Components of Standing Postural Control Evaluated in Pediatric Balance Measures: A Scoping Review

Two Physiotherapy Methods to Improve the Physical Condition of Children with Autism Spectrum Disorder

This study presents two simple physiotherapy programs that were implemented for five weeks and showed positive changes in balance, coordination, and motor skills in kindergarteners with ASD. Physiotherapy programs in a gym and games on a smart board with balance plates and an unstable base were applied to improve the physical condition of children with ASD. Thirty children with ASD (4-6 years old) attending special needs kindergarten were enrolled in the study. Three tests were used to assess participants' physical condition before and after the study: the modified Berg Balance Scale, the Imbalance Coordination Sample, and the Bruininks-Oseretsky Motor Proficiency Test (BOTMP). The resulting mean change, calculated from each group's scores, shows that the participants who received physical therapy sessions at the smart board had the greatest change of 1.58 points. It shows that the opportunity to play games on a smart board motivates children with ASD to work harder; therefore, it is a simple and easy way to engage children in different types of physical exercise. A slightly smaller change of 1.51 was obtained in the group that received gym sessions. However, working in the gym was more psychologically challenging for the children with ASD due to their lack of desire and motivation. Both methods are relatively simple and easy to apply at home; therefore, parents can make a significant contribution to improving children's physical condition and that can be an effective tool to assist these individuals with activities in daily life.

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.

Examination of posture and balance in children with primary monosymptomatic nocturnal enuresis

PURPOSE

This study aimed to examine symptom severity, posture, and balance of children with primary monosymptomatic nocturnal enuresis (PMNE) and compare to a healthy control group.

METHODS

Thirty-five children with PMNE and 34 healthy children were included in this study. Physical and sociodemographic characteristics of the children were recorded. Symptom severity was assessed with a Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES), a four-day bladder diary and a seven-day bowel diary. Standing postural alignment was assessed with the Spinal Mouse device, and the sensory integration of static balance and dynamic standing balance was assessed with the Biodex Balance System SD.

RESULTS

Compared to healthy controls, children with PMNE demonstrated increased symptom severity (p = 0.001), increased upright lumbar lordosis (p = 0.018) and sacral-hip angles (p = 0.029), decreased static balance in the sensory condition of unstable surface with eyes closed (p = 0.001), and decreased mediolateral dynamic balance (p = 0.049).

CONCLUSION

Children with PMNE demonstrate altered postural alignment, static and dynamic postural instability, and greater symptom severity on the Vancouver NLUTD/DES than age-matched controls.

Assessment of postural control in children

The relevance of the study is due to the high incidence of postural control impairment in patients with neurological diseases and lack of common approaches to their diagnosing in children. In this article we show the main stages in the formation of postural control and mechanisms of balance maintaining in childhood. We assessed the information content of existing clinical scales used to study components of postural balance in children in clinical practice. Also, we studied the diagnostic significance of functional methods for assessing postural control. Particular attention we paid to the study of the diagnostic significance of computer posturography (stabilometry) and accelerometry. We identified the main clinical and functional diagnostic markers of postural imbalance in children of different age and nosological groups. Further research in this area will make it possible to develop the most objective criteria for impaired postural control in childhood, which will increase the effectiveness of treatment and rehabilitation measures. 

Impairment and characteristics of postural control sub-components in people with COPD: a scoping review

Purpose: Impairment of postural control is common in people with COPD. However, the precise characteristics of this alteration are not clearly known. The "Systems Framework for Postural Control" which define postural control sub-components, represents an interesting tool to explore this field. The main aim of this review was to identify which postural control sub-components are impaired in people with COPD and to summarise characteristics for each sub-component. A secondary aim was to precise the relation between postural control and activities of daily living (ADL).Materials and methods: A scoping review was conducted, according to the JBI methodology. Medline, Cochrane Library, Scielo, Google Scholar, OpenGrey, and HAL were searched from inception to May 2022. The search was performed in English and French.Results: Eighty-nine articles were included. There was evidence of a potential impairment for most of the postural control sub-components. Characteristics of every sub-component alteration were heterogeneous. Reduced postural control could be associated with difficulties in ADL.Conclusions: People with COPD may have impairment in a wide range of postural control sub-components. Further research is needed to clarify if a common pattern of modification exits for this alteration and to precise the link with ADL.Implications for rehabilitationImpairment of postural control is a common extra-respiratory manifestation in people with COPD and so clinicians must include it in their clinical reasoning.Numerous postural control sub-components could be altered in people with COPD, suggesting that postural control assessment must be holistic.This scoping review shows that characteristics of postural control impairment are varied and that there may be no common pattern at the COPD population level.The relationship between impaired postural control and activities of daily living remains unclear, but clinicians should be alert to potential negative interactions between these two areas.

