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

Results of Construct Validity Analysis

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).

Discussion & Conclusion

Sample & Methods

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)
Childrens ages were 1.5-5 years
Mean age = 38.1 months; SD=11.4
Mean GMFM-66 GMAE scores = 44.1, SD = 20.8
Childrens 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 familys 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 teams 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.

Early Clinical Assessment of Balance (ECAB)

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
Previous MAI Items re-scaled from original MAI
ECAB 2
HEAD RIGHTING EXTENSION
rated as:
ECAB 3
HEAD RIGHTING FLEXION
0 (no response)
1 (slight response)
ECAB 4
ROTATION IN TRUNK
2 (moderate response)
ECAB 5
EQUILIBRIUM REACTIONS IN SITTING
3 (complete & consistent response)
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
Previous PBS Items rated as:
ECAB 9
SITTING TO STANDING
0 (cannot do)
ECAB 10
STANDING UNSUPPORTED WITH EYES CLOSED
1 (slight ability to complete)
ECAB 11
ECAB 12

STANDING UNSUPPORTED WITH FEET TOGETHER

TURNS 360 DEGREES

2 (some ability to complete)

3 (almost completes)
4 (fully completes)

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.

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):

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Acknowledgements
1

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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.

Additional Members of the Move & PLAY Team: P. Rosenbaum6, B. Stoskopf6, A. Yocum7, A.
3
Wood3 L Kang3, N Almasri3, H Chang3, D. Begnoche
With funding from:
National Institutes of Disability
and Rehabilitation Research
MOP-81107

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