Permalink: Title: Ghent developmental balance test, manual ISBN: 429 Author: De Kegel, Alexandra UGentVan Waelvelde, HildeLaroy, Peter editor Publisher: Ghent Academia Press 2009 Summary: Balance is a fundamental component of movement, involving the ability to recover from instability and to avoid instability, to anticipate balance disturbances. Various developmental motor disorders cause poor balance, resulting in difficulties with postural control and disturbing the development of numerous activities of daily living. To plan interventions for these young children with motor disabilities, a specific measure to evaluate balance is an essential part of the assessment.Most of the standardized developmental motor tests encompass balance tasks. However the isolated balance items can not be interpreted. Therefore, we aim to develop a new assessment tool to evaluate balance from independent walking to 6 years of age. The Ghent Developmental Balance Test aims at offering a complete developmental series of tasks, reflecting specifically the development of the child’s balance abilities. This test is fit for typically developing children between 18 months and six years zero months or for children with a similar level of balance control.
Classification: B1 Subject: Medicine and Health Sciencespre school childrenassessment of balance E-Location: fullText acapressinhoudtestmotorischgestoorden45097.pdf ugent Object id: 1854/LU-1182607. De Kegel A, Van Waelvelde H. Ghent developmental balance test, manual. Laroy P, editor. Ghent: Academia Press; 2009.
RIS: TY - BOOKUR -pugLA - engTI - Ghent developmental balance test, manualPY - 2009SN - 429PB - Ghent Academia Press 2009AU - De Kegel, Alexandra UGent 58135AU - Van Waelvelde, Hilde GE020-0002-7330-7615AU - Laroy, Peter editorAB - Balance is a fundamental component of movement, involving the ability to recover from instability and to avoid instability, to anticipate balance disturbances. Various developmental motor disorders cause poor balance, resulting in difficulties with postural control and disturbing the development of numerous activities of daily living. To plan interventions for these young children with motor disabilities, a specific measure to evaluate balance is an essential part of the assessment.Most of the standardized developmental motor tests encompass balance tasks. However the isolated balance items can not be interpreted.
Therefore, we aim to develop a new assessment tool to evaluate balance from independent walking to 6 years of age. The Ghent Developmental Balance Test aims at offering a complete developmental series of tasks, reflecting specifically the development of the child’s balance abilities. This test is fit for typically developing children between 18 months and six years zero months or for children with a similar level of balance control.ER. Permalink: 00000nam^a2200301^i^7.s2009-eng-020a 429024a 1854/LU-1182607 2 handle040a UGent245a Ghent developmental balance test, manual260a Ghent b Academia Press c 2009520a Balance is a fundamental component of movement, involving the ability to recover from instability and to avoid instability, to anticipate balance disturbances. Various developmental motor disorders cause poor balance, resulting in difficulties with postural control and disturbing the development of numerous activities of daily living.
To plan interventions for these young children with motor disabilities, a specific measure to evaluate balance is an essential part of the assessment.Most of the standardized developmental motor tests encompass balance tasks. However the isolated balance items can not be interpreted. Therefore, we aim to develop a new assessment tool to evaluate balance from independent walking to 6 years of age.
The Ghent Developmental Balance Test aims at offering a complete developmental series of tasks, reflecting specifically the development of the child’s balance abilities. This test is fit for typically developing children between 18 months and six years zero months or for children with a similar level of balance control.598a B1700a De Kegel, Alexandra u UGent 0 51 0 35 0 91 9 F5A69228-F0ED-11E1-A9DE-61C894A0A6B4700a Van Waelvelde, Hilde u GE37 0 77 0 74 0 0000-0002-7330-7615 9 F7D311A2-F0ED-11E1-A9DE-61C894A0A6B4700a Laroy, Peter e editor650a Medicine and Health Sciences653a pre school children653a assessment of balance8563 fullText u z ugent y acapressinhoudtestmotorischgestoorden45097.pdf920a bookZ30x GE 1 GE24922a UGENT-GE.
Background: Current clinical balance assessment tools do not aim to help therapists identify the underlying postural control systems responsible for poor functional balance. By identifying the disordered systems underlying balance control, therapists can direct specific types of intervention for different types of balance problems.Objective: The goal of this study was to develop a clinical balance assessment tool that aims to target 6 different balance control systems so that specific rehabilitation approaches can be designed for different balance deficits. Balance deficits are one of the most common problems treated by physical therapists.
