How to Use the Pediatric Balance Scale

Elise falls frequently during the course of her school day.   She often has skinned knees and bruises.  Although she is 10,  she walks down stairs one step at a time.    What will you use to measure Elise’s functional balance skills?  How will you document her progress?  

Pediatric physical therapists informally evaluate balance and postural control in every movement.   Multiple body systems contribute to balance, and this makes measurement of functional balance somewhat challenging.

The Pediatric Balance Scale (PBS) meets this challenge as a criterion-referenced outcome measure, modified from the Berg Balance Scale.  Criterion-referenced means that the child’s performance is compared to their prior performance to determine change.  The PBS has been validated on school-aged children from 5 to 15 years of age with known mild to moderate balance impairment.  It consists of 14 functional balance items, each one scored from 0 to 4.

The PBS was originally created to identify children who, like Elise, have not developed critical balance skills and have people concerned for their safety.  Secondly, it was created to measure change in children who are maturing or receiving intervention.  Finally, it can be used to determine whether a child has regressed in balance skill.

In 2015, the developer, Mary Franjoine,  did a follow-up study using Rasch analysis and concluded that the PBS does not identify specific aspects of balance (static, reactive, controlled mobility).  However, it does identify mild or moderate balance deficits in children less than 6 years of age and is capable of tracking progress with intervention.  For older school-aged children with moderate balance deficits, the PBS  is useful to attain a baseline or identify any changes in balance.

The PBS is easily used in almost any environment.  What do you need to score the Pediatric Balance Scale?

  • Link to Pediatric Balance Scale Score Sheet with minimal detectable change (MDC) & minimally clinically important difference (MCID)  values.
  • Adjustable height bench
  • Chair with back support and arm rests
  • Stopwatch
  • Masking tape 1″ wide
  • Step stool 6″ in height
  • Chalkboard eraser
  • Ruler or yardstick
  • Small level

When filling out the International Classification of Functioning, Disability and Health (ICF), which category does PBS data belong in?  Body Structure & Function, subcategory Posture/Balance

If you want to learn more about the PBS, here are journal articles:

  • Franjoine MR, Gunther JS, Taylor MJ. 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. 2003; 15(2):114-128.
  • Franjoine MR, Darr N, Held SL, Kott K, Young BL. The Performance of Children Developing Typically on the Pediatric Balance Scale. Pediatric Physical Therapy. 2010; 22(4): 350-359.
  • Francine MR, Darr N, Campbell SK, Smith E.  Psychometric Properties of the Pediatric Balance Scale Using Rasch Analysis. Pediatric Physical Therapy. 2015 Winter; 27(4):337-48.

Author: spritelypt

Pediatric physical therapist

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