The Effects of Sternocleidomastoid Muscle Taping on Postural Control in Healthy Young Adults: A Pilot Crossover Study

Background: Postural control is a complex ability, also controlled by the somatosensory connection of the neck muscles with the vestibular nuclei. This circuit seems to be interested in maintaining head stabilization during movements. The sternocleidomastoid (SCM) muscle is the dominant source of the vestibular afferents as confirmed by neurophysiological acquisition. The aim of this study is to evaluate whether the application of kinesio-tape on the SCM muscle can induce a perturbation of the standing postural control by altering the somatosensory system of the neck muscles. Methods: Thirteen healthy participants (age: 24.46 ± 3.04 yrs; 9 female) were enrolled, and the four kinesio-tape (KT) conditions were performed in a random order: without KT application (Ctrl); right KT application (R-SCM); left KT application (L-SCM); and bilateral KT application (B-SCM). All conditions were performed three times with open eyes and closed eyes. Results: There was a significant increase in the length of the centre of pressure (CoP), in the maximal oscillation, and in the anteroposterior root mean square between the three tape application conditions with respect to the Ctrl condition with open eyes. The same parameters were statistically different when the participants were blindfolded in the B-SCM condition with respect to the Ctrl condition. A statistical decrease in the difference in weight distribution between the two feet was observed in the B-SCM group with respect to the Ctrl group in both open and closed eyes conditions. Conclusions: Our results suggest that KT on the SCM muscles may involve some space-time parameters of postural control. Bilateral KT improved the weight distribution between the feet but showed a parallel increase in anteroposterior oscillations and in the length of the CoP with respect to the Ctrl condition. The perturbation seems to be greater in the somatosensory system when it is working coupled with visual afferences during an upright position.

S, Balakrishna Shetty H, Anaby D, Gopalakrishna S, Venkatesan VS, Rao BK. Physiotherapy interventions for head and trunk control in children with developmental disabilities: A scoping review protocol

Background: Head and trunk control is prerequisite skill that maximizes engagement and participation in one's environment by integrating vision, oromotor skill, arm control and respiration. Various physiotherapy and technology-based interventions have been utilized to facilitate head and trunk control in children with developmental disabilities. This scoping review is planned to map and summarize existing studies from the scientific literature on physiotherapy and technology-based interventions for head and trunk control in children with developmental disabilities. Methods: The scoping review will utilize the Joanna Briggs Institute scoping review methodology. The review will cover studies including children and adolescents aged between six months and 17 years 11 months 29 days, with developmental disabilities where in child finds difficulty in lifting its head and aligning head and trunk. We will include randomized controlled trial (RCT), non-RCT, quasi-experimental trial, and systematic reviews that have employed physiotherapy and technology-based interventions. Database-specific search strategy will be used to search records in Medline (PubMed and Web of Science), Embase, Scopus, CINAHL, PEDro, and Cochrane Library. Additionally, various grey literatures and clinical-trial registries will be searched. Two reviewers, independently, will screen and extract the data. Tables and visual representations will be utilized to present the extracted data. Registration details: The protocol has been registered in Open Science Framework, DOI:  10.17605/OSF.IO/B3RSU (22 ^nd August 2022).

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.

An Accessible Training Device for Children With Cerebral Palsy

Walking and balance capabilities can be improved upon using repetitive ankle dorsiflexion exercises. Here we developed two types of pedal switches incorporated with training devices to improve their walking and balance performance of children with cerebral palsy. The first type of pedal switch can be used to operate a home appliance, while the second type of pedal switch can connect them to web games. Pedal switches can be used for home rehabilitation. This randomized controlled trial included patients in the intervention (n = 24) and control (n = 24) groups who completed 15 weeks of ankle training. The experimental group performed ankle dorsiflexion using a pressure-activated pedal switch connected to the web games. The control group performed ankle dorsiflexion exercises using a pedal switch that operated a home appliance (a fan). Standing balance and walking performance were estimated using the Zebris FDM system, a pressure force platform, the Pediatric Balance Scale score, and the 1-minute walk test. The pre- and posttest data were analyzed using analysis of variance and analysis of covariance, which revealed that the intervention group had more significant improvements in sway patterns and balance and walking. The developed facility of a modified pedal switch integrated with web games can achieve better exercise adherence to promote balance and walking performance than that with home appliances. Maintaining motivation in children with cerebral palsy plays a very important role in the rehabilitation process.

