Balance ability of 7 and 10 year old children in the population: results from a large UK birth cohort study

Effect of dance movement therapy on balance in adults with Down Syndrome. A pilot study

Systematic participation in dance therapy may improve balance and reduce risk of falls. The aim of this study was to assess the effect of dance therapy on balance and risk of falls in adults with Down syndrome. Study participants comprised 23 persons with Down syndrome aged 26- 49 years who underwent dance therapy. Before and after the therapy, all participants were measured on a BioSway balance platform using three tests: postural stability, limits of stability, and M-CTSIB fall risk. Mean result was lower following intervention (2.40 ± 1.81 vs. 1.65 ± 1.32; p = .006) in the postural stability test. The limits of stability test found a statistically significant difference (26.30 ± 8.99 vs. 37.90 ± 12.54; p < .001). The results of this study only partially supported the hypothesis that dance therapy improves balancing skills in adults with Down Syndrome.

Static and dynamic postural control assessment in schoolchildren: Reliability and reference values of the Modified Flamingo Test and Bar Test

INTRODUCTION

Single-leg stance tests have been widely used to evaluate static balance, like the Modified Flamingo Test. The evaluation of dynamic balance on small support surfaces is the objective of some tests like the Bar Test.

RESEARCH QUESTION

How is the performance of postural control during the performance of these tests in schoolchildren between 6 and 11 years of age in both sexes? What are the reference values of these tests in this population?

METHOD

A cross-sectional study in which a total of 282 children. The evaluation included both tests.

RESULTS

The relative reliability was excellent (Intraclass Correlation Coefficient = 0.84-0.98), and the absolute reliability ranged between 4.5% and 7.1% for coefficient variation and between 0.5 and 1.5 for the standard error of measurement. The average results were 3.8 ± 2.7 floor touches for the Modified Flamingo Test and 5 ± 3.5 m for the Bar Test. The results of both tests improve progressively with the increase of age.

DISCUSSION

It can be asserted that children of different ages, as well as boys and girls of the same age, perform differently in these tests. Particularly, according to the analysis based on age subgroups, there were greater improvements in the performance of both tests between 8 and 11 years of age.

CONCLUSIONS

The girls obtained in both tests better results, although between 6 and 7 years of age the differences between sexes are not significant.

Psychometric properties of functional postural control tests in children: A systematic review

BACKGROUND

Postural control deficits are one of the most common impairments treated in pediatric physiotherapeutic practice. Adequate evaluation of these deficits is imperative to identify postural control deficits, plan treatment and assess efficacy. Currently, there is no gold standard evaluation for postural control deficits. However, the number of studies investigating the psychometric properties of functional pediatric postural control tests has increased significantly.

OBJECTIVE

To facilitate the selection of an appropriate pediatric functional postural control test in research and clinical practice.

METHODS

Systematic review following the PRISMA guidelines. PubMed, Web of Science and Scopus were systematically searched (last update: June 2022; PROSPERO: CRD42021246995). Studies were selected using the PICOs-method (pediatric populations (P), functional assessment tools for postural control (I) and psychometric properties (O). The risk of bias was rated with the COSMIN checklist and the level of evidence was determined with GRADE. For each test, the postural control systems were mapped, and the psychometric properties were extracted.

RESULTS

Seventy studies investigating 26 different postural control tests were included. Most children were healthy or had cerebral palsy. Overall, the evidence for all measurement properties was low to very low. Most tests (95%) showed good reliability (ICC>0.70), but inconsistent validity results. Structural validity, internal consistency and responsiveness were only available for 3 tests. Only the Kids-BESTest and FAB covered all postural control systems.

CONCLUSION

Currently, 2 functional tests encompass the entire construct of postural control. Although reliability is overall good, validity results depend on task, age and pathology. Future research should focus on test batteries and should particularly explore structural validity and responsiveness in different populations with methodologically strong study designs.

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.

