Interrater and test-retest reliability of two pediatric balance tests

Contribution of static and dynamic balance skills to activities of daily living in children with intellectual disabilities

BACKGROUND

Static and dynamic balance skills can be related to the activities of daily living (ADL) in children with non-syndromic intellectual disabilities, and the type of balance skills affecting ADL can differ depending on the domain of ADL (self-care, mobility, and social function).

METHODS

The ADL capabilities of 66 children with intellectual disabilities were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and were examined in relation to static and dynamic balance skills.

RESULTS

Significant positive correlations were found between the one-leg standing and PEDI (r = .841 for self-care, r = .700 for mobility, and r = .760 for social function). Our analysis showed that static balance skills affected self-care, dynamic balance skills affected mobility, and intelligence quotient affected social function.

CONCLUSIONS

Improving balance skills is important for enhancing ADL capabilities, and the type of balance skills that need enhancement vary based on the domain of ADL.

Comparison of different methods used in balance evaluation in children with diparetic cerebral palsy

PURPOSE

In this study, we aimed to investigate the validity and reliability of Single Leg Stance (SLS), Tandem Stance (TS) and Pediatric Reach Tests (PRT) in children with Cerebral Palsy (CP).

METHODS

Fifty-three children (31 boys, 22 girls, age:3-15 years, Gross Motor Function Classification System (GMFCS) Level I- II with diparetic CP were included the study. SLS, TS, PRT test used for balance evaluations. SLS test was made by standing on dominant (D) and non-dominant (ND) extremity both eyes opened (EO) and closed (EC).

RESULTS

The mean age of childrens were 7.88±3.43 years. The Cronbach's - coefficients of all tests used to evaluate the internal consistency were found to excellent to acceptable level. SLS-D with EO/ EC, SLS-ND with EO/ EC and TS with EO had strong correlation, TS with EC and PRT-Forward moderate correlation, PRT-Right and eft low correlation with GMFCS. All tests except PRT-Right and PRT-Left were discriminate balance ability between GMFCS level I and level II (AUC>0.800).

CONCLUSION

In this study, we used SLS, TS, PRT for balance evaluations and we investigated reliability and validity (construct and predictive) of each balance tests in childeren with diparetic CP. All tests were sensitive in distinguishing between GMFCS levels I and II, except PRT-Right and PRT-Left. As a result of the study, it was determined that the tests were valid and reliable, suggesting that physiotherapists will provide clinical advantage in order to quickly learn about the balance of children with CP.

Psychometric properties of functional postural control tests in children: A systematic review

BACKGROUND

Postural control deficits are one of the most common impairments treated in pediatric physiotherapeutic practice. Adequate evaluation of these deficits is imperative to identify postural control deficits, plan treatment and assess efficacy. Currently, there is no gold standard evaluation for postural control deficits. However, the number of studies investigating the psychometric properties of functional pediatric postural control tests has increased significantly.

OBJECTIVE

To facilitate the selection of an appropriate pediatric functional postural control test in research and clinical practice.

METHODS

Systematic review following the PRISMA guidelines. PubMed, Web of Science and Scopus were systematically searched (last update: June 2022; PROSPERO: CRD42021246995). Studies were selected using the PICOs-method (pediatric populations (P), functional assessment tools for postural control (I) and psychometric properties (O). The risk of bias was rated with the COSMIN checklist and the level of evidence was determined with GRADE. For each test, the postural control systems were mapped, and the psychometric properties were extracted.

RESULTS

Seventy studies investigating 26 different postural control tests were included. Most children were healthy or had cerebral palsy. Overall, the evidence for all measurement properties was low to very low. Most tests (95%) showed good reliability (ICC>0.70), but inconsistent validity results. Structural validity, internal consistency and responsiveness were only available for 3 tests. Only the Kids-BESTest and FAB covered all postural control systems.

CONCLUSION

Currently, 2 functional tests encompass the entire construct of postural control. Although reliability is overall good, validity results depend on task, age and pathology. Future research should focus on test batteries and should particularly explore structural validity and responsiveness in different populations with methodologically strong study designs.

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.

The effects of exercises with a Pilates ball on balance, reaction time and dual-task performance of kindergarten children

Aim: This study investigated the effects of exercises conducted with a Pilates ball on the motor skills of preschool children. Methods: 62 preschool children were randomly divided into two groups: an intervention group (IG) (n = 30) and a control group (CG) (n = 32). Exercises with a Pilates ball were practiced in IG. The One Leg Standing test, Functional Reach test, Ruler Drop test and Timed-Up and Go test were the outcome measures. Results: Static balance performance and dual-task performance were found to be significantly improved in the intragroup and intergroup comparisons, favoring the IG (p < 0.05). Conclusion: The exercises carried out in this study were found to be effective on static balance and dual-task performance. The study can guide an exercise program for the preschool age group. Clinical Trial Registration: NCT04575441 (ClinicalTrials.gov).

Effects of compression garment on muscular efficacy, proprioception, and recovery after exercise-induced muscle fatigue onset for people who exercise regularly

Fatigue is a major cause of exercise-induced muscle damage (EIMD). Compression garments (CGs) can aid post-exercise recovery, therefore, this study explored the effects of CGs on muscular efficacy, proprioception, and recovery after exercise-induced muscle fatigue in people who exercise regularly. Twelve healthy participants who exercised regularly were enrolled in this study. Each participant completed an exercise-induced muscle fatigue test while wearing a randomly assigned lower-body CG or sports pants (SP); after at least 7 days, the participant repeated the test while wearing the other garment. The dependent variables were muscle efficacy, proprioception (displacements of center of pressure/COP, and absolute error), and fatigue recovery (muscle oxygen saturation/SmO₂, deoxygenation and reoxygenation rate, and subjective muscle soreness). A two-way repeated measure analysis of variance was conducted to determine the effect of garment type. The results indicated that relative to SP use, CG use can promote muscle efficacy, proprioception in ML displacement of COP, and fatigue recovery. Higher deoxygenation and reoxygenation rates were observed with CG use than with SP use. For CG use, SmO₂ quickly returned to baseline value after 10 min of rest and was maintained at a high level until after 1 h of rest, whereas for SP use, SmO₂ increased with time after fatigue onset. ML displacement of COP quickly returned to baseline value after 10 min of rest and subsequently decreased until after 1 hour of rest. Relative to SP use, CG use was associated with a significantly lower ML displacement after 20 min of rest. In conclusion, proprioception and SmO₂ recovery was achieved after 10 min of rest; however, at least 24 h may be required for recovery pertaining to muscle efficacy and soreness regardless of CG or SP use.

The effectiveness of three-phase physiotherapy program in children with clubfoot after Ponseti treatment

BACKGROUNDS

Clubfoot is a foot disorder frequently seen. Although, there are several studies about the efficiency of physiotherapy in the treatment of clubfoot, physiotherapy programs may be more efficient if the treatment apply step by step similar to the logic of the serial casting progression of the involved foot. Therefore, the aim of this study was to determine the effectiveness of three-phase physiotherapy program in children with clubfoot.

METHODS

Fifty-seven patients (37 males, 20 females; 7.26 ± 1.27 years) with clubfoot which had Ponseti treatment before were included. The ankle dorsiflexion (DF) and plantar flexion (PF) ranges of motion (ROM), one-leg standing time, sit-to-stand test, The Oxford Ankle Foot Questionnaire (OxAFQ) and treatment satisfaction were evaluated before and after treatment. A three-phase physiotherapy program was applied for 3 months.

