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. 2019 Feb 1;99(2):217-228.
doi: 10.1093/ptj/pzy132.

Developmental Trajectories for the Early Clinical Assessment of Balance by Gross Motor Function Classification System Level for Children With Cerebral Palsy

Alyssa LaForme Fiss  1 , Sarah Westcott McCoy  2 , Doreen Bartlett  3 , Lisa Avery  4 , Steven E Hanna  5 ; On Track Study Team
Affiliations

Developmental Trajectories for the Early Clinical Assessment of Balance by Gross Motor Function Classification System Level for Children With Cerebral Palsy

Alyssa LaForme Fiss et al. Phys Ther. .

Abstract

Background: Children with cerebral palsy (CP) characteristically present with impairments in balance. Currently, the pattern and timing of the development of balance ability have not been described for children with CP of varying Gross Motor Function Classification System (GMFCS) levels.

Objective: The purpose of this study was to document longitudinal developmental trajectories in a measure of balance, the Early Clinical Assessment of Balance (ECAB) scores, along with age-specific reference percentiles and the amount of change typical over a 1-year period for children within different GMFCS levels.

Design: The design was a longitudinal cohort study.

Methods: Participants included 708 children with CP, aged 18 months through their 12th birthday, and their families. Children participated in 2 to 5 assessments using the GMFCS and ECAB.

Results: Longitudinal trajectories describing the average change in the ECAB score with respect to age were created by fitting separate nonlinear mixed-effect models for children in each GMFCS level. Reference percentiles were constructed using quantile regression of ECAB data from the first visit (baseline) and 12-month and 24-month visits. Using these reference points, the amount of change in percentiles was calculated for all children by subtracting the baseline percentile score from the 12-month percentile score. Children whose percentile changes are within the 80% limits can usually be described as "developing as expected" for their age and GMFCS levels.

Limitations: Limitations of this study included use of a convenience sample, a ceiling effect of the ECAB for some children in GMFCS levels I and II, and the use of both a 12-month and 24-month study protocol that impacted the number of children available for each assessment session.

Conclusions: When used appropriately to monitor development and change over time for children with CP, the ECAB longitudinal trajectories, reference percentiles, and the associated change scores presented here should assist therapists and families in collaborative interaction to proactively plan services and interventions relative to balance ability.

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Figures

Figure 1.
Figure 1.
On Track Study participant flow diagram. CIHR = Canadian Institutes of Health Research; PCORI = Patient-Centered Outcomes Research Institute. Reprinted with permission from McCoy SW, Bartlett D, Smersh M, Galuppi B, Hanna S. Monitoring development of children with cerebral palsy: the On Track study. Protocol of a longitudinal study of development and services. https://www.canchild.ca/en/resources/294-monitoring-development-of-children-with-cerebral-palsy-the-on-track-study-protocol-of-a-longitudinal-study-of-development-and-services..
Figure 2.
Figure 2.
Longitudinal developmental trajectories in Early Clinical Assessment of Balance (ECAB) score by Gross Motor Function Classification System (GMFCS) level. Model 1 was fit for levels I and II; model 2 was fit for level III; and model 3 was fit for levels IV and V. See statistical supplement for details (available at https://academic.oup.com/ptj).
Figure 3.
Figure 3.
Reference percentiles by Gross Motor Function Classification System (GMFCS) level.
See this image and copyright information in PMC

References

    1. Westcott S, Burtner P. Postural control for children: implications for pediatric practice. Phys Occup Ther Pediatr. 2004;24:5–55. - PubMed
    1. Woollacott M, Shumway-Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance?. Neural Plast. 2005;12:211–219. - PMC - PubMed
    1. Liu W, Zaino C, Westcott McCoy S. Anticipatory postural adjustments in children with cerebral palsy and children with typical development during functional reaching: a center of pressure study. Pediatr Phys Ther. 2007;19:188–195. - PubMed
    1. Naslund A, Sundelin G, Hirschfeld H. Reach performance and postural adjustments during standing in children with severe spastic diplegia using dynamic ankle foot orthoses. J Rehabil Med. 2007;39:715–723. - PubMed
    1. Hsue B, Miller F, Su F. The dynamic balance of children with cerebral palsy and typical development during gait. Part I: Spatial relationship between COM and COP trajectories. Gait Posture. 2009;29:465–470. - PubMed

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