Elsevier

Gait & Posture

Volume 60, February 2018, Pages 122-127
Gait & Posture

Full length article
Reference values and equations reference of balance for children of 8 to 12 years

https://doi.org/10.1016/j.gaitpost.2017.11.004Get rights and content

Highlights

  • Definition of normative values of balance for children 8 to 12 years.

  • With increasing age increases balance.

  • Definition of equations of reference values of balance for children 8 to 12 years.

Abstract

Purpose

There are still no normative data in balance sway for school-age children in Brazil. We aimed 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.

Methods

The study included 165 healthy children (83 boys and 82 girls; age, 8–12 years) recruited from a public school in the city of Florianópolis, Santa Catarina, Brazil. We used the Sensory Organization Test to assess the balance scores and both a digital scale and a stadiometer to measure the anthropometric variables. We tested a stepwise multiple-regression model with sex, height, weight, and mid-thigh circumference of the dominant leg as predictors of the balance score.

Results

For all experimental conditions, girls’ age accounted for over 85% of the variability in balance scores; while, boys’ age accounted only 55% of the variability in balance scores. Therefore, balance scores increase with age for boys and girls.

Conclusion

This study described the ranges of age- and sex-specific normative values for balance scores in children during 6 different testing conditions established by the sensory organization test. We confirmed that age was the predictor that best explained the variability in balance scores in children between 8 and 12 years old. This study stimulates a new and more comprehensive study to estimate balance scores from prediction equations for overall Brazilian pediatric population.

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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