Therapists need to identify who has a balance problem and then decide the best approach to rehabilitation. Current standardized clinical balance assessment tools are directed at screening for balance problems and predicting fall risk, particularly in elderly people. – These tools identify which patients may benefit from balance retraining, but they do not help therapists decide how to treat the underlying balance problems. Besides not being aimed at guiding treatment, the current balance assessment tools were developed specifically for older adults with balance problems. This article presents a new balance assessment tool developed to help physical therapists identify the underlying postural control systems that may be responsible for poor functional balance so that treatments can be directed specifically at the abnormal underlying systems.Although many clinical tests are designed to test a single “balance system,” balance control is very complex and involves many different underlying systems. – Whereas previous motor control models assumed postural control consisted of heirarchical righting and equilibrium reflexes, we wanted to develop a clinical test of balance control based on Bernstein's concept that postural control results from a set of interacting systems. Model summarizing systems underlying postural control corresponding to sections of the Balance Evaluation Systems Test (BESTest).summarizes the performance tasks grouped under each postural system for the BESTest.
The entire BEStest with scoring, examiner, and patient instructions is presented in the. The performance tasks are grouped to reveal function or dysfunction of a particular system underlying balance control (see reviews by Horak and colleagues – ). Here, we briefly summarize the role of these systems in balance control and how each task item is related to its system. ACoM=center of mass, ROM=range of motion, CTSIB=Clinical Test of Sensory Integration for Balance, EO=eyes open, EC=eyes closed.I.
Biomechanical Constraints: Biomechanical constraints for standing balance include the quality of the base of foot support (item 1), geometric postural alignment (item 2), functional ankle and hip strength (force-generating capacity) for standing (items 3 and 4), and ability to rise from the floor to a standing position (item 5).II. Stability Limits/Verticality: This system includes items for an internal representation of how far the body can move over its base of support before changing the support or losing balance, as well as an internal perception of postural vertical., The ability to lean as far as possible in a sitting position with eyes closed (item 6) provides a measure of lateral limits of stability in a sitting posture, and the ability to realign the trunk and head back to perceived vertical (item 6) provides a measure of internal representation of gravity. The ability to reach maximally forward and laterally while standing (items 7 and 8) represents the functional limits of stability, although this may not necessarily be correlated with how far a person can lean the body's center of mass when not reaching.,III. Anticipatory Postural Adjustments: This system includes tasks that require an active movement of the body's center of mass in anticipation of a postural transition from one body position to another. For example, we include the transitions from a sitting to a standing position (item 9), from normal stance to stance on toes (item 10), and from 2-legged- to 1-legged stance (item 11).
Item 12 involves repetitive weight shifting from leg to leg in anticipation of tapping a forefoot on a stool, and item 13 involves anticipatory postural adjustments prior to rapid, bilateral arm raises with a weight.,IV. Postural Responses: Reactive postural responses include both in-place and compensatory stepping responses to an external perturbation induced by the examiner's hands using the unique “push and release” technique.
To induce an automatic postural response with the patient's feet in place (ankle or hip strategy), the tester pushes isometrically against either the front (item 14) or back (item 15) of the patient's shoulders until either the toes or the heels just begin to raise without changing the initial position of the body's center of mass over the feet before suddenly letting go of the push. To induce compensatory stepping responses, the tester requires a forward (item 16) or backward (item 17) or lateral (item 18) lean of the patient's center of mass over the base of foot support prior to release of pressure, requiring a fast, automatic step to recover equilibrium.,V. Sensory Orientation: This system identifies any increase in body sway during stance associated with altering visual or surface somatosensory information for control of standing balance. Item 19 is the modified Clinical Test of Sensory Integration for Balance (CITSIB), and item 20 involves standing on a 10-degree, toes-up incline with eyes closed.VI. Stability in Gait: This system includes evaluation of balance during gait (item 21) and when balance is challenged during gait by changing gait speed (item 22), by head rotations (item 23), by pivot turns (item 24), and by stepping over obstacles (item 25). This section also includes the Timed “Get Up & Go” Test, which evaluates how fast a patient can sequence rising from a chair, walking 3 m, turning, and sitting back down again without (item 26) and with (item 27) a secondary cognitive task to challenge the patient's attention.Although several separate neural systems underlie control of balance, each task may involve more than one system that interacts with others.
For example, the task of tapping alternate feet onto a stair (item 12) is placed in the “Anticipatory Postural Adjustments” system because it requires adequate anticipatory postural weight shifting from one leg to the other. However, it also requires an adequate base of support and strength in the hip abductors (“Biomechanical Constraints” system). Interactions among systems can be seen by how a single pathology, such as abnormal vestibular function, will likely affect several tasks, such as the ability to stand on foam with eyes closed (item 19 in the “Sensory Orientation” system) and the ability to rotate the head while walking (item 23 in the “Stability in Gait” system). Future studies are needed to determine the extent to which postural system problems cluster, such that disorders in each system can be differentiated in the clinic.The purpose of this article is to present the BESTest, with its theoretical framework and its first interrater reliability and concurrent validity analysis. This is the first step in maximizing the psychometric properties of this new balance assessment tool. Development of the BESTestThe conceptual framework for developing a balance assessment tool that separates control of balance into its underlying systems is based on the scientific literature about laboratory measures of postural disorders in elderly people and in people with neurological disorders.
