•  ECAB comprised of 7 items from the MAI (with permission from the original authors) and 6 from the PBS.

•  PBS items weighted, as explained below, for progression of balance development

•  ECAB covers balance development from head control through sitting protective responses (MAI) to higher-level sitting & standing balance (PBS)

•  MAI & PBS items link together, as verified by the GMFM: “Item 24 – SIT ON MAT: maintain arms free 3 seconds” (high end of MAI) is one item away from “Item 34 – SIT ON BENCH: maintains arms and feet free” (representing low end of PBS).

Development of the Early Clinical Assessment of Balance for Young Children with Cerebral Palsy

S McCoy1, D Bartlett2, L Chiarello3, R Palisano3, L Jeffries4, A Fiss5, Move and PLAY Study Team 1University of Washington, 2University of Western Ontario, 3Drexel University, 4Langston University, 5Mercer University

Background and Purpose

Sample & Methods

Acknowledgements

Early Clinical Assessment of Balance (ECAB)

References 1.  Sprigle S, Maurer C, Holowka M. Development of valid and reliable measures of

postural stability. J Spinal Cord Med. 2007;30(1):40-49. 2.  Mancini M, Horak FB. The relevance of clinical balance assessment tools to

differentiate balance deficits. Eur J Phys Rehabil Med. 2010; 46(2):239-248. 3.  Westcott, S.L. & Burtner P. Postural control for children: Implications for

pediatric practice. Phys Occup Ther Pediatr. 2004; 24(1-2):5-55. 4.  Bartlett DJ, Chiarello LA, McCoy SW, Palisano RJ, Rosenbaum PL, Jeffries L,

Fiss AL, & Stoskopf B. The Move & PLAY study: An example of comprehensive rehabilitation outcomes research. Phys Ther, 2010; 90(11):1660-1672.

5.  Chiarello L, Bartlett D, Palisano R, McCoy SW, Jeffries L, Fiss A. A Multivariate Model of Determinants of Change in Motor Abilities and Engagement in Self Care and Play of Young Children with Cerebral Palsy. Phys Occup Ther Pediatr. 2011; 31(2):150-168.

6.  Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the Berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther. 2003;15(2):114-128.

7.  Chandler LS, Andrew MS, Swanson MW. Movement Assessment of Infants: A Manual. Rolling Bay, WA 98061: P.O Box 4631; 1980.

Discussion & Conclusion

Sample: •  Convenience sample of children with CP from the four

USA and nine Canadian Move & PLAY study sites •  410 children with CP participated (231 males) •  Children’s ages were 1.5-5 years •  Mean age = 38.1 months; SD=11.4 •  Mean GMFM-66 GMAE scores = 44.1, SD = 20.8 •  Children’s GMFCS levels were:

•  138 in Level I •  49 in Level II •  51 in Level III •  76 in Level IV •  96 in Level V

Methods: •  Physical and occupational therapists:

•  Trained and reached 80% agreement for scoring items from videotapes on the tests described below.

•  Collected data in family’s homes or clinics.

•  During data collection: •  Children in GMFCS levels I-III were scored on all items

from the Pediatric Balance Scale (PBS)6

•  Children in GMFCS levels III-V were scored on the Equilibrium section of the Movement Assessment of Infants (MAI)7

•  Items from the two tests were merged to create the ECAB based on: •  Move & PLAY team’s conceptual analysis of postural

control across age & severity of children with CP •  Reduction of respondent burden by decreasing number

of items •  Maintenance of data spread across GMFCS levels •  Desire for one comprehensive test of balance across all

participants

•  Descriptive, comparison and correlation statistics were completed to determine validity of the ECAB.

1 2 3 4 5 6 7

National Institutes of Disability and Rehabilitation Research

#H133G060254

With funding from:

MOP-81107

Additional Members of the Move & PLAY Team: P. Rosenbaum6, B. Stoskopf6, A. Yocum7, A. Wood3 L Kang3, N Almasri3, H Chang3, D. Begnoche3

Start testing with Item 1 if the child is classified in GMFCS level III, IV or V. If the child is in GMFCS Level I or II, start with Part II, Item 8. For children with hemiplegia, start with Item 5.

PART I: Head and Trunk Postural Control (specific scoring criteria noted on score sheet) ECAB 1 HEAD RIGHTING - LATERAL ECAB 2 HEAD RIGHTING – EXTENSION ECAB 3 HEAD RIGHTING – FLEXION ECAB 4 ROTATION IN TRUNK ECAB 5 EQUILIBRIUM REACTIONS IN SITTING ECAB 6 PROTECTIVE EXTENSION – SIDE ECAB 7 PROTECTIVE EXTENSION – BACKWARD PART II: Sitting and Standing Postural Control: (specific scoring criteria noted on score sheet) ECAB 8 SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL ECAB 9 SITTING TO STANDING ECAB 10 STANDING UNSUPPORTED WITH EYES CLOSED ECAB 11 STANDING UNSUPPORTED WITH FEET TOGETHER ECAB 12 TURNS 360 DEGREES ECAB 13 PLACING ALTERNATE FOOT ON THE STEP WHILE STANDING UNSUPPORTED (Items 8 & 9 are weighted x 1.5; Items 10 & 11 x 2.5; and Items 12 & 13 x 4 for total score.)

PART I: Head and Trunk Postural Control TOTAL SCORE PART I (MAX 36): ______ PART II: Sitting & Standing Postural Control TOTAL SCORE PART II (MAX 64): ______

TOTAL ECAB SCORE (MAX 100): _______

The full ECAB is available on the Move & PLAY website: http://www.canchild.ca/en/ourresearch/moveplay.asp Copyright: Sarah W. McCoy (westcs@uw.edu), Doreen J. Bartlett, Lisa A. Chiarello, Robert J. Palisano, Lynn Jeffries, Alyssa Fiss. Unpublished work, 2010.

Results of Construct Validity Analysis

Previous MAI Items re-scaled from original MAI rated as:

0 (no response) 1 (slight response) 2 (moderate response) 3 (complete & consistent response)

Previous PBS Items rated as: 0 (cannot do) 1 (slight ability to complete) 2 (some ability to complete) 3 (almost completes) 4 (fully completes)