Pediatric Balance Scale

Posted on: March 14, 2015 | By: akuzbary | Filed under: Pediatric Balance Tests
  1. Descriptive Information
    1. Title, Dates of Publication: Pediatric Berg Balance Scale,2003
    2. Author (s): Mary Rose Franjoine, MS, PT, PCS, Joan S. Gunther, PhD, PT, and Mary Jean Taylor, MA, PT, PCS
    3. Source: Research Report
    4. Costs: Free to download; requires items that can generally be found in the clinic
    5. Purpose: Assess balance in school age children
    6. Type of Test: screening, evaluative
    7. Target Population and Ages: school age children (5- 15) for children with mild to moderate motor impairments; typically developing children plateau around age 7-8 2,3
    8. Time Requirements – Administration and Scoring:  <15 mins
  2. Test Administration
    1. Administration: This is a 14 item test. Verbal instructions for each item are given. The child may receive one practice trial per item. If the child is unable to understand the directions, a second trial may be given. Verbal and visual instructions are given to clarify.
    2. Scoring: Each item is scored 0 – 4
    3. Type of information, resulting from testing: Balance score out of 56 like Berg.
    4. Environment for Testing: anywhere in the clinic or school
    5. Equipment and Materials Needed: adjustable height bench, chair with back support and arm rest, stopwatch or watch with a second hand, masking tape, – 1 inch wide, a step stool 6 inches in height, chalkboard eraser, ruler or yardstick, a small level.
      1. Optional items that may help with administration: 2 child-size foot prints, blindfold, a brightly colored object of at least two inches in size, flash cards, 2 inches of adhesive-backed hook Velcro, two 1 foot strips of look Velcro
    6. Examiner Qualifications: Examiner should understand scoring which is similar to that of the Berg and follow the directions on the test.
    7. Psychometric Characteristics 5
      1. Tasks constraints: static, dynamic, and transfer stability
      2. Reliability:
        1. Typically developing 5-7 y/o test-retest: 0.850
        2. Motor impairment 5-15 y/o interrater: 0.997 test-retest: 0.998
        3. Cerebral Palsy 6-13 y/o intrarater: 0.978-0.988 interrater: 0.905 test-retest: 0.958
      3. Standardization/normative data 4
        1. Average scores have been found for various age groups.
Age Mean +/- SD
4.0-4.5 49.5 5.76
4.6-4.11 51.2 5.07
5.0-5.5 54.0 2.52
5.6-5.11 53.3 3.20
6.0-6.5 53.8 2.49
6.6-6.11 54.4 1.89
7.0 and 13.17 55.2 1.74

 

  1. Evidence of Reliability: 3
    1. Test-retest reliability: high [ICC (3,1) = 0.998]
    2. Interrater reliability: high [ICC (3,1) = 0.997]
  2. Evidence of Validity1
    1. One study found good criterion-related concurrent and predictive validity with children with CP. The authors state that PBS has the capability to predict motor function and ADL at follow up .
  3. MDC/MCID

For children with CP1

MDC90          MCID

  1. PBS – Static 79                1.47-2.92
  2. PBS – dynamic 96                2.23-2.92
  3. PBS – total 59                3.66-5.83
  • Summary Comments
    1. Strengths: provides clinicians with a standardized protocol for testing balance more appropriate for a child’s developing balance skills; inexpensive; requires no additional equipment;
    2. Weaknesses: test does not assess locomotive balance; test does not assess overhead reaching;
    3. Clinical Applications: This test provides clinicians with a balance test similar to the Berg Balance Scale but organized and designed to assess a child’s developing balance skills. This could be a helpful tool to assess balance in children with motor impairments.

 

Article summary:

Silkwood-Sherer DJ, Killian CB, Long TM, Martin KS. Hippotherapy— an intervention to habilitate balance deficits in children with movement disorders: a clinical trial. Phys Ther. 2012;92: 707–717.