RESULTS

DF, PF, one-leg standing time, sit-to-stand test, treatment satisfaction and all parameters of OxAFQ except 'Emotional' parameter of OxAFQ-Children significantly improved after treatment (p < 0.05).

CONCLUSIONS

The three-phase physiotherapy program increased the ankle range of motion, improved functional status and treatment satisfaction in children with clubfoot. The three-phase physiotherapy might be a reasonable treatment for clubfoot. Although, there is a need for long-term studies to understand its effects on preventing relapse.

Exercise-Based Interventions Aimed at Improving Balance in Children with Autism Spectrum Disorder: A Meta-Analysis

Children with Autism Spectrum Disorder (ASD) often have deficits in motor skills, especially balance. This article presents a meta-analytic review of 15 intervention studies that aimed to improve balance in children and adolescents with ASD. Across these studies, there were 195 participants with ASD for whom pre-intervention and post-intervention balance scores were available. We measured the standardized mean difference (Hedges' g) between their pre-intervention and post-intervention balance scores and found a large, positive effect from these balance interventions (standardized mean difference-1.82 (95% CI [1.34, 2.29])). Various balance intervention procedures were shown to be very efficacious for children and adolescents with ASD. Clearly, balance is a motor skill that is very susceptible to intervention efforts. We also provided recommendations to researchers regarding what information to include when conducting intervention studies.

Evaluation of balance in children with sensorineural hearing loss according to age

PURPOSE

Hearing is an important sensory skill for psychomotor development. As the cochlea and vestibule share the membranous labyrinth of the inner ear, children with sensorineural hearing loss (SNHL) may have vestibular dysfunction. This study aimed to evaluate static, dynamic, functional balance, and mobility as a whole in children with SNHL.

MATERIAL AND METHODS

Eighty children, 40 with bilateral severe-to-profound SNHL (20 children between the ages of 6-10 were included in the Group 1, and 20 children between the ages of 11-15 were included in the Group 2) and 40 with normal-hearing (the Group 3 included 20 children between the ages of 6-10 and the Group 4 of 20 children between the ages of 11-15) were included in the study. The Single-Leg Stance (SLS) Test, Functional Reach Test (FRT), Time Up and Go (TUG) Test, and Pediatric Balance Scale (PBS) were used to evaluate the balance skills of children.

RESULTS

The present study found out that children with SNHL in both age groups performed worse than those with normal-hearing in FRT, SLS, and PBS. In the TUG test, children with SNHL in the younger age group had lower performance compared to their peers with normal-hearing while the TUG performance of children with SNHL in the older age group was similar to their normal-hearing peers.

CONCLUSION

It was concluded that the static, dynamic and functional balance skills of children with SNHL were impaired compared to their normal-hearing peers. Including balance assessment in the routine test battery in children with SNHL may be decisive for early diagnosis and rehabilitation of balance disorders. It may be beneficial to add static, dynamic and functional balance tests to the test battery in addition to mobility assessment, especially in children with SNHL in the older age groups.

The effects of age at cochlear implantation on balance in children: A pilot study

AIM

The evaluation of the effects of age at cochlear implantation on balance in children.

RESEARCH DESIGN

Cross-sectional study.

STUDY SAMPLE

Twenty children who received their cochlear implants (CI) before the chronologic age of 48 months (Early CI Group), and 20 children who received their CI at 48 months chronologic age or later (Late CI Group).

INTERVENTION

All children underwent Tandem Romberg (TR) test, Single-Leg stance (SLS) test, Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB), Pediatric Balance scale (PBS) and Timed Up and Go (TUG) test.

DATA COLLECTION AND ANALYSIS

The scores of TR, SLS and P-CTSIB and TUG tests and PBS were recorded. Mann Whitney U test and Independent-samples t-test were used to compare data between groups.

RESULTS

TR (eyes opened-EO), SLS (EO), PBS, and TUG scores and incidence in dizziness symptoms did not show significant differences between the groups (p > 0.05). Duration of TR and SLS tests (eyes closed-EC), P-CTSIB-positions 5, and 6 were significantly longer in the Early CI Group than the Late implanted group(p < 0.05).

CONCLUSION

Although the age of cochlear implantation did not affect functional balance for children, it has been found to cause impaired balance performance in difficult static conditions and increased frequency of dizziness.

Effects of Balance Training on Balance Performance in Youth: Are There Age Differences?

Purpose: In youth, cross-sectional studies reported age differences in balance performance that were in favor of adolescents. Thus, trainability of balance performance might be different in children compared to adolescents. The purpose of this study was therefore to compare the effects of balance training (BT) on balance performance between children and adolescents.Method: Thirty children (7.5 ± 0.5 years) and 42 adolescents (14.7 ± 0.5 years) participated in this study and were assigned to either a BT-group or a control (CON) group. In both age groups, BT was conducted over five weeks while the CON-groups received their regular physical education lessons. Pre- and posttests included the assessment of mobility, static steady-state, proactive, and reactive balance.Results: Significant Test × Group × Age interactions were found for static steady-state balance (i.e., CoP displacements during single leg stance) and mobility (i.e., 10-m gait velocity). For both measures, post hoc analysis revealed larger improvements (+16-37%, 0.001 ≤ p ≤ 0.033, 0.65 ≤ d ≤ 2.24) for children compared to adolescents. For proxies of proactive and reactive balance, we could not detect significant Test × Group × Age interactions.Conclusions: We conclude that trainability of static steady-state balance and mobility seems to be higher in children than in adolescents indicating larger adaptive reserves in children compared to adolescents. However, there were no age differences in adaptations to BT with respect to proactive and reactive balance.

Balance Tests in Pre-Adolescent Children: Retest Reliability, Construct Validity, and Relative Ability

Balance is an essential prerequisite for the normal physical development of a child. It consists of the ability to maintain the body’s centre of mass over its base of support, which is enabled by automatic postural adjustments, and maintain posture and stability in various conditions and activities. The present study aimed to determine the measurement characteristics (reliability and concurrent validity) and the relative ability of balance tests and different motor tests in healthy 11-year-olds. We also evaluated the impact of vision on balance ability. Our results showed high interrater reliability (from 0.810 to 0.910) and confirmed the construct validity of the included balance tests. Girls performed significantly better than boys in laboratory tandem stance in following balance components: total sway path with eyes open (BSEO) (t = 2.68, p = 0.01, effect size (ES) = 0.81), total body sway with eyes closed of centre of pressure (CoP) displacement in the a-p direction (BSEC) (t = 1.86, p = 0.07, ES = 0.57), mean velocity of CoP displacements (VEO) (t = 2.67, p = 0.01, ES = 0.83), mean amplitude of CoP displacements in the a-p direction (AapEO) (t = 3.38. p = 0.00, ES = 1.01) and in mean amplitude of CoP displacements in the m-l direction (AmlEO) (t = 3.68, p = 0.00, ES = 1.19). With eyes closed, girls performed significantly better (t = 2.28, p = 0.03, ES = 0.70) than boys did in the mean amplitude of COP displacements in the a-p direction (AapEO) and significantly better (t = 2.37, p = 0.03, ES = 0.71) in the mean amplitude of COP displacements in the m-l direction (AmlEC). Insignificant correlations between different balance tests, except for a correlation between the flamingo test and one-leg stance on a low beam (r = 0.558, p < 0.01), show that each test assesses different aspects of balance ability; therefore, balance cannot be assessed with a single test.

