Aim The aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP). Method A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology. Six databases were searched using the following keywords: (‘cerebral palsy’ OR ‘brain injury’); AND (‘postur*’ OR ‘balance’ OR ‘postural balance’ [MeSH]); AND (‘intervention’ OR ‘therapy’ OR ‘exercise’ OR ‘treatment’). Articles were evaluated based on their level of evidence and conduct. Results Searches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with CP. Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no‐BWS), trunk‐targeted training, and reactive balance training. Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high‐level evidence. Interpretation The use of exercise‐based treatments to improve postural control in children with CP has increased significantly in the last decade. Improved study design provides more clarity regarding broad treatment efficacy. Research is required to establish links between postural control impairments, treatment options, and outcome measures. Low‐burden, low‐cost, child‐engaging, and mainstream interventions also need to be explored.

This study evaluated the intra-rater, inter-rater and test-retest reproducibility of the FullBESTest and Mini-BESTest when assessing postural control in children. Thirty-four children aged 7-17 years participated in intra-rater and inter-rater evaluation, and 22 children repeated assessment six weeks later for evaluation of test-retest reliability.Postural control was assessed using the Full Balance Evaluation Systems Test (FullBESTest) and the short-form Mini-BESTest. Intra-rater, inter-rater and test-retest reproducibility were examined using video assessment. Test-retest reproducibility was also assessed in real-time. Reproducibility was examined by agreement and reliability statistics. Agreement was calculated using percentage of agreement, Limits of Agreement and Smallest Detectable Change. Reliability was calculated using Intra-class Correlation Coefficients. Results showed that the reliability of Total Scores was excellent for the Full-BESTest for all conditions (all ICCs>0.82), whereas the MiniBESTest ranged from fair to excellent (ICC=0.56 to 0.86). Percentage of Domain Scores with good-excellent reliability (ICCs>0.60) was slightly higher for the FullBESTest (66%) compared to the Mini-BESTest (59%). Smallest Detectable Change scores were good to excellent for the Full-BESTest (2% to 6%) and for the BESTest (5% to 10%) relative to total test scores. Both the Full-BESTest and MiniBESTest can discriminate postural control abilities within and between days in schoolaged children. The Full-BESTest has slightly better reproducibility and a broader range of items, which could be the most useful version for treatment planning. We propose minor modifications are recommended to improve reproducibility for children, and indicate the modified version by the title Kids-BESTest. Future psychometric research is recommended for specific paediatric clinical populations.

Objective: To identify whether consensus can be achieved in how clinicians and researchers define, describe, assess, and treat postural control dysfunction in children with cerebral palsy (CP). Design: Delphi study with 3 iterative rounds. Setting: Electronic survey. Participants: Researchers and/or clinicians (NZ43) from 7 countries with a mean AE SD of 20AE11 years of experience working with children with CP participated. Participants included authors of published works on postural control in CP (identified from a recent systematic review

Running Head: Reproducibility of the Kids-BESTest for CP Reproducibility of the Kids Balance Evaluation Systems Test (Kids-BESTest) and the Kids-Mini-BESTest for children with cerebral palsy

Purpose: Evaluate validity of the Clinical Test of Sensory Integration of Balance (CTSIB) when scored using Kids-Balance Evaluation Systems Test (Kids-BESTest) criteria compared to laboratory measures of postural control. Method: Participants were 58 children, 7-18 years, 17 with ambulant CP (Diplegia=4, Hemiplegia=13; 11 males) and 41 typically developing (TD). Postural control in standing was assessed using CTSIB items for firm and foam surfaces, with eyes open (EO) then closed (EC). Face validity was evaluated by comparing clinical Kids-BESTest scores between groups, from 0='unable' to 3='stable for 30s'. Concurrent and content validity were assessed by evaluating force plate centre-of-pressure (CoP) data (excursion, velocity, area) and correlating this with clinical scores.Results: Face validity: TD children scored 2-3 points for all CTSIB conditions, whereas children with CP scored lower (0-3 points). Concurrent validity: agreement between clinical and CoP derived scores ranged from poor to excellent (Firm-EO=76%, Firm-EC=76%, Foam-EO=59%, Foam-EC=94%). Clinical scores of '2-unstable' and '3stable' were not distinguished reliably by force plate measures. Content validity for children with CP: significant correlations were found between clinical scores and CoP data for the two intermediate conditions (Firm-EC: rs -0.40 to -0.72; Foam-EO: rs -0.12 to -0.50), but not the easier (Firm-EO: rs -0.41 to -0.36) or harder conditions (Foam-EC: rs -0.25 to -0.27). Conclusion: Face validity of Kids-BESTest CTSIB criteria was supported. Content and concurrent validity were partially supported. To improve Kids-BESTest scoring, new terms were recommended to better describe postural characteristics of '2-unstable'. 3 Abbreviations Antero-posterior (AP) BOS (Base-of-support) Cerebral Palsy (CP) CoM (Centre-of-Mass) CoP (Centre-of-pressure) CTSIB (Clinical Test of Sensory Integration of Balance) EO (Eyes open) EC (Eyes closed) Kids-Balance Evaluation Systems Test (Kids-BESTest) Medio-lateral (ML) Typically Developing (TD)