Correlation between gross motor coordination and basic coordination capacities in normal-weight and overweight/obese children aged 9-10 years

Background

Gross motor coordination (GMC) plays a crucial factor in children's motor development and daily activities. It encompasses various sub-capacities, such as spatial orientation, rhythm, and motor reaction, collectively referred to as basic coordination capacities (BCC). However, children who are overweight and obese (OW/OB) often display poorer GMC. This study aims to examine the impact of gender and weight status (BMI categories) on children's GMC and BCC. It also seeks to investigate the impact of BCC and BMI on GMC.

Method

The study involved 266 participants, 135 in the NW group (boys: n = 75; girls: n = 60) and 131 in the OW/OB group (boys: n = 68; girls: n = 63). An NW status is defined by a BMI z-score between ≥-2SD to ≤1SD, while an OW/OB status corresponds to a BMI z-score > 1SD. Physical activity was assessed using the Physical Activity Questionnaire for Children, developed by the University of Saskatchewan, Canada. We used six field tests to evaluate BCC, including single leg standing test (static balance), YBT (dynamic balance), rhythmic sprint test (rhythm), reaction time test (motor reaction), target standing broad test (kinesthetic differentiation), and numbered medicine ball running test (spatial orientation). GMC was evaluated with Kiphard-Schilling's Body Coordination Test (KTK).

Result

The motor quotient (MQ) was primarily affected by weight status (F = 516.599, p < 0.001; gender: F = 6.694, p = 0.01), with no significant interaction effect (F = 0.062, p = 0.803). In BCC, gender had a significant main effect on rhythm capacity (F = 29.611, p < 0.001) and static balance (F = 11.257, p = 0.001) but did not significant influence other sub-capacities (p > 0.05). Weight status impacted dynamic balance (F = 11.164, p = 0.001). The interaction of gender and weight status significantly impacted motor reaction (F = 1.471, p = 0.024) and kinesthetic differentiation (F = 5.454, p = 0.02), but did not affect other sub-capacities (p > 0.05). The physical activity was not significant affected by gender (F = 0.099, p = 0.753), weight status (F = 0.171, p = 0.679) and the interactions of two variables (F = 0.06, p = 0.806). In the regression analysis, except motor reaction (p > 0.05), other BCC sub-capacities influenced GMC to varying extents (β = -0.103-0.189, p < 0.05). Nonetheless, only two types of balance significantly mediated the relationship between BMI and GMC (BMI→MQ: β = -0.543, p < 0.001; BMI→YBT: β = -0.315, p < 0.001; BMI→SLS: β = -0.282, p < 0.001; SLS→MQ: β = 0.189, p < 0.001; YBT→MQ: β = 0.182, p < 0.001).

Conclusion

Compared to gender, the main effect of weight status on most GMC and BCC's sub-capacities was more pronounced. OW/OB children exhibited poorer GMC, which is related to their reduced static and dynamic balance due to excess weight. Kinesthetic differentiation, spatial orientation, and rhythm capacity are not significantly associated with BMI, but these sub-capacities positively influence gross motor coordination (GMC), except for hand-eye motor reaction.

Checks and balances: a meta-analysis on the known-groups validity of functional postural control tests in children

INTRODUCTION

Pediatric physical therapists commonly treat children with postural control deficits. Ideally, pediatric functional postural control tests should therefore be able to identify postural control deficits in children with various disorders. Despite a plethora of available tests, evidence for their validity - especially known-groups - remains scarce. This review aims to determine the known-group validity of available functional postural control tests to differentiate various pediatric pathological groups of different ages from their typically developing (TD) peers.

EVIDENCE ACQUISITION

PubMed, Web of Science and Scopus were systematically searched (last update: February 2023; PROSPERO: CRD42023408982). Forty case-control studies with a pathological pediatric sample (N.=1331) and TD peers (N.=1889) were included and selected for data-extraction and -analysis. Risk of bias was assessed using the SIGN checklist and level of evidence was scored using GRADE. Random-effect meta-analyses were performed to estimate pooled standardized mean differences (SMD) for the various test types and subclassified based on pathology and/or age.

EVIDENCE SYNTHESIS

When compared with TD peers, children with underlying pathologies performed significantly worse on pediatric functional postural control test batteries (SMD=-2.21), the Timed Up and Go Test and variants (SMD=2.30), the One Leg Stance test and variants (SMD=-2.14), while the Reach tests showed a smaller difference (SMD=-1.19). Subclassification within the meta-analyses showed that pathology was an influencing factor for the test batteries and the one leg stance test and variants. Age was an influencing factor for the reach tests. None of the included functional postural control tests exceeded a low level of evidence.

CONCLUSIONS

Pediatric functional postural control tests that assess multiple aspects of postural control (such as test batteries) seem to offer higher known-groups validity than single-task tests (e.g. reach tests). The underlying pathology has a larger impact on the validity of these tests than age. There remains an overall low level of evidence for the known-groups validity of pediatric functional postural control tests indicating the need for research with more homogenous groups and norm reference data.

Vestibular Dysfunction Among Children with Otitis Media and Effusion in a Multiracial Setting

Otitis media with effusion (OME) is a common presentation to the Otorhinolaryngology clinic. Besides hearing impairment, recent evidence shows that approximately 30% of these children have some degree of vestibular and balance impairment. To assess the presence of vestibular dysfunction among children with OME. Children between 4 and 17, with and without OME, underwent vestibular assessment using video head impulse test (VHIT), subjective visual subjective (SVV), and single leg raising test (SLS). Data were recorded and analysed. 24 OME children were included with male predominance. No statistical significance was found between the VOR gain (p > 0.05), SVV (p = 0.056) and SLS (p = 0.06). Simple linear regression analysis showed that age and gender are potential factors for VOR gain. Our study found that children with OME have normal vestibular function.

Physical fitness in adolescent patients with familial Mediterranean fever

INTRODUCTION

Familial Mediterranean fever (FMF) is the most frequent monogenic auto-inflammatory disease worldwide responsible for episodes of fever, serositis and musculoskeletal symptoms. Inflammatory attacks are responsible for sedentary behavior and FMF patients may be at increased cardiovascular risk. Cardiorespiratory Fitness (CRF) and physical capacities during adolescence are associated with cardiovascular mortality in adulthood. In this study, we aimed to describe the physical fitness of FMF adolescents.

METHODS

A monocentric retrospective study at the Versailles Hospital between January 2020 and June 2023. All FMF patients over 14-year-old who had completed a routine physical test were included. Clinical and physical data including results of the 6-minute walking test, timed unipedal stance test, Ruffier-Dickson index, 30-seconds chair-stand test and sit-and-reach test were extracted from medical records. Results were compared with previously published normative reference values and criterion-referenced standards for healthy subjects.

RESULTS

Eighteen FMF patients (12 girls, 6 boys) were included. The median age was 16 years old [14-18]. Clinical history included joint symptoms (n = 11), chest pleuritis (n = 8), and leg pain (n = 11). Estimated VO2max was below the recommended thresholds in 13 patients, which predicts cardiovascular risk. Cardiovascular adaptation was poor in 11 patients. Low VO2max was associated with CRP > 5 mg/l on test day and history of joint symptoms.

CONCLUSION

FMF patients displayed altered physical capacities compared to normative values of healthy subjects. History of musculoskeletal pain, systemic inflammation and sedentary behavior may participate in impaired physical abilities and promote cardiovascular diseases in adulthood. Specific exercise programs could benefit patients for disease control and cardiovascular risk reduction.

Body composition and motor function in children born large for gestational age at term

BACKGROUND

This cross-sectional study compared body composition and motor function between children who were born large for gestational age (LGA) and those born appropriate for gestational age (AGA) and to investigate the association between gait quality and other variables.

METHODS

Body composition was determined using a bioelectrical impedance analyzer. Motor functions were assessed using one-leg standing time, timed up-and-go test, five times sit-to-stand test, and three-dimensional gait analysis. We compared the results between two groups. We performed multiple regression analysis to evaluate the association between gait deviation index and variables of LGA, fat mass index, and motor functions (adjusted for age and sex).

RESULTS

Children aged 6-12 years who were born LGA at term (n = 23) and those who were born AGA at term (n = 147) were enrolled. The LGA group had a higher fat mass index (2.9 vs. 2.2, p = 0.006) and lower gait deviation index (91.4 vs. 95.4, p = 0.011) than the AGA group. On multiple regression analysis, gait deviation index was associated with being LGA and fat mass index.