Age and gender differences in static and dynamic balance of Chinese preschool children

Objectives: Balance is a crucial ability of early age, but there is conflicting evidence with regard to age and gender differences in preschool children's balance ability. Additionally, there are several tools available to measure balance, yet, wide variation in their use has restricted the capacity to synthesize the reference values. Therefore, the primary purpose of this study was to investigate the balance ability of preschool-aged children and determine how it is moderated by age and gender. The analysis pertained to determining whether different testing methods affect the results of static or dynamic balancing ability to provide a basis for normative balance ability data for healthy boys and girls between 3 and 6 years of age. Method: Six hundred and nineteen preschool children (296 boys and 323 girls) aged 3-6 years participated in the study. The static balance (SB) was assessed with children standing on one leg (OST) and in a tandem stance (TS) with respect to time. The balance beam test (BBT) and functional reach test (FRT) were used to evaluate dynamic balance (DB) by measuring the time spent and the distance reached, respectively. Result: The results revealed significant differences in OST with respect to gender (η2 = 0.037, p < 0.001), TS (η2 = 0.026, p < 0.001) and FRT (η2 = 0.016, p = 0.002); the girls performed better than boys on most balance tests except on BBT (η2 = 0.000, p = 0.596). Age had positive effects on the static and dynamic balance performance on the OST (η2 = 0.336, p < 0.001), TS (η2 = 0.205, p < 0.001), BBT (η2 = 0.367, p < 0.001) and FRT (η2 = 0.392, p < 0.001). Older children performed better than their younger counterparts. No significant interactions between age groups and sex were found. Conclusion: This study revealed that static and dynamic balance stability in preschool-aged children was affected by gender and age. Gender dimorphism is present in preschool children, older girls displayed better postural stability than boys, and balance performance improved with age. In addition, the study provides age- and gender-specific balance performance reference values for preschool children across multiple methods, which can be used to monitor static and dynamic balance development.

The influence of vestibular system and fetal presentation on handedness, cognitive and motor development: A comparison between cephalic and breech presentation

Genetics are undoubtedly implicated in the ontogenesis of laterality. Nonetheless, environmental factors, such as the intrauterine environment, may also play a role in the development of functional and behavioral lateralization. The aim of this study was to test the Left-Otolithic Dominance Theory (LODT; Previc, 1991) by investigating a hypothetical developmental pattern where it is assumed that a breech presentation, which is putatively associated with a dysfunctional and weakly lateralized vestibular system, can lead to weak handedness and atypical development associated with language and motor difficulties. We used the ALSPAC cohort of children from 7 to 10 years of age to conduct our investigation. Our results failed to show an association between the vestibular system and fetal presentation, nor any influence of the latter on hand preference, hand performance, or language and motor development. Bayesian statistical analyses supported these findings. Contrary to our LODT-derived hypotheses, this study offers evidence that fetal presentation does not influence the vestibular system's lateralization and seems to be a poor indicator for handedness. Nonetheless, we found that another non-genetic factor, prematurity, could lead to atypical development of handedness. This article is protected by copyright. All rights reserved.

Does weight loss affect the center of pressure of children with obesity: a follow-up study

Background

Children with obesity were found to show the greater postural instability compared to the normal-weighted children. However, it’s still unclear if their altered postural control ability would recover towards normal pattern after weight loss. The purpose of this study was to investigate the effect of weight loss on the center of pressure (COP) for obese children.

Method

Totally 147 children were conducted a follow-up study in three years. A total number of 22 participants aged 7–13 years were recruited for their remission of obesity problem after 36 months. Their dynamic plantar pressure data were collected by Footscan pressure plate. The normalized time of four sub-phases, displacements and velocities of COP in anterior–posterior (AP) and medial–lateral (ML) directions were calculated to perform the Kolmogorov–Smirnov test and paired sample t test for statistical analyses.

Results

After weight loss, children’s normalized time of forefoot contact phase (FFCP) increased significantly, and their duration of flat foot phase (FFP) decreased significantly. They also exhibited the more medial and posterior orientated COP path after weight loss. In ML-direction, the COP displacement during FFP and FFPOP increased, and the COP velocity during FFPOP increased. In AP-direction, COP velocity during FFP and FFPOP increased.

Conclusions

The findings indicated that weight loss would have effects on the COP characteristics and postural stability for obese children. COP trajectory can provide essential information for evaluating foot function. The findings may be useful for obese children, medical staff, and healthcare physician.

Graphical Abstract

Validity and reliability of balance Y-MED application in chronic mechanical low back pain patients

Background

Low back pain patients suffer from balance disturbance. Balance allows a person to interact with the surrounding environment and to do his daily activities. As recent technology has facilitated patient monitoring and enhanced our ability to monitor patients remotely, smartphone apps have been developed to achieve this goal. There are various balance assessment instruments used nowadays. It may be subjective or objective assessments. This study was applied to verify if the measurements of balance Y-MED smartphone applications are valid and reliable compared to the HUMAC balance board in order to offer easy, fast, cost-effective, and time-effective valid and reliable balance assessment that can be used in a clinical setting.