Validity and reliability evidence for motor competence assessments in children and adolescents: A systematic review

Valid and reliable tests of motor competence are necessary to allow researchers and practitioners to quantify levels of motor competence, identify skill deficiencies, and determine the effectiveness of motor skill interventions. The primary study aim was to systematically review the validity and reliability of scores derived from gross motor competence tests for typically developing child and adolescent populations. The secondary aim of this review was to identify the most prevalent motor skills assessed across all instruments. A search of seven electronic databases identified 57 different skill assessment tools from 107 studies. Construct validity was the most common measurement property examined (60 studies; 56%). Content validity (21 studies; 20%) was the least commonly explored measurement property. Scores derived from the Test of Gross Motor Development - second and third edition had the most support for validity and reliability. The most common skills included in these skill batteries were the overhand throw (n = 33), catch (n = 32), jump (n = 31) and hop (n = 26). Research efforts should focus on: (1) further investigation of measurement properties of existing tools rather than developing new assessments and (2) further investigation of existing tools and their measurement properties in adolescent populations.

Development of Concise Physical Performance Test Batteries in Young Athletes

PURPOSE

This study aimed 1) to define the principal components of physical function assessed by 10 common lower extremity physical performance tests and 2) to derive a reduced-item set of physical performance tests that efficiently and accurately measures raw performance and limb symmetry on each underlying component in pediatric and adolescent athletes.

METHODS

This study included healthy, uninjured volunteers (n = 100) between the ages 6 and 18 yr (mean age = 11.7 ± 3.6 yr; 52 females). Subjects performed the stork balance, stork balance on BOSU® Balance Trainer, single leg squat (SLS), SLS on BOSU, clockwise and counterclockwise quadrant single leg hop (SLH), forward SLH, timed SLH, triple crossover SLH, and lower quarter Y-Balance Test™. Item reduction was performed using principal components analysis (PCA). We developed separate principal components analysis for average raw performance and side-to-side limb symmetry, with secondary analyses to evaluate consistency of results by age and sex.

RESULTS

We identified two components for average raw performance (accounting for 65.2% of the variance in total test battery) with a reduced-item set composed of five tests, and four components for limb symmetry (accounting for 62.9% of the variance in total test battery) with a reduced-item set of seven tests. The most parsimonious test suitable for screening both average raw performance and limb symmetry would consist of five tests (stork balance on BOSU, SLS on BOSU, forward SLH, timed SLH, and lower quarter Y-Balance Test™). Age- and sex-specific test batteries may be warranted.

CONCLUSION

Comprehensive screening for lower extremity average raw performance and limb symmetry is possible with short physical performance test batteries.

The effect of 8 weeks proprioception training without visual input on single-limb standing balance time in deaf students: A randomized controlled trial

INTRODUCTION

The aim of this study was to determine the effects of 8 weeks proprioception training without visual input on the proprioception of the knee and ankle and single standing balance time in deaf students.

METHODS

Twenty male deaf students participated in this study and were randomly assigned into control (n = 10) and experimental (n = 10) groups. Subjects' proprioception was measured using an electrogoniometer. In addition, balance performance was evaluated through single-limb standing performance test under four sensory conditions (condition 1: eyes open on one leg; condition 2: eyes closed on one leg; condition 3: eyes open on foam; condition 4: eyes closed on foam).

RESULTS

The findings showed that proprioception training without visual input induced meaningful, significant effects in knee and ankle proprioception (p ≤ 0.001), and single-limb standing time of deaf students at condition 1 (p ≤ 0.03) and 2 (p ≤ 0.001). However, training programs did not have any significant effects on single-limb standing time in conditions 3 (p ≤ 0.41) and 4(p ≤ 0.22).

CONCLUSIONS

Proprioception training without visual input improves proprioception of ankle, knee and single-limb standing balance time in deaf students.

Assessment of Selected Anthropometric Parameters Influence on Balance Parameters in Children

BACKGROUND AND OBJECTIVES

Balance is the ability of an organism to maintain its position in space. Balance disorders in children can lead to injuries and limited physical activity. Balance maintenance changes throughout puberty as well as in response to external factors. The study aimed to evaluate the influence of anthropometric parameters on balance in children aged 10 to 13 years.

MATERIALS AND METHODS

308 children were accessed to eligibility to participate in the study. After considering the inclusion and exclusion criteria the study included 223 participants (123 boys and 100 girls) aged 10 to 13 from elementary schools in Szczecin. The stabilometry of examineted children was performed using the SIGMA balance platform.

RESULTS

It was shown that the balance parameters in children aged 10 to 13 worsen with increasing body mass and height, and do not correlate with age.

CONCLUSION

Rapid diagnosis and identification of postural disorders in children make it possible to start targeted physical exercises and to make the therapeutic process more effective and complex. Future research is needed to obtain more data and draw conclusions crucial for physiotherapy practice.

Single- and Dual-Task Balance Training Are Equally Effective in Youth

Due to maturation of the postural control system and secular declines in motor performance, adolescents experience deficits in postural control during standing and walking while concurrently performing cognitive interference tasks. Thus, adequately designed balance training programs may help to counteract these deficits. While the general effectiveness of youth balance training is well-documented, there is hardly any information available on the specific effects of single-task (ST) versus dual-task (DT) balance training. Therefore, the objectives of this study were (i) to examine static/dynamic balance performance under ST and DT conditions in adolescents and (ii) to study the effects of ST versus DT balance training on static/dynamic balance under ST and DT conditions in adolescents. Twenty-eight healthy girls and boys aged 12-13 years were randomly assigned to either 8 weeks of ST or DT balance training. Before and after training, postural sway and spatio-temporal gait parameters were registered under ST (standing/walking only) and DT conditions (standing/walking while concurrently performing an arithmetic task). At baseline, significantly slower gait speed (p < 0.001, d = 5.1), shorter stride length (p < 0.001, d = 4.8), and longer stride time (p < 0.001, d = 3.8) were found for DT compared to ST walking but not standing. Training resulted in significant pre-post decreases in DT costs for gait velocity (p < 0.001, d = 3.1), stride length (-45%, p < 0.001, d = 2.4), and stride time (-44%, p < 0.01, d = 1.9). Training did not induce any significant changes (p > 0.05, d = 0-0.1) in DT costs for all parameters of secondary task performance during standing and walking. Training produced significant pre-post increases (p = 0.001; d = 1.47) in secondary task performance while sitting. The observed increase was significantly greater for the ST training group (p = 0.04; d = 0.81). For standing, no significant changes were found over time irrespective of the experimental group. We conclude that adolescents showed impaired DT compared to ST walking but not standing. ST and DT balance training resulted in significant and similar changes in DT costs during walking. Thus, there appears to be no preference for either ST or DT balance training in adolescents.

Cross-education does not accelerate the rehabilitation of neuromuscular functions after ACL reconstruction: a randomized controlled clinical trial

PURPOSE

Cross-education reduces quadriceps weakness 8 weeks after anterior cruciate ligament (ACL) surgery, but the long-term effects are unknown. We investigated whether cross-education, as an adjuvant to the standard rehabilitation, would accelerate recovery of quadriceps strength and neuromuscular function up to 26 weeks post-surgery.