CONCLUSIONS

In school-aged children who were born LGA, monitoring increased fat mass index and decreased gait deviation index could lessen the risk of metabolic syndrome and reduced gait function.

IMPACT

Children aged 6-12 years who were born large for gestational age (LGA) at term showed a higher fat mass index and lower gait deviation index than those who were born appropriate for gestational age at term. No significant differences in balance function or muscle strength were observed between groups. On multiple regression analysis, gait deviation index was associated with being LGA at birth and fat mass index. In school-aged children who were born LGA, monitoring increased fat mass index and decreased gait deviation index could lessen the risk of metabolic syndrome and reduced gait function.

Factors Affecting Balance Performance in Adolescents

(1) Background: The influence of different factors on balance in adolescence is assessed by conducting functional balance tests that examine its different components. (2) Materials and methods: The study sample comprised 110 healthy adolescents of both sexes, aged 12-18 years. Single Leg Stance with Eyes Open (SLS-EO) and Eyes Closed (SLS-EC) tests were conducted to evaluate static balance, whereas the Functional Reach Test (FRT) and Lateral Reach Test (LRT) were performed to establish functional stability limits. The influence of sex, age, demographic factors, anthropometric characteristics, participation in sports activities, and trunk extensor muscle endurance (Biering-Sorensen test) on balance performance was determined through correlational and univariate linear regression analyses. (3) Results: Older age (Beta [β] = 0.247; 95% CI [0.75, 5.20]; p < 0.01) and better trunk extensor muscle endurance (β = 0.224; 95% CI [0.015, 0.13]; p < 0.05) were significant predictors of the SLS-EO results, while younger age (β = -0.219; 95% CI [-1.32, -0.11]; p < 0.05) and higher muscle percentage (β = 0.237; 95% CI [0.06, 0.48]; p < 0.05) emerged as significant predictors of LRT performance, and greater bone mass was a significant predictor of FRT results (β = 0.444; 95% CI [3.62, 8.17]; p < 0.01). However, none of the independent variables was a statistically significant predictor of the SLS-EC results. (4) Conclusions: The current study found that age, trunk extensor muscle endurance, muscle percentage, and bone mass are significant predictors of different balance components, suggesting that balance is task-specific.

Acute and Longitudinal Effects of Sport-related Concussion on Reactive Balance

Postural instability is a common observation after concussions, with balance assessments playing a crucial role in clinical evaluations. Widely used post-concussion balance tests focus primarily on static and dynamic balance, excluding the critical aspect of reactive balance. This study investigated the acute and longitudinal effects of concussion on reactive balance in collegiate athletes. The assessments were conducted at pre-season baseline and 4 post-concussion timepoints: acute, pre-return-to-play, post-return-to-play, and six months post-concussion. The instrumented-modified Push and Release test measured reactive balance. Longitudinal effects of concussions on time to stability and step latency metrics were investigated applying Generalized Estimating Equations. Acutely after concussion, athletes demonstrated impaired reactive balance, indicated by longer times to stability, in dual-task conditions ( p = 0.004). These acute impairments were transient and recovered over time. Exploratory analyses revealed that athletes who sustained their first lifetime concussion exhibited both acute ( p = 0.037) and longitudinal ( p = 0.004 at post-return-to-play) impairments in single- and dual-task compared to controls with no lifetime concussion. This comprehensive evaluation provides insights into the multifaceted nature of post-concussion impairments and emphasizes the importance of considering cognitive demand and history of concussions in assessing athletes' balance.

Instrumented Balance Error Scoring System in Children and Adolescents-A Cross Sectional Study

Background: The Balance Error Scoring System (BESS) is a commonly used method for clinically evaluating balance after traumatic brain injury. The utilization of force plates, characterized by their cost-effectiveness and portability, facilitates the integration of instrumentation into the BESS protocol. Despite the enhanced precision associated with instrumented measures, there remains a need to determine the clinical significance and feasibility of such measures within pediatric cohorts. Objective: To report a comprehensive set of posturographic measures obtained during instrumented BESS and to examine the concurrent validity, reliability, and feasibility of instrumented BESS in the pediatric point of care setting. Methods: Thirty-seven participants (18 female; aged 13.32 ± 3.31 years) performed BESS while standing on a force plate to simultaneously compute stabilometric measures (instrumented BESS). Ellipse area (EA), path length (PL), and sway velocity (VM) were obtained for each of the six BESS positions and compared with the respective BESS scores. Additionally, the effects of sex and age were explored. A second BESS repetition was performed to evaluate the test-retest reliability. Feedback questionnaires were handed out after testing to evaluate the feasibility of the proposed protocol. Results: The BESS total score was 20.81 ± 6.28. While there was no statistically significant age or sex dependency in the BESS results, instrumented posturography demonstrated an age dependency in EA, VM, and PL. The one-leg stance on a soft surface resulted in the highest BESS score (8.38 ± 1.76), EA (218.78 cm2 ± 168.65), PL (4386.91 mm ± 1859.00), and VM (21.93 mm/s ± 9.29). The Spearman's coefficient displayed moderate to high correlations between the EA (rs = 0.429-0.770, p = 0.001-0.009), PL (rs = 0.451-0.809, p = 0.001-0.006), and VM (rs = 0.451-0.809, p = 0.001-0.006) when compared with the BESS scores for all testing positions, except for the one-leg stance on a soft surface. The BESS total score significantly correlated during the first and second repetition (rs = 0.734, p ≤ 0.001), as did errors during the different testing positions (rs = 0.489-0.799, p ≤ 0.001-0.002), except during the two-legged stance on a soft surface. VM and PL correlated significantly in all testing positions (rs = 0.465-0.675, p ≤ 0.001-0.004; (rs = 0.465-0.675, p ≤ 0.001-0.004), as did EA for all positions except for the two-legged stance on a soft surface (rs = 0.392-0.581, p ≤ 0.001-0.016). A total of 92% of participants stated that the instructions for the testing procedure were very well-explained, while 78% of participants enjoyed the balance testing, and 61% of participants could not decide whether the testing was easy or hard to perform. Conclusions: Instrumented posturography may complement clinical assessment in investigating postural control in children and adolescents. While the BESS score only allows for the consideration of a total score approximating postural control, instrumented posturography offers several parameters representing the responsiveness and magnitude of body sway as well as a more differentiated analysis of movement trajectory. Concise instrumented posturography protocols should be developed to augment neuropediatric assessments in cases where a deficiency in postural control is suspected, potentially stemming from disruptions in the processing of visual, proprioceptive, and/or vestibular information.

Multisensory and biomechanical influences on postural control in children

Children's ability to maintain balance requires effective integration of multisensory and biomechanical information. The current project examined the interaction between such sensory inputs, manipulating visual input (presence vs. absence), haptic (somatosensory) input (presence vs. absence of contact with a stable or unstable finger support surface), and biomechanical (sensorimotor) input (varying stance widths). Analyses of mean velocity of the center of pressure and the percentage stability gain highlighted the role of varying multisensory inputs in postural control. Developmentally, older children (6-11 years) showed a multisensory integration advantage compared with their younger counterparts (3-5.9 years), with the impact of varying sensory inputs more closely akin to that seen in adults. Subsequent analyses of the impact of anthropometric individual difference parameters (e.g., height, leg length, weight, areas of base of support) revealed a shifting pattern across development. For younger children, these parameters were positively related to postural stability across experimental conditions (i.e., increasing body size was related to increasing postural control). This pattern transitioned for older children, who showed a nonsignificant relation between body size and balance. Interestingly, because adults show a negative relation between anthropometric factors and stability (i.e., increasing body size is related to decreasing postural control), this shift for the older children can be seen as a developmental transition from child-like to adult-like balance control.

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.

A Home-Based Exercise Program With Active Video Games for Balance, Motor Proficiency, Foot and Ankle Ability, and Intrinsic Motivation in Children With Chronic Ankle Instability: Feasibility Randomized Controlled Trial

Background

Children with chronic ankle instability (CAI) frequently experience ankle unsteadiness, causing trips, falls, and ankle sprain injuries resulting in poor quality of life. A specific exercise program focused on physical and psychological purposes in children with CAI is needed.