Methods

Fifty-four patients (12 males and 42 females) with chronic mechanical low back pain for more than 3 months was volunteered to participate in the current study with an age range of 25–60 years and BMI range of 18–34 kg/m2. Compared with the HUMAC balance board, the validity of the balance Y-MED smartphone application is evaluated, and the test-retest reliability of the balance Y-MED smartphone application is obtained by the same examiner 3 times.

Results

For concurrent validity, the correlations between balance measurements by Y-MED smartphone application and HUMAC balance board were not significant in both eyes open (r = − 0.12, p = 0.38) and eyes closed (r = 0.26, p = 0.054). The smartphone application showed poor test-retest reliability measurement of balance with eyes open; (ICC was 0.279, with 95% CI − 0.117–0.554) and with eyes closed (ICC was − 0.159, with 95% CI − 0.814–0.287).

Conclusions

According to the evaluation scheme selected in this study, the researchers were unable to confirm the validity of the balance Y-MED smartphone application in the balance assessment of patients with mechanical chronic low back pain. More than that, the balance Y-MED smartphone application has been shown poor score reliability. This makes it inaccurate for use in assessment balance.

Effects of Soccer Exercise on Balance Ability and Kinesthesia of the Lower Limb Joints in Children Aged 5-6 Years

Age-, height- and weight-matched children were recruited to the experimental group (EG; n = 31) and control group (n = 32). Following a 16-week soccer training program, balance ability and dominant-side lateral knee and ankle kinesthesia changes were tested. Regarding balance ability, the Sway Index, when children stood on a firm or foam surface with their eyes closed in the static balance test, and the dynamic balance test time were 13.5%, 11.6%, and 14.3% lower in the EG than in the control group, respectively. The scores in the left and right directions were 23.7% and 24.2% higher in the EG, respectively. Regarding kinesthesia, the angle of knee extension and ankle metatarsal flexion and dorsiflexion were 13.4%, 20.0%, and 16.8% lower in the EG than in the control group. These results indicate children in the EG had a better performance. After soccer exercise, children aged 5-6 years displayed improved balance in the left and right directions and improved knee extension, ankle plantarflexion, and dorsiflexion kinesthesia.

Effects of Short-Term Dynamic Balance Training on Postural Stability in School-Aged Football Players and Gymnasts

Static and dynamic balance abilities enable simple and complex movements and are determinants of top athletic performance. Balance abilities and their proficiency differ fundamentally with respect to age, gender, type of balance intervention, and type of sport. With this study, we aim to investigate whether 4weeks of dynamic balance training (DBT) improves static balance performance in school-aged gymnasts and football players. For this purpose, young male gymnasts (n=21) and male football players (n=20) completed an initial static balance assessment consisting of two one-legged stance (left and right foot) and two two-legged stance (eyes open and eyes closed) tasks. Subsequently, all participants underwent a 4-week intervention. DBT consisting of nine individual tasks was performed two times per week. Another static balance assessment followed 1day after the last training session and retention was assessed 2weeks later. Dynamic balance scores and total path length were analyzed via rank-based repeated measures designs using ANOVA-type statistics. The influence of factors GROUP and TIME on the static and dynamic balance performance was examined. Prior to DBT, young gymnasts showed better static balance performance than football players. However, after intervention, both groups improved in both one-legged stance tasks and also had high retention rates in these tasks. No significant improvements were seen in either group in the two-legged balance tests. Both groups improved in the dynamic balance tasks, although no differences in learning rates were evident. Our findings imply an inter-relationship between both static and dynamic balance components. Consequently, training regimes should include both balance components to facilitate early development of balance ability.

The Evaluation of Postural Stability and Fall Risk in Patients with Primary Hip Osteoarthritis

BACKGROUND

The hip is a significant weight-bearing joint and hip osteoarthritis (HOA) is one of the common musculoskeletal disorders. HOA may affect postural stability and fall risk by disrupting joint biomechanics.

METHODS

Fourty patients with unilateral primary HOA and a control group consisting of 41 healthy subjects were included in the study. HOA was radiographically graded by Kellgren Lawrence (KL) HOA classification. There were 26 patients with mild HOA (KL grade ≤ 2) and 14 patients with moderate-severe HOA (KL grade ≥ 3). The falls efficacy scale-international was used to assess fear of falling. Postural stability and the fall risk were evaluated by using the Biodex Stability System.

