Skip to main content
  

Rehab Measures: Pediatric Balance Scale

Link to instrument

Link to PBS 

Title of Assessment

Pediatric Balance Scale 

Acronym

PBS

Instrument Reviewer(s)

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

Summary Date

9/4/2015 

Purpose

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

Description

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

Area of Assessment

 

Body Part

 

ICF Domain

Activity 

Domain

 

Assessment Type

 

Length of Test

06 to 30 Minutes 

Time to Administer

Less than 20 minutes

Number of Items

14 items 

Equipment Required

  • Adjustable height bench
  • Chair with back support and arm rests
  • Stopwatch or watch with a second hand
  • Masking tape one inch wide
  • Step stool six inches in height
  • Chalkboard eraser
  • Ruler or yardstick
  • A small level

Optional items that may be helpful:

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

Training Required

Instructions listed prior to each item on how to perform and how to instruct participant who is completing the instrument

Type of training required

Reading an Article/Manual 

Cost

Free 

Actual Cost

  • Cost of equipment
  • The Pediatric Balance Scale is freely available online

Age Range

 

Administration Mode

 

Diagnosis

 

Populations Tested

  • Children typically developing
  • Children with mild, moderate, and severe motor impairments
    • Prader-Willi syndrome
    • Learning disabled and speech-language impaired
    • Mental retardation
    • Spina bifida
    • Status post-brain resection
    • Cerebral palsy: athetoid, hemiplegia, hypotonia, spastic diplegia

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

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

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

Minimally Clinically Important Difference (MCID)

Cerebral Palsy: (Chen et al, 2013)

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

Cut-Off Scores

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

Age range

Cut off

2y 0m to 2y 5 m

23.3 points

2y 6m to 2y 11m

32.7 points

3y 0m to 3y 5m

45.4 points

3y 6m to 3y 11m

47.5 points

4y 0m to 4y 5m

48.5 points

4y 6m to 4y 11m

50.4 points

5y 0m to 5y 5m

53.2 points

5y 6m to 5y 11m

52.2 points

6y 0m to 6y 5m

52.8 points

6y 6m to 6y 11m

53.3 points

7y 0m and older

54.6 points

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

Normative Data

Typically Developing Children: (Franjoine et al, 2010)

Age range

Mean total score ± SD

2y 0m to 2y 5 m

26.2 ± 6.38 points

2y 6m to 2y 11m

34.3 ± 7.72 points

3y 0m to 3y 5m

46.0 ± 6.55 points

3y 6m to 3y 11m

48.5 ± 5.02 points

4y 0m to 4y 5m

49.5 ± 5.76 points

4y 6m to 4y 11m

51.2 ± 5.07 points

5y 0m to 5y 5m

54.0 ± 2.52 points

5y 6m to 5y 11m

53.3 ± 3.20 points

6y 0m to 6y 5m

53.8 ± 2.49 points

6y 6m to 6y 11m

54.4 ± 1.89 points

7y 0m and older

55.2 ± 1.74 points

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

Test-retest Reliability

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

  • Excellent test-retest reliability (ICC=0.850)

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

  • Excellent test-retest reliability (ICC=0.998)

Interrater/Intrarater Reliability

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

  • Excellent interrater reliability (ICC=0.997)

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

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

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

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

Predictive validity:

Cerebral Palsy ( Chen et al, 2013)

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

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

Construct Validity (Convergent/Discriminant)

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

Convergent validity:

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

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

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

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

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

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

Discriminant Validity:

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

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Typically developing children: (Franjoine et al, 2010)

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

Responsiveness

Cerebral Palsy: ( Chen et al, 2013)

  • SRM=0.748-0.754

Professional Association Recommendations

 

Considerations

Franjoine et al, 2010

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

Bibliography

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

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

Franjoine, M.R., Gunther J.S., Taylor, M.A. (2003). “Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment.” Pediatr Phys Ther 15(2): 114-128.

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

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

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

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 9/4/2015 8:34 AM  by Jason Raad 
Last modified at 9/4/2015 8:35 AM  by Jason Raad