– The principle of having physical therapists evaluate 6 subcomponent systems underlying balance function initially was suggested as a qualitative assessment by Horak and Shumway-Cook in their continuing medical education courses between 1990 and 1999. –, After Horak and Frank developed the BESTest, thousands of experienced physical therapy clinicians contributed to continued development of the BESTest by providing feedback about clarity, sensitivity, and practicality of items across 38 continuing education workshops delivered by Horak between 1999 and 2005. Following 2 days of didactic and observational training in the test, therapists in the workshops practiced performance of the test on each other and provided critical feedback to improve the clarity and specificity of instructions to patients and therapists. Some of the balance tasks in the test have been borrowed from current assessment tools, although they are now placed within our theoretical framework and the therapist and patient instructions, and most of the rating scales have been modified to improve consistency and reliability. This is the first balance assessment tool to include a clinical method for assessing postural responses to external perturbations (section IV) and verticality (section II).
ACTSIB=Clinical Test of Sensory Interaction on Balance, EO=eyes open, EC=eyes closed.The BESTest consists of 27 tasks, with some items consisting of 2 of 4 subitems (eg, for left and right sides), for a total of 36 items. Each item is scored on a 4-level, ordinal scale from 0 (worst performance) to 3 (best performance). Scores for the total test, as well as for each section, are provided as a percentage of total points. Specific patient and rating instructions and stopwatch and ruler values are used to improve reliability (see the for the full test). Session 1: Raters and SubjectsTo evaluate the interrater reliability and internal consistency of the original version of the BESTest (current sections II–VI), we recruited 12 ambulatory adults with a wide range of balance function.
Subjects were recruited as a sample of convenience from individuals who previously had participated in research studies on balance and postural control. No subjects had completed the BESTest prior to the first session. However, subjects may have completed specific items that were adapted from other clinical tests such as the Dynamic Gait Index. For this session, we included 3 subjects with PD, 5 subjects with vestibular dysfunction (3 with bilateral loss, 2 with unilateral loss), 1 subject with peripheral neuropathy and a total hip arthroplasty, and 3 subjects who were healthy (controls).
All subjects met the following inclusion criteria: (1) ability to follow 3-step commands, (2) ability to provide informed consent, (3) ability to ambulate 6 m (20 ft) without human assistance, and (4) ability to tolerate the balance tasks without excessive fatigue. Subjects were provided short rest breaks as needed. The subjects (5 female, 7 male) ranged in age from 50 to 80 years ( X ̄=63, SD=10).
Balance Test For Vertigo
Descriptive information for the subjects who completed the BESTest is listed in. None of the subjects used an assistive device during the testing. ABESTest=Balance Evaluation Systems Test. ABC Scale=Activities-specific Balance Confidence Scale, OP=outpatient, IP=inpatient, F=female, M=male, UVL=unilateral vestibular loss, BVL=bilateral vestibular loss, PD=Parkinson disease, PNP=peripheral neuropathy, THA=total hip arthroplasty, NA=not applicable. Asterisk indicates participation in both sessions.The 9 raters consisted of a convenience sample of 6 physical therapists from various practice settings and 3 Doctor of Physical Therapy students from Pacific University (mean age=33.1 years, SD=4.7; 3 male, 6 female; ). Physical therapists were included if they had a valid Oregon physical therapist license, and physical therapist students were included if they had completed the relevant course work in relation to the evaluation and treatment of balance disorders.
Session 2: Raters and SubjectsAfter initial analysis of the first reliability data, a second testing session 18 months later evaluated the interrater reliability of a newly developed section I (“Biomechanical Constraints”) and a revised section VI (“Stability in Gait”). Section VI was revised due to a low intraclass correlation coefficient (ICC 2,1=.54) obtained in the first session. The goals of this second testing session were to improve the reliability of section VI by modifying the criteria for scoring and requiring raters to view subjects from the front or back while walking and to add section I on biomechanical constraints affecting postural control. Testing session 2 involved 11 raters, including 3 raters from the first session (denoted by asterisks in ). No students were included, although 2 raters were PhD researchers in human balance disorders without any physical therapy training or experience.
Eleven subjects, including 4 subjects from the first session, were administered 2 sections of the BESTest. As in the first session, subjects were a sample of convenience recruited from individuals who had previously participated in laboratory studies but who had no experience with the BESTest. Subjects in session 2 met the same inclusion criteria as in session 1. The subjects consisted of 6 subjects who were healthy (controls), 1 subject with unilateral vestibular loss, 1 subject with bilateral vestibular loss, 2 subjects with PD, and 1 subject with both peripheral neuropathy and bilateral hip arthroplasty. The subjects (5 female, 6 male) ranged in age from 67 to 88 years ( X ̄=75, SD=7.6).The data and analysis from sections I through IV (current sections II–V) of session I and the new section I and revised section VI from session 2 are presented in this article. For both sessions, each subject completed an informed consent statement according to the Declaration of Helsinki.
