Jump to content

Pediatric Balance Scale

Original Editor - Meaghan Rieke


Top Contributors - Meaghan Rieke, Kim Jackson, Angeliki Chorti, Rucha Gadgil and Lucinda hampton

Objective

The Pediatric Balance Scale is a modified version of the Berg Balance Scale that is used to assess functional balance skills during tasks that mimic experiences of everyday living in school-aged children. [1] The scale consists of 14 balance-related test items that are scored from 0 points (lowest function) to 4 points (highest function) with a maximum score of 56 points.[1]

Intended Population

The Pediatric Balance Scale is intended for use with school-aged children with mild to moderate motor impairments. Pilot testing was performed on children aged 5 to 15 years.[1]

Method of Use

The tester shows to the child how to do each task. The child has three chances of performing each task. The final score for each item derives from calculating the sum of the three scores.

Equipment

The equipment used is[1]:

  • Adjustable height bench
  • Chair with back support and arm rests
  • Stopwatch or watch with a second hand
  • Masking tape (1 inch wide)
  • Step stool 6 inches in height
  • Chalkboard eraser
  • Ruler or yardstick
  • Small level

Optional equipment that may be helpful includes: 2 child size footprints, blindfold, brightly colored object at least 2 inches in size, flash cards, 2 inches of adhesive-backed hook Velcro, two 1 foot strips of loop Velcro.

Time requirements

Its administration time is approximately 20 minutes. [2]

Item Descriptions

  1. Sitting to standing
  2. Standing to sitting
  3. Transfers
  4. Standing unsupported
  5. Sitting unsupported
  6. Standing with eyes closed
  7. Standing with feet together
  8. Standing with one foot in front
  9. Standing on one foot
  10. Turning 360 degrees
  11. Turning to look behind
  12. Retrieving object from floor
  13. Placing alternate foot on stool
  14. Reaching forward with outstretched arm

Scoring Interpretation

Scoring of the PBS ranges from 0 points (lowest function) to 4 points (highest function) for each item. The maximum total score is 56 points.[1] Higher total scores suggest that the child has good balance ability and may be at a lower risk for falls. However, it must be noted that for lower scores that indicate limited balance, interpretation may vary for different age groups and conditions. [3]

Evidence

The PBS has been frequently used in clinical and research settings; its validity and reliability has been studied in various diagnoses in the pediatric patient population. [4] [5][6][7]

Reliability

Reliability testing performed with a sample of 20 children ages 5-15 years old with mild to moderate motor impairments showed good test-retest reliability (ICC=0.998) and good interrater reliability (ICC=0.997).[1]

Validity

Validity testing performed with a sample of 30 children ages 4-10 years old with spastic cerebral palsy in GMFCS Levels I-III showed a strong correlation between the Pediatric Balance Scale and the self-care (r=0.73, p<0.001) and mobility (r=0.82, p<0.001) dimensions of the Pediatric Disability Evaluation Inventory (PEDI).[8]

Validity testing performed with a sample of 23 children ages 6-15 years old with spastic cerebral palsy (hemiplegia or diplegia) showed a strong correlation (r=0.797, p<0.05) between the Pediatric Balance Scale and the Selective Control Assessment of Lower Extremity (Scale).[9]

The relationship between the tandem stance (TS) (item 3) and the single-limb stance (SLS) (item 9) in the Pediatric Balance Scale (PBS) with the PBS total score was investigated in 42 children with impaired balance.[2] Loss of the ability to balance was due to neurological (n=22) or other reasons in typically developing children (n=20). The SLS item explained 64.5% of variance in total PBS score making it a useful first indicator when assessment time is limited.[2] Although this suggests that this task is important when assessing balance in children with disabilities, further work is however needed with larger sample sizes to solidify this conclusion. [2]

Limitations

- Some items of the scale may not accurately represent a child’s balance abilities, especially in young children with attention deficits secondary to a neurologic condition, because of the unrealistic time required to maintain stationary postures. [10][11]

- For a similar reason, the inability to tolerate the time demands of performing all the items of the PBS may result in inaccurate estimates of a child’s true balance ability. [2]

- Balance improvements for both typically developing children and children with mild to moderate physical deficiencies may be missed due to ceiling effects in the PBS’s scoring system. [12][13]

Links

General instructions, equipment list, and scoring criteria are available at this link: Pediatric Balance Scale.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther 2003;15(2):114-28.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Cesar GM, Giebler M, Buster TW, Burnfield JM. Balance assessment with decreased base of support for children with disabilities. Clin Exp Pediatr. 2024 Dec;67(12):718-724.
  3. ↑ Franjoine MR, Darr N, Young B, McCoy SW, LaForme Fiss A. Examination of the effects of age, sex, and motor ability level on balance capabilities in children with cerebral palsy GMFCS levels I, II, III and typical development using the Pediatric Balance Scale. Dev Neurorehabil. 2022 Feb;25(2):115-124.
  4. ↑ Gan SM, Tung LC, Tang YH, Wang CH. Psychometric properties of functional balance assessment in children with cerebral palsy. Neurorehabil Neural Repair. 2008 Nov-Dec;22(6):745-53.
  5. ↑ Cesar G, Buster T, Burnfield J. Cardiorespiratory fitness, balance and walking improvements in an adolescent with cerebral palsy (GMFCS II) and autism after motor-assisted elliptical training. Eur J Physiother. 2018; 22(3): 124–32.
  6. ↑ Chen CL, Shen IH, Chen CY, Wu CY, Liu WY, Chung CY. 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.
  7. ↑ Ölçek G, Çelik İ, Başoǧlu Y, Kaymakçı S, Gürlek E. Comparison of children with and without dyslexia using functional head impulse test and pediatric balance scale. Front Neurol. 2023 Jun 2;14:1153650.
  8. ↑ Duarte Nde A, Grecco LA, Franco RC, Zanon N, Oliveira CS. Correlation between pediatric balance scale and functional test in children with cerebral palsy. J Phys Ther Sci 2014;26(6):849-53.
  9. ↑ Lim H. Correlation between the selective control assessment of lower extremity and pediatric balance scale scores in children with spastic cerebral palsy. J Phys Ther Sci 2015;27(12):3645-49.
  10. ↑ Narad ME, Kennelly M, Zhang N, Wade SL, Yeates KO, Taylor HG, Epstein JN, Kurowski BG. Secondary Attention-Deficit/Hyperactivity Disorder in Children and Adolescents 5 to 10 Years After Traumatic Brain Injury. JAMA Pediatr. 2018 May 1;172(5):437-43.
  11. ↑ Craig F, Savino R, Trabacca A. A systematic review of comorbidity between cerebral palsy, autism spectrum disorders and Attention Deficit Hyperactivity Disorder. Eur J Paediatr Neurol. 2019 Jan;23(1):31-42.
  12. ↑ Darr N, Franjoine MR, Campbell SK, Smith E. Psychometric Properties of the Pediatric Balance Scale Using Rasch Analysis. Pediatr Phys Ther. 2015 Winter;27(4):337-48.
  13. ↑ Jantakat C, Ramrit S, Emasithi A, Siritaratiwat W. Capacity of adolescents with cerebral palsy on paediatric balance scale and Berg balance scale. Res Dev Disabil. 2015 Jan;36C:72-7.
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Pediatric_Balance_Scale&oldid=365015"