METHODS

Group allocation was randomized. The experimental (n = 22) and control (n = 21) group received standard rehabilitation. In addition, the experimental group strength trained the quadriceps of the non-injured leg in weeks 1-12 post-surgery (i.e., cross-education). Primary and secondary outcomes were measured in both legs 29 ± 23 days prior to surgery and at 5, 12, and 26 weeks post-surgery.

RESULTS

The primary outcome showed time and cross-education effects. Maximal quadriceps strength in the reconstructed leg decreased 35% and 12% at, respectively, 5 and 12 weeks post-surgery and improved 11% at 26 weeks post-surgery, where strength of the non-injured leg showed a gradual increase post-surgery up to 14% (all p ≤ 0.015). Limb symmetry deteriorated 9-10% more for the experimental than control group at 5 and 12 weeks post-surgery (both p ≤ 0.030). One of 34 secondary outcomes revealed a cross-education effect: Voluntary quadriceps activation of the reconstructed leg was 6% reduced for the experimental vs. control group at 12 weeks post-surgery (p = 0.023). Both legs improved force control (22-34%) and dynamic balance (6-7%) at 26 weeks post-surgery (all p ≤ 0.043). Knee joint proprioception and static balance remained unchanged.

CONCLUSION

Standard rehabilitation improved maximal quadriceps strength, force control, and dynamic balance in both legs relative to pre-surgery but adding cross-education did not accelerate recovery following ACL reconstruction.

Components of Standing Postural Control Evaluated in Pediatric Balance Measures: A Scoping Review

OBJECTIVE

To identify measures of standing balance validated in pediatric populations, and to determine the components of postural control captured in each tool.

DATA SOURCES

Electronic searches of MEDLINE, Embase, and CINAHL databases using key word combinations of postural balance/equilibrium, psychometrics/reproducibility of results/predictive value of tests, and child/pediatrics; gray literature; and hand searches.

STUDY SELECTION

Inclusion criteria were measures with a stated objective to assess balance, with pediatric (≤18y) populations, with at least 1 psychometric evaluation, with at least 1 standing task, with a standardized protocol and evaluation criteria, and published in English. Two reviewers independently identified studies for inclusion. There were 21 measures included.

DATA EXTRACTION

Two reviewers extracted descriptive characteristics, and 2 investigators independently coded components of balance in each measure using a systems perspective for postural control, an established framework for balance in pediatric populations.

DATA SYNTHESIS

Components of balance evaluated in measures were underlying motor systems (100% of measures), anticipatory postural control (72%), static stability (62%), sensory integration (52%), dynamic stability (48%), functional stability limits (24%), cognitive influences (24%), verticality (9%), and reactive postural control (0%).

CONCLUSIONS

Assessing children's balance with valid and comprehensive measures is important for ensuring development of safe mobility and independence with functional tasks. Balance measures validated in pediatric populations to date do not comprehensively assess standing postural control and omit some key components for safe mobility and independence. Existing balance measures, that have been validated in adult populations and address some of the existing gaps in pediatric measures, warrant consideration for validation in children.

An anterior cruciate ligament injury does not affect the neuromuscular function of the non-injured leg except for dynamic balance and voluntary quadriceps activation

PURPOSE

The function of the anterior cruciate ligament (ACL) patients' non-injured leg is relevant in light of the high incidence of secondary ACL injuries on the contralateral side. However, the non-injured leg's function has only been examined for a selected number of neuromuscular outcomes and often without appropriate control groups. We measured a broad array of neuromuscular functions between legs of ACL patients and compared outcomes to age, sex, and physical activity matched controls.

METHODS

Thirty-two ACL-deficient patients (208 ± 145 days post-injury) and active and less-active controls (N = 20 each) participated in the study. We measured single- and multi-joint neuromuscular function in both legs in each group and expressed the overall neuromuscular function in each leg by calculating a mean z-score across all neuromuscular measures. A group by leg MANOVA and ANOVA were performed to examine group and leg differences for the selected outcomes.

RESULTS

After an ACL injury, duration (-4.3 h/week) and level (Tegner activity score of -3.9) of sports activity decreased and was comparable to less-active controls. ACL patients showed bilateral impairments in the star excursion balance test compared to both control groups (P ≤ 0.004) and for central activation ratio compared to active controls (P ≤ 0.002). There were between-leg differences within each group for maximal quadriceps and hamstring strength, voluntary quadriceps activation, star excursion balance test performance, and single-leg hop distance (all P < 0.05), but there were no significant differences in quadriceps force accuracy and variability, knee joint proprioception, and static balance. Overall neuromuscular function (mean z-score) did not differ between groups, but ACL patients' non-injured leg displayed better neuromuscular function than the injured leg (P < 0.05).

CONCLUSIONS

Except for poorer dynamic balance and reduced quadriceps activation, ACL patients had no bilateral neuromuscular deficits despite reductions in physical activity after injury. Therapists can use the non-injured leg as a reference to assess the injured leg's function for tasks measured in the present study, excluding dynamic balance and quadriceps activation. Rehabilitation after an ACL injury should be mainly focused on the injured leg.

LEVEL OF EVIDENCE

III.

Influence of Familiarization of Preschool Children With Motor Tests on Test Results and Reliability Coefficients

The study was conducted with the aim to research the influence of familiarization on test results for the assessment of motor skills in preschool children. In sum, 165 children (84 boys and 81 girls; mean age = 5.2 years, SD = 0.91) participated in the study. The measurement protocol consisted of six series of measurements in three different motor tests. Results showed a significant improvement of 11.51% in the standing long jump test, 13.02% in the polygon backwards test, and 26.29% in the hand taping test. In assessing the motor status of preschool children, it is essential to conduct a process of familiarizing with motor tests as well as the overall situation in which the measurement is carried out and wait for the stabilization of scores before their use.

Difference in Agility, Strength, and Flexibility in Competitive Figure Skaters Based on Level of Expertise and Skating Discipline

Slater, LV, Vriner, M, Zapalo, P, Arbour, K, and Hart, JM. Difference in agility, strength, and flexibility in competitive figure skaters based on level of expertise and skating discipline. J Strength Cond Res 30(12): 3321-3328, 2016-Figure skating is an extremely difficult sport that requires a combination of grace, artistry, flexibility, speed, and power. Although many skaters are involved with strength and conditioning programs, there is no current information about differences in off-ice performance measures based on skating discipline and level. The purpose of this study was to compare agility, strength, and flexibility performance based on skating discipline and level. A total of 343 figure skaters from 4 different disciplines (singles, dance, pair, and synchronized skating) and 3 different levels (novice, junior, and senior) completed combine testing with the United States Figure Skating Association. All subjects completed the hexagon agility test, t-test, triple bound jumps, vertical jump, timed tuck jumps, push-ups, v-ups, hand press, front split, seated reach, and stork pose. A multivariate analysis of variance with Scheffe's post hoc was used to identify differences in performance based on skating discipline and level. Mean differences, Cohen's d effect sizes, and 95% confidence intervals were reported for all significant differences. Senior and junior skaters tended to be faster and stronger than novice skaters. Singles, dance, and pair skaters tended to be more agile, stronger, and flexible than synchronized skaters, however, senior synchronized skaters tended to perform better than senior skaters in other disciplines. These results indicate that strength and conditioning professionals should consider skating discipline and level when designing strengthening programs for figure skaters.