Contributions of PCSS, BESS, Tandem Gait, and Romberg Test for Identifying Balance Deficits in Pediatric Concussions

OBJECTIVE

Balance deficits are common after concussions in pediatric patients. This study evaluates 3 clinical tools for identifying postconcussion balance deficits in a pediatric population: (1) Post-Concussion Symptom Scale (PCSS); (2) Balance Error Scoring System (BESS); and (3) physical examination measures of balance: tandem gait (TG) and Romberg test.

SETTING

Data were collected in a tertiary care outpatient pediatric sports medicine clinic.

PARTICIPANTS

English-speaking patients aged 8 to 17 years who presented to a tertiary care hospital-based pediatric sports medicine clinic and diagnosed with concussion between August 2014 and February 2018 were invited to participate. A total of 614 patients were screened and/or approached during the inclusion period and 500 were enrolled. Of those enrolled, 423 patients had complete data collected and analyzed.

DESIGN

This is a cross-sectional, observational data set from a longitudinal, prospective study.

MAIN MEASURES

Data extracted from patients' electronic medical records included physical examination, PCSS, and BESS scores from their initial visit. Descriptive statistics were calculated for the outcome measures. A logistic regression was performed to evaluate significant contributors to abnormal BESS score (≥25).

RESULTS

There were 423 patients (56.7% female; 14.7 ± 2.01 years old) included in the study. Overall, we identified 336 patients (79.4%) with balance difficulties. Of the 336 with balance difficulties, 284 (84.5%) reported "balance problems" and/or "dizziness" on PCSS, 153 (45.5%) had abnormal BESS scores (≥25), and 100 (29.8%) had an abnormality on either TG or Romberg test.

CONCLUSION

Balance difficulties were identified in close to 80% of children with concussions. Using PCSS and BESS along with physical examination measures, TG and Romberg test, identified more patients with balance deficits than using TG and Romberg test alone.

The Scale for Retropulsion: Internal consistency, reliability and construct validity

BACKGROUND

Retropulsion is an impairment of body orientation against gravity in the sagittal plane. In a Delphi study, the Scale for Retropulsion (SRP) was developed with a high level of expert agreement.

OBJECTIVE

To assess the clinimetric properties of the German SRP in patients with neurological disorders.

METHODS

The SRP was applied to 70 hospitalized patients with neurological disorders (stroke, critical illness neuropathy and/or myopathy, Parkinson syndromes). Internal consistency was determined with the Cronbach ɑ. Test-retest and interrater reliabilities were evaluated with the weighted kappa, intraclass correlation coefficient (ICC), and Bland-Altman plots. The construct validity was evaluated with Spearman correlation.

RESULTS

The median (interquartile range) SRP score was 5 (3-8) and ranged from 0 to 22 (total scale range: 0 to 24). The SRP had excellent internal consistency (Cronbach ɑ = 0.875) and good to excellent test-retest reliability (weighted kappa = 0.957, ICC = 0.957) and interrater reliability (weighted kappa = 0.837, ICC = 0.837). Analysis of construct validity resulted in good correlations with other clinical balance scales (rSp > 0.80), and fair to moderate correlations with posturographic measures (rSp = 0.27-0.56) and the subjective postural vertical error in the sagittal plane (rSp = -0.325, p = 0.012) as well as the range in the frontal plane (rSp = 0.359, p=0.007). The SRP discriminated between patients classified with and without retropulsion by an independent clinical expert (p<0.001).

CONCLUSION

The SRP provides a valid and reliable bedside test to quantify retropulsion in individuals with neurological disorders.

Influence of Visual Information and Sex on Postural Control in Children Aged 6-12 Years Assessed with Accelerometric Technology

The performance of postural control is believed to be linked to how children use available sensory stimuli to produce adequate muscular activation. Therefore, the aim of the present study was to thoroughly explore postural stability under normal conditions and without visual information in postural control in children aged 6–12 years during static single-leg support. A descriptive cross-sectional study was conducted with 316 children (girls = 158). The analyzed variables were the mean and maximum values obtained in each of the three body axes and their root mean square during two static single-leg support tests: one with eyes open and one with eyes closed. Girls showed lower magnitudes in the recorded accelerations at all ages and in all the variables of both tests. Accelerations during the tests showed progressively lower values from 6 to 12 years of age. The sex had a significant influence on the magnitude obtained in the accelerations recorded during the tests. Improvements in balance with increasing age were greater with visual information than without visual information. The tests of single-leg support showed preferential sensorimotor strategies in boys and girls: boys tend to rely more on visual inputs, and girls process somesthetic information in a preferential way.