RESULTS

The postural stability and the fall risk indices were statistically significantly higher in the study group. Also, there was a positive correlation between the number of falls in the last 1 year, weight, and body mass index; and these correlations were statistically significant (r 0.686, p 0.003; r 0.477, p 0.002; r 0.444, p 0.004). There was no statistically significant difference in fall risk by the HOA was mild or moderate-severe.

CONCLUSIONS

Determining the deterioration in postural stability and the fall risk in patients with both mild and moderate-severe HOA may be a stimulus for early initiation of postural stability exercises in HOA.

Relationships between types of balance performance in healthy individuals: Role of age

BACKGROUND

Balance is considered to be task-specific as indicated by studies reporting only small-sized and non-significant correlations between types of balance (e.g., static, dynamic). However, it remains unclear whether these associations differ by age and the comparability of studies is limited due to methodological inconsistencies.

RESEARCH QUESTION

Are associations between types of balance performance affected by age in children, adolescents, and young adults?

METHODS

Static, dynamic, and proactive balance performance was assessed in 30 children (7.6 ± 0.6 years), 43 adolescents (14.7 ± 0.5 years), and 54 young adults (22.8 ± 2.8 years) using the same standardized balance tests. Pearson's correlation coefficients (r) were calculated for associations between types of balance and statistically compared to detect differences between age groups.

RESULTS

Except for the association between static (i.e., medio-lateral [M/L] sway) and proactive (Y-balance test) balance performance in young adults (r = .319, p < .05), our analyses revealed small-sized and non-significant associations between measures of static, dynamic, and proactive balance performance in children (-.302 ≤ r ≤ .245, p > .05), adolescents (-.276 ≤ r ≤ .202, p > .05), and young adults (-.120 ≤ r ≤ .161, p > .05). Significant differences between age groups were observed for associations between dynamic and proactive balance, which were lesser in young adults (r = .161) compared to adolescents (r = -.276, p = .017) and children (r = -.302, p = .023) and for associations between static (i.e., M/L sway) and proactive balance, which were larger in young adults (r = .319) compared to adolescents (r = -.131, p = .029).

CONCLUSIONS

Practitioners (e.g., PE teachers) should be aware that associations between types of balance performance are small and hardly affected by age in youth. Therefore, they should be trained and tested individually in children, adolescents, and young adults.

The role of age, sex, anthropometry, and body composition as determinants of physical fitness in nonobese children aged 6-12

Purpose

The determinants of physical fitness in children have been given limited attention. In particular, the relative role of chronological age, sex, anthropometry, and body composition in physical fitness of children has been barely investigated. This cross-sectional study investigated determinants of physical fitness using a set of predictive variables including, in addition to chronological age and sex, a large panel of anthropometric measurements as well as body composition. The study was carried out in a convenience sample of children aged 6–12 participating in a summer camp.

Methods

One-hundred-ninety-three children (128 males) fulfilled all requirements and entered analysis. Health-related physical fitness components (speed, muscular power and balance) were explored by means of field tests, namely the 30-m dash test for running speed, the standing long jump and the seated chest pass test for lower limbs and upper body muscular power, respectively, and the flamingo balance test for static balance. Determinants of physical fitness were investigated by regression analysis using chronological age, sex, anthropometry, and body composition in a hierarchical approach. To minimize the expected effect of collinearity in predictor variables, an original statistical approach using Random Forests analysis was adopted.

Results

Age predicted 45.2%, 43.6%, 35.6% and 25.6%; and sex 9.5%, 10.7%, 6.3% and 2.0% of variance in the 30-m dash, seated chest pass, standing long jump, and flamingo balance test, respectively. Anthropometry and body composition explained a limited or no percentage of variance. The adjusted R² (root mean square error) was 0.61 (0.31 s), 0.45 (0.32 m), 0.58 (0.15 m) and 0.41 (0.75 logs) for the 30-m dash, seated chest pass, standing long jump, and flamingo balance test, respectively making these models useful when physical fitness tests are not feasible.

Conclusions

We highlighted the respective role of chronological age, sex, anthropometry, and body composition in physical fitness of children in the wide age range 6–12 years. Data confirm and expand on previous literature by showing with a strictly conservative statistical approach that chronological age is a main determinant of physical fitness of both boys and girls, sex playing a limited role. The role of anthropometry was even less important, and no role was found for body composition. These findings should be considered when planning/implementing motor development or physical education programs.

