Elise is constantly falling during her school day. She often has skinned knees and bruises. Although she is 10, she walks down stairs one step at a time. As Elise’s physical therapist, what observational measure will you use to measure her functional balance skills? How will you document her progress?
Balance is defined as the ability to keep the center of mass over the base of support.
Postural control is the act of maintaining, achieving or restoring a state of balance during an activity.
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, lack age-appropriate functional 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?
- Adjustable height bench
- Chair with back support and arm rests
- Masking tape 1″ wide
- Step stool 6″ in height
- Chalkboard eraser
- Ruler or yardstick
- Small level
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.