Objective

The purpose of this study was to investigate the feasibility of a 4-week home-based exercise training program using active video games (AVGs) for balance, motor proficiency, foot and ankle ability, and intrinsic motivation in children with CAI.

Methods

Sixty children with CAI (mean age 10, SD 2 years) were randomly assigned to an experimental group (AVG group; n=30) or a control group (CG; n=30). The AVG group played 2 selected video games, Catching Fish and Russian Block, while the CG received the traditional exercise program for CAI. Both programs were scheduled for 30 minutes per day, 3 times per week, for 4 weeks at home. The single-leg stance test was used to assess static balance. The walking forward on a line and standing long jump tests were used to assess motor proficiency. The Foot and Ankle Ability Measure (FAAM) and the Intrinsic Motivation Inventory questionnaire were used to assess foot and ankle ability and intrinsic motivation, respectively. Assessments were conducted at baseline and after 4 weeks.

Results

In the AVG group, the single-leg stand test (eyes open; on floor and on foam conditions), the FAAM (activities of daily living subscale), and intrinsic motivation (interest/enjoyment, pressure/tension, and value/usefulness dimensions) were improved compared with the CG (all P<.05). Motor proficiency did not differ between the 2 groups at the end of the 4-week program (P=.31 for the walking forward on a line, P=.34 for the standing long jump test).

Conclusions

A 4-week home-based exercise training program using AVGs can be beneficial and may be an effective approach for improving balance, foot and ankle ability, and enhancing positive motivation by increasing the interest/enjoyment and value/usefulness dimensions and lowering the pressure/tension dimension in children with CAI that require long-term rehabilitation sessions.

Assessment of rehabilitation effects in children with mild intellectual disability

Research on effectiveness of rehabilitation programmes continues to investigate impact of therapeutic interventions on various motor parameters in children with intellectual disability (ID). This study compared the effectiveness of rehabilitation, reflected by physical fitness, static balance, and dynamic balance measurements, in children with mild ID. A total of 70 children with mild ID were enrolled for the study and were divided into two equal groups based on their body mass index (BMI) percentile, reflecting obesity or normal weight. Physical fitness was assessed using the Eurofit Special Test, whereas balance was evaluated with single-leg stance and timed up and go tests. The examinations were performed twice: At the beginning and at the end of a six-month therapy programme. Improvements were shown in the muscle strength of the upper limbs (p < 0.001) and lower limbs (p = 0.001), flexibility (p = 0.005), and static balance (p < 0.001) for the entire cohort. The effects of rehabilitation did not differ significantly between the children with obesity and those with a normal weight. These results may be important from the viewpoint of clinical practice and preventive measures, as they present evidence showing that rehabilitation is equally effective in both obese and normal weight children with mild ID. Therefore, these findings may be of assistance to those designing therapeutic programmes in special education centres.

Establishing cervical vestibular evoked myogenic potential (cVEMP) normative data in Singapore school-aged children

OBJECTIVES

The Cervical Vestibular Evoked Myogenic Potential (cVEMP) is often employed in routine clinical practice as part of the vestibular test battery assessments. However, there is currently no well-established paediatric cVEMP normative data in Singapore. Additionally, limited literature has examined the relationship between neck length and cVEMP parameters. The main aims of this study are to 1) establish cVEMP normative data from Singaporean school-aged children aged 6-12 years old, and 2) examine if there is a significant correlation between neck length and cVEMP parameters.

METHODS

31 healthy children participated in this study. Every participant was screened to ensure that they had normal auditory and vestibular profiles before completing the cVEMP procedure, which involved 500 Hz tone burst through insertphones and head elevation from supine position as the method of neck contraction.

RESULTS

The response rate in 62 ears was 98.4% at 95 dBnHL and 100% at 100 dBnHL. The mean P1 and N1 latencies were 13.96 ± 1.17 m s and 21.50 ± 1.66 m s, with a mean corrected P1-N1 amplitude of 0.88 ± 0.34, and mean asymmetry ratio of 13 ± 10%. Median threshold was 80 dBnHL. Significant positive correlation between neck length and both P1, N1 latencies, and significant negative correlation between neck length and corrected P1-N1 amplitude were observed.

CONCLUSIONS

cVEMP paediatric normative data has been established for Singaporean school-aged children. The study also confirmed that neck length did have a significant influence on both latencies and corrected amplitude.

Factors associated with balance ability in Duchenne and Becker muscular dystrophies

BACKGROUND

Problems such as progressive muscle function loss, postural deteriorations, and contractures seen in patients with Duchenne and Becker muscular dystrophies (D/BMD) may affect children's balance ability, and impaired balance ability may lead to limitations in children's functional level.

RESEARCH QUESTION

What factors are associated with balance ability in children with D/BMD?

METHODS

Twenty participants with D/BMD were included in the study. Participants' ages were asked; height, body weight, and body mass index (BMI) were recorded. Children's functional level was assessed with the Motor Function Measurement-32 (MFM-32), Brooke and Vignos Scales. Muscle strength of hip flexion and extension, knee flexion and extension, and ankle dorsiflexion was measured with a handheld dynamometer. Balance measurements were performed using the Balance Master System. The relationship between balance and continuous independent variables was determined using Spearman's test.

RESULTS

The mean age of the participants was 8.57 ± 3.27 years. The balance abilities of children with BMD were better than those of children with DMD (p < 0.05). The balance diminished with age (p < 0.05), while there was a positive correlation between balance and weight, height, BMI (p < 0.05). There was a positive correlation between the balance and the MFM-32 total and subsection scores. Muscle strength was positively related to balance (p < 0.05).

SIGNIFICANCE

The results showed the balance ability in children with D/BMD was affected by age, height, weight, BMI, functional level, and muscle strength. Based on the results of this study, balance and strength training should be an integral part of the rehabilitation of children with D/BMD.

Lower Limb Asymmetry Evaluation Using the Balance Tracking System (BTrackS) Single Leg Stance Protocol

Single Leg Stance (SLS) balance testing is a common means of determining lower limb asymmetries in motor behavior. The Balance Tracking System (BTrackS) Balance Plate is a low-cost, portable force plate for objectively obtaining balance measurements. The present study provides the first known balance results for the BTrackS SLS protocol. BTrackS SLS testing was conducted on 161 young adults (90 women, 71 men) according to the test's standardized instructions. Specifically, participants performed one-legged (left or right) stance on the BTrackS Balance Plate for four, (2 practice, 2 actual) 20 s trials. SLS test outputs included total Center of Pressure path length and absolute symmetry index. Results showed that women had better SLS performance than men and that both sexes performed better on the actual compared to practice trial. Systematic one-sample t-tests of the Absolute Symmetry Index measures showed that a difference of 16% or greater between legs represented asymmetric performance. These results have clear value for individuals using BTrackS SLS testing to evaluate potential asymmetries. Additionally, these findings agree with previous reports showing sex differences favoring women on tests of static balance, and validate the use of a practice trial in the BTrackS SLS protocol.

The Most Active Child Is Not Always the Fittest: Physical Activity and Fitness Are Weakly Correlated

The present cross-sectional study aimed to evaluate the impact of physical activity level (PA) on physical fitness by controlling for individual characteristics in Italian children. A total of 329 children (girls n = 155, 42.6%; from five primary schools, 17 classes) aged 8-10 filled out the Physical Activity Questionnaire for Older Children (PAQ-C) to assess their PA level and performed anthropometric measurements (body mass, height, and BMI) and physical tests for measuring sprint (20 m sprint), cardiorespiratory fitness (shuttle-run test), balance (single-leg stance), handgrip strength (handgrip), lower-limb power (standing long-jump), peak force (countermovement jump), and low-back flexibility (sit-and-reach) skills. Linear mixed-effects models were applied to determine the relationship between physical fitness and PAQ-C score controlling for individual characteristics (i.e., gender, age, BMI). Results reported significant relationships between PAQ-C scores and sit-and-reach, shuttle-run, long-jump, and sprint tests. All considered physical tests were correlated with gender, age, and BMI, except for sit-and-reach from BMI. The variance in age, gender, BMI, and PAQ-C score accounted altogether for 30.0% of the variance in handgrip, 23.0% in single-leg stance, 26% in sit-and-reach, 36% in shuttle-run, 31% in long-jump, 34% in sprint, and 31% in countermovement jump. Therefore, the relationship between PA and fitness is not absolute and depends on the test and children's characteristics.