The purpose of this study was to assess the effectiveness of hippotherapy for managing postural instability in children with mild to moderate balance problems and to determine whether there is a correlation between balance and function. This study had 16 children ages 5 to 16 years old. Intervention was two 45 minute sessions of hippotherapy per week for 6 weeks. Participants were assessed before and after treatment by two main outcome measures, Pediatric Balance Scale (PBS) and Activities Scale for Kids – Performance (ASKp). This study found a statistically significant difference between pre- and post-intervention assessment with median increases of 5.5 and 4.0 points from baseline. Significant differences in ASKp scores were seen between pre- and post-interventions assessments when compared to baseline. The authors found no correlation between the changes in PBS scores and the changes in ASKp scores. This study findings suggest the hippotherapy may be a helpful intervention strategy for reducing balance deficits and improving function in children with mild to moderate balance deficits.

References:

  1. Chen C-I et al. Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy. Res Dev Disabil. 2013 Mar;34(3):916-22.
  1. Butz SM et al. Relationships among age, gender, anthropometric characteristics, and dynamic balance in children 5 to 12 years old. Pediatr Phys Ther. 2015 Feb 18; eprint PMID: 25695196.
  1. Franjoine MR, Gunther JS, Taylor MJ. Pediatric Balance Scale: A Modified Version of the Berg Balance Scale for the School Age Child with Mildto Moderate Motor Impairment. Pediatr Phys Ther. 2003; 15(2):114-128.
  1. Franjoine MR, Darr N, Held SL, Kott K, Young BL. The Performance of Children Developing Typically on the Pediatric Balance Scale. Pediatr Phys Ther. 2010; 22(4): 350-359,
  1. Verbecque E et al. Psychometric properties of functional balance tests in children: a literature review. Dev Med Child Neurol. 2014 Dec 11. PMID: 25495539.

 

3 responses to “Pediatric Balance Scale”

  1. apearsall says:
    March 14, 2015 at 1:17 pm

    Prior to reading this, I was not aware there was a pediatric version of the Berg, so thank you for your informative post. It’s interesting that norms variability requires breaking down ages into 6-month intervals from 4-7 years old before balance performance levels off after 7 years old. Overall, the data is suggesting this is a valid and reliable test whose value is further supported by the fact that it’s been tested on multiple populations including CP, motor impairment, and typically developing children. Like the actual Berg, this scale would have a floor effect in patients unable to stand, but otherwise, seems like a viable, convenient, and fairly simple means to assess balance in pediatric populations. Great work!

  2. jbelk says:
    March 16, 2015 at 10:40 am

    I was also unfamiliar with a pediatric version of the Berg Balance Scale. I was impressed at the high reliability of this test used with CP and motor development impairments. I found it a little odd that the test is not as reliable for the normally developing pediatric population. I am also wondering how much this test takes short attention span or inability/unwillingness to follow instructions. I know with my patient for pediatrics, he has impairments in balance, and an objective measure would be fantastic. However it would be very difficult to have him complete this test efficiently and in a timely manner due to his short attention span. I do like that they made this test applicable to children and have age referenced normative data to compare as well as making an objective measure for balance.

  3. jsalley says:
    March 17, 2015 at 6:23 pm

    When I was researching the Early Clinical Assessment of Balance I found out that the Pediatric balance scale was a component to the development of its structure. Primarily that certain questions were used to develop the ECAB in combination with other tests in order to increase effectiveness of the Tests and measure. Essentially, it seemed that the researchers came to the conclusion that the pediatric balance scale already showed evidence for being reliable. Therefore, the components can be more effective in evaluating changes in balance in the cerebral palsy population in pediatrics. In regards to sensitivity to change I would expect the pediatric balance scale to demonstrate more score changes in comparison. I base this assumption on the fact that the pediatric balance scale is out of 56 points compared to the early clinical assessment of balance that is out of 100.

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