Rajiv Gandhi University of Health Sciences s60

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

ANNEXURE II

1 Name of the candidate PARMAR HETALBEN MOHANSINH and Address SRINIVAS COLLEGE OF PHYSIOTHERAPY, PANDESHWARA, MANGALORE-575001

2 Name of the Institute SRINIVAS COLLEGE OF PHYSIOTHERAPY, MANGALORE. 3 Course of study and Master of Physiotherapy (MPT) Subject 2 years Degree Course. “Physiotherapy in Pediatrics” 4 Date of Admission 07.03.2008 To course 5 Title of the Topic “ A STUDY TO FIND OUT THE CORRELATION OF AGE,GENDER AND PEDIATRIC BALANCE SCALE”

1 6 Brief resume of the intended work: 6.1 Need for the study:

Balance, the ability to maintain a state of equilibrium , is one of the critical underlying elements of movement that facilitates the performance of functional skills.1

Examination of balance is an important element of a physical therapy evaluation for a school-age child.1 As balance skills are an integral part of gross motor abilities and poor balance causes difficulties with functional tasks involved in activities of daily living.2

Children with developmental disabilities may have postural instability, which contributes to delayed or deficient motor skill development.3 Children with learning disabilities4-7, hearing impairments 8-9, cerebral palsy10-12 and mental retardation13-15 have balance deficits.

The standardized and non-standardized measures that currently exist provide clinicians with valuable information, but may not fully meet their needs to assess a child’s functional balance abilities.1

Berg Balance Scale (BBS) emphasizes function, and captures a wide range of functional abilities and has potential for use with children as a measure of functional balance.2

Pediatric Balance Scale, a modified version of BBS which was designed to measure balance in children as they perform a variety of functional tasks. Preliminary testing of the PBS reveals very high test-retest (ICC= 0.99) and inter-rater reliability (ICC = 0.99) and clinical observations support the

2 content validity of the PBS. The modification included were, 1) reordering the test items. 2) Reducing time standards for maintenance of static posture. 3) Clarifying directions.1 The modifications to the BBS were made to address the developmental levels of children in the cognitive and physical domains.16

Many studies have reported relations between sway parameters and age.17 Age related changes in movement patterns used to perform skills first acquired during infancy continue during early childhood and adolescence and throughout the rest of the human life span; changes in the form of movements are related to age.18 Age related decreases in sway velocity have been seen in mixed sex groups between 4 and 13 years(Riach and Starkes 1994), 4 and 15 years(Taguchi and Tada 1988), and 5 to 18 years(Wolff et al 1998).19

Studies have shown that the amplitude of sway decreases with age. There was considerable variation in sway amplitude in the young children. This variance systematically lowered with age and with children’s improved balance.20

There are measurements which are capable of measuring the age related changes in term of balance. Clinical Test of Sensory Interaction on Balance (CTSIB) 21, Functional Reach Test (FRT) 22, and FUNCTIONAL INDEPENDENCE MEASURE 23 is some of the measure which has been proved to measure age related changes.

Till now no other study has been done to detect the age related changes using PBS. It is mandatory to know whether PBS is sensitive enough to find out the age and gender related changes on balance and whether any difference is there between boys and girls in a particular age group.

3 6.2 Review of Literature:

1) Gomyeongsuk( Myung-sook Ko) et al. (2008) studied inter-examiner reliability of the Korean version of PBS for children with developmental delays and they concluded that PBS have high inter-examiner reliability when applied to children with movement disorder and has relatively lower reliability in children with developmental delay secondary to mental retardation.24

2) Plaiwan Suttanon (2006) compared the balance performance between children aged 7 to 10 and 11-15 years measured by the Clinical Test Of Sensory Interaction On Balance(CTSIB) and to determine the correlation between the balance performance and characteristics of the subjects.( age, weight, height , BMI ) and concluded that the balance performance was not different in ages 7-18 years and there were few significant correlation between balance performance and the characteristics of subjects, especially age in this study.21

3) Jongjit et al (2006) studied the Functional Independence Measure for Children (WeeFIM) for evaluating function in disabled children aged 9-100 months. It was developed to determine a child’s functional capacity and performance in Thai children and they concluded the WeeFIM total and domain scores increased progressively with age.23

4) Lee Nolan et al. (2005) studied the sex and age differences in standing balance in girls and boys of age group of 9 to 16 years. They concluded that there are sex differences in balance parameters, with boys exhibiting greater and faster movement of center of pressure than girls at 9-10 years of age.19

5) N. Franjoine et al (2004) aimed to ascertain whether the PBS is

4 responsive to changes in functional balance. They concluded that PBS is sensitive to changes in functional balance in children with mild-moderate motor impairments.25

