.89 [-1.51/-0.26]). Low-to-moderate correlations between the players' technical level and unipedal balance ability were retrieved, particularly in the non-dominant limb (R from 0.30 to 0.48). Balance training improved some technical soccer skills more than habitual soccer training alone, suggesting that young soccer players may benefit from additional balance training added to their traditional training.

Spatial and temporal analysis center of pressure displacement during adolescence: Clinical implications of developmental changes

This study aimed to provide insight into the development of postural control abilities in youth. A total of 276 typically developing adolescents (155 males, 121 females) with a mean age of 13.23 years (range of 7.11-18.80) were recruited for participation. Subjects performed two-minute quiet standing trials in bipedal stance on a force plate. Center of pressure (COP) trajectories were quantified using Sample Entropy (SampEn) in the anterior-posterior direction (SampEn-AP), SampEn in the medial-lateral direction (SampEn-ML), and Path Length (PL) measures. Three separate linear regression analyses were conducted to predict the relationship between age and each of the response variables after adjusting for individuals' physical characteristics. Linear regression models showed an inverse relationship between age and entropy measures after adjusting for body mass index. Results indicated that chronological age was predictive of entropy and path length patterns. Specifically, older adolescents exhibited center of pressure displacement (smaller path length) and less complex, more regular center of pressure displacement patterns (lower SampEn-AP and SampEn-ML values) compared to the younger children. These findings support prior studies suggesting that developmental changes in postural control abilities may continue throughout adolescence and into adulthood.

Reference values and equations reference of balance for children of 8 to 12 years

PURPOSE

There are still no normative data in balance sway for school-age children in Brazil. We aimed to establish the reference ranges for balance scores and to develop prediction equations for estimation of balance scores in children aged 8 to 12 years old.

METHODS

The study included 165 healthy children (83 boys and 82 girls; age, 8-12 years) recruited from a public school in the city of Florianópolis, Santa Catarina, Brazil. We used the Sensory Organization Test to assess the balance scores and both a digital scale and a stadiometer to measure the anthropometric variables. We tested a stepwise multiple-regression model with sex, height, weight, and mid-thigh circumference of the dominant leg as predictors of the balance score.

RESULTS

For all experimental conditions, girls' age accounted for over 85% of the variability in balance scores; while, boys' age accounted only 55% of the variability in balance scores. Therefore, balance scores increase with age for boys and girls.

CONCLUSION

This study described the ranges of age- and sex-specific normative values for balance scores in children during 6 different testing conditions established by the sensory organization test. We confirmed that age was the predictor that best explained the variability in balance scores in children between 8 and 12 years old. This study stimulates a new and more comprehensive study to estimate balance scores from prediction equations for overall Brazilian pediatric population.

ASSOCIATION BETWEEN POSTURAL BALANCE AND ANTHROPOMETRIC INDEXES IN ELEMENTARY SCHOOLCHILDREN

OBJECTIVE

To analyze the association between postural balance and anthropometric indicators in elementary school students.

METHODS

This cross-sectional, descriptive and quantitative study included children enrolled in the first year of elementary school, of both sexes, in the age group of 6 to 7 years. Children with any physical or cognitive impairment, children who did not participate in all stages of the study evaluation, or those who failed to perform postural balance assessments were excluded. The children underwent a balance evaluation through a computerized dynamic posturograph, with sensory organization tests (TOSs) in six different sensory conditions. In order to verify the anthropometric indicators, the body weight and height measurements were evaluated for later calculation of the body mass index (BMI), which was categorized into four groups: low weight, normal, overweight and obesity.

RESULTS

Eighty children with a mean age of 6.2±0.8 years were included, being 47 girls (58.8%). The analysis of the anthropometric indicators identified that 26.3% of students were overweight and 15% were obese. The children had averages below the reference values considered for their age range in conditions III and VI. There was a negative association between condition V and BMI and a positive association between values below normal in condition VI with overweight and obesity.

CONCLUSIONS

There were associations between excess body weight and values below normal in some balance conditions, indicating that the anthropometric indicators interfered in the children's postural balance.