ProcedureAll raters were provided with the BESTest and written instructions for administering the test approximately 1 week prior to the session. On the day of the study, the raters participated in a 45-minute training session with one of the developers of the BESTest (FBH). For training raters, each item of the BESTest was demonstrated on a subject who did not participate in the reliability study, and the rating criteria were discussed.
The raters were allowed to ask questions regarding the scoring of the test. However, the raters were instructed to rate each outcome with no assistance or discussion with the other raters. The BESTest took 20 to 30 minutes to administer.During the experimental sessions, the raters were asked to concurrently rate each of the subjects. In both sessions 1 and 2, one of the authors (FBH), who was not one of the raters, administered the BESTest once for each subject while the raters observed. The raters were allowed to position themselves around the area where the subjects were performing the test and to move about as needed in order to optimally view the subjects’ performance for recording the outcome. Only one opportunity was provided to view the performance of each test item.
If a rater missed the performance of an item, the item was repeated (3 items for session 1 and 1 item for session 2), and all of the raters scored the second performance for consistency. Raters were provided with separate scoring sheets for each subject and did not discuss scoring among subjects. The raters were instructed to rate each outcome independently, with no assistance from or discussion with the other raters. The diagnoses of the subjects who completed the BESTest were masked from the raters.To begin to describe concurrent validity, subjects completed the Activities-specific Balance Confidence (ABC) Scale. The ABC Scale quantifies how confident a person feels that he or she will not lose balance while performing 16 activities of daily living. The ABC Scale has demonstrated test-retest reliability ( r=.92).
Scores on the ABC Scale range from 0, indicating no confidence, to 100, indicating complete confidence in the person's ability to perform the task without losing balance. Scores on the ABC Scale have been correlated with ratings of older adults’ level of community function. Data AnalysisInterrater agreement for individual BESTest items was determined using the Kendall coefficient of concordance for ordinal data. Concurrent validity was assessed by analyzing the correlation of the BESTest total and subsection scores of the rater with the most exposure to the BESTest (DMW) with the ABC Scale scores using the Spearman correlation coefficient. Coefficients of.00 to.25 were interpreted to indicate little to no relationship,.25 to.50 as a fair relationship,.50 to.75 as a moderate to good relationship, and above.75 as a strong relationship., A Mann-Whitney U test was used on the ranking of BESTest total scores (of the rater with the most exposure to the BESTest) among subjects to determine whether the 3 controls scored better than the 7 subjects with balance problems. Interrater ReliabilityInterrater reliability statistics for BESTest total and subsection scores are presented in. The interrater reliability of the BESTest total scores was excellent, with an ICC (2,1) of.91.
Subsection ICCs ranged from.79 to.96, and Kendall coefficients ranged from.79 to.95, indicating good to excellent reliability. Reliability statistics for individual BESTest items are presented in. Individual items demonstrated Kendall coefficients ranging from.46 to 1.00. Items based on stopwatch time, such as items in section V (“Sensory Orientation”), tended to show the highest concordance, whereas judgments of alignment, ankle strength, and sitting limits of stability and verticality tended to show the lowest concordance.
Only 3 items could not have concordance measured accurately because of limited variability among subjects (denoted by asterisks in ). All raters scored all subjects as excellent (score of 3) on standing arm raise, and they scored the majority of subjects as excellent on the alternate stair touch (92%) and stance with eyes open (98%).
AICC=intraclass correlation coefficient, CI=confidence interval.The ICCs for the BESTest total scores were.94 among the 3 students and.87 among the 6 therapists. The ICCs for each item within section VI (“Stability in Gait”) improved for the second interrater testing session compared with the first session, by instructing raters to view the subjects’ gait from the front or back rather than from the side. The ICCs for the BESTest total scores for items in section VI increased from.54 to.88, with the range of Kendall coefficients for individual items of.51 to.72 for the first interrater testing session increasing to a range of.62 to.90 for the second interrater testing session.
Test PerformanceThe subjects showed a wide range of variability on their performance of the test. Presents the median and interquartile ranges of BESTest total scores (expressed as percentages) across diagnostic categories. Median scores of all subjects ranged from 65% to 95%, with control subjects clustered at the high end and subjects with PD clustered at the low end.
The Mann-Whitney U test showed that control subjects scored significantly higher (better) than the subjects with balance problems ( P=.036). Median and interquartile range of Balance Evaluation Systems Test (BESTest) total scores across diagnostic categories for sections II through VI in testing session 1. Note the variation in scores among subjects tested. UVL=unilateral vestibular loss, BVL=bilateral vestibular loss, PD=Parkinson disease, PNP=peripheral neuropathy.Consistent with our theoretical construct, the scores for each BESTest section by diagnostic subgroup show that the subjects with unilateral vestibular loss scored the worst in section V (“Sensory Orientation”) (60%), whereas the subjects with PD scored the worst in section IV (“Postural Responses”) (50%). The 1 subject with neuropathy scored the worst on section III (“Anticipatory Postural Adjustments”). Although this score was similar to that of the subjects with unilateral vestibular loss (67% versus 69%), the subject with neuropathy could be distinguished by a much higher score on section V (“Sensory Orientation”) (93% versus 60%) and a higher BESTest total score (79% versus 73%). ABVL=bilateral vestibular loss, PNP=peripheral neuropathy, UVL=unilateral vestibular loss, PD=Parkinson disease.The most difficult items for our subjects were: single-limb stance, stance on foam with eyes closed, Timed “Get Up & Go” Test with a cognitive task, walk with horizontal head turns, backward in-place postural responses, and standing hip strength.