Physical Function of Japanese Preadolescents during the COVID-19 Pandemic

Children's exercise habits have changed during the COVID-19 pandemic. This study aimed to examine the physical function and physical activity of preadolescent children before and during the COVID-19 pandemic. This cross-sectional study compared time spent in moderate-to-vigorous physical activity (MVPA), grip strength, single-leg standing time, and two-step tests of healthy children aged 10 to 12 years, enrolled from January 2018 to January 2020 (pre-COVID-19 group, n = 177) and from January 2021 to September 2022 (during-COVID-19 group, n = 69). The during-COVID-19 group had weaker grip strength (median: 14.4 vs. 15.8 kg; p = 0.012), worse performance on the two-step test (mean: 1.56 vs. 1.60; p = 0.013), and less MVPA (median: 4 vs. 7 h per week; p = 0.004). Logistic regression showed that the during-COVID-19 group was significantly related to weaker grip strength (odds ratio: 0.904, 95% CI: 0.829-0.986; p = 0.022) and worse performance in the two-step test (odds ratio: 0.976, 95% CI: 0.955-0.997; p = 0.028). The COVID-19 pandemic decreased exercise opportunities for preadolescent children, which may have had a negative impact on muscle strength and balance. It is essential to increase the amount of MVPA among preadolescent children.

Physical Functions among Children before and during the COVID-19 Pandemic: A Prospective Longitudinal Observational Study (Stage 1)

One major impact of the COVID-19 pandemic on children's lifestyles is the lack of exercise owing to activity restrictions. However, information regarding the way in which physical functions among children decline under these circumstances remains scarce. In this study, we compared the physical functions and life habits among children before and during the COVID-19 pandemic in Japan. The participants involved 40 children aged between 9-15 years (23 girls and 17 boys) who were examined medically both before and during the pandemic. The compared variables included muscle strength, static and dynamic balance functions, gait speed, body fat percentage, screen and sleep times, quality of life, and physical activity time. During the pandemic, compared to before the pandemic, children had lower levels of dynamic balance functions (p = 0.039), increased body fat percentages (p < 0.0001), longer screen time per day (p = 0.002), and shorter sleep time per day (p < 0.0001). Between the two periods, there were no significant differences in muscle strength, static balance functions, gait speed, quality of life, and physical activity time. The activity restrictions imposed as a result of the COVID-19 pandemic negatively affect dynamic balance functions, body-fat levels, and life habits among children.

The effect of educational gymnastics on postural control of young children

Fundamental movement skill (FMS) proficiency does not develop solely due to maturation, but also via diverse perceptual-motor experiences across childhood. Practicing gymnastics has been shown to improve postural control. The purpose of the present study was to examine potential changes to postural control of children following a course of educational gymnastics. Two groups of children both completed 20 × 45-min physical education (PE) lessons; one group (n = 43, age = 6.4 ± 0.7, 56% male) completed educational gymnastics lessons in school delivered by a professional coach, the other group completed their typical PE classes (n = 18, age = 6.5 ± 0.3, 33% male). Unipedal balancing performance was assessed by calculating the percentage of successful trials made. Postural sway dynamics were explored by calculating center-of-pressure sample entropy, 95% ellipse sway area and sway velocity. Measurements were taken before the lessons began and immediately after the lessons were completed. The gymnastics group performed better than the typical PE group at unipedal balancing. Females outperformed males in both groups. Males made different changes to postural control (i.e., increased sway regularity and improved stability) compared to females across 3 months. Educational gymnastics enabled children in a critical period of development to make more rapid improvements to postural performance and control. Novel movement experiences, like those offered by educational gymnastics, may have a positive influence on postural control and importantly, physical literacy. Future work should examine how sex effects the development of postural control strategies in young children.

Vitamin D Status and Health Outcomes in School Children in Northern Ireland: Year One Results from the D-VinCHI Study

(1) Background: Vitamin D status has never been investigated in children in Northern Ireland (UK). (2) Methods: Children (4-11 years) (n = 47) were recruited from November 2019 to March 2020 onto the cross-sectional study. Anthropometry was assessed. Plasma 25-hydroxyvitamin D (25(OH)D) was analysed. Vitamin D intake, parental knowledge and perceptions, participant habits, physical activity and sedentary behaviour were established via questionnaire. Muscle strength was assessed via isometric grip strength dynamometry and balance via dominant single-leg and tandem stance. Parathyroid hormone, bone turnover markers (OC, CTX and P1NP), glycated haemoglobin and inflammatory markers (CRP, IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8 and TNF-α) were analysed. (3) Results: Mean (SD) 25(OH)D was 49.17 (17.04) nmol/L (n = 47); 44.7% of the children were vitamin D sufficient (25(OH)D >50 nmol/L), 48.9% were insufficient (25-50 nmol/L) and 6.4% were deficient (<25 nmol/L). 25(OH)D was positively correlated with vitamin D intake (µg/day) (p = 0.012, r = 0.374), spring/summer outdoor hours (p = 0.006, r = 0.402) and dominant grip strength (kg) (p = 0.044, r = 0.317). Vitamin D sufficient participants had higher dietary vitamin D intake (µg/day) (p = 0.021), supplement intake (µg/day) (p = 0.028) and spring/summer outdoor hours (p = 0.015). (4) Conclusion: Over half of the children were vitamin D deficient or insufficient. Wintertime supplementation, the consumption of vitamin D rich foods and spring/summer outdoor activities should be encouraged to minimise the risk of vitamin D inadequacy.

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

PURPOSE

Explore effects of age, sex, and motor ability level on balance capabilities in preschoolers with and without Cerebral Palsy (CP).

METHOD

PBS was administered to 477 children 24 through 59 months: 258 with typical development (TD) and 219 with CP GMFCS levels I, II and III.

RESULTS

3-way ANOVA indicated PBS scores were significantly affected by age (F4,437=26.95, p<0.0001, η2p=0.198), motor ability level (F3,437=482.15, p<0.0001, η²p=0.768) and sex (F1,437=4.64, p<0.03, η²p=0.01) with significant interaction between motor ability level and age (F 12,437=5.25, p<0.001, η²p=0.126). Children's performance on individual items was analyzed by age, sex and motor ability level.

CONCLUSION

Children with TD outperformed children with CP GMFCS level I 36-59 months and children with CP GMFCS levels II and III 24-59 months. Expected performance values for children with TD and children with CP, ages 24-59 months, at GMFCS levels I, II and III are provided.

Static Body Balance in Children and Expert Adults Ballroom Dancers: Insights from Spectral Analysis of Shifts

OBJECTIVE

The purpose of this study was to assess the differences in maintaining body balance (influence of different sensorial sub-systems) in a representative sample of active Dance Sport competitors (children and adults).

METHODS

Overall, 13 children and 15 high-level adults sport dancers underwent a static equilibrium test on a force platform, in which 17 different parameters were examined, including a spectral analysis of shifts using an FFT algorithm that can assess the contribution of different somatic-sensory systems on maintaining body balance.

RESULTS

Younger subjects rely on their somatic-sensory reactions to maintain their balance, while adults rely more on the vestibular system, according to shifts' spectral analysis. No differences were noted between the male and female participants.

CONCLUSIONS

Children predominantly use the somatic-sensory system in body balance, while adults make more use of the vestibular system. According to these results and due to the trainability phases, exercises that challenge the somato-sensorial system are recommended to train balance in young dancers, while exercises that challenge the vestibular system are recommended in adult dancers which who have not developed exceptional somato-sensory balance abilities during their growth and training history.

Thirty-Second Single-Leg Stance Identifies Impaired Postural Control in Children After Concussion: A Preliminary Report

CONTEXT

Objective and expedient assessments of standing postural control incorporating static and dynamic tasks are necessary for identifying subtle motor deficits and clearing children to return to high-risk activities after concussion. The Revised Physical and Neurological Examination for Subtle Signs (PANESS) gaits and stations tasks evaluate both static and dynamic aspects of postural control. While the PANESS gaits and stations subscale is sensitive to concussion in youth, the benefit of each specific task for this purpose is unknown.

PURPOSE

This study evaluated whether specific PANESS tasks identify postural impairments after youth concussion.