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.

Body balance analysis of children and youth with intellectual disabilities

BACKGROUND

Children and adolescents with intellectual disabilities (IDs) are an identified group with postural disturbances resulting from a lack of integration among the visual, vestibular and proprioceptive systems. The insufficient level of maturity of the sensory systems is at least partly responsible for disturbances in maintaining body balance. More sway can increase the risk of falls and body injuries. The aims of the study were (1) to compare the ability to maintain the body balance of children and youth with a varying degree of ID, both with the eyes open and closed, and (2) to determine to what extent factors such as sex, level of ID, visual stimulus and body height independently affect the ability to maintain body balance in children and adolescents with ID.

METHOD

The study involved 131 people aged 13-21 years (65 girls and 66 boys). The participants were classified as (1) with mild disability (42 girls and 47 boys) and (2) with moderate disability (23 girls and 19 boys), based on IQ test results. Sway measures were collected with the Zebris platform, with the eyes open and closed. Sway path, sway path in anterio-posterior and medio-lateral directions and sway area were analysed.

RESULTS

Boys with moderate ID were characterised by a significantly more sway indicating their worse postural balance ability than boys with mild ID, both in the trials with open eyes and closed ones. The type of test (eyes open/eyes closed) to a small extent had influenced the body balance of the examined children with ID. Results of analyses of covariance had showed that all analysed factors (sex, level of ID, type of the test performance and body height), irrespectively from direction of sway (sway path in anterio-posterior and medio-lateral directions), worked independently influencing body balance.

CONCLUSIONS

It could be assumed that lower height, moderate disability and male sex are factors significantly reducing ability of maintenance of balance of children and youth with ID.

Dynamic Postural Control in Children: Do the Arms Lend the Legs a Helping Hand?

There is growing empirical evidence lending support to the existence of an "upper body strategy" to extend the ankle and hip strategies in maintaining upright postural stability among adults. Both postural stability and arm movement functions are still developing in children. Therefore, enquiry concerning arm contribution to postural stability among children is needed. This proof of concept study seeks to determine whether the arms play a functionally relevant role in dynamic postural control among children. Twenty-nine children (girls, n = 15; age, 10.6 ± 0.5 years; height, 1.48 ± 0.08 m; mass, 42.8 ± 11.4 kg; BMI, 19.2 ± 3.7 kg/m²) completed three dynamic balance tests; (1) Y Balance test^®, (2) timed balance beam walking test, (3) transition from dynamic to static balance using the dynamic postural stability index (DPSI). Each test was performed with free and restricted arm movement. Restricting arm movements elicited a marked degradation in the Y Balance reach distance (all directions, P ≤ 0.001, d = -0.85 to -1.13) and timed balance beam walking test (P ≤ 0.001, d = 1.01), while the DPSI was the only metric that was not different between free and restricted arm movements (P = 0.335, d = -0.08). This study provides direct evidence that the arms play a functionally relevant role in dynamic balance performance among children. These findings may provide the impetus to develop training interventions to improve the use of the arms in activities of daily living.

Associations Between Types of Balance Performance in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis

Background: The objective of this systematic review and meta-analysis was to quantify and statistically compare correlations between types of balance performance in healthy individuals across the lifespan. Methods: Literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus. Studies were included if they investigated healthy individuals aged ≥6 years and reported measures of static/dynamic steady-state, proactive, and/or reactive balance. The included studies were coded as follows: age group, gender, and balance type, test, parameter. Pearson's correlation coefficients were extracted, transformed (i.e., Fisher's z-transformed r _z -value), aggregated (i.e., weighted mean r _z -value), back-transformed to r-values, classified according to their magnitude, and statistically compared. The methodological quality of each study was assessed using the Appraisal tool for Cross-Sectional Studies. Results: We detected twenty-six studies that examined associations between types of balance and exclusively found small-sized correlations, irrespective of the age group considered. More specifically, the weighted mean r _z-values amounted to 0.61 (back-transformed r-value: 0.54) in old adults for the correlation of dynamic steady-state with proactive balance. For correlations between dynamic and static steady-state balance, the weighted mean r _z-values amounted to 0.09 in children (r-value: 0.09) and to 0.32 in old adults (r-value: 0.31). Further, correlations of proactive with static steady-state balance revealed weighted mean r _z-values of 0.24 (r-value: 0.24) in young adults and of 0.31 (r-value: 0.30) in old adults. Additionally, correlations between reactive and static steady-state balance yielded weighted mean r _z-values of 0.21 (r-value: 0.21) in young adults and of 0.19 (r-value: 0.19) in old adults. Moreover, significantly different correlation coefficients (z = 8.28, p < 0.001) were only found for the association between dynamic and static steady-state balance in children (r = 0.09) compared to old adults (r = 0.31). Lastly, we detected trivial to considerable heterogeneity (i.e., 0% ≤ I² ≤ 83%) between studies. Conclusions: Our systematic review and meta-analysis showed exclusively small-sized correlations between types of balance performance across the lifespan. This indicates that balance performance seems to be task-specific rather than a "general ability." Further, our results suggest that for assessment/training purposes a test battery/multiple exercises should be used that include static/dynamic steady-state, proactive, and reactive types of balance. Concerning the observed significant age differences, further research is needed to investigate whether they are truly existent or if they are caused by methodological inconsistencies.

