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Published on: December 11, 2013
The construct and concurrent validity of brief standing sway assessments in children with and without cerebral palsy
James B Tracy1, Drew A Petersen2, Benjamin C Conner3
1Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
Insights
Shorter postural sway (standing balance) recordings of 5-25 seconds maintain validity in children. These findings are useful when fidgeting limits longer balance assessments.
Area of Science:
- Pediatrics
- Biomechanics
- Neurology
Background:
- Standing postural sway is crucial for balance assessment.
- Longer sway recordings in children are often invalidated by fidgeting.
- Shorter sway durations may offer a feasible alternative.
Purpose of the Study:
- To determine if reduced postural sway sample durations (5-30 seconds) maintain construct and concurrent validity.
- To assess the impact of fidgeting on balance measurements in children.
Main Methods:
- Postural sway was measured in 41 children (5-12 years) with and without cerebral palsy (CP).
- Data from 30-second recordings were analyzed in 5-second increments (5-30 seconds).
- Seven time-domain sway variables were quantified under eyes-open and eyes-closed conditions.
Main Results:
- Seven sway measures demonstrated persistent construct validity (Glass's Δ ≥ 0.81) at durations as short as 5-25 seconds.
- Concurrent validity was maintained, with correlations to 30-second measures (r ≥ 0.83).
- Effective measures were predominantly in the eyes-closed condition and involved mediolateral or transverse plane sway.
Conclusions:
- Postural sway durations under 30 seconds can reliably assess balance in children.
- Eyes-closed, mediolateral, and transverse plane sway measures are particularly valid at shorter durations.
- These findings support the use of shorter sway recordings when fidgeting is a concern.
Background:
Standing postural sway is often quantified from center of pressure trajectories. During assessments of longer durations, children may fidget, thus limiting the feasibility and validity of sway recordings.
Research Question:
Do postural sway sample durations less than 30 s maintain construct and concurrent validity?
Methods:
In this case-control, observational study, we measured postural sway in 41 children (age 5-12 years, 23 typically developing (TD); 18 with spastic cerebral palsy (CP), 13 diplegic and 5 hemiplegic, 11 GMFCS level I and 7 level II) for 30-second eyes-opened and eyes-closed conditions. From a single recording, 5-second incremental durations of 5-30 s were considered in this analysis. We quantified anteroposterior, mediolateral, and transverse-plane sway using seven time-domain variables: root-mean-square error, total excursion, mean frequency, mean distance, sway area, and 95 % confidence circle and ellipse areas. Variables were calculated in eyes-opened and eyes-closed conditions, as well as the ratio of the two. Construct validity was evaluated by the persistence of large effect sizes (Glass's Δ ≥ 0.80) between CP and TD participants at shorter durations than 30 s. Concurrent validity was evaluated by the correlations of shorter duration measures to the 30 s measure.
Results:
Seven sway measures had large between-group effects (Glass's Δ ≥ 1.02) for the 30 s measure that persisted (Glass's Δ ≥ 0.81) at shorter durations (5-25 s) and also maintained concurrent validity (r ≥ 0.83). Six of these seven measures were taken in the eyes-closed condition, and all seven measures were in the mediolateral direction or transverse plane.
Significance:
Our analysis suggests that sway durations less than 30 s can uphold construct and concurrent validity. These measures were primarily in the eyes-closed conditions and mediolateral direction. These results are a promising indicator that shorter-duration sway measures may be of utility when fidgeting prevents longer recordings.
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