DESIGN

Cross-sectional study.

SETTING

Academicallyaffiliated research laboratory.

PARTICIPANTS

Sixty youth, ages 10-17 years, comprised 3 groups: (1) youth symptomatic from concussion (4-14 d postinjury [n = 18]), (2) clinically-recovered youth (27-122 d postinjury [n = 15]), and (3) age- and gender-matched never-concussed controls (n = 27).

MAIN OUTCOME MEASURE

PANESS gaits and stations tasks (6 dynamic and 3 static) at the time of the initial research visit.

RESULTS

Kruskal-Wallis statistic identified a significant main effect of group on standing on one foot (a 30-s task). Both symptomatic and clinically-recovered youth showed deficits on standing on one foot relative to controls.

CONCLUSIONS

Single-leg tasks of longer duration may maximize the ability to detect residual postural deficits after concussion and can be readily incorporated in targeted sport rehabilitation protocols.

Is There a Link between Balance and Body Mass Composition in Children and Adolescents?

School-age children are particularly prone to disturbances in body composition, because this is a period of intensive growth and a period in which correct habits are shaped, especially in relation to diet. This is why it is so important to diagnose emerging disorders early so as to implement therapeutic or educational activities. The aim of this study was to assess the relationship between the factors of body mass composition and body mass index (BMI), as well as the balance parameters in children and adolescents. The study group consisted of 1137 children aged 7 to 15. There were 559 girls and 578 boys among the subjects. The study used the Tanita 780 body mass composition analyser and the Zebris stabilometric platform. It was found that girls were characterized by a significantly higher content of adipose tissue (24.37% vs. 20.45%), while boys were characterized by a higher content of lean tissue (32.99% vs. 30.43%), muscle tissue (31.23% vs. 28.86%) and water (24.15% vs. 22.28%). Interestingly, the girls had better balance than their peers in all analyzed parameters (COF TTL.-616.72 vs. 661.50; CEArea-73.63 vs. 112.24; COF HD-3.44 vs. 4.23; COF VD-4.52 vs. 5.12). It turned out that among children in adolescence, a higher adipose tissue content and a higher BMI correlated with a smaller surface area (p < 0.05) defined by the center of gravity and smaller deviations of the center of gravity in the horizontal plane (p < 0.05). Sex and adolescence play an important role in differentiating both body composition and body balance. The results of this study allow us to conclude that children with higher BMI values have better balance. Due to the fact that these conclusions are inconsistent with those of other researchers, it will be worth continuing the research (e.g., on a different population group) in order to confirm the results and to draw far-reaching conclusions.

Normative database of postural sway measures using inertial sensors in typically developing children and young adults

OBJECTIVE

Reference values utilizing the APDM MobilityLab® inertial sensor system have not been established in children and young adults ages 5-30. These values are necessary for clinicians and researchers to compare to children with balance impairments.

METHODS

A group of 144 typically developing children and young adults from age 5-30 years completed the instrumented SWAY test during 6 test conditions: normal stance, firm surface, eyes open (EO) and closed (EC); normal stance, foam surface, EO and EC; and tandem stance, firm surface, EO and EC. Selected variables for normative outcomes included total sway area, and the mean, sagittal and coronal values for RMS sway, jerk, sway velocity and path length. Sex differences were examined within age groups via t tests. The effect of age on postural sway variables was analyzed using a one-way ANOVA for the mean values of total sway area, RMS sway, velocity and jerk, followed by post-hoc pairwise comparisons.

RESULTS

All sway parameters decreased significantly with age (p < 0.0001). Adult-like total sway area and jerk were achieved by ages 9-10 except for jerk during EC on foam. RMS sway and sway velocity reached adult levels by ages 11-13 during all EO and tandem stance conditions, and 14-21 with EC during normal stance on firm and foam surfaces for RMS sway and EC on firm surfaces for velocity. Females ages 5-6 performed more poorly during EO firm and EC foam for certain variables, but better during EO tandem and females ages 7-13 outperformed males when sex differences were found.

SIGNIFICANCE

These reference values can now be used by clinicians and researchers to evaluate abnormal postural sway and response to interventions in children and young adults.

Effect of the COVID-19 Emergency on Physical Function among School-Aged Children

In April 2020, the Japanese government declared a state of emergency due to the novel coronavirus disease (COVID-19). Schools were closed and a stay-at-home order was issued in April and May 2020. This before-and-after study aimed to measure the effects of these COVID-19-related restrictions on physical function among Japanese children. The study included children aged 6–7 years, enrolled before and after the emergency declaration. Their body fat percentage, single-leg standing time, Gait Deviation Index score, and history of falls were compared. There were 56 and 54 children in the before and after groups, respectively. Children in the after group had a higher body fat percentage (p = 0.037), shorter single-leg standing time (p = 0.003), and a larger number of falls per month (p < 0.001) than those in the before group. In the logistic regression analysis, children in the after group had a significantly shorter single-leg standing time (odds ratio (OR): 0.985, 95% confidence interval (CI): 0.972−0.997, p = 0.013), a greater number of falls per month (OR: 1.899, 95% CI: 1.123−3.210, p = 0.017), and a higher body fat percentage (OR: 1.111, 95% CI: 1.016−1.215, p = 0.020) than those in the before group. The COVID-19 emergency restrictions had a negative effect on children’s physical function, especially on balance.

Construct Validity and Reliability of the Revised Physical and Neurological Examination of Subtle Signs (PANESS) Gaits and Stations Measures

Purpose: To facilitate precise diagnosis and provide tailored treatment of postural anomalies in the pediatric population, appropriate assessments are essential. In light of the multicomponent structure of postural control, understanding underlying constructs of an assessment is valuable in selecting and interpreting assessments. This study investigates the construct validity of the Gaits and Stations variables in the Revised Physical and Neurological Examination of Subtle Signs, a measure used to evaluate standing postural control in youth with mild neurological deficits. Methods: Data were included from 350 healthy participants ages 10–19 years old. An exploratory factor analysis with varimax rotation was performed. Individual loadings of ≥0.4 were used for factor designation. Results: Three latent factors were identified and labeled, based on evidence, as dynamic stability, movement strategies/coordination, and underlying motor systems—musculoskeletal strength. Conclusions: These brief, easily administered Gaits and Stations measures of the Physical and Neurological Examination of Subtle Signs facilitate evaluation of three constructs of standing postural control relevant to youth with mild neuromotor impairments. This information will potentially assist in clinical practice to identify youth with postural control deficits and establish developmentally appropriate interventions and in research to refine understanding of pathology and the impact on components of postural control.

The construct of balance control in primary school-aged children: Unidimensional and task-specific

The aim of this study was to determine the dimensionality and task-specificity of balance control by investigating the relationships between different tasks and the degree to which these tasks belong to the same construct in primary school-aged children. Seventy-four South African children were randomly selected from a sample of convenience. They performed 18 different balance tasks that were grouped into four balance scales: the Performance and Fitness (PERF-FIT) static balance score, the PERF-FIT dynamic balance score, the PERF-FIT moving cans balance score and the Balance Sensory score. Spearman rank correlations were calculated between the scores. Principal component analysis (PCA) was used to investigate the number of factors within the construct. Moderate to good correlations were found between: i) PERF-FIT Moving cans balance score and the Balance Sensory score (r = 0.605, p < 0.001); ii) PERF-FIT static balance score and the PERF-FIT Moving cans (r = 0.586, p < 0.001); iii) PERF-FIT static balance score and the Balance Sensory score (r = 0.541, p < 0.001). All other correlations were low to fair. The PCA revealed one component. The three PERF-FIT items (moving cans-, static- and dynamic balance score) and the Balance Sensory score explained 59.4% of the variance of total balance performance.

Postural Control in Subjects with Incomplete Partition Inner Ear Malformations: A Comparison of Incomplete Partition Types

INTRODUCTION

Children with inner ear malformation (IEM) are at risk of vestibular loss as well as hearing loss. Incomplete partition (IP) anomalies constitute about 41% of all IEMs. This study aimed to investigate the postural control in subjects with the same type of IP on both sides and to compare their results with cochlear implant (CI) users without IEM and healthy peers.