Prenatal lead, cadmium and mercury exposure and associations with motor skills at age 7 years in a UK observational birth cohort

BACKGROUND

Lead and mercury are freely transferred across the placenta, while cadmium tends to accumulate in the placenta. Each contributes to adverse neurological outcomes for the child. Although prenatal heavy metal exposure has been linked with an array of neurodevelopmental outcomes in childhood, its association with the development of motor skills in children has not been robustly studied.

AIMS/OBJECTIVE

The aim of the present study was to investigate the association between prenatal exposure to lead, cadmium and mercury, measured as maternal blood concentrations during pregnancy, and motor skills, measured as subtests of the Movement Assessment Battery for Children (Movement ABC) at age 7 years in a large sample of mother-child pairs enrolled in a UK observational birth cohort study (Avon Longitudinal Study of Parents and Children, ALSPAC).

METHODS

Whole blood samples from pregnant women enrolled in ALSPAC were analysed for lead, cadmium and mercury. In a complete case analysis (n = 1558), associations between prenatal blood concentrations and child motor skills assessed by Movement ABC subtests of manual dexterity, ball skills and balance at 7 years were examined in adjusted regression models. Associations with probable developmental coordination disorder (DCD) were also investigated.

RESULTS

The mean prenatal blood levels were: lead 3.66 ± 1.55 μg/dl; cadmium 0.45 ± 0.54 μg/l; mercury 2.23 ± 1.14 μg/l. There was no evidence for any adverse associations of prenatal lead, cadmium or mercury exposure with motor skills measured at age 7 years with Movement ABC subtests in adjusted regression models. Further, there were no associations with probable DCD.

CONCLUSIONS

There was no evidence to support a role of prenatal exposure to heavy metals at these levels on motor skills in the child at age 7 years measured using the Movement ABC. Early identification of symptoms of motor skills impairment is important, however, to enable investigation, assessment and treatment.

The ALSPAC Coordination Test (subtests of the Movement ABC): Methodology and data on associations with prenatal exposures to lead, cadmium and mercury

As part of the Avon Longitudinal Study of Parents and Children (ALSPAC), measures of child motor skills were collected in research clinics. The ALSPAC Coordination Test was derived from subtests of the Movement ABC at age 7 years in children participating in ALSPAC. Maternal blood lead, cadmium and mercury concentrations were measured by inductively-coupled plasma mass spectrometry in samples from women at a median gestation age of 11 weeks. Maternal reports at 32 weeks’ gestation were used to generate data on a range of potential confounders. The data were used to determine the associations between prenatal exposure to lead, cadmium and mercury and child motor skills at age 7 years. For results, please see Taylor et al. [1].

Visually Induced Dizziness in Children and Validation of the Pediatric Visually Induced Dizziness Questionnaire

Aims

To develop and validate the Pediatric Visually Induced Dizziness Questionnaire (PVID) and quantify the presence and severity of visually induced dizziness (ViD), i.e., symptoms induced by visual motion stimuli including crowds and scrolling computer screens in children.

Methods

169 healthy (female n = 89; recruited from mainstream schools, London, UK) and 114 children with a primary migraine, concussion, or vestibular disorder diagnosis (female n = 62), aged 6–17 years, were included. Children with primary migraine were recruited from mainstream schools while children with concussion or vestibular disorder were recruited from tertiary balance centers in London, UK, and Pittsburgh, PA, USA. Children completed the PVID, which assesses the frequency of dizziness and unsteadiness experienced in specific environmental situations, and Strength and Difficulties Questionnaire (SDQ), a brief behavioral screening instrument.