Simplified digital balance assessment in typically developing school children

BACKGROUND

Postural balance can be considered a conjoined parameter of gross motor performance. It is acquired in early childhood and honed until adolescence, but may also be influenced by various conditions. A simplified clinical assessment of balance and posture could be helpful in monitoring motor development or therapy particularly in pediatric patients. While analogue scales are considered unprecise and lab-based force-plate posturography lacks accessibility, we propose a novel kinematic balance assessment based on markerless 3D sensor technology.

RESEARCH QUESTION

Can balance and posture be assessed by tracking kinematic data using a single 3D motion tracking camera and are the results representative of normal motor development in a healthy pediatric cohort?

METHODS

A proprietary algorithm was developed and tested that uses skeletal data from the Microsoft Kinect™ V2 3D motion capture camera to calculate and track the center of mass in real time during a set of balance tasks. The algorithm tracks the distance of the COM traveled over time to calculate a balance score (COM speed). For this study, 432 school children aged 4-18 years performed 5 balance tasks and the resulting balance scores were analyzed and correlated with demographic data.

RESULTS

Preliminary experiments demonstrated that the system was able to reliably detect differences in COM speed during different balance tasks. The method showed moderate correlation with age and sex. Athletic activity positively correlated with balance skill in the age group < 8 years, but not in older children. Body mass appeared not to be correlated with balance ability.

SIGNIFICANCE

This study demonstrates that markerless 3D motion analysis can be used for the clinical assessment of coordination and balance and could potentially be used to monitor gross motor performance at the point-of-care.

Validity and Reliability of a Tool for Accelerometric Assessment of Balance in Scholar Children

In Pediatrics, balance is assessed through low-sensitivity clinical tests which identify developmental alterations at already advanced stages that cannot be detected at earlier stages. Therefore, the aim of this study was to develop an easily applicable quantitative tool that can be used to evaluate postural control. Consequently, a cross-sectional study was carried out with 91 healthy children. All of them performed a series of six accelerometric functional tests and four clinical tests of balance (Modified Flamingo Test, Bar Test, Babinski-Weil Test, and Fukuda Stepping Test). The Bar Test obtained mild inverse correlations with accelerations produced in the mediolateral axis and the root mean square of all the tests in monopodal support. The Flamingo Test obtained direct correlations with the root mean square of the tests in monopodal support and with the mediolateral axis of the monopodal tests and gait. The pediatric balance assessment scale consists of three factors and eleven items extracted from five accelerometric functional tests: the monopodal balance test with six items, normal gait test with three items, and bipodal balance test with two items. This tool is easy to apply and allows analysis in the evaluation of the balance state based on the accelerations of the center of mass.

Balance control in individuals with developmental coordination disorder: A systematic review and meta-analysis

BACKGROUND

Although it is recognized that the majority of children with developmental coordination disorder (DCD) have balance deficits, comprehensive insights into which balance domains are affected, are still lacking in literature.

RESEARCH QUESTION

To what extent is balance control deficient in individuals with DCD compared to controls?

METHODS

Pubmed, Scopus and Web of Science were systematically searched. Risk of bias was assessed with the Scottish Intercollegiate Guidelines Network checklist for case-control studies. Mean and standard deviations characterizing balance control were extracted to calculate standardized mean differences (SMD) and pooled, if possible, using Review Manager.

RESULTS

The results of 31 studies (1152 individuals with DCD, 1103 typically developing (TD) peers, mean age 10.4 years old) were extracted of which 17 were used for meta-analysis. The mean SMD for the balance subscale of the Movement Assessment Battery for Children was 1.63 (pooled 95 %CI =[1.30;1.97]), indicating children with DCD to perform significantly poorer than their TD peers. Force plate studies also revealed that children with DCD present with a larger sway path during bipedal stance with eyes closed (pooled mean SMD = 0.55; 95 %CI=[0.32;0.78]). Children with DCD tend to have direction-specific limited stability limits and task-independent delayed onset of anticipatory postural adjustments.

INTERPRETATION

Children with DCD perform poorer on different domains of balance compared to TD peers. Future research should focus on comprehensive balance assessment in these children, preferably using a longitudinal design.

