Pediatric Balance Scale

What is the Pediatric Balance Scale?

During your practice, you may encounter pediatric patients who frequently trip and struggle to keep up with friends during playtime. These presentations can raise concerns about underlying balance impairments that may hinder a child's participation and social engagement. The Pediatric Balance Scale (PBS) can be valuable in these situations.

The Pediatric Balance Scale is a modified version of the Berg Balance Scale. Instead of assessing older adults, this version's target population is school-age children, specifically those with mild to moderate motor impairments (Franjoine et al., 2003).

Reliability of the Pediatric Balance Scale

Now that we know the Pediatric Balance Scale, let's examine some studies that have tested its ability to give consistent results.

Franjoine et al. (2003) studied 20 children (5-15 years old) with balance impairments who underwent the PBS twice by one examiner. Ten pediatric physical therapists independently scored video recordings from 10 randomized test sessions to assess test-retest reliability. 

The PBS demonstrated good test-retest reliability (intraclass correlation coefficient (ICC) model 3,1 = 0.998) with no significant difference in total test scores or individual items measured by one therapist on two occasions. Spearman Rank Correlation Coefficients for individual items ranged from 0.89 to 1.0, further supporting consistent scoring. Similarly, no significant difference was found among ratings by different physical therapists on the PBS for total test scores (ICC 3,1 = 0.997).

In another study that focused on how reliable the PBS is for children with spastic cerebral palsy, researchers found the PBS to be highly reliable, with consistent scores between different examiners (inter-rater) and when the same examiner tested children twice (test-retest). These results suggest that PBS is a dependable measure of balance in children with this condition (Alimi et al., 2019)

These findings support the PBS as a dependable tool for clinical assessment and monitoring of balance function in the pediatric population.

What does the Pediatric Balance Scale seek to assess?

Like the original, this scale version will be used by pediatric physical therapists or similar providers who are experts in measuring functional balance skills, analyzing motor functions, determining the severity, assessing fall risk, and evaluating performance in everyday tasks.

The scale comprises 14 items, each representing a specific exercise the patient must perform, scored on a 5-point ordinal scale (0-4) for a maximum total score of 56. Here are the following tasks:

• Sitting to standing
• Standing to sitting
• Transfers
• Standing unsupported
• Sitting with back unsupported and feet supported on the floor
• Standing unsupported with eyes closed
• Standing unsupported with feet together
• Standing unsupported with one foot in front
• Standing on one leg
• Turn 360 degrees
• Turning to look behind left and right shoulders while standing still
• Pick up an object from the floor from a standing position
• Placing an alternate foot on a step stool while standing unsupported
• Reaching forward with outstretched arm while standing

Through these exercises, professionals will observe their patient's motor skills, conduct a balance assessment, and identify any motor function and balance deficits.

How is the Pediatric Balance Scale administered?

The test can be conducted anywhere in a clinic or school. To administer this assessment, an examiner would first guide the child through a series of 14 tasks by doing these (Elon University, 2015):

Step 1: Prepare equipment for Pediatric Balance Scale exercises

Before administering the Pediatric Balance Scale, the healthcare professional must prepare the following items :

• Adjustable height bench
• Chair with back support and armrests
• Stopwatch or watch with a second hand
• Masking tape that's one-inch wide
• A step stool six inches high
• Chalkboard eraser
• Ruler or yardstick
• A small level

They can also use the following items, but these are optional:

• 2x child-size footprints
• Blindfold
• A brightly-colored object at least two inches in size
• Flashcards
• Two inches of adhesive-backed hook Velcro
• 2x one-foot strips of loop Velcro

Step 2: Demonstrate each task and give instructions

Each exercise has a standardized protocol. Since the patient being assessed is a school-age child with mild to moderate motor impairment, the professional conducting this balanced assessment must demonstrate each exercise and specify the instructions to the child.

Step 3: Conducting the assessment

After relaying the instructions to the child, the professional must give them a practice trial. Suppose the child cannot complete the practice trial based on their understanding of directions. In that case, the professional can give them a second practice trial and provide verbal and visual directions through physical prompts. After the practice trial, the official trials will begin.

Note: You can also use the OCD in Children Symptoms Checklist Template to identify and track symptoms of obsessive-compulsive disorder in younger patients. This template aids in recognizing key behaviors and concerns, supporting more accurate diagnoses and effective interventions. Additionally, the Berg Balance Scale Template can help assess balance and stability in patients, which is crucial for developing comprehensive treatment plans for those with balance impairments.

How is the Pediatric Balance Scale scored?

Pediatric Balance Scale scores are divided into 14 items, scored between 0 to 4. What counts as 0 and 4 will vary from exercise to exercise, but 0 is considered the worst performance, and 4 is the best. Retrials are unnecessary if they score a 4 on the first trial. Some exercises have time and distance requirements.

Points will be deducted if they cannot complete the time and distance requirements and require external support or assistance from another person.

How are Pediatric Balance Scale scores calculated and interpreted?

After all the exercises, you must add all the score ratings per item to calculate the total test score. The maximum score is 56. Higher total test scores indicate that the school-aged child is more capable of maintaining balance and has little to no motor impairments. Lower total test scores indicate moderate balance problems (or severe if the scores are extremely low or 0), motor impairment, and negatively impacted balance function.

What are the next steps after scoring the Pediatric Balance Scale?

Once the total score has been calculated, the following steps will depend on the score. School-aged children who scored high will likely need less support than those who scored low. If balance impairments are evident in the children, it would be best to assess their severity and have them undergo pediatric physical therapy to habilitate balance deficits (mild or moderate) and improve basic motor abilities.

Given this, it would be prudent to schedule routine check-ups on patients and conduct the Pediatric Balance Scale exercises again to check for any improvements in their functional balance and motor functions. This will allow pediatricians to adjust any treatment or rehabilitation plans they've created for each patient.

References

Alimi, E., Kalantari, M., Nazeri, A.-R., & Akbarzade Baghban, A. (2019). Test-retest & inter-rater reliability of Persian version of Pediatric Balance Scale in children with spastic cerebral palsy. Iranian Journal of Child Neurology, 13(4), 163–171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789081/

Elon University. (2015). Tests & measures: A resource for pediatric physical therapy practitioners / pediatric balance scale. https://blogs.elon.edu/ptkids/2015/03/14/pediatric-balance-scale/

Franjoine, M. R., Gunther, J. S., & Taylor, M. J. (2003). Pediatric Balance Scale: A modified version of the Berg Balance Scale for the school-age child with mild to moderate motor impairment. Pediatric Physical Therapy, 15(2), 114–128. https://doi.org/10.1097/01.pep.0000068117.48023.18

Laspa, V., Besios, T., Xristara, A., Tsigaras, G., Milioudi, M., Mauromoustakos, S., & Kottaras, S. (2020). Reliability and clinical significance of the Pediatric Balance Scale (PBS) in the Greek language in children aged 4 to 18 years. Open Journal of Preventive Medicine, 10(05), 73–81. https://doi.org/10.4236/ojpm.2020.105005