Results

The PVID showed high internal consistency (11 items; α = 0.90). A significant between-group difference was noted with higher (i.e., worse) PVID scores for patients vs. healthy participants (U = 2,436.5, z = −10.719, p < 0.001); a significant difference was noted between individual patient groups [χ²(2) = 11.014, p = 0.004] but post hoc analysis showed no significant pairwise comparisons. The optimal cut-off score for discriminating between individuals with and without abnormal ViD levels was 0.45 out of 3 (sensitivity 83%, specificity 75%). Self-rated emotional (U = 2,730.0, z = −6.169) and hyperactivity (U = 3,445.0, z = −4.506) SDQ subscale as well as informant (U = 188.5, z = −3.916) and self-rated (U = 3,178.5, z = −5.083) total scores were significantly worse for patients compared to healthy participants (p < 0.001).

Conclusion

ViD is common in children with a primary concussion, migraine, or vestibular diagnosis. The PVID is a valid measure for identifying the presence of ViD in children and should be used to identify and quantify these symptoms, which require specific management incorporating exposure to optokinetic stimuli.

Balance, Proprioception, and Gross Motor Development of Chinese Children Aged 3 to 6 Years

The authors' aim was to find the features of balance, proprioception, and gross motor development of Chinese children 3-6 years old and their correlations, provide theoretical support for promoting children's motor development, and enrich the world theoretical system of motor development. This study used a Tekscan foot pressure measurement instrument (Tekscan, Inc., Boston, MA), walking on a balance beam, Xsens 3-dimensional positional measuring system (Xsens Technologies, Enschede, the Netherlands), and Test of Gross Motor Development-2 to assess static balance, dynamic balance, knee proprioception, and levels of gross motor development (GMD) of 3- to 6-year-old children (n = 60) in Beijing. The results are as follows: children had significant age differences in static balance, dynamic balance, proprioception, and levels of GMD; children had significant gender differences in static balance, proprioception, and levels of GMD; children's static balance, dynamic balance, and proprioception had a very significant positive correlation with GMD (p < .01), but no significant correlation with body mass index.

The Pediatric Vestibular Symptom Questionnaire: A Validation Study

OBJECTIVE

To develop and validate the Pediatric Vestibular Symptom Questionnaire (PVSQ) and quantify subjective vestibular symptom (ie, dizziness, unsteadiness) severity in children.

STUDY DESIGN

One hundred sixty-eight healthy children (female, n = 91) and 56 children with postconcussion dizziness or a vestibular disorder (female, n = 32), between ages 6 and 17 years, were included. The PVSQ contains questions regarding vestibular symptom frequency during the previous month. The Strengths and Difficulties Questionnaire (SDQ), a brief behavioral screening instrument, was also completed.

RESULTS

The PVSQ showed high internal consistency (10 items; Cronbach α = 0.88). A significant between-group difference was noted with higher (ie, worse) PVSQ scores for children with vestibular symptoms (P < .001); no significant differences were noted between patient groups. The optimal cut-off score for discriminating between individuals with and without abnormal levels of vestibular symptoms was 0.68 out of 3 (sensitivity 95%, specificity 85%). Emotional and hyperactivity SDQ subscale scores were significantly worse for patients compared with healthy participants (P ≤ .01). A significant relationship was noted between mean PVSQ and SDQ (parent-rated version) hyperactivity and total scores for patients (P ≤ .01) and the SDQ (self-rated) emotional, hyperactivity, and total score (P ≤ .01) in healthy controls. However, mean SDQ subscale and total scores were within normal ranges for both groups.

CONCLUSIONS

Self-reported vestibular symptoms, measured by the PVSQ, discriminated between children presenting with vestibular symptoms and healthy controls and should be used to identify and quantify vestibular symptoms that require additional assessment and management.

Balance ability in 7- and 10-year-old children: associations with prenatal lead and cadmium exposure and with blood lead levels in childhood in a prospective birth cohort study

OBJECTIVES

Most studies reporting evidence of adverse effects of lead and cadmium on the ability to balance have been conducted in high-exposure groups or have included adults. The effects of prenatal exposure have not been well studied, nor have the effects in children been directly studied. The aim of the study was to identify the associations of lead (in utero and in childhood) and cadmium (in utero) exposure with the ability to balance in children aged 7 and 10 years.

