Objective assessment of the quality of response during two equilibrium tasks

Therapists typically evaluate the balance abilities of children as part of developmental or diagnostic assessments. While the pattern or quality of a child's balance reaction is considered to be an important indicator of developmental delay or disability, no criteria for objectively scoring the qualitative aspects of balance reactions have been developed. As a result, the evaluation of the quality of a balance reaction has remained subjective. The purpose of this investigation was to develop a qualitative grading scale for scoring the overall pattern of balance reactions on two clinical tests of balance: Tilt Board Reach and Flat Board Reach. Six patterns of response were identified in an initial sample of 66 normal children and 25 children with learning disabilities. Two trained assistants, unaware of age and group membership, then graded the responses of an independent sample of 263 normal children between 2 and 13 years of age, and 26 boys with learning disability and sensory integrative dysfunction between 7 and 14 years of age. Descriptive analysis of patterns of response by age for the normal children resulted in the identification of three normal patterns and three atypical patterns. Although boys with identified learning disabilities associated with sensory integrative dysfunction often used normal patterns, they were more likely than normal children to use either abnormal patterns or patterns commonly used by very young children.