Clinical and instrument-based assessment of balance, gait, and motor functions in pediatric cerebral palsy: A systematic review

Abstract

Specialists globally employ various clinical scales and instruments to assess balance, gait, and motor functions in children with cerebral palsy (CP). Selecting appropriate assessment tools is essential for planning studies, developing effective treatment strategies, and tracking clinical outcomes. Given the diversity in assessment needs - whether evaluating dynamic, functional, or static balance - there is a need to identify the most suitable tools for each aspect. Therefore, the primary objective of this review is to critically analyze current clinical and instrument-based assessment methods in the literature to determine the most effective approaches for pediatric CP. This systematic review retrieved 1,812 papers, of which only 23 met the inclusion criteria and presented assessment methods for evaluating balance and motor functions in pediatric CP. These methods were further organized into clinical and instrument-based assessment groups. Among clinical examinations, the Pediatric Balance Scale and Gross Motor Function Measures were considered gold standards and featured in eight studies. In contrast, postural sway measured with the Biodex Balance System, Gait Stability Indices from the GAITRite system, and EMG sensing were the predominant instrument-based observations. Despite this variety, a consensus on the best assessment methods remains lacking. This review highlights the potential of integrating AI-driven metrics that combine clinical and instrument-based data to enhance precision and individualized care. Future research should focus on creating integrated, individualized profiles to better capture the unique capabilities of children with CP, enabling more personalized and effective intervention strategies.

Keywords: biomechanics; embedded electronics; feedback devices; performance characterisation.

Figure 1.

PRISMA flowchart on the selection for papers.

Figure 2.

Summarizing the clinical assessment tools and the number of studies in which each tool was utilized. (a) Clinical Assessment Tools and Their Usage Across Studies. Pediatric Balance Scale (PBS); Gross Motor Function Measure (GMFM); Six-Minute Walk Test (6MWT); Ten-Meter Walk Test (10MWT); Ten-meter Shuttle Run Test (10mSRT) Timed Up and Go Test (TUGT); Timed Up and Down Stairs (TUDS); Functional Ambulation Category (FAC); Trunk Control Measurement Scale (TCMS); Community Balance and Mobility Scale (CB&M); Balance Error Scoring System (BESS); Functional Reach Test (FRT); Functional Mobility Scale (FMS); One-Minute Walk Test (1MWT); Five Times Sit-to-Stand Test (FTSST); Functional Walking Test (FWT). (b) Instrumental Assessment Tools and Their Usage Across Studies.