METHODS

The study group consists of 17 subjects with the same IP types on both sides and using auditory implants on at least one side, with the following 3 groups: 6 IP-I subjects (mean age 12.28 ± 6.25), 6 IP-II subjects (mean age 12.90 ± 3.23), and 5 IP-III subjects (mean age 6.98 ± 3.10). Six unilateral CI users (mean age 11.38 ± 3.57) with normal inner ear structures were included in the CI control group, and 6 healthy peers (10.20 ± 4.79) were included in the healthy control group. The postural control was measured using the Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2) balance subtest. All devices were turned off during the balance test.

RESULTS

The BOT-2 balance scale scores were observed to be significantly different between the IP-I and healthy control group (medians of balance scores being 3.00 and 16.00, respectively, p < 0.001) and the IP-III and healthy control group (medians of balance scores being 6.60 and 16.00, respectively, p = 0.04). The IP-II group had better balance scores (median = 8.00) than those of the other IP groups, although there were no significant differences between the IP-II and other groups (p > 0.05).

CONCLUSION

This study demonstrated that subjects with the same IP type on both sides and with early implantation may differ in terms of their postural control abilities depending on their IP type. Subjects with IP should be regularly followed up by the vestibular assessment and supported by their postural control ability by vestibular rehabilitation.

Relationship between the skeletal muscle mass index and physical activity of Japanese children: A cross-sectional, observational study

Regular physical activity is an important component of physical health of children and has been associated with increasing skeletal muscle mass and muscle strength. Children with low levels of physical activity may experience health problems, such as loss of muscle mass, later in life. Thus, it may be valuable to identify declining physical function in children who do not perform the recommended amount of physical activity. Therefore, we aimed to evaluate the relationship between the amount of physical activity performed for ≥60 min per day for ≥5 days per week and the skeletal muscle mass index and physical function in young children. In total, 340 typically developing children aged 6–12 years (175 girls; average age, 9.5±1.9 years) were included in this cross-sectional study. We evaluated the proportion of children performing the recommended minimum of 60 min of daily moderate-to-vigorous physical activity at least 5 days per week. The skeletal muscle mass and Gait Deviation Index scores, gait speed, grip strength, Five Times Sit-to-Stand test results, Timed Up-and-Go test results, one-leg standing time, and gait efficiency were evaluated. Multiple logistic regression analyses were performed to assess the association of moderate-to-vigorous physical activity with the skeletal muscle mass index, percent body fat, and physical function, after controlling for confounding factors (age and sex). A logistic regression analysis revealed that the skeletal muscle mass index was independently associated with moderate-to-vigorous physical activity (odds ratio, 2.34; 95% confidence interval, 1.17–4.71; P = 0.017). Performance of moderate-to-vigorous physical activity for ≥5 days per week for ≥60 min per day was associated with the skeletal muscle mass index score of Japanese children. Our findings highlighted the importance of performing moderate-to-vigorous physical activity for the development of skeletal muscle mass in children.

Movement performance and movement difficulties in typical school-aged children

INTRODUCTION

Developmental Coordination Disorder (DCD) is an impairment of executive motor skills. Children aged 7-10 years gradually develop effective movement that enables smooth performance in various daily self-care, academic and sport activities. The purpose of this study was to examine whether the Movement Assessment Battery for Children-Second Edition-Age Band 2, (MABC2-AB2), which is a western standardized test, could be used in Thai children for differentiating between movement performance and movement difficulties.

METHOD

Three hundred and sixty typical Thai children aged 7-10 years old were recruited from three primary schools in Chiang Mai district, Thailand. The participants were divided into four age groups and tested using the Movement Assessment Battery for Children-Second Edition-Age Band 2-Thai version (MABC2-AB2-T).

RESULTS

Manual Dexterity, Aiming and Catching, and Balance rose with age increment. Older participants had better movement performance than younger ones. The results showed that 91.11 percent of the participants had typical movement, while 3.61 and 5.28 percent of them had movement difficulty and movement at risk, respectively. In addition, three test items: Drawing Trail, Walking Heel to Toe Forward, and Hopping on Mats had a ceiling effect when used for Thai children.

CONCLUSION

The MABC2-AB2-T could be used to assess movement performance and movement difficulties in Thai children. About 9 percent of typical Thai children aged 7-10 years old needed early intervention. Administration of the three test items may need to be revised.

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.

Fundamental Movement Skills and Accelerometer-Measured Physical Activity Levels during Early Childhood: A Systematic Review

Early childhood is a key period for children to begin developing and practicing fundamental movement skills (FMS), while aiming to perform sufficient physical activity (PA). This study reviews the current evidence for the levels of achievement in FMS and PA measured using accelerometers among 4-5-year-old children and examines differences by gender. This review was conducted using the PRISMA framework. Keyword searches were conducted in Pubmed, Medline, Google Scholar and SPORTDiscus. Inclusion criteria included age: 4-5 years old; FMS measurement: Test of Gross Motor Development 2 and 3; PA measurement: objective methods; balance measurement: static single limb; study design: cross-sectional observational/descriptive, randomised control trials, intervention studies; language: English. Twenty-eight articles from twenty-one countries met the inclusion criteria and were split into either FMS and PA articles (n = 10) or balance articles (n = 18). Three articles showed children achieving 60 min of moderate to vigorous PA per day, two articles demonstrated significant differences between girls' and boys' performance of locomotor skills and five reported locomotor skills to be more proficient than object control skills at this age for both genders. Balance was measured in time (n = 12), points score (n = 3) or biomechanical variables (n = 3), displaying heterogeneity of not only measurement but also outcomes within these data, with static single limb balance held between 6.67 to 87.6 s within the articles. Four articles reported girls to have better balance than boys. There is little conclusive evidence of the current levels for FMS, PA and balance achievement in young children 4-5 years of age. The academic literature consistently reports low levels of FMS competence and mixed evidence for PA levels. Inconsistencies lie in balance measurement methodology, with broad-ranging outcomes of both low and high achievement at 4-5 years old. Further research is required to focus on increasing practice opportunities for children to improve their FMS, increase PA levels and establish sufficient balance ability. Consistent and comparable outcomes during early childhood through more homogenous methodologies are warranted.

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.

Postural Control Profiles of Typically Developing Children From 6 to 12 Years old: An Approach Using Self-Organizing Maps

The purposes of the present study were a) to establish postural control profiles for individuals 6–12 years of age, b) to analyze the participants’ characteristics (age, sex, weight, height, and physical activity) in those profiles, and c) to analyze the influence of visual information in the profiles found. Two hundred and eight typically developing children aged 6–12 years performed two trials in bipedal standing position with eyes open and closed. Feature extraction involved time, frequency, and sway-density plot variables using signals from the center of pressure. A Self-Organizing Map was used to classify and visualize the values of the participants in all the postural control variables tested. A k-means cluster analysis was applied to generate a small number of postural control profiles. The results determined six postural control profiles; three with participants denoting high stability and three considered as low stability profiles. Age, sex, and height were related to the postural control profiles. Boys were more frequently allocated in high stability clusters than girls, while the other factors yielded unclear difference between high and low stability profiles. The analysis of children’s profiles reflecting postural stability should therefore involve more than one factor including the individuals’ age, sex, and height.

Balance in focus: a simple observational scale to monitor the effect of exercises on static balance in case of childhood flexible flat foot

[Purpose] Childhood flexible flat foot is the most common lower limb deformity. Observational evaluation of the underlying elements of reactive balance during static positions is an accepted tool besides the timed measures. We aim to assess the effects of combined balance training on the foot function and to test the usefulness of our observational static balance score. [Participants and Methods] A total of 19 healthy primary school students with flexible flat foot deformity volunteered for the study. We evaluated the foot’s dynamic properties and static postural stability before and after a 20-week combined balance training. On the basis of the observational findings, the time vs. quality observational static balance score was developed. All data were subjected to Wilcoxon’s test and Friedman’s ANOVA to compare the effects of the training on foot trajectory and observational static balance score. [Results] Better strength and endurance in the foot extensors and improved foot function were noted after the training. Using our observational static balance score, the quality of the balance performance remarkably changed. [Conclusion] The quality domain of our new scale seems to be a useful tool in daily clinical practice and a more sensitive measure in eyes-closed situations.

Understanding the impact of age, gender, height and body mass index on children's balance

AIM

This research aimed to understand the influence of age, gender, height and body mass index (BMI) on balance ability in children aged 4-12 years. The secondary aim was to develop normative values for three balance tests on the Balance Master system.