Reliability and sensitivity to change of the timed standing balance test in children with down syndrome

Objective:

To estimate the reliability and sensitivity to change of the timed standing balance test in children with Down syndrome (DS).

Methods:

It was a nonblinded, comparison study with a convenience sample of subjects consisting of children with DS (n = 9) aged 8–17 years. The main outcome measure was standing balance which was assessed using timed standing balance test, the time required to maintain in four conditions, eyes open static, eyes closed static, eyes open dynamic, and eyes closed dynamic.

Results:

Relative reliability was excellent for all four conditions with an Interclass Correlation Coefficient (ICC) ranging from 0.91 to 0.93. The variation between repeated measurements for each condition was minimal with standard error of measurement (SEM) of 0.21–0.59 s, suggestive of excellent absolute reliability. The sensitivity to change as measured by smallest real change (SRC) was 1.27 s for eyes open static, 1.63 s for eyes closed static, 0.58 s for eyes open dynamic, and 0.61 s for eyes closed static.

Conclusions:

Timed standing balance test is an easy to administer test and sensitive to change with strong absolute and relative reliabilities, an important first step in establishing its utility as a clinical balance measure in children with DS.

Vestibular Assessments in Children With Global Developmental Delay: An Exploratory Study

PURPOSE

To compare results of 3 clinical vestibular tests between children with global developmental delay (GDD) and children with typical development (TD) and investigate the test-retest reliability.

METHODS

Twenty children with GDD (aged 4.1-12.1 years) and 11 age-matched controls with TD participated. Participants with GDD underwent 2 sessions of testing. Each session consisted of the Clinical Test of Sensory Interaction and Balance (CTSIB), Dynamic Visual Acuity (DVA) test, and the modified Emory Clinical Vestibular Chair Test (m-ECVCT).

RESULTS

Up to 33% of the children with GDD had abnormal DVA scores. m-ECVCT results of children with GDD demonstrated larger variance than children with TD. The CTSIB score was significantly reduced in the group with GDD. The test-retest reliability varied, with good reliability for the m-ECVCT and CTSIB, and fair reliability for the DVA.

CONCLUSIONS

Findings suggest vestibular involvement in children in GDD. The clinical tests demonstrated moderate test-retest reliability.

Reliability and validity of the Four Square Step Test in children with cerebral palsy and Down syndrome

Little is known about the measurement properties of clinical tests of stepping in different directions for children with cerebral palsy (CP) and Down syndrome (DS). The ability to step in various directions is an important balance skill for daily life. Standardized testing of this skill can yield important information for therapy planning. This observational methodological study was aimed at defining the relative and absolute reliability, minimal detectable difference, and concurrent validity with the Timed Up-&-Go (TUG) of the Four Square Step Test (FSST) for children with CP and DS. Thirty children, 16 with CP and 14 with DS, underwent repeat testing 2 weeks apart on the FSST by 3 raters. TUG was administered on the second test occasion. Intraclass correlation coefficients (ICC [1,1] and [3,1]) with 95% confidence intervals, standard error of measurement (SEM), minimal detectable difference (MDD) and the Spearman rank correlation coefficient were computed. The FSST demonstrated excellent interrater reliability (ICC=.79; 95% CI: .66, .89) and high positive correlation with the TUG (r=.74). Test-retest reliability estimates varied from moderate to excellent among the 3 raters (.54, .78 and .89 for raters 1, 2 and 3, respectively). SEM and MDD were calculated at 1.91s and 5.29s, respectively. Scores on the FSST of children with CP and DS between 5 and 12 years of age are reliable and valid.

Psychometric properties of functional balance tests in children: a literature review

AIM

Identifying balance problems are the first step towards monitoring and rehabilitation. Therefore, this paper aims to make an overview of the psychometric properties of the functional balance tests available for children.

METHOD

A literature search was performed in PubMED and Web of Science on 8 February 2014 and updated on 6 July 2014. A conceptual framework for functional balance tests was defined, taking balance control components and task constraints into account. The tests were selected for inclusion by consensus of 2-3 reviewers using the conceptual framework.

RESULTS

Fourteen tests were investigated in 25 articles and analysed within the conceptual framework. The Timed Up and Go test, Pediatric Balance Scale, and Pediatric Reach Test are well investigated and all show good reliability. Validity remains unclear because of lack of a criterion standard to measure balance control.

INTERPRETATION

Because of the lack of good methodological studies, strong evidence for the use of one or more functional balance tests in children cannot be provided. Moreover, it is necessary that a criterion standard to measure balance is established.

Differential effects of water-based exercise on the cognitive function in independent elderly adults

BACKGROUND

Physical exercise has been reported to be the most effective method to improve cognitive function and brain health, but there is as yet no research on the effect of water-based exercise.

AIMS

The aim of the present study was to compare the effects of water-based exercise with and without cognitive stimuli on cognitive and physical functions.

METHODS

The design is a single-blind randomized controlled study. Twenty-one participants were randomly assigned to a normal water-based exercise (Nor-WE) group or a cognitive water-based exercise (Cog-WE) group. The exercise sessions were divided into two exercise series: a 10-min series of land-based warm-up, consisting of flexibility exercises, and a 50-min series of exercises in water. The Nor-WE consisted of 10 min of walking, 30 min of strength and stepping exercise, including stride over, and 10 min of stretching and relaxation in water. The Cog-WE consisted of 10 min of walking, 30 min of water-cognitive exercises, and 10 min of stretching and relaxation in water. Cognitive function, physical function, and ADL were measured before the exercise intervention (pre-intervention) and 10 weeks after the intervention (post-intervention).

RESULTS

Participation in the Cog-WE performed significantly better on the pegboard test and the choice stepping reaction test and showed a significantly improved attention, memory, and learning, and in the general cognitive function (measured as the total score in the 5-Cog test). Participation in the Nor-WE dramatically improved walking ability and lower limb muscle strength.

CONCLUSION

Our results reveal that the benefits elderly adults may obtain from water-based exercise depend on the characteristics of each specific exercise program. These findings highlight the importance of prescription for personalized water-based exercises to elderly adults to improve cognitive function.

Effects of short-term daily community walk aide use on children with unilateral spastic cerebral palsy

PURPOSE

To determine the effects of functional electrical stimulation (FES) on the main impairments affecting gait in children with unilateral spastic cerebral palsy.

METHODS

A 20-week, multiple single-subject A-B-A design included a 6-week pre-FES phase, an 8-week FES phase, and a 6-week post-FES phase. Twelve children, aged 5 to 16 years, wore an FES device (the Walk Aide) daily for 8 weeks. Weekly measures included ankle range of motion, selective motor control, dorsiflexion and plantar flexion strength, gastrocnemius spasticity, single-limb balance, Observational Gait Scale (OGS) score, and self-reported toe drag and falls in the community.

RESULTS

Compared with the pre-FES phase, the FES phase showed significant improvements in ankle range of motion, selective motor control and strength, and reductions in spasticity, toe drag, and falls, but no change in OGS score. These improvements were maintained during the post-FES phase.

CONCLUSIONS

Intermittent, short-term use of FES is potentially effective for reducing impairments affecting gait in children with unilateral spastic cerebral palsy.