6) Mary Rose Franjoine et al. (2003) studied test-retest and interrater reliability of the Pediatric Balance scale, a modified version of Berg Balance Scale for school-age children with mild to moderate impairments and they concluded that the PBS have good test-retest and interrater reliability when they used in children with cerebral palsy.1 7) Gayatri Kembhavi et al. (2002) studied the use of Berg Balance Scale to assess the balance abilities of the children with cerebral palsy. They concluded that BBS can be considered as a clinical measure of balance for children with cerebral palsy.2

8) Karen M. Kott et al. (2002) they used Pediatric Balance Scale as outcome measurement to study the upright function in children and adolescents with cerebral palsy, with or without orthoses. They found that the PBS is an easy- to-use clinical tool for assessing steady-state and anticipatory balance skills in children and adolescents.16

9) Betsy Donahoe et al (1994) studied the effect of age, gender, height, weight and arm length on functional reach and they concluded as age increases, height, weight and functional reach increases.22

6.3 Objective of the study

1) To determine the correlation between age, gender and PBS in children with 5 – 12 years of age.

5 6.4 Hypothesis:

Experimental hypothesis: There will be a correlation between age, gender and pediatric balance scale (PBS).

Null hypothesis:

There will be no correlation between age, gender and pediatric balance.

Material and Methods:

7.1 Source of data:

 Children will be taken from various schools of Mangalore city.

7.2 Method of collection of data:

The study will be consisting of 320 normal school going children, 40 each (20 boys and 20 girls) in age group between 5-12 years. The children will be screened for the inclusion and exclusion criteria and those who fulfill the criteria will be considered for the study. Consent will be taken from the parents and the respective schools.

Sampling: PURPOSIVE SAMPLING.

Measurement procedure :

Each task will be demonstrated to the subjects. Child will receive a practice trial on each task. Verbal and visual directions may be clarified 6 through the use of physical prompts.

7 The items included in PBS are:

1) Sitting to standing 2) Standing to sitting 3) Transfers 4) Standing unsupported 5) Sitting unsupported 6) Standing with eyes closed 7) Standing with feet together 8) Standing with one foot in front 9) Standing on one foot 10) Turning 360 degrees 11) Turning to look behind 12) Retrieving object from floor 13) Placing alternate foot on stool 14) Reaching forward with outstretched arm

 Maximum Score = 56  Each item will be scored utilizing the 0-4 scale.  Multiple trials are allowed on many items.  If on first trial a child achieves the maximal score of 4, additional trials will not be administered.  Subjects have to maintain their balance while attempting the tasks.

Materials to be used:

7 1) adjustable height bench 2) chair with back support and arm rests 3) stopwatch or watch with a second hand 4) masking tape-1inch wide 5) a step stool 6 inches in height 6) chalkboard eraser 7) ruler or yardstick 8) a small level

 And score of PBS will be compared with age and gender.

Inclusion Criteria

1) Healthy school going children aged 5 – 12 years

2) Subjects who are able to understand the commands.

Exclusion criteria

1) Children with any physical disabilities 2) Children with orthopedic problems 3) Children with neurological problem

Stastical analysis

Study design: CORRELATIONAL STUDY DESIGN.

TEST: t – test. ANOVA. Karl Pearson’s correlation coefficient

8 7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly. YES.

I intend to measure the pediatric balance scale on school going children to know the influence of age and gender on balance

7.4 Has ethical clearance been obtained from your institution in case of 7.3? YES. Consent has been taken from the college.

9 List of reference.

1. Mary Rose Franjoine, Joan S. Gunther, Mary Jean Taylor. Pediatric Balance Scale: A Modified Version of the Berg Balance Scale for the School-Age Child with Mild to Moderate Motor Impairment. Pediatric Physical Therapy.2003; 15:114-128.

2. Gayatri Kembhavi, Johanna Darrah, Joyce Magill-Evans, Joan Loomis. Using the Berg Balance Scale to Distinguish Balance Abilities in Children with Cerebral Palsy. Pediatric Physical Therapy. 2002; 14:92- 99.

3. Sarah W Atwater, Terry K Crowe, Jean C Deltz, Pamela K Richardson. Interrater and Test-Retest Reliability of Two Pediatric Balance Tests. Physical Therapy. Number 2. February 1990; 70:79-87

4. Ayres AJ: Sensory Integration and Learning Disorders. Los Angeles, CA, Western Psychological Services, 1972.

5. Fisher AG, Bundy AC: Equilibrium reactions in normal children and in boys with sensory integrative dysfunction. The Occupational Therapy Journal of Research. 1982; 2(3):171-183.