METHODS

Children were recruited in 2017 through community advertising. Balance testing occurred at three recreational centres in Frankston, Victoria, Australia. Data were collected by the Rhythmic Weight Shift, modified Clinical Test of Sensory Integration and Limits of Stability balance tests of the Balance Master equipment. Multiple regression analysis determined associations between variables including age, gender, height and BMI.

RESULTS

There were 91 children recruited and consented. Children were aged between 4 and 12 years old. Balance ability was shown to improve with age (P < .05), with girls demonstrating more mature balance strategies at earlier ages. Decreased BMI was associated with greater balance ability and postural control (P < .05).

CONCLUSION

The normative values established may be used to support clinical paediatric assessment with this equipment. Findings of this study suggest that increased BMI may be associated with poorer balance ability in children. However, further research studies are needed to explore this assertion.

Adolescents’ Postural Control Learning According to the Frequency of Knowledge of Process

Feedback is one of the most influential factors for motor skills learning. Physical Education teachers commonly use verbal cues to provide knowledge of process (KP) when teaching motor skills, but the ideal presentation frequency for KP in adolescents is unclear. The aim of this study was to compare the effectiveness of the frequency of KP (i.e., 100%, 67%, 0%) on dynamic balance. Thirty adolescents, age 14–15 years, participated in the study. Performance on a stabilometer platform was used to assess dynamic balance. Participants received feedback after each trial (100%), in two out of three trials (67%), or no feedback during 12 30-s trials of practice. Adolescents who received feedback (67% or 100%) required lower mean velocity to maintain similar dynamic balance performance (i.e., root mean square). Moreover, adolescents receiving 100% feedback had a higher α-scaling than those who did not received it. During the post-test and the retention, both 67% and 100% KP frequencies were effective at improving postural control, compared to the no feedback control.

Age and sex differences in human balance performance from 6-18 years of age: A systematic review and meta-analysis

Background

The process of growing leads to inter-individual differences in the timing of growth, maturational, and developmental processes during childhood and adolescence, also affecting balance performance in youth. However, differences in balance performance by age and sex in youth have not been systematically investigated yet.

Objective

The objective of the present study was to characterize and quantify age- and sex-related differences in balance performance in healthy youth.

Methods

A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus. To be applicable for analysis, studies had to report at least one measure of static steady-state, dynamic steady-state, proactive or reactive balance in healthy children (6–12 years) and/or adolescents (13–18 years). Coding of the studies was done according to the following criteria: age, sex, and balance outcome. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies. Weighted standardized mean differences were calculated and classified according to their magnitude.

Results

Twenty-one studies examined age-related differences in balance performance. A large effect for measures of static steady-state balance (SMD_ba = 1.20) and small effects for proxies of dynamic steady-state (SMD_ba = 0.26) and proactive balance (SMD_ba = 0.28) were found; all in favor of adolescents. Twenty-five studies investigated sex-related differences in balance performance. A small-sized effect was observed for static steady-state balance (SMD_bs = 0.33) in favor of girls and for dynamic steady-state (SMD_bs -0.02) and proactive balance (SMD_bs = -0.15) in favor of boys. Due to a lack of studies, no analysis for measures of reactive balance was performed.

Conclusions

Our systematic review and meta-analysis revealed better balance performances in adolescents compared to children, irrespective of the measure considered. Sex-related differences were inconsistent. These findings may have implications for example in terms of trainability of balance in youth that should be investigated in future studies.

Normative Data for the BTrackS Balance Test Concussion-Management Tool: Results From 10 045 Athletes Aged 8 to 21 Years

CONTEXT

Balance tests are a recommended assessment of motor function in concussion protocols. The BTrackS Balance Test (BBT) is a tool for concussion balance testing that uses low-cost force-plate technology to objectively measure postural sway.

OBJECTIVE

To provide normative data for the BBT in a large population of athletes.

DESIGN

Cross-sectional study.

SETTING

Concussion baseline testing at multiple facilities.

PATIENTS OR OTHER PARTICIPANTS

Male and female athletes (n = 10 045) ages 8 to 21 years.

INTERVENTION(S)

Athletes performed three 20-second trials of eyes-closed standing on the BTrackS Balance Plate with feet shoulder-width apart and hands on hips.

MAIN OUTCOME MEASURE(S)

Postural sway was measured as the average total center-of-pressure path length over 3 testing trials.

RESULTS

Postural sway was reduced (ie, balance improved) as athlete age increased and was less in female athletes than in male athletes. Percentile ranking tables were calculated based on sex and 2-year age groupings.

CONCLUSIONS

Our findings (1) provide context for BBT results performed in the absence of a baseline test, (2) can help mitigate athlete malingering, and (3) might identify individuals with latent neuromuscular injuries during baseline tests.

Development of postural control during single-leg standing in children aged 3-10 years

BACKGROUND

The ability to control the center of mass (COM) during single-leg standing (SLS) is imperative for individuals to walk independently. However, detailed biomechanical features of postural control during SLS performed by children remain to be comprehensively investigated.

RESEARCH QUESTION

We aimed to investigate the development of postural control during SLS in children aged 3-10 years.

METHODS

Forty-eight healthy children (26 boys and 22 girls) aged 3-10 years and 11 young adults participated in this experiment. The child population was divided into four groups by age: 3-4, 5-6, 7-8, and 9-10 years. The SLS task included standing on a single leg as long and as steady as possible for up to 30 s. A three-dimensional motion capture system and two force plates were used for calculating the COM and center of pressure (COP). The task was divided into three phases (accelerated, decelerated, and steady) on the basis of the relationship between COM and COP.

RESULTS

COP-COM distances in the 5-6 years' and 7-8 years' groups were significantly increased during the acceleration phase when compared with those in the adult group. Furthermore, COP-COM distances during the decelerated phase were significantly higher in all children's groups compared with those in the adult group. Lastly, COP-COM distance during the steady phase was significantly higher in the 3-4 year age group than in the 9-10 year age and adults groups.

SIGNIFICANCE

These results suggest that postural control during the acceleration and steady phases mature by 9 years. Conversely, children ∼10 years did not attain adult-like levels of postural control during the decelerated phase. The developmental process for postural control at each phase possibly plays a significant role in the basic biomechanics of movement and does not display a monotonic pattern.

The trajectory of balance skill development from childhood to adolescence was influenced by birthweight: a latent transition analysis in a British birth cohort

OBJECTIVE

To identify classes of balance skills and their trajectories from childhood to adolescence and the association of birthweight with these trajectories.

STUDY DESIGN AND SETTING

Participants (n = 13,443) from the 1970 British Cohort Study were assessed for four balance skills in childhood and adolescence. Latent class analysis was used to determine classes of balance skills over time, and latent transition analysis was used to explain the association between birthweight and the probabilities of changing classes over time.

RESULTS

A three-class solution, good balance skills (GBS) group, intermediate in balance skills (IBS) group, and poor balance skills (PBS) group, best fit the data for both childhood and adolescence. Most (49.97%, n = 6.713) had GBS in childhood and GBS in adolescence; the probability of "staying" as GBS was 86%. Birthweight was associated with higher likelihood of remaining GBS at adolescence (OR = 1.82, 95% CI = 1.40-2.37). Those who were classified as IBS and PBS in childhood had 75.2% and 62.7% probability of becoming GBS in adolescence, respectively. A small percentage of children stayed in the PBS group (1.92%, n = 258), with probability of remaining as such being 15.1%.

CONCLUSIONS

The higher the birthweight, the better the outcomes in those with GBS and IBS in the childhood. However, although small proportion of children stayed at the lowest level of balance skills in adolescence, some clinical attention should be given to those classified at this level in childhood.

Physical fitness reference standards for preschool children: The PREFIT project

OBJECTIVES

Reference values are necessary for classifying children, for health screening, and for early prevention as many non-communicable diseases aggravate during growth and development. While physical fitness reference standards are available in children aged 6 and older, such information is lacking in preschool children. Therefore, the purposes of this study were (1) to provide sex-and age-specific physical fitness reference standards for Spanish preschool children; and (2) to study sex differences across this age period and to characterise fitness performance throughout the preschool period.

DESIGN

Cross-sectional.

METHODS

A total of 3179 preschool children (1678 boys) aged 2.8-6.4 years old from Spain were included in the present study. Physical fitness was measured using the PREFIT battery.

