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Pediatric Balance Scale

Pediatric Balance Scale

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Purpose

A 14-item criterion-referenced measure that examines functional balance in the context of everyday tasks in the pediatric population.

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Instrument Details

Acronym PBS

Cost

Free

Diagnosis/Conditions

  • Cerebral Palsy
  • Pain Management
  • Pediatric + Adolescent Rehabilitation
  • Spina Bifida

Key Descriptions

  • Steady state and anticipatory balance activities of varying difficulty are performed with and without visual input.
  • Item level scores range from 0-4 which is determined by the ability to perform the assessed activity.
  • Item scores are summed.
  • Maximum score = 56 points with 56 points being a perfect score.

Number of Items

14

Equipment Required

  • Adjustable height bench
  • Chair with back support and arm rests
  • Stopwatch or watch with a second hand
  • Masking tape one inch wide
  • Step stool six inches in height
  • Chalkboard eraser
  • Ruler or yardstick
  • A small level
  • Optional items that may be helpful: Two child-size footprints, Blindfold, A brightly colored object of at least two inches in size, Flash cards, Two inches of adhesive-backed hook, Velcro, Two, one foot strips of loop velcro

Time to Administer

Less than 20 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Amber Boyd, PT, DPT, SCS, CSCS in 4/2015

ICF Domain

Activity

Considerations

Franjoine et al, 2010

  • Performance on the Pediatric Balance Scale is significantly affected by age and gender. As children age, scores increase with age with the biggest increase between ages six and seven. Scores on the Pediatric Balance Scale are moderately correlated to age (r=0.689) and height (r=0.650) in typically developing children. Females demonstrated significantly higher scores than their male counterparts across all age groups with the greatest differences occurring between two and four years old. Most children who are seven years and older who are typically developing demonstrate mastery of items on the Pediatric Balance Scale. This scale may be most appropriate and detect greatest changes in children aged three to six years in typically developing children and those with mild to moderate motor impairment. It is important to correlate this outcome measure with clinical examination findings for greatest clinical utility.

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Cerebral Palsy

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Minimal Detectable Change (MDC)

Cerebral Palsy: (Chen et al, 2013; n=45; mean age = 49 (19.9) months; with cerebral palsy 36 bilateral, 9 unilateral) 

  • Pediatric Balance Scale total=1.59 points
  • Pediatric Balance Scale-static=0.79 points
  • Pediatric Balance Scale-dynamic=0.96 points

Minimally Clinically Important Difference (MCID)

Cerebral Palsy: (Chen et al, 2013)

  • Pediatric Balance Scale total=5.83 points
  • Pediatric Balance Scale-static=2.92 points
  • Pediatric Balance Scale-dynamic=2.92 points

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Cerebral Palsy ( Chen et al, 2013; n=45; age range: 19-77 months) 

  • Excellent concurrent validity between Pediatric Balance Scale and the Gross Motor Function Measurement (GMFM-66) at baseline (r=0.92-0.95), follow-up (r=0.89-0.91) 

  • Adequate validity between Pediatric Balance Scale and the WeeFim at baseline (r=0.47-0.78), follow-up (r=0.44-0.87) 

 

Predictive validity:

Cerebral Palsy ( Chen et al, 2013) 

  • Excellent predictive validity of the Pediatric Balance Scale and the GMFM-66 at follow-up (r=0.90-0.92)

  • Adequate predictive validity between Pediatric Balance Scale and the WeeFim at follow-up (r=0.43-0.76)

Construct Validity

Ambulatory children with spastic cerebral palsy (Yi et al, 2012; n=38; age range: 4 to 10 years) 

Convergent validity:

  • Poor convergent validity of the Pediatric Balance Scale and the Sensory Organization Test Equilibrium score, eyes open (r=0.579) 

  • Poor convergent validity of the Pediatric Balance Scale and the Sensory Organization Test Equilibrium score, eyes closed (r=0.448) 

  • Poor convergent validity of the Pediatric Balance Scale and the Sensory Organization Test equilibrium score vision differential (r=0.295) 

  • Excellent convergent validity of the Pediatric Balance Scale is strongly correlated with motor capacity GMFM-88 total score (r=0.926), GMFM-66 (r=0.902), GMFM D (r=0.929) 

  • Adequate convergent validity of t Pediatric Balance Scale and the performance on the PEDI mobility capability (r=0.713) 