Accelerometric Assessment of Postural Balance in Children: A Systematic Review

The correct development of postural control in children is fundamental to ensure that they fully reach their psychomotor capacities. However, this capacity is one of the least studied in the clinical and academic scope regarding children. The objective of this study was to analyze the degree of implementation of accelerometry as an evaluation technique for postural control in children and how it is being used.

METHODS

A systematic search was conducted in PubMed, SpringerLink, SportsDiscus, Medline, Scopus, and Web of Science with the following terms: balance, postural control, children, kids, accelerometry, and accelerometer.

RESULTS

The search generated a total of 18 articles. Two groups of studies were differentiated: those which exclusively included healthy individuals (n = 5) and those which included children with pathologies (n = 13). Accelerometry is being used in children mainly to assess the gait and static balance, as well as to identify the differences between healthy children and children with developmental disorders.

CONCLUSIONS

Accelerometry has a discrete degree of implementation as an evaluation tool to assess postural control. It is necessary to define a systematic method for the evaluation of postural control in pediatrics, in order to delve into the development of this capacity and its alterations in different neurodevelopmental disorders.

To what extent do older adult community exercise programs in Winnipeg, Canada address balance and include effective fall prevention exercise? A descriptive self-report study

Background

Effective fall prevention exercise for community-dwelling older adults requires (i) challenging balance exercise, (ii) offered at least 3 hrs/ week, and (iii) on an ongoing basis, to reduce falls. Community exercise programs are a potential implementation strategy for fall prevention exercise; however, the extent to which they address balance and include effective fall prevention exercise is unknown. Study objectives were to describe program delivery, exercise design, and assessment characteristics of older adult community exercise programs in Winnipeg, Canada; determine if they included effective fall prevention exercise; determine the balance challenge and components of postural control addressed in the most- and least-frequently reported exercises.

Methods

A public inventory of older adult community exercise programs served as the sampling frame for cross-sectional telephone questionnaires exploring program, exercise, and assessment characteristics. Exercises were coded independently by two investigators for balance challenge level and components of postural control. Programs were categorized by number of effective fall prevention exercise components established by evidence-based recommendations. Descriptive statistics were calculated.

Results

Thirty-three eligible programs were identified and nine individuals participated. Most programs (n = 5, 56%) identified as general exercise, and two (22%) as fall prevention exercise. Most programs (n = 5, 56%) were offered two or more times/ week and reported exercise intensity as somewhat challenging. Exercise time offered ranged between 1 and 3 h/ week. Assessments were conducted in two programs (22%). Only one program (general exercise) included all components of effective fall prevention exercise. Two programs (22%) included the component of being offered at least 3 hrs/ week. Three programs (33%) included the component of being offered on an ongoing basis. Seven programs (78%) prescribed mostly moderate challenge balance exercise, and one program (11%) prescribed mostly high challenge exercise. Most of the 19 most-frequently prescribed exercises (n = 17, 89%) targeted static stability and none targeted reactive postural control.

Conclusions

Most of the older adult community exercise programs participating in this study did not focus on fall prevention, and did not include all components of effective fall prevention exercise. Future studies should focus on fall prevention programs and explore factors influencing implementation of effective fall prevention exercise components to facilitate planning.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1224-x) contains supplementary material, which is available to authorized users.

Effects of a 6-month balance intervention on postural control of preschoolers born with biological risk factors

Study aim: To investigate the effects of 6-month sensorimotor training on postural control of 5-6-year-old preschool children born with ‘biological risk factors’ (BRF). Material and methods: Sixty-four Hungarian preschoolers participated in this study, and were assigned to an experimental group (n = 17), control group 1 (n = 23) and control group 2 (n = 24). The experimental group (born with BRF) attended a 6-month balance intervention based on Ayres’ therapy, while control group 1 (born with BRF) and control group 2 (born with no BRF) fol­lowed the regular preschool schedule. Birth weight, gestational age at birth, Apgar score and other abnormalities during pregnancy and birth were considered to be BRF. A moveable platform (stabilometer) was used to examine the distance of center of pressure movements of all participants prior to the start and after the end of the intervention. The testing procedure was performed with four enjoyable tests in the same sequence (‘Mouse in the hole’, ‘Center’, ‘Christmas tree’, ‘Square painting’). Results: The balance intervention program resulted in significant improvements in postural control of the experimental group. In three of six variables the balance index scores of the intervention group approached the scores of their peers born without BRF, and they even had better performance in three of six variables. Conclusions: Balance training with instability training devices could help children born with BRF attain a higher level of inte­gration through the stimulation of tactile and balancing senses.