Wii-based Balance Therapy to Improve Balance Function of Children with Cerebral Palsy: A Pilot Study

[Purpose] Cerebral palsy is a sensorimotor disorder that affects the control of posture and movement. The Nintendo^® Wii Fit offers an inexpensive, enjoyable, suitable alternative to more complex systems for children with cerebral palsy. The aim of this study was to investigate the efficacacy of Wii-based balance therapy for children with ambulatory cerebral palsy. [Subjects] This pilot study design included fourteen ambulatory patients with cerebral palsy (11 males, 3 females; mean age 12.07 ± 3.36 years). [Methods] Balance functions before and after treatment were evaluated using one leg standing, the functional reach test, the timed up and go test, and the 6-minute walking test. The physiotherapist prescribed the Wii Fit activities,and supervised and supported the patients during the therapy sessions. Exercises were performed in a standardized program 2 times a week for 12 weeks. [Results] Balance ability of every patient improved. Statistically significant improvements were found in all outcome measures after 12 weeks. [Conclusion] The results suggest that the Nintendo^® Wii Fit provides a safe, enjoyable, suitable and effective method that can be added to conventional treatments to improve the static balance of patients with cerebral palsy; however, further work is required.

A preliminary randomized controlled study on the effectiveness of vestibular-specific neuromuscular training in children with hearing impairment

Objective:

To determine the effectiveness of vestibular-specific neuromuscular training on motor skills, balance and health-related quality of life in children with hearing impairment.

Design:

Controlled, randomized, preliminary study.

Setting:

Rehabilitation school for children with hearing impairment.

Subjects and intervention:

Twenty-three children with mean age of 7.5–8.1 years with hearing impairment were randomized to either the intervention or the control group. Children in the experimental group ( n = 11) participated in vestibular-specific neuromuscular training for six weeks and the children in the control group continued their regular activities followed at school.

Outcome measures:

Measurement of motor skills (Test of Gross Motor Development-2), postural control (Pediatric Reach Test, One Leg Standing Balance Test and postural sway meter) and health-related quality of life (PedsQL Generic Core Scale).

Results:

Following intervention, the scores of motor skills (Test of Gross Motor Development P = 0.02; throw for distance P = 0.042; kick for distance P = 0.08; jump for distance P = 0.001; 15-yard dash P = 0.001), postural control measures (Pediatric Reach Test P = 0.001; One Leg Standing Test P = 0.03; and anteroposterior sway (eyes open P = 0.007, eyes closed P = 0.03); mediolateral sway (eyes open P = 0.014, eyes closed P = 0.017) and health-related quality of life ( P = 0.01) improved significantly in the experimental group and not in the control group.

Conclusion:

The findings of the study suggest that vestibular-specific neuromuscular training programme may improve the motor skills, balance and health-related quality of life in children with hearing impairment.

Ghent developmental balance test: a new tool to evaluate balance performance in toddlers and preschool children

BACKGROUND

Balance is a fundamental component of movement. Early identification of balance problems is important to plan early intervention. The Ghent Developmental Balance Test (GDBT) is a new assessment tool designed to monitor balance from the initiation of independent walking to 5 years of age.

OBJECTIVE

The purpose of this study was to establish the psychometric characteristics of the GDBT.

METHODS

To evaluate test-retest reliability, 144 children were tested twice on the GDBT by the same examiner, and to evaluate interrater reliability, videotaped GDBT sessions of 22 children were rated by 3 different raters. To evaluate the known-group validity of GDBT scores, z scores on the GDBT were compared between a clinical group (n = 20) and a matched control group (n = 20). Concurrent validity of GDBT scores with the subscale standardized scores of the Movement Assessment Battery for Children-Second Edition (M-ABC-2), the Peabody Developmental Motor Scales-Second Edition (PDMS-2), and the balance subscale of the Bruininks-Oseretsky Test-Second Edition (BOT-2) was evaluated in a combined group of the 20 children from the clinical group and 74 children who were developing typically.

RESULTS

Test-retest and interrater reliability were excellent for the GDBT total scores, with intraclass correlation coefficients of .99 and .98, standard error of measurement values of 0.21 and 0.78, and small minimal detectable differences of 0.58 and 2.08, respectively. The GDBT was able to distinguish between the clinical group and the control group (t(38) = 5.456, P<.001). Pearson correlations between the z scores on GDBT and the standardized scores of specific balance subscales of the M-ABC-2, PDMS-2, and BOT-2 were moderate to high, whereas correlations with subscales measuring constructs other than balance were low.

CONCLUSIONS

The GDBT is a reliable and valid clinical assessment tool for the evaluation of balance in toddlers and preschool-aged children.

Stable unstable reliability theory

Classical reliability theory assumes that individuals have identical true scores on both testing occasions, a condition described as stable. If some individuals' true scores are different on different testing occasions, described as unstable, the estimated reliability can be misleading. A model called stable unstable reliability theory (SURT) frames stability or instability as an empirically testable question. SURT assumes a mixed population of stable and unstable individuals in unknown proportions, with w(i) the probability that individual i is stable. w(i) becomes i's test score weight which is used to form a weighted correlation coefficient r(w) which is reliability under SURT. If all w(i) = 1 then r(w) is the classical reliability coefficient; thus classical theory is a special case of SURT. Typically r(w) is larger than the conventional reliability r, and confidence intervals on true scores are typically shorter than conventional intervals. r(w) is computed with routines in a publicly available R package.

Feasibility study of short-term effects of chiropractic manipulation on older adults with impaired balance

OBJECTIVE

The purpose of this study was to collect preliminary information on the effects of chiropractic spinal manipulation on reducing risk of falls in older adults with impaired balance, as assessed by the Berg Balance Scale (BBS). This information is necessary to develop a line of investigation into the role of chiropractic care on reduction of fall risk in this population.

METHODS

Randomized, 2-group pretest/posttest design feasibility study with a target sample size of 10 (5 per group), conducted within the outpatient health center of a chiropractic college. Inclusion criteria were as follows: aged 60 years or older, able to stand on one leg <5 seconds, and able to attend all sessions. Patients were assigned to chiropractic care (CMT) or supervised exercise (EX) and scheduled for 2 visits per week for 8 weeks.

RESULTS

A total of 26 people responded to recruitment; and 11 were enrolled: 6 in the CMT and 5 in the EX group. Two patients dropped out at the baseline visit when they were assigned to the EX group. One CMT patient dropped out in the seventh week because of a fall at home resulting in a leg fracture. All remaining patients were compliant with treatment protocols. Five of 6 CMT patients and 4 of 5 EX patients had baseline BBS scores <45, indicating increased risk of falls. At visit 16, 2 CMT and 1 of the 3 remaining EX patients had BBS scores <45. One mild and transient adverse event was noted.

CONCLUSION

Further investigation of the possible role of chiropractic care in reducing fall risk in this population appears feasible.

Test-retest reliability of the assessment of postural stability in typically developing children and in hearing impaired children

The purpose of this study was to establish test-retest reliability of centre of pressure (COP) measurements obtained by an AccuGait portable forceplate (ACG), mean COG sway velocity measured by a Basic Balance Master (BBM) and clinical balance tests in children with and without balance difficulties. 49 typically developing children and 23 hearing impaired children, with a higher risk for stability problems, between 6 and 12 years of age participated. Each child performed the modified Clinical Test of Sensory Interaction on Balance (mCTSIB), Unilateral Stance (US) and Tandem Stance on ACG, mCTSIB and US on BBM and clinical balance tests: one-leg standing, balance beam walking and one-leg hopping. All subjects completed 2 test sessions on 2 different days in the same week assessed by the same examiner. Among COP measurements obtained by the ACG, mean sway velocity was the most reliable parameter with all ICCs higher than 0.72. The standard deviation (SD) of sway velocity, sway area, SD of anterior-posterior and SD of medio-lateral COP data showed moderate to excellent reliability with ICCs between 0.55 and 0.96 but some caution must be taken into account in some conditions. BBM is less reliable but clinical balance tests are as reliable as ACG. Hearing impaired children exhibited better relative reliability (ICC) and comparable absolute reliability (SEM) for most balance parameters compared to typically developing children. Reliable information regarding postural stability of typically developing children and hearing impaired children may be obtained utilizing COP measurements generated by an AccuGait system and clinical balance tests.

