CE Progress

Children with cerebral palsy (CP) often have impaired balance and postural control, affecting their ability to sit, stand, and walk independently. Postural control refers to the body’s ability to maintain, achieve, or restore a stable position, while balance involves controlling the center of mass within the base of support.

Importance of Assessing Balance and Postural Control in Children with Cerebral Palsy (CP)

Assessing balance and postural control in children with cerebral palsy (CP) is crucial because these skills are essential for independent mobility, daily activities, and overall quality of life. Children with CP often have impaired postural control, leading to difficulty in sitting, standing, walking, and maintaining stability during movement.

Key Reasons for Assessment:

1. Identifies Movement Limitations and Functional Abilities

• Helps determine how well a child can maintain and adjust their posture in different positions (e.g., sitting, standing, walking).
• Classifies motor abilities using tools like GMFCS (Gross Motor Function Classification System).
• Assists in identifying risk factors for falls, instability, and difficulty with mobility.

2. Guides Individualized Therapy and Rehabilitation Plans

• Helps physical and occupational therapists develop targeted interventions to improve stability and balance.
• Determines the need for core strengthening, balance training, or assistive devices (e.g., walkers, orthotics, wheelchairs).

3. Supports Decision-Making for Assistive Devices and Interventions

• Identifies children who may benefit from:
  • Orthotics (e.g., ankle-foot orthoses for ankle stability).
  • Mobility aids (e.g., walkers, crutches, wheelchairs).
  • Surgical interventions (e.g., selective dorsal rhizotomy, tendon releases).

4. Improves Mobility and Participation in Daily Activities

• Balance and postural control are essential for:
  • Walking safely without falling.
  • Playing with peers (e.g., running, jumping).
  • Performing self-care tasks (e.g., dressing, reaching for objects).
• Better balance leads to greater independence and improved participation in school, sports, and social activities.

5. Tracks Progress Over Time and Evaluates Treatment Effectiveness

• Helps monitor improvements in postural stability and mobility after therapy, surgeries, or use of orthotics.
• Allows therapists to adjust interventions based on progress.

6. Prevents Secondary Complications

• Poor balance and posture can lead to:
  • Increased risk of falls and injuries.
  • Abnormal walking patterns (gait abnormalities).
  • Musculoskeletal deformities (e.g., scoliosis, contractures).
• Early assessment helps implement preventive strategies like stretching, bracing, and postural training.

Measuring tools to assess Balance & Postural Control

Pediatric Balance Scale (PBS) – Assesses balance in children.

Posture and Postural Ability Scale (PPAS) – evaluate postural control in children.

Functional Reach Test (FRT) – Measures postural control.

Berg Balance Scale (BBS) – Evaluates functional balance.

Comparison of Posture and Balance Assessment Tools

Feature	PPAS (Posture and Postural Ability Scale)	BBS (Berg Balance Scale)	PBS (Pediatric Balance Scale)	FRT (Functional Reach Test)
Purpose	Assesses posture quality and postural control in different positions.	Measures static and dynamic balance in functional tasks.	Child-friendly version of BBS, assessing balance and postural control.	Assesses dynamic balance by measuring forward reach.
Number of Items	Varies by position (lying, sitting, standing).	14 tasks (e.g., sitting, standing, transfers, reaching).	14 tasks, adapted for children.	1 task (reach forward while standing).
Scoring System	Graded scale for postural alignment and ability in each position.	0–4 per task, max 56 points.	0–4 per task, max 56 points.	Distance reached (in cm).
Best For	Children with mild to severe CP (GMFCS I–V), including non-ambulatory children.	Children with mild to moderate balance impairments (GMFCS I–III).	Children with mild to moderate CP (GMFCS I–III).	Children with mild balance impairments and dynamic stability issues.
Strengths	✅ Evaluates both postural alignment and ability. ✅ Covers multiple positions (lying, sitting, standing). ✅ Suitable for all GMFCS levels.	✅ Comprehensive balance assessment. ✅ Evaluates static and dynamic balance. ✅ Good for ambulatory children.	✅ Designed for children. ✅ Tracks postural control and balance. ✅ Useful for therapy progress monitoring.	✅ Simple, quick, and easy to use. ✅ Good for assessing forward dynamic balance. ✅ Minimal equipment needed.
Limitations	❌ Does not assess dynamic balance (e.g., walking or stepping). ❌ Requires detailed clinical expertise for scoring.	❌ Not suitable for non-ambulatory children. ❌ May show ceiling effects in high-functioning children.	❌ Less suitable for non-ambulatory children. ❌ May not detect subtle balance impairments in high-functioning children.	❌ Only measures forward reach, not lateral or backward stability. ❌ Not a full postural or balance assessment.

Which One to Use?

• Use PPAS to assess postural alignment and active postural control in all children (GMFCS I–V).
• Use BBS or PBS for a detailed balance assessment in ambulatory children (GMFCS I–III).
• Use FRT for a quick, simple assessment of forward dynamic balance.