Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review

Abstract

We aimed to review tools used to assess balance in clinical practice in children and adults with cerebral palsy (CP), to describe their content and measurement properties and to evaluate the quality of the studies that have examined these properties. CINAHL, Embase, and PubMed/MEDLINE were searched. The COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) was used to assess the 'quality of studies' and the Terwee criteria were used to assess the 'result of studies'. Twenty-two clinical balance tools were identified from 35 papers. The content and focus of the tools varied significantly. There was moderate or limited levels of evidence for most of the measurement properties of the tools; the strongest level of evidence was found for the Trunk Control Measurement Scale and the Level of Sitting Scale, in the category 'maintain balance', the Timed Up and Go and the Segmental Assessment of Trunk Control in the categories 'achieve balance' and 'restore balance' respectively. Information on responsiveness was scarce. Further studies providing better evidence for reliability and responsiveness for clinical balance tools are needed. In the meantime, results of studies evaluating effects of treatment of balance in individuals with CP should be interpreted with caution.

Perspectives on Postural Control Dysfunction to Inform Future Research: A Delphi Study for Children With Cerebral Palsy

“…Health professionals were contacted from (1) the CPL and CP Alliance through the organization's representative; (2) members of the AusACPDM (nonmedical AusACPDM members, eg, lawyers or parents, were not contacted); and (3) authors of research articles about postural control who were identified in recent systematic reviews [8][9][10] and who have published contact details. Potential participants numbered approximately 711, based on the number of invitations disseminated (fig 1).…”

“…Respondents who submitted Round 1 also gave consent to participate in subsequent rounds. Round 1 contained open-ended questions constructed by the authors (box 1) based on theoretical principles of postural control and systematic reviews of postural control assessments, 8,9 interventions, 10 and approaches. 10 The questions sought responses for postural control (1) definitions; (2) framework for development, assessment, and intervention; (3) assessments; and (4) interventions for children with CP.…”

“…This analysis was reviewed and confirmed by the other authors. These items were combined with those identified in the systematic reviews [8][9][10] to form the Round 2 item list. Round 2 (week 8) and 3 (week 20 after initial mail out) were subsequently e-mailed to all Round 1 respondents (see fig 1).…”

“…Two systematic reviews of clinical 8 and laboratory-based 9 postural control assessments for children with CP (both published in 2013) identified 3 laboratory tools and 22 different clinical assessments of postural control used in this population. Results support validity and reliability of laboratory tools such as forceplates, electromyography, and kinematic analysis.…”

“…9 However, clinical assessment measures had limited psychometric evidence, and the psychometrics for assessment batteries that differentiate the components of postural control remain to be examined. 8 The extent to which recommended assessments have been translated into clinical practice is unknown. Furthermore, the systematic review 10 of postural control interventions for children with CP in 2015 identified that clinical assessment measures have rarely been used as outcome measures for clinical trials.…”