Balance ability of 7 and 10 year old children in the population: results from a large UK birth cohort study

OBJECTIVE

The literature contains many reports of balance function in children, but these are often on atypical samples taken from hospital-based clinics and may not be generalisable to the population as a whole. The purpose of the present study is to describe balance test results from a large UK-based birth cohort study.

METHODS

Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. A total of 5402 children completed the heel-to-toe walking test at age 7 years. At age 10 years, 6915 children underwent clinical tests of balance including beam-walking, standing heel-to-toe on a beam and standing on one leg. A proportion of the children returned to the clinic for retesting within 3 months allowing test-retest agreement to be measured.

RESULTS

Frequency distributions for each of the balance tests are given. Correlations between measures of dynamic balance at ages 7 and 10 years were weak. The static balance of 10 year old children was found to be poorer with eyes closed than with eyes open, and poorer in boys than in girls for all measures. Balance on one leg was poorer than heel-to-toe balance on a beam. A significant learning effect was found when first and second attempts of the tests were compared. Measures of static and dynamic balance appeared independent. Consistent with previous reports in the literature, test-retest reliability was found to be low.

CONCLUSIONS

This study provides information about the balance ability of children aged 7 and 10 years and provides clinicians with reference data for balance tests commonly used in the paediatric clinic.

Construct validity of the assessment of balance in children who are developing typically and in children with hearing impairments

BACKGROUND

Children with hearing impairments have a higher risk for deficits in balance and gross motor skills compared with children who are developing typically. As balance is a fundamental ability for the motor development of children, a valid and reliable assessment to identify weaknesses in balance is crucial.

OBJECTIVE

The purpose of this study was to investigate the construct validity of posturography and clinical balance tests in children with hearing impairments and in children who are developing typically.

METHODS

The study involved 53 children with typical development and 23 children with hearing impairments who were between 6 and 12 years of age and without neuromotor or orthopedic disorders. All participants completed 3 posturography tests (modified Clinical Test of Sensory Interaction of Balance [mCTSIB], unilateral stance, and tandem stance) and 4 clinical balance tests (one-leg stance with eyes open and with eyes closed, balance beam walking, and one-leg hopping).

RESULTS

Three conditions of the mCTSIB, unilateral stance, and 2 clinical balance tests were able to distinguish significantly between the 2 groups. Children with hearing impairments showed more difficulties in balance tasks compared with children who were developing typically when 1 or 2 types of sensory information were eliminated or disturbed. The study showed only low to moderate correlations among the different methods of evaluating balance.

CONCLUSIONS

Clinical balance tests and posturography offer different but complementary information. An assessment protocol for balance consisting of posturography and clinical balance tasks is proposed. Static and dynamic balance abilities could not be differentiated and seem not to be a valid dichotomy.

A novel tool for the assessment of dynamic balance in healthy individuals

The purpose of this study was to evaluate the intra- and inter-session reliability of a newly developed portable electronic balance measurement system (Clever Balance Board; CBB). In the first experiment, 36 male athletes performed three trials of the Sharpened-Romberg test, single limb stance test, and the CBB test in a randomized order. In the second experiment, eight physically active men and 12 women performed the CBB test in two sessions separated by 48 h. The first experiment revealed a large trial-to-trial improvement for the Sharpened-Romberg test (46%) and single limb stance test (21%), while the same effect was relatively small for the three CBB scores (5-7%). The second experiment revealed a minimal improvement in the CBB scores between two sessions (0.6-2.3%). The observed intraclass correlation coefficients (ICC) and coefficients of variation (CV) suggested an acceptable retest correlation (ICC = 0.85 and 0.76), but very large within-individual variation (CV = 42.1% and 45.7%) of the Sharpened-Romberg test and the single limb stance test. Regarding the CBB scores, the corresponding retest correlation coefficients and within-individual variations were ICC = 0.90-0.96 and CV = 6.9-16.2%, respectively. Finally, inter-session reliability coefficients proved that the CBB scores had high retest correlation and an acceptable within-individual variation (ICC = 0.77-0.90 and CV = 8.4-13.9%). These results generally suggest that the CBB could be a reliable tool for dynamic balance assessment in healthy and physically active individuals.

Pilot study of the effect of a limited and extended course of chiropractic care on balance, chronic pain, and dizziness in older adults

OBJECTIVE

The purpose of this study was to collect preliminary information on the effect of a limited and extended course of chiropractic care on balance, chronic pain, and associated dizziness in a sample of older adults with impaired balance.

METHODS

The authors conducted a randomized pilot study targeting a sample size of 30, comparing 2 schedules of chiropractic care to a no-treatment group. Group 1 (limited schedule) was treated for 8 weeks, group 2 (extended schedule) was treated for 8 weeks and then once per month for 10 months, and group 3 received no treatment. Assessments were made at baseline and 1, 2, 6, and 12 months later. The primary outcome was changed in the Berg Balance Scale (BBS) from baseline to 1 year. Changes in the Pain Disability Index and Dizziness Handicap Index were also measured.

RESULTS

Thirty-four patients were enrolled, 13 in group 1, 15 in group 2, and 6 in group 3. Only 5 had baseline BBS scores less than 45, indicating increased risk for falls. There were no treatment-related adverse events. Nine patients dropped out by 1 year. No significant differences within or between groups in median BBS from baseline to 12 months were observed. Median Pain Disability Index scores improved more from baseline to 1 year in group 2 compared with groups 1 and 3 (P = .06, Kruskal-Wallis test). For the 9 patients with dizziness, a clinically significant improvement in Dizziness Handicap Index scores of groups 1 and 2 was observed at 1 month and remained lower than baseline thereafter; this was not true of group 3.

CONCLUSION

Further investigation of the possible benefit of chiropractic maintenance care (extended schedule) for balance and pain-related disability is feasible and warranted, as well as both limited and extended schedules for patients with idiopathic dizziness.

Chiropractic care for older adults: effects on balance, dizziness, and chronic pain

OBJECTIVE

This study is part of an avenue of research exploring the effect of chiropractic care on balance in older adults. The purpose of this study was to (1) assess the use of the 7-item version of the Berg Balance Scale, (2) explore possible effects of an 8-week course of chiropractic care on balance as measured by the 7-item Short-Form Berg Balance Scale (SF-BBS) in adults 65 years or older with impaired balance, and (3) collect preliminary information on the possible relationships of dizziness and/or chronic pain to poor balance.

METHODS

This was a single-group, pretest/posttest design intervention study. Patients 65 years and older who could stand on one leg for less than 5 seconds were eligible. They received pragmatic chiropractic care for 16 visits for an 8-week period. Outcomes were assessed at baseline, visit 8 and visit 16 in terms of balance SF-BBS, dizziness (Dizziness Handicap Inventory [DHI]), chronic pain (Pain Disability Index), and depression (Geriatric Depression Scale).