In one item (standing arm raise), all subjects had perfect scores; the other least-difficult items included stance with eyes open, alternate stair touch, sitting verticality and leans, and stance with eyes closed. Sorted by difficulty, the mean score (SD) and the frequency of how often a score was given for an individual item are summarized in.
Variability among subjects and raters provided a wide range of scores across BESTest items. Concurrent Validity With ABC ScaleThe BESTest total scores correlated significantly with each subject's balance confidence, as measured by the subject's average ABC Scale score ( r=.685, r 2=.47, P. Discussion and ConclusionsThis study presents a new clinical balance assessment tool that is the first tool aimed at distinguishing the underlying systems that may be contributing to balance problems in individual patients. By distinguishing which systems underlying balance control are affected, this is the first clinical balance assessment tool to help direct rehabilitation of people with balance disorders.
The most important contribution of the BESTest is to provide a conceptual framework around which to evaluate and treat patients with different types of balance problems.Most existing clinical balance tests are directed at predicting fall risk or whether a balance problem exists, rather than what type of balance problem exists. – Although these tests have proven valid in predicting the likelihood of future falls, with sensitivity and specificity values of 80% to 90%, the test results do not help therapists direct treatment.
– Lord et al developed a different type of test, directed at identifying physiological impairments that could affect balance, such as impaired proprioception, visual function, or reaction time delays. Although the test is helpful for understanding the physiological reasons for balance problems, it is not apparent how to translate many of the impairments into specific balance exercise programs. Identification of impairments may help to identify the pathology, such as peripheral neuropathy or vestibular loss, that may be responsible for the balance problem. LimitationsThis study had several limitations. It is possible that other systems important for balance control are missing from the test and only the last item is related to cognitive constraints on balance, and this may be inadequate. Whether or not the sections of the BESTest accurately detect dissociable balance deficits remains to be investigated to establish its construct validity.
How well section III (“Postural Responses”) and section IV (“Sensory Orientation”) are related to similar measures using computerized posturography is unknown. Sections I and II should be revised to improve their test-retest reliability. In addition, the test is quite long, such that future clinimetric studies need to identify redundant, insensitive items for a more efficient clinical tool.
We also do not know how sensitive the BESTest is to change with intervention.Further psychometric testing is warranted for the BESTest to establish its construct and concurrent validity, sensitivity and specificity, and ability to direct effective treatment for people with balance disorders. The scale is quantitative, and scoring is reproducible both for the test as a whole and for its subsections, as demonstrated by agreement among raters with varying experience. The BESTest appears to be testing functionally relevant aspects of balance control as seen by the agreement with subjects’ self-reported balance confidence. However, success of the BESTest will depend on how useful it is in assisting therapists to organize their systematic assessment of balance disorders to develop specific treatments based on each individual's balance constraints. NotesAll authors provided concept/idea/project design and writing. Dr Horak and Dr Wrisley provided data collection and analysis, project management, fund procurement, and subjects. Dr Horak provided facilities/equipment, institutional liaisons, and clerical support.
Dr Horak and Dr Frank provided consultation (including review of manuscript before submission).The authors thank Larry Meyer and Trent Thompkins for collecting data on the first interrater reliability study as part of their Doctor of Physical Therapy thesis, as well as all of the subjects and raters who participated in this study. The authors also are indebted to the physical therapists who provided helpful criticisms of early versions of the test in continuing education workshops by Dr Horak. Statistical support from Dr George Knafl and Dawn Peters also is appreciated.This work was supported by the National Institute on Aging grant R0-1 AG006457.Poster presentations of this research were given at the Combined Sections Meetings of the American Physical Therapy Association; February 4–8, 2004; Nashville, Tennessee; and February 23–27, 2005; New Orleans, Louisiana.The BESTest Training DVD is distributed through Oregon Health and Science University's Technology and Research Collaborations Office and is available via a nonexclusive license.