DESIGN

Prospective birth cohort study.

PARTICIPANTS

Maternal blood lead (n=4285) and cadmium (n=4286) levels were measured by inductively coupled plasma mass spectrometry in women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) during pregnancy. Child lead levels were measured in a subsample of 582 of ALSPAC children at age 30 months.

MAIN OUTCOME MEASURES

Children completed a heel-to-toe walking test at 7 years. At 10 years, the children underwent clinical tests of static and dynamic balance. Statistical analysis using SPSS V.19 included logistic regression modelling, comparing categories of ≥ 5 vs <5 µg/dL for lead, and ≥ 1 vs <1 µg/L for cadmium.

RESULTS

Balance at age 7 years was not associated with elevated in utero lead or cadmium exposure (adjusted OR for balance dysfunction: Pb 1.01 (95% CI 0.95 to 1.01), n=1732; Cd 0.95 (0.77 to 1.20), n=1734), or with elevated child blood lead level at age 30 months (adjusted OR 0.98 (0.92 to 1.05), n=354). Similarly, neither measures of static nor dynamic balance at age 10 years were associated with in utero lead or cadmium exposure, or child lead level.

CONCLUSIONS

These findings do not provide any evidence of an association of prenatal exposure to lead or cadmium, or lead levels in childhood, on balance ability in children. Confirmation in other cohorts is needed.

Psychometric properties of functional balance tests in children: a literature review

AIM

Identifying balance problems are the first step towards monitoring and rehabilitation. Therefore, this paper aims to make an overview of the psychometric properties of the functional balance tests available for children.

METHOD

A literature search was performed in PubMED and Web of Science on 8 February 2014 and updated on 6 July 2014. A conceptual framework for functional balance tests was defined, taking balance control components and task constraints into account. The tests were selected for inclusion by consensus of 2-3 reviewers using the conceptual framework.

RESULTS

Fourteen tests were investigated in 25 articles and analysed within the conceptual framework. The Timed Up and Go test, Pediatric Balance Scale, and Pediatric Reach Test are well investigated and all show good reliability. Validity remains unclear because of lack of a criterion standard to measure balance control.

INTERPRETATION

Because of the lack of good methodological studies, strong evidence for the use of one or more functional balance tests in children cannot be provided. Moreover, it is necessary that a criterion standard to measure balance is established.

Prenatal alcohol exposure and childhood balance ability: findings from a UK birth cohort study

OBJECTIVE

To investigate the association of prenatal alcohol exposure with balance in10-year-old children.

DESIGN

Population-based prospective longitudinal study.

SETTING

Former Avon region of UK (Southwest England).

PARTICIPANTS

6915 children from the Avon Longitudinal Study of Parents and Children who had a balance assessment at age 10 and had data on maternal alcohol consumption.

OUTCOME MEASURES

3 composite balance scores: dynamic balance (beam-walking), static balance eyes open, static balance eyes closed (heel-to-toe balance on a beam and standing on one leg, eyes open or closed).

RESULTS

Most mothers (95.5%) consumed no-to-moderate amounts (3-7 glasses/week) of alcohol during pregnancy. Higher total-alcohol consumption was associated with maternal-social advantage, whereas binge drinking (≥4 units/day) and abstinence were associated with maternal social disadvantage. No evidence was found of an adverse effect of maternal-alcohol consumption on childhood balance. Higher maternal-alcohol use during pregnancy was generally associated with better offspring outcomes, with some specific effects appearing strong (static balance eyes open and moderate total alcohol exposure at 18 weeks, adjusted OR 1.23 (95% CI 1.01 to 1.49); static balance eyes closed and moderate total alcohol exposure at 18 weeks, adjusted OR 1.25 (95% CI 1.06 to 1.48). Similar results were found for both paternal and postnatal maternal alcohol exposure. A Mendelian-randomization approach was used to estimate the association between maternal genotype and offspring balance using the non-synonymous variant rs1229984*A (ADH1B) to proxy for lower maternal alcohol consumption; no strong associations were found between this genotype/proxy and offspring balance.

CONCLUSIONS

No evidence was found to indicate that moderate maternal alcohol consumption in this population sample had an adverse effect on offspring balance at age 10. An apparent beneficial effect of higher total maternal alcohol consumption on offspring balance appeared likely to reflect residual confounding.