RESULTS

Sixteen patients were enrolled; 14 completed the study. There was one mild and transient adverse effect, muscle soreness, which self-resolved. One patient was depressed, and his Geriatric Depression Scale score improved significantly during the study. Of the 6 patients with significant dizziness at baseline, 3 had scores of 0 (no dizziness) on the DHI at visit 16. Patients with dizziness tended to have greater chronic pain and show greater reductions in that pain than nondizzy patients. No clinically important effects on balance as measured by the SF-BBS were apparent for the group as a whole, although 3 individual patients improved by 4 to 6 points.

CONCLUSION

The Short-Form Berg Balance Scale (SF-BBS) did not show a great deal of clinical responsiveness in this study population. The outcome measures used for chronic pain (Pain Disability Index) and dizziness (DHI) appear to be appropriate for assessing patients in future larger studies for longer periods.

Age-related changes of single-limb standing balance in children with and without deafness

OBJECTIVE

The purposes of the present study were to elucidate the age-related changes in single-limb standing balance and sensory compensation for maintaining single-limb standing in profoundly deaf (PD) children, and to compare them with age-matched normal-hearing (NH) children.

METHODS

This study involved 57 PD children, aged 4-14 years and 57 age-matched NH children. Each group was subdivided into the following age groups: 4-6 years, 7-9 years, and 12-14 years. Postural stability was assessed using a single-limb standing test under four different sensory conditions: standing on a firm surface with eyes open (condition 1), standing on a firm surface with eyes closed and covered (condition 2), standing on a foam surface with eyes open (condition 3), and standing on a foam surface with eyes closed and covered (condition 4).

RESULTS

The age-related changes in single-limb standing balance of the PD children were notably affected by sensory conditions, in contrast with those of the NH children, which were not influenced by sensory conditions. In conditions 1 and 3, where visual information was enabled, the mean time of maintaining single-limb standing for the PD children significantly increased with age, and even reached levels similar to those of the NH children. However, in condition 2, where visual input was removed, the deficit of single-limb standing balance in the PD children persisted. Condition 4 revealed no significant age-related changes in the PD children.

CONCLUSION

These results suggest that the postural stability of PD children improves as a result of adaptive sensory compensation, both visual and somatosensory. In addition, it appears that postural control is more highly dependent upon visual input than on somatosensory input.

Reliability of health-related physical fitness tests in European adolescents. The HELENA Study

OBJECTIVE

To examine the reliability of a set of health-related physical fitness tests used in the European Union-funded Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study on lifestyle and nutrition among adolescents.

DESIGN

A set of physical fitness tests was performed twice in a study sample, 2 weeks apart, by the same researchers.

PARTICIPANTS

A total of 123 adolescents (69 males and 54 females, aged 13.6+/-0.8 years) from 10 European cities participated in the study.

MEASUREMENTS

Flexibility, muscular fitness, speed/agility and aerobic capacity were tested using the back-saver sit and reach, handgrip, standing broad jump, Bosco jumps (squat jump, counter movement jump and Abalakov jump), bent arm hang, 4 x 10 m shuttle run, and 20-m shuttle run tests.

RESULTS

The ANOVA analysis showed that neither systematic bias nor sex differences were found for any of the studied tests, except for the back-saver sit and reach test, in which a borderline significant sex difference was observed (P=0.044). The Bland-Altman plots graphically showed the reliability patterns, in terms of systematic errors (bias) and random error (95% limits of agreement), of the physical fitness tests studied. The observed systematic error for all the fitness assessment tests was nearly 0.

CONCLUSIONS

Neither a learning nor a fatigue effect was found for any of the physical fitness tests when repeated. The results also suggest that reliability did not differ between male and female adolescents. Collectively, it can be stated that the reliability of the set of physical fitness tests examined in this study is acceptable. The data provided contribute to a better understanding of physical fitness assessment in young people.

Psychometric Properties of Functional Balance Assessment in Children With Cerebral Palsy

Background. Children with cerebral palsy often suffer from a lack of balance compared with typically developing children. Because balance capacity is relevant to functional activities, reliable and valid functional balance measures are crucial for the pediatric clinical setting. Objective. This study examined the reliability and validity of 3 functional balance measures. Methods. Thirty children aged 60 to 142 months with Gross Motor Function Classification System (GMFCS) levels of I to IV were recruited. For test-retest reliability, the same physical therapist administered the Functional Reach Test (FRT), Berg Balance Scale (BBS), and Timed Up and Go (TUG) twice. For interrater reliability, the testing processes were video recorded and later scored by another therapist. For convergent validity, children with cerebral palsy received the Gross Motor Function Measures (GMFM), walking speed, and 10-second sit-to-stand test within 1 week and the results evaluated. Results. The 3 functional balance measures had excellent test-retest reliability (intraclass correlation coefficient [ICC] >0.95) and interrater reliability (ICC = 0.98-1.00). With regard to convergent validity, the BBS and the TUG were highly correlated with GMFM total score, walking speed, and the 10-second sit-to-stand test. The discriminate validity indicates that the FRT can distinguish children with cerebral palsy with different GMFCS levels, whereas the BBS total score and TUG failed to distinguish between children with cerebral palsy with GMFCS levels of I and II. Conclusion. The 3 functional balance measures are simple, valid, and reliable for examining children with cerebral palsy and are thus suitable for clinical practice.

The functional reach test in 3- to 5-year-old children without disabilities

PURPOSE

The purposes of this study were to describe normal values and variability of the Functional Reach Test (FRT) scores in young children and to examine the relationship between anthropometric measures and FRT scores.

METHODS

One hundred twenty-one children aged 3 to 5 years without known disabilities participated in this study. The mean of three successful FRT trials was analyzed.

RESULTS

Three-year-old children reached 11.4 +/- 2.6 cm (mean +/- SD), 4-year-old children 13.6 +/- 3.0 cm, and 5-year-old children 15.7 +/- 4.4 cm. The 95% confidence intervals for the mean and the cutoff reach value for 2 standard deviations below the mean are reported. Weight was the only significant anthropometric measure that predicted FR (R(2) = 0.34).

CONCLUSION

The FRT is a feasible test to examine the balance of 4- to 5-year-old children and should be used with caution for 3-year-old children.

Motor development of deaf children with and without cochlear implants

The purpose of this study was to investigate the impact of a cochlear implant (CI) on the motor development of deaf children. The study involved 36 mainstreamed deaf children (15 boys, 21 girls; 4- to 12-years old) without any developmental problems. Of these children, 20 had been implanted. Forty-three hearing children constituted a comparison group. Motor development was assessed by three standardized tests: the Movement Assessment Battery for Children, the Körperkoordinationstest für Kinder, and the One-leg standing test. Results showed that the hearing children performed on average significantly better than the deaf children (whether or not using a CI). Regarding the use of a CI, there was only a significant difference on one subtest between both groups, although there was a nonsignificant trend for the deaf +CI group to score somewhat worse on average than the deaf -CI group. This led to some significant differences between the hearing group and the deaf +CI group on measures requiring balance that did not hold for the hearing/deaf -CI comparison. Although this study could demonstrate neither a positive nor a negative impact of CI on balance and motor skills, the data raise the need for further, preferably longitudinal, research.