6. Polatajko HJ, Sullivan T: Postural–sway responses in learning-disabled 8 children: Pilot data. The Occupational Therapy Journal of Research.1987; 7(1):37-51.

7. Bundy AC, Fisher AG, Freeman M, et al: Concurrent validity of equilibrium tests in boys with learning disabilities with and without vestibular dysfunction. Am J Occupational Therapy.1987; 41:28-34.

8. Effgen SK: Effect of an exercise program on the static balance of deaf

10 children. Physical Therapy.1981; 61:873-877.

9. Horak FB, Shumway-Cook A, Crowe TK, et al: Vestibular function and motor proficiency of children with impaired hearing or with learning disability and motor impairments. Dev Med Child Neurology.1988; 30:64-79.

10.Bobath K, Bobath B: The facilitation of normal postural reactions and movements in the treatment of cerebral palsy. Physiotherapy.1964; 50:246-262.

11.Shambes GM: Static postural control in children. Am J Phys Med. 1976; 55:221-252.

12.Nashner LM, Shumway-Cook A, Marin O. Stance posture control in select groups of children with cerebral palsy: deficit in sensory organization and muscular coordination. Exp Brain Res. 1983; 49:393- 409.

13.Shumway-Cook A, Woollacott MH: Dynamics of postural control in the child with Down syndrome. Phys Ther. 1985; 65:1315-1322.

14.Connolly BH, Michael BT: Performance of retarded children, with and without Down syndrome,on the Bruininks-Oseretsky Test of Motor Proficiency. Phys Ther. 1986; 66:344-348

15.Rider RA, Mahler TJ, Ishee J: Comparison of static balance in trainable mentally handicapped and nonhandicapped children. Percept Mot Skills.1983; 56:311-314.

16.Karen M. Kott, Sharon L. Held: Effects of Orthoses on Upright Functional skills of Children and Adolescents with Cerebral Palsy.

11 Pediatric Physical Therapy. 2002; 14:199-207.

17.Portfors-Yeomans CV, Riach CL: Frequency characteristics of postural control with and without visual impairment. Dev Med Child Neurol. 1995; 37:456-463.

18.Jan Stephen Tecklin: Pediatric Physical Therapy (third edition).Normal Motor Development.

19.Lee Nolan, Anatoli Grigorenko, Alf Thorstensson: Balance Control:sex and age differences in 9-to 16-year-olds. Dev Med Child Neurol. 2005; 47:449-454.

20.Shumway-Cook, Marjorie H. Woollacott: Motor Control therapy and practical inplications (second edition).Development of postural control.

21.Plaiwan Suttanon: Comparison of Balance Performance between Healthy Thai Aged 7-10 and 11-15 Years Measured by CTSIB. Thammasat Int. J. Sc. Tech. April-June 2006,Vol 11, No 2.

22.Betsy Donahoe, Dale Turner, Ted Worrell: The Use of Functional Reach as a Measurement of Balance in boys and Girls without Disabilities Ages 5 to 15 years. Pediatric Physical Therapy. 1994; 6:189-193.

23.Jongjit, Jithathai; Komsopapong, Ladda; Saikaew, Thedkean; Wanich, Udomporn; Chewapanich, Suliphon; Udomsubpayakul, Umaporn; Ruangdaraganon, Nichara. Reliability of the Functional Independence Measure for children in normal Thai children. Pediatric international. April 2006; vol 48, no 2, 132-137.

24.Gomeyeongsuk, Yinamhyeon, Yijeongha, Jeonhyeseon. Inter-Examiner Reliability of the Korean Version of the Pediatric Balance Scale. Journal 12 of Physical Thearpy Specialists Korea. 2008; 86-95.

25.M Franjoine, B.L. Young: The Performance of Six School-Age Children with Cerebral Palsy On The Pediatric Balance Scale (PBS): A Three YEAR Study Of Changes In Functional Balance. Abstracts for the 2004 combined sections meeting, Pediatric Physical Therapy.

13 9 Signature of the candidate

10 Remarks of the guide

11 Name & Designation of:

11.1 Guide Dr. T.JOSELEY SUNDERRAJ PANDIAN Associate Professor in Physiotherapy and P.G Coordinator.

11.2 Signature

Dr. PRIYANKA SAHU 11.3 Co-Guide (If Any) Lecturer in Physiotherapy

11.4 Signature

Dr. T.JOSELEY SUNDERRAJ 11.5 Head of the Department PANDIAN Associate Professor in Physiotherapy and P.G Coordinator. 11.6 Signature

12 DR. RAMPRASAD M. 12.1 Remarks of Chairman and Principal and associate professor in Principal physiotherapy

12.2 Signature 14