Tests & Measures: A Resource for Pediatric Physical Therapy Practitioners

Early Clinical Assessment of Balance

1. Descriptive Information
   • Title, Edition, Dates of Publication and Revision
     • Early Clinical Assessment of Balance
     • Version 1
     • 9/14/2010
   • Author (s)
     • Sarah W. McCoy, Doreen J. Bartlett, Lisa A. Chiarello, Robert J. Palisano, Lynn Jefferies, Alyssa Fiss
   • Source (publisher or distributor, address)
     • Canadian Institutes of Health Research
     • US Department of Education
     • Nation Institutes of Disability and Rehabilitation Research
   • Costs (booklets, forms, kit)
     • Outcome measure sheet
   • Purpose
     • To quantify deficits in balance that may be present in specific pediatric populations.
• Type of Test (eg, screening, evaluative; interview, observation, checklist or inventory)*
  • Checklist with Parts 1(36 points) and Parts 2(64 points) that are added for a max score of 100 points.
• Target Population and Ages
  • Pediatrics- patients with Cerebra l Palsy
  • Research studies have evaluated the validity of this outcome measure in patient between the ages of 1.5 and 5 years old.
• Time Requirements  – Administration and Scoring
  • 15 to 30mins

• Test Administration
  • Administration
    • Testing is completed objectively via health care provider and subsequently scored with number scale
  • Scoring
    • Make sure to circle the statement that matches the childs  ability. If you caught up and are between two scores than take the lower score.
    • Variable starting points for the Outcome measure based off of Gross Motor Classification System Level.
      • Start at item 1 if: their GMFCS is 3,4 or 5
      • Start at item 8 if: their GMFCS is I or II
    • Scoring is on a 0-3 scale for part 1
      • 0: not being able to perform action
      • 3: Performs action with no deviation and maintains position as required.
    • Part 2 scoring:
      • Presents with both Ordinal and Summary Scoring
        • The score range also varies based on tests.
        • The smallest range being 0-6
        • Largest 0-16
  • Type of information, resulting from testing (e.g. standard scores, percentile ranks)
    • Quantifiable data regarding balance.
  • Environment for Testing
    • Open space in clinic with bench and table.
  • Equipment and Materials Needed
    • Bench, Mat, Table if PT’s preference.
• Examiner Qualifications
  • Pediatrician, Pediatrics Physical Therapist
• Psychometric Characteristics
  • Communication components, Mental,
  • MCID= not noted
• Standardization/normative data
  • Highest score possible matches up with normal performance.
• Evidence of Reliability
  • Not been extensively studied
• Evidence of Validity
  • High Validity – ECAB and Gross motor function scores were found to be strongly correlated with a r= .95
• Discriminative
  • No difference found between Male and female.
  • Children <31 months old present with lower scores than older children.
    • Which makes sense
• Predictive
  • Not a predictive test

• Summary Comments
  • Strengths
    • Validity has been confirmed by research. Cost efficient, time efficient, can be retested to evaluate progress.
  • Weaknesses
    • Reliability has not been established.
  • Clinical Applications
    • Essentially is a berg balance test for pediatrics that can quantifiably measure the patient progression. These numbers can then identify the patient at being high risk for falling due to balance. Retesting the outcome measure later would ultimately establish whether or not improvements were made.

 

 

McCoy SW, Bartlett DJ, Yocum A, et al. Development and validity of the early clinical assessment of balance for young children with cerebral palsy. Dev Neurorehabil. 2014;17(6):375-383. doi: 10.3109/17518423.2013.827755 [doi].

 

Randall KE, Bartlett DJ, McCoy SW. Measuring postural stability in young children with cerebral palsy: A comparison of 2 instruments. Pediatr Phys Ther. 2014;26(3):332-337. doi: 10.1097/PEP.0000000000000062 [doi].

 

http://canchild.ca/en/ourresearch/resources/move_play_supplementary_file.pdf

 

 

The article that I chose for review of this outcome measure was conducted by the same researchers that created the outcome measure.  In this study the researchers goal was to determine the validity of the early clinical assessment of balance for monitoring postural stability in children. More specifically the validity of this outcome measured used on children with cerebral palsy.  The study design utilized a  large sample size of 410 children with cerebral palsy, which is excellent because it helps to increase the strength of the study. The children in the study ranged in ages from 1.5 to 5 years old.  The early clinical assessment of balance borrows components from various pediatric outcome measures in regards to reactions as well as balance.  These contributions from other research studies  are noted in this article and the at the top of the early clinical assessment of balance as well. The primary portion in the methods portion of this article uses the early clinical assessment of balance scores and attempts to identify similar reporting to the Gross Motor Function Measure 66 basal and Ceiling.  Establishing a correlation between these two outcome measures will ultimately, determine the validity. The results of the study  confirmed the validity of the early clinical assessment of balance. Older children obviously had improved scores compared to the younger children and there was no male to female difference.  At the end of the article the researchers established that although validity was confirmed there still needs to be more research to evaluate reliability of the early clinical assessment of balance.