RESULTS

Age- and sex-specific percentiles for the physical fitness components are provided. Boys performed better than girls in the cardiorespiratory fitness, muscular strength, and speed-agility tests over the whole preschool period studied and for the different percentiles. In contrast, girls performed slightly better than boys in the balance test. Older children had better performance in all fitness tests than their younger counterparts.

CONCLUSIONS

Our study provides age- and sex-specific physical fitness reference standards in preschool children allowing interpretation of fitness assessment. Sexual dimorphism in fitness tests exists already at preschool age, and these differences become larger with age. These findings will help health, sport, and school professionals to identify preschool children with a high/very low fitness level, to examine changes in fitness over time, and to analyse those changes obtained due to intervention effects.

Normative Data for the BTrackS Balance Test of Postural Sway: Results from 16,357 Community-Dwelling Individuals Who Were 5 to 100 Years Old

BACKGROUND

Postural sway is routinely assessed because increased postural sway is associated with poorer performance of activities of daily living, higher rates of residential care, and increased risk of falling. Force plate technology is one of the most sensitive and objective means of assessing postural sway in the clinic.

OBJECTIVE

The aim of this study was to provide the first set of normative data for the BTrackS Balance Test (BBT) of postural sway.

DESIGN

The design was descriptive and population based.

METHODS

BBT results from 16,357 community-dwelling individuals who were 5 to 100 years old were accumulated and assessed for effects of age, sex, height, and weight. Percentile rankings were calculated for significant groupings.

RESULTS

BBT results were dependent on age and sex but not height or weight. Therefore, percentile rankings were determined for male and female individuals in each age category, with no consideration of participant height or weight.

LIMITATIONS

Data were collected by third-party practitioners with various backgrounds in more than 50 locations across the United States and Canada. There was an imbalance in the sample sizes for age and sex groupings.

CONCLUSIONS

The findings of this study represent the largest normative dataset ever published for postural sway results. Normative data on the BBT can assist in determining abnormalities in postural sway, which have been linked to negative clinical outcomes.

Evidence of balance training-induced improvement in soccer-specific skills in U11 soccer players

The present study aimed to determine the role of balance training improving technical soccer skills in young players. Two U11 soccer teams were randomly assigned one to either balance training (BT; n = 22) or control group (Ctrl; n = 21). At the end of their habitual soccer training (identical in BT and Ctrl), BT underwent additional balance training for 12 weeks (3 sessions/week, 20 minutes per session), while Ctrl had a 20-minute scrimmage. Before and after the intervention, BT and Ctrl underwent two soccer-specific tests (Loughborough Soccer Passing, LSPT, and Shooting, LSST, Tests), and bipedal and unipedal balance evaluations. After intervention, both groups decreased the trials time and improved passing accuracy, with larger improvements in BT than Ctrl (LSPT penalty time [CI_95% ]: -2.20 seconds [-2.72/-1.68]; ES [CI_95% ]: -2.54 seconds [-3.34/-1.74]). Both groups improved balance ability, with BT showing larger increments in bipedal tests than Ctrl (static balance: -29 mm [-42/-16]; ES: -1.39 [-2.05/-0.72]; limit of stability: 4% [3/5]; ES 3.93 [2.90/4.95]; unipedal quasi-dynamic balance: 0.07 a.u. [0.03/0.11]; ES: 1.04 [0.40/1.67] and active range of motion: -5% [-8/-2]; ES -0.89 [-1.51/-0.26]). Low-to-moderate correlations between the players' technical level and unipedal balance ability were retrieved, particularly in the non-dominant limb (R from 0.30 to 0.48). Balance training improved some technical soccer skills more than habitual soccer training alone, suggesting that young soccer players may benefit from additional balance training added to their traditional training.

Physical Fitness and Body Composition in 8-10-Year-Old Danish Children Are Associated With Sports Club Participation

Larsen, MN, Nielsen, CM, Ørntoft, CØ, Randers, M, Manniche, V, Hansen, L, Hansen, PR, Bangsbo, J, and Krustrup, P. Physical fitness and body composition in 8–10-year-old Danish children are associated with sports club participation. J Strength Cond Res 31(12): 3425–3434, 2017—We investigated whether physical fitness and body composition in 8–10-year-old Danish children are associated with sports club participation. The study included 423 schoolchildren, comprising 209 girls and 214 boys, of whom 67 and 74%, respectively, were active in sports clubs. Yo-Yo intermittent recovery level 1 for children (YYIR1C), balance, jump and coordination tests, together with dual-energy X-ray absorptiometry, were used to determine exercise capacity and body composition. Children active in sports clubs had better (p < 0.05) YYIR1C (33%, 767 ± 26 vs. 575 ± 29 m), 20-m sprint (3%, 4.33 ± 0.03 vs. 4.48 ± 0.04 seconds), coordination (6%, 68 ± 1 vs. 72 ± 1 second), and balance test performances (9%, 19.3 ± 0.5 vs. 21.2 ± 0.7 falls·min⁻¹) and lower fat mass index (16%, 3.8 ± 0.1 vs. 4.5 ± 0.2 kg[fat]·m⁻²) than children not active in sports clubs. Ball game players had better (p < 0.05) YYIR1C (38%, 925 ± 39 vs. 671 ± 28 m), 20-m sprint (4%, 4.25 ± 0.03 vs. 4.42 ± 0.04 seconds), and coordination test performances (5%, 65 ± 1 vs. 69 ± 1 second), along with higher (p < 0.05) lean body mass (5%, 24.00 ± 0.22 vs. 22.83 ± 0.25 kg) and whole-body BMD (2%, 0.90 ± < 0.01 vs. 0.88 ± <0.01 g·cm⁻²) compared with children active in other sports. The study showed that 8‒10-year-old Danish children engaged in sports-club activity, especially ball game players, have better exercise capacity and superior body composition compared with children not active in sports clubs.

A new motor screening assessment for children at risk for motor disorders: construct validity

OBJECTIVE

To develop a motor screening assessment and provide preliminary evidence of its psychometric properties.

METHODS

A sample of 365 elementary school students was assessed, with structural equation modeling applied to obtain evidence of the adequacy of the factor structure of the motor screening assessment. As well, differential item functioning was used to evaluate whether various identifiable subgroups of children (i.e., sex and grade) perform particular tasks differently.

RESULTS

Overall, girls obtained higher scores than boys while, for both sexes, the assessment scores increased with age. Furthermore, differential item function analysis revealed that the precision of the test was highest for those with moderate to low motor performance, suggesting that this tool would be appropriate for identifying individuals with movement difficulties.

CONCLUSION

Although further tests of its psychometric properties are required, the motor screening assessment appears to be a reliable, valid, and quickly-administered tool for screening children's movements.

Assessment of the Postural Stability of Female and Male Athletes

OBJECTIVE

Postural stability is often affected by sport-related injuries and subsequently evaluated during postinjury examinations. Intrinsic factors, however, may also affect postural control. We sought to compare the postural control of female and male athletes as measured simultaneously by (1) the modified balance error scoring system (mBESS) and (2) a video-force plate system.

DESIGN

Cross-sectional study.

SETTING

Sports injury prevention center.

PARTICIPANTS

Pediatric, adolescent, and young adult athletes who performed mBESS during an injury prevention evaluation.

INDEPENDENT VARIABLES

We compared the postural control of female and male athletes. We also accounted for independent variables associated with postural stability, including age, body mass index, and history of ankle injury, concussion, and migraine headache.

MAIN OUTCOME MEASURES

Total errors committed during the mBESS and measurements derived from integrated kinematic and kinetic data obtained by a video-force plate system. Differences between males and females were tested using analysis of covariance.

RESULTS

Participants (n = 409) ranged in age from 10 to 29 years (mean = 14.6 ± 2.8); 60% were female. No significant differences on mBESS were detected between females and males; however, female athletes demonstrated significantly better postural stability on the video-force plate analysis during double-leg (P = 0.03, d = 0.28), single-leg (P < 0.001, d = 0.62), and tandem stances (P < 0.001, d = 0.53) when compared with males.

CONCLUSIONS

Uninjured female athletes demonstrate better postural stability on video-force plate analysis than their uninjured male counterparts. These findings provide an important information assistive to clinicians during interpretation of postinjury balance tests.