  • Adequate convergent validity of t Pediatric Balance Scale and the performance on the PEDI mobility performance (r=0.639) 

 

Discriminant Validity: 

  • Significant difference in the Pediatric Balance Scale and the three GMFCS levels (p<0.05) and significant difference in Pediatric Balance Scale scores being transformed to ranks among all three levels

Responsiveness

Cerebral Palsy: ( Chen et al, 2013)

  • SRM=0.748-0.754

Pediatric Disorders

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Cut-Off Scores

Typically Developing Children: (Franjoine et al, 2010; n=641; age range 2 years 4 months to 13 years 7 months; typically developing) 

Age range 

Cut off 

2y 0m to 2y 5 m 

23.3 points 

2y 6m to 2y 11m 

32.7 points 

3y 0m to 3y 5m 

45.4 points 

3y 6m to 3y 11m 

47.5 points 

4y 0m to 4y 5m 

48.5 points 

4y 6m to 4y 11m 

50.4 points 

5y 0m to 5y 5m 

53.2 points 

5y 6m to 5y 11m 

52.2 points 

6y 0m to 6y 5m 

52.8 points 

6y 6m to 6y 11m 

53.3 points 

7y 0m and older 

54.6 points 

Table 1. Y=year. M=month. These cut-off scores were established for typical performance and outlier ranges within each age group using 95% CI of the means. These scores are the lower boundary of the 95% CI of the means. Scoring below these scores may indicate decreased functional balance but should be interpreted with findings from a clinical examination.

Normative Data

Typically Developing Children: (Franjoine et al, 2010) 

Age range 

Mean total score ± SD 

2y 0m to 2y 5 m 

26.2 ± 6.38 points 

2y 6m to 2y 11m 

34.3 ± 7.72 points 

3y 0m to 3y 5m 

46.0 ± 6.55 points 

3y 6m to 3y 11m 

48.5 ± 5.02 points 

4y 0m to 4y 5m 

49.5 ± 5.76 points 

4y 6m to 4y 11m 

51.2 ± 5.07 points 

5y 0m to 5y 5m 

54.0 ± 2.52 points 

5y 6m to 5y 11m 

53.3 ± 3.20 points 

6y 0m to 6y 5m 

53.8 ± 2.49 points 

6y 6m to 6y 11m 

54.4 ± 1.89 points 

7y 0m and older 

55.2 ± 1.74 points 

Table 2. SD=standard deviation. Y=year. M=month.

Test/Retest Reliability

Typically developing children: (Kobes & Lach, 1997; n=40; age range: 5-7 years) 

  • Excellent test-retest reliability (ICC=0.850) 

 

School-age children with mild to moderate motor impairments:(Franjoine et al, 2003; n=20; mean age=9 years with range from 5 to 15 years) 

  • Excellent test-retest reliability (ICC=0.998)

Interrater/Intrarater Reliability

School-age children with mild to moderate motor impairments:(Franjoine et al, 2003) 

  • Excellent interrater reliability (ICC=0.997)

Floor/Ceiling Effects

Typically developing children: (Franjoine et al, 2010) 

  • Ceiling effects noted for typically developing children seven years old and older (69.1% of seven year olds achieved the maximal score of 56 and 95% of these children scored 53 or greater)

Bibliography

Chen, C. Shen, I., Chen, C., Wu, C., Liu, W., et al. (2012). “Validity, responsiveness, minimal detectable change, and minimal clinically important change of pediatric balance scale in children with cerebral palsy.” Res Dev Disabil 34:916-922.

Franjoine, M.R., Darr, N., Held, S., Kott, K., Young, B.L. (2010). “The performance of children developing typically on the pediatric balance scale.” Pediatr Phys Ther 22(4): 350-359.

Franjoine, M.R., Gunther J.S., Taylor, M.A. (2003). “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 15(2): 114-128.

Kobes K., Lach J. (1997). “Determining the Intertester and Intratester Reliability of the Pediatric Balance Scale for Normal Developing Children.” Amherst, NY: Daemen College, Bachelor’s Thesis.

Seale, J. (2010). “Valuable and reliable instruments for the clinical assessment of the effect of ankle-foot orthoses on balance.” J Prosthet Orthot 10:38-45.

Yi, S.H., Hwang, J.H., Kim, S.J., Kwon, J.Y. (2012). “Validity of pediatric balance scales in children with spastic cerebral palsy.” Neuropediatrics 43(6):307-313.

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