Full length articleReference values and equations reference of balance for children of 8 to 12 years
Introduction
Postural control refers to a person's ability to support and stabilize the body in the standing position and maintain balance. To achieve balance in quiet standing, the imaginary vertical line passing through the body's center of mass (COM) should lie within the support base [1]. Controlling body balance (or postural sway) is considered an important indicator of the proper functioning of the sensorimotor system and therefore must be evaluated not only in patients but in healthy individuals [2].
The control of posture (body orientation and alignment) and balance depends primarily on the ability of the visual, somatosensory, and vestibular systems [3], [4] to indicate the spatial position of each body segment correctly. During growth and development, the response of these systems varies with age, as does the body’s ability to achieve or maintain balance, especially when postural instability is present [5].
Eight to 9 years old children have show balance adaptation strategies similar to those described in adults [6], [7]. However, Hirabayashi and Iwasaki [7] suggested that children up to 14 years may not have the same degree of visual and vestibular control as those noted in adults, which could be related to a higher incidence of balance disorders. Such changes were observed in children with congenital heart disease, motor development delays, or deformities [8], [9], who have shown a decrease in the performance of functional skills. Therefore, establishing normative values of postural balance scores in children with typical development will allow for better monitoring of balance ability in children with atypical development.
Evaluation of balance is usually performed using clinical scales such as the Berg Balance test [10] and the Pediatric Balance Scale [11], which provide reliable assessments among elderly individuals [10] and infants [11] with balance dysfunction, respectively. Computed dynamic posturography involving a sensory organization test (SOT) [12], [13] has also been used to evaluate balance in these populations, allowing an objective assessment of sensory and motor components of posture control. The SOT evaluates the use of sensory information through the measurement of postural sway during different experimental conditions. The reference values (baseline) for quiet standing balance on bipedal stance is assessed via a force platform with all three senses (visual, vestibular, and somatosensory) available. The other experimental conditions eliminate the visual input or distort information from the somatosensory and vestibular systems. For these latter conditions, the force platform and visual surroundings respond according to the oscillation of the subject’s center of pressure, respectively [14], [15]. Hence, postural sway measured by the force platform at the baseline is compared to the subsequent experimental conditions.
SOT-based normative data have been published for children aged 3 to 15 years living in the USA; in this population, younger children showed greater fluctuation in balance scores, and this fluctuation decreased inversely with the process of growth and development [15], [16]. Children at the age of 7 years showed no mature postural responses regarding postural sway during standing and using sensorial information [15].
Studies have shown lower performance regarding balance score in Brazilian children [5], [6], [7]. Although Brazil has a large territory with a diversified population in terms of race and ethnicity, to date, normative values for Brazilian children have not been made available. This investigation aims first to determine normative values for Brazilian children with typical development residents in the city of Florianópolis situated in the Santa Catarina (SC) State, Southern of Brazil; such findings are expected to help in the early detection of balance or posture control changes related to alterations in the sensorimotor system.
The main objective of this study was to establish the reference ranges for balance scores and to develop prediction equations for estimation of balance scores in children aged 8 to 12 years old. Regarding population-specific findings, we hypothesize that the differences in balance scores between Brazilian children from the southern region and children from other countries are related to economic and socio-cultural characteristics. Our second hypothesis is that the balance scores will improve with age and age will be the main predictor of variability in balance. To test these hypotheses, we will evaluate healthy boys and girls aged 8–12 years through the SOT to determine sex- and age-specific reference ranges.
Section snippets
Participants
The study recruited students of a public school in the city of Florianópolis, SC, Brazil. Firstly, the guardians were contacted and invited to enroll their children in the study. Those who agreed to have their children participate in the study signed an informed consent form, as required by the Ethics Committee in Research of UDESC, which approved the study (361 552). The sample size calculation was determined a priori using the G*Power software 3.1.7 with an alpha of 5% and a beta of 80%
Results
The process of recruiting children for this study is shown in Fig. 1. The characteristics of the 165 children recruited are described in Table 1. All children were classified as active making our sample homogeneous regarding physical activity. We found no difference in balance between boys and girls at different ages.
Using multiple linear regression analysis, the best combination of independent variables to estimate the balance scores for each SOT was identified. The BMI variable was not
Discussion
This study aimed to establish the reference ranges of balance scores for children aged between 8 and 12 years old. The measurement of balance scores can contribute to the assessment of the balance in children with typical and atypical development. Using a multiple linear regression model, this study described the relationship between the main independent predictors of balance.
Age was the best predictor that explained the balance score under all SOT conditions. When the variable of weight was
Conclusion
We have determined normative values for balance scores in boys and girls aged 8–12 years old. Balance score values increase linearly with age. Furthermore, our regression analysis demonstrated that, in healthy children, balance can be predicted as a function of age, as there was a strong association between this variable and balance scores. Our findings also suggest that, in older children, balance can be partially affected by height and weight. Age-related changes in balance control might be
Acknowledgements
Support from the Support Foundation for Scientific and Technological Research of the State of Santa Catarina (grant 2017TR764).
Grant support: National Counsel of Technological and Scientific Development − CNPq (Process number 479704/2013-9) and Support Foundation for Scientific and Technological Research of the State of Santa Catarina (Termo de Outorga 2015 TR661).
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2021, Gait and PostureCitation Excerpt :However, normative values for all preselected variables are presented for reference purposes by clinicians and researchers. Additionally, we have abstained from direct comparison of our inertial sensor derived values, due to limited studies reporting numeric reference values for static posturography [21] and because the majority of normative pediatric balance literature is force plate-based, presenting either a composite balance or equilibrium score [18,20,26,27] or data that cannot be directly compared to our values due to differing units or graphic representation [1–3,19,28–30]. There appear to be two positions within the literature regarding the impact of age on postural control maturation.
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