92 (6).p.841-852 Author( UGent),( UGent),( UGent),( UGent),( UGent)and( UGent)Organization.Abstract Background: Balance is a fundamental component of movement. Early identification of balance problems is important to plan early intervention. The Ghent Developmental Balance Test (GDBT) is a new assessment tool to monitor balance from the moment of independent walking to 5 years of age.Objective: The purpose of this study was to establish the psychometric characteristics of the GDBT.Methods: To evaluate test-retest reliability, 144 children were tested twice on GDBT by the same examiner, and to evaluate inter-rater reliability, videotaped GDBT test sessions of 22 children were rated by 3 different raters. To evaluate the known-group validity of GDBT, z-scores on GDBT were compared between a clinical group (n=20) and a matched control group (n=20). Subject Year 2012 Publication typejournalArticle(original)Publication status publishedJournal titlePhys. ISSN Volume 92 Issue 6 Pages 841 - 852 DOI Language UGent publication?
Yes UGent classification Web of Science type Article Web of Science id JCR category JCR impact factor 2.778 (2012) JCR rank 5/63 (2012) JCR quartile 1 (2012) Copyright statement I have transferred the copyright for this publication to the publisher id 2119984 Handle Date created 2012-05-30 09:52:30 Date last changed 2018-11-13 14:54:31.
MethodsTo evaluate test-retest reliability, 144 children were tested twice on the GDBT by the same examiner, and to evaluate interrater reliability, videotaped GDBT sessions of 22 children were rated by 3 different raters. To evaluate the known-group validity of GDBT scores, z scores on the GDBT were compared between a clinical group (n=20) and a matched control group (n=20). Concurrent validity of GDBT scores with the subscale standardized scores of the Movement Assessment Battery for Children–Second Edition (M-ABC-2), the Peabody Developmental Motor Scales–Second Edition (PDMS-2), and the balance subscale of the Bruininks-Oseretsky Test–Second Edition (BOT-2) was evaluated in a combined group of the 20 children from the clinical group and 74 children who were developing typically. ResultsTest-retest and interrater reliability were excellent for the GDBT total scores, with intraclass correlation coefficients of.99 and.98, standard error of measurement values of 0.21 and 0.78, and small minimal detectable differences of 0.58 and 2.08, respectively. The GDBT was able to distinguish between the clinical group and the control group ( t 38=5.456, P.
Balance or postural stability is a fundamental component of movement, involving the ability to recover from instability and the ability to anticipate as well as to move in ways to avoid instability. It is the complex ability to maintain the body's center of gravity over the base of support while a person is stationary, in motion, or preparing to move or to stop moving.
Interrater ReliabilityThe within-subjects effects for repeated measures of the total score showed a significant difference among the evaluations of the 3 raters (F 2,42=5.032, P=.014). Shows the interrater reliability of the total score, which was excellent, with an ICC of.98 and a SEM of 0.78, resulting in an MDD of 2.08.
Presents the interrater reliability of the item scores, which showed good to very good agreement among the raters, with weighted kappa values higher than 0.64 for most items. Only items 34 and 35 showed moderate to good agreement (weighted kappa values between 0.38 and 0.81) among the raters. No weighted kappa values could be calculated for items 1 to 11 and item 13 because of a skewed distribution.
Internal ConsistencyThe Cronbach alpha for the total score on the GDBT was.97. Known-Group ValidityA comparison between the clinical group and the 20 age- and sex-matched children with typical development showed no significant differences for age ( t 38=0.142, P=.888) or for sex (χ 2 1, N=40=0.0, P=1.0), but showed a significant difference for the total score ( t 38=5.401, P.
GroupM-ABC-2PDMS-2BOT-2Manual DexterityAiming and CatchingBalanceTotalStationaryLocomotionTotal group (n=48)0.48 (0.23 to 0.67)0.36 (0.08 to 0.58)0.69 (0.51 to 0.81)0.66 (0.46 to 0.80)0.60 (0.38 to 0.76)0.35 (0.07 to 0.58)0.80 (0.67 to 0.88)Clinical group (n=20)0.52(0.10 to 0.78)0.11 (−0.35 to 0.53)0.13 (−0.33 to 0.54)0.40 (−0.05 to 0.72)0.39 (−0.06 to 0.71)0.04 (−0.41 to 0.47)0.75 (0.46 to 0.90)Control group (n=28)0.17 (−0.22 to 0.55)0.23 (−0.16 to 0.56)0.50 (0.16 to 0.74)0.50 (0.16 to 0.74)0.72 (0.48 to 0.86)0.36 (−0.02 to 0.65)0.61 (0.31 to 0.80). GroupM-ABC-2PDMS-2BOT-2Manual DexterityAiming and CatchingBalanceTotalStationaryLocomotionTotal group (n=48)0.48 (0.23 to 0.67)0.36 (0.08 to 0.58)0.69 (0.51 to 0.81)0.66 (0.46 to 0.80)0.60 (0.38 to 0.76)0.35 (0.07 to 0.58)0.80 (0.67 to 0.88)Clinical group (n=20)0.52(0.10 to 0.78)0.11 (−0.35 to 0.53)0.13 (−0.33 to 0.54)0.40 (−0.05 to 0.72)0.39 (−0.06 to 0.71)0.04 (−0.41 to 0.47)0.75 (0.46 to 0.90)Control group (n=28)0.17 (−0.22 to 0.55)0.23 (−0.16 to 0.56)0.50 (0.16 to 0.74)0.50 (0.16 to 0.74)0.72 (0.48 to 0.86)0.36 (−0.02 to 0.65)0.61 (0.31 to 0.80). GroupM-ABC-2PDMS-2BOT-2Manual DexterityAiming and CatchingBalanceTotalStationaryLocomotionTotal group (n=48)0.48 (0.23 to 0.67)0.36 (0.08 to 0.58)0.69 (0.51 to 0.81)0.66 (0.46 to 0.80)0.60 (0.38 to 0.76)0.35 (0.07 to 0.58)0.80 (0.67 to 0.88)Clinical group (n=20)0.52(0.10 to 0.78)0.11 (−0.35 to 0.53)0.13 (−0.33 to 0.54)0.40 (−0.05 to 0.72)0.39 (−0.06 to 0.71)0.04 (−0.41 to 0.47)0.75 (0.46 to 0.90)Control group (n=28)0.17 (−0.22 to 0.55)0.23 (−0.16 to 0.56)0.50 (0.16 to 0.74)0.50 (0.16 to 0.74)0.72 (0.48 to 0.86)0.36 (−0.02 to 0.65)0.61 (0.31 to 0.80). GroupM-ABC-2PDMS-2BOT-2Manual DexterityAiming and CatchingBalanceTotalStationaryLocomotionTotal group (n=48)0.48 (0.23 to 0.67)0.36 (0.08 to 0.58)0.69 (0.51 to 0.81)0.66 (0.46 to 0.80)0.60 (0.38 to 0.76)0.35 (0.07 to 0.58)0.80 (0.67 to 0.88)Clinical group (n=20)0.52(0.10 to 0.78)0.11 (−0.35 to 0.53)0.13 (−0.33 to 0.54)0.40 (−0.05 to 0.72)0.39 (−0.06 to 0.71)0.04 (−0.41 to 0.47)0.75 (0.46 to 0.90)Control group (n=28)0.17 (−0.22 to 0.55)0.23 (−0.16 to 0.56)0.50 (0.16 to 0.74)0.50 (0.16 to 0.74)0.72 (0.48 to 0.86)0.36 (−0.02 to 0.65)0.61 (0.31 to 0.80). DiscussionThe present study aimed to establish the psychometric properties of the GDBT for children from the moment of independent walking until the age of 5 years. The GDBT showed excellent test-retest and interrater reliability for the total score, reflecting the balance performance of the child.
Notwithstanding the excellent test-retest reliability, the clinician who wants to monitor an individual child has to take into account the significant difference in performance throughout subsequent testing. This systematic error, probably attributable to a practice effect, should be considered carefully by the clinician, and frequent testing over short time periods should be avoided.The MDD represents the minimal change in the individual GDBT total score (ranging from 0 to 70) that reflects real change rather than measurement error. The minimal change in the GDBT total score between 2 test occasions conducted by the same examiner needs to be at least 0.58 above or below the total score before it can be concluded that an individual has really improved or worsened.
The GDBT total score showed a very small MDD, with a value even smaller than 1 point. However, the MDDs differed somewhat among the different age groups.
The largest MDD (ie, 1.77) was found in the youngest age group, although this value is still good.Regarding interrater reliability, we established a significant difference among the 3 raters. In addition, the MDD for interrater reliability of the GDBT total score was higher than those for test-retest reliability but was still acceptable. If the child is retested by another examiner, the clinician needs to be aware that a minimal change of at least 2.08 is needed to reflect a real change.The GDBT had high internal consistency, which means that all items measure the same underlying balance construct although each item measures a different developmental level.The known-group validity could be proved by the fact that the GDBT total score was significantly different between the clinical and control groups in this study. This result suggests that the test is able to differentiate between children with a higher risk for balance difficulties and children with typical development.In children aged 3 years and older, the GDBT total score showed a strong correlation with the balance subscale of the BOT-2 and moderate correlations with the balance subscale of the M-ABC-2 and the PDMS-2, confirming that the GDBT evaluates balance.
However, in the clinical group, the correlations with the balance subscale of the M-ABC-2 and the PDMS-2 were low. A possible explanation for the somewhat lower correlations of the GDBT with the balance subscale of the M-ABC-2 could be the “jumping on mats” item of the M-ABC-2, which requires jumping force, coordination, and timing. The lower correlation with the stationary subscale of the PDMS-2 could perhaps be explained by the fact that this subscale evaluates only static balance and encompasses curl-ups and push-ups. Furthermore, in children younger than 3 years, the association between the GDBT scores and scores on the stationary subscale of the PDMS-2 was very weak. The reason for this finding could be the developmental gap of the stationary subscale in the age range of 13 and 31 months, one of the reasons for which the GDBT was developed. The developmental gap can be confirmed by the fact that 88.7% of the children younger than 3 years in the validity part of the study had a raw score ranging between 37 and 39 on the stationary subscale of the PDMS-2, whereas the raw scores on the GDBT were equally spread between 8 and 29.The GDBT showed low correlations with the manual dexterity and aiming and catching subscales of the M-ABC-2 and the subscales of the PDMS-2 measuring constructs other than balance.
Those results confirm the discriminant validity of the GDBT. The strong correlation of the GDBT with the age of the children and the significant effect of age on the GDBT suggest a good developmental sequence of the test and confirm the construct validity.The GDBT is a test specific for children in the toddler and preschool age range. Notwithstanding concerns such as difficulty understanding instructions and the limited attention span of these young children, the GDBT showed excellent reliability. Dvd free software download. Thus, this young population is able to be tested reliably with the GDBT, probably because the test construction allows the therapist to adapt the test order to encourage the child and because the number of trials needed to perform the task is not restricted.To evaluate the test-retest reliability, the children were tested twice in the same week.
This short period was chosen because young children develop very fast, but it probably explains the systematic error between the 2 test occasions.The results of the interrater reliability analysis showed a significant difference among the ratings of the 3 assessors. This difference could not be explained by the experience of the raters in scoring the GDBT. All raters had no practical experience in scoring the test prior to the study, and they all learned to score the test by reading the manual thoroughly.
However, the aim was to evaluate a real-life use of the test whereby clinicians learn to score the test by the manual. The results showed that rater 3 scored consistently lower than raters 1 and 2. This finding could have been influenced by the fact that scoring was based on videotaped assessments. Observing and scoring a performance test from a videotape is different from observing a child in real life. When therapists examine a child in a clinical setting, they are free to take the best possible viewpoint. This advantage is not possible when a videotape is used, and this constraint certainly accounted for some of the errors found in this study. Items 34 and 35, in particular, showed the lowest agreement between rater 3 and the other 2 raters.
Those items evaluate the amount of time the child can stand with eyes closed on a line with the heel touching the toes. The difficulty in scoring those items based on videotapes was the inability to observe whether the children closed their eyes permanently and did not move their feet during the trial. Probably, if the observation was in real life, those items could show better agreement. Therefore, in future studies, we suggest evaluating the interrater reliability between 2 raters in a real-life context.The first items of the GDBT are especially relevant for children with balance disabilities. Those children learn to walk later than average, and in the beginning they have more difficulties in walking across unstable surfaces or over obstacles. Although the test can be used for children from the moment of independent walking until the age of 5 years, we started inclusion in the norm standardization sample from the age of 18 months because the moment of independent walking varies a lot in children who are developing typically.
As a consequence, most of the children in the reliability part of the study reached a maximum score on the first items, and reliability of those items could not be calculated because of a skewed distribution. In future studies, the reliability of the GDBT should be investigated in groups of children with motor and balance disabilities to determine in greater depth the reliability of the first items and how different motor patterns influence scoring and reliability.Based on the current norm standardization sample of 360 children with typical development, preliminary percentile scores can be calculated for clinical interpretation of the total score on the GDBT. However, before the test can be used for wider practice, the norm standardization sample must be enlarged and expanded to other countries. Because therapists can use this assessment tool to note a child's progress, continued research is needed to examine the responsiveness, sensitivity, and specificity of the GDBT. ConclusionsThe GDBT is a reliable and valid clinical measurement tool for the evaluation of balance in young children from the moment of independent walking until the age of 5 years.
It is inexpensive, quick to administer, and easily scored. The GDBT appears to be a promising outcome measurement tool to screen for balance difficulties and to plan intervention programs aimed at improving balance. The Bottom LineWhat do we already know about this topic?A review of the available tests for children within the age range of 18 months to 5 years revealed the lack of a tool to systematically monitor balance and necessitated the development of a new assessment tool. The Ghent Developmental Balance Test (GDBT) offers a complete series of tasks reflecting the development of a child's balance abilities in the toddler and preschool age range.What new information does this study offer?This study examined the reliability and validity of the GDBT. The test-retest and interrater reliability of the GDBT was excellent. Pearson correlations between the GDBT and balance subscales of other motor assessment tools confirm that the GDBT evaluates “balance.”If you're a caregiver, what might these findings mean for you?The GDBT is a reliable and valid clinical assessment tool for the evaluation of balance in toddlers and preschool children.
This test will help physical therapists accurately assess your child's balance. All authors provided concept/idea/research design. Ms De Kegel, Ms Baetens, Dr Maes, Dr Dhooge, and Dr Van Waelvelde provided writing. Ms De Kegel, Mr Peersman, and Dr Van Waelvelde provided data collection and analysis. Ms De Kegel provided project management, fund procurement, participants, institutional liaisons, and clerical support. Ms De Kegel, Dr Dhooge, and Dr Van Waelvelde provided facilities/equipment.
Ms De Kegel, Mr Peersman, Dr Dhooge, and Dr Van Waelvelde provided consultation (including review of manuscript before submission).
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