Which outcomes are key to the pre-intervention assessment profile of a child with developmental coordination disorder? A systematic review and meta-analysis.

BACKGROUND: Purpose of this study was to determine what key aspects of function should be incorporated to make up a pre-intervention assessment profile of a child with Developmental Coordination Disorder (DCD); more specifically, what aspects of functioning are implicated in DCD and what is their relative impact? METHODS: A systematic review and meta-analysis were conducted, for which Pubmed, Web of Science, Scopus and Proquest were searched (last update: April 2023, PROSPERO: CRD42023461619). Case-control studies were included to determine point estimates for performances on field-based tests in different domains of functioning. Risk of bias was assessed, and level of evidence estimated. Random-effect meta-analyses were performed to calculate the pooled standardized mean differences for domains of functioning and subgrouping was done for clinically relevant subdomains. Heterogeneity was determined with I2. RESULTS: 121 papers were included for analyses. Data of 5 923 children with DCD were included (59.8% boys) and 23 619 Typically Developing (TD) children (45.8% boys). The mean (SD) age of the DCD group was 10.3y (1.2) and 9.3y (1.3) for the TD children. Moderate evidence was found for motor performance, executive functions, sensory processing and perceptions, cognitive functions and sports and leisure activities to be affected in children with DCD. CONCLUSION: Differences between the two groups varied per domain of functioning. This emphasizes the diversity present within children with DCD and provides a rationale for explaining the heterogeneity in this patient group. Yet, results highlight the potential involvement of all these domains and call for clinicians to be alert not only to examine motor skill difficulties but also other aspects of function. Results indicate the need to develop an individualized pre-intervention multi-dimensional assessment profile for each child with DCD. It also supports the important role that clinicians play in an interdisciplinary team to tackle the difficulties encountered by children with DCD.

Checks and balances: a meta-analysis on the known-groups validity of functional postural control tests in children.

INTRODUCTION: Pediatric physical therapists commonly treat children with postural control deficits. Ideally, pediatric functional postural control tests should therefore be able to identify postural control deficits in children with various disorders. Despite a plethora of available tests, evidence for their validity - especially known-groups - remains scarce. This review aims to determine the known-group validity of available functional postural control tests to differentiate various pediatric pathological groups of different ages from their typically developing (TD) peers. EVIDENCE ACQUISITION: PubMed, Web of Science and Scopus were systematically searched (last update: February 2023; PROSPERO: CRD42023408982). Forty case-control studies with a pathological pediatric sample (N.=1331) and TD peers (N.=1889) were included and selected for data-extraction and -analysis. Risk of bias was assessed using the SIGN checklist and level of evidence was scored using GRADE. Random-effect meta-analyses were performed to estimate pooled standardized mean differences (SMD) for the various test types and subclassified based on pathology and/or age. EVIDENCE SYNTHESIS: When compared with TD peers, children with underlying pathologies performed significantly worse on pediatric functional postural control test batteries (SMD=-2.21), the Timed Up and Go Test and variants (SMD=2.30), the One Leg Stance test and variants (SMD=-2.14), while the Reach tests showed a smaller difference (SMD=-1.19). Subclassification within the meta-analyses showed that pathology was an influencing factor for the test batteries and the one leg stance test and variants. Age was an influencing factor for the reach tests. None of the included functional postural control tests exceeded a low level of evidence. CONCLUSIONS: Pediatric functional postural control tests that assess multiple aspects of postural control (such as test batteries) seem to offer higher known-groups validity than single-task tests (e.g. reach tests). The underlying pathology has a larger impact on the validity of these tests than age. There remains an overall low level of evidence for the known-groups validity of pediatric functional postural control tests indicating the need for research with more homogenous groups and norm reference data.

Body composition and associated factors among 5-7-year-old children with moderate acute malnutrition in Jimma town in southwest Ethiopia: A comparative cross-sectional study.

Acute malnutrition affects not only the growth and development but also the body composition of children. However, its specific effects have not yet been characterized. This study aims to compare the body composition of 5-7-year-old children with moderate acute malnutrition (MAM) to that of their well-nourished (WN) peers and identify associated factors. A school-based comparative cross-sectional study was conducted from June to July 2022 in Jimma town, southwest Ethiopia. The study participants were selected from eight kindergartens and eight primary schools using a simple random sampling technique based on the proportional allocation of the sample to the size of the population in the respective school. Descriptive statistics and multivariable linear regression analyses were used to assess the mean differences and associations between variables and isolate independent predictors of body composition, respectively. The statistical significance was determined using ß-coefficients with 95% confidence intervals and a p value of ≤ 0.05. Data were captured from 388 (194 MAM and 194 WN) children with a response rate of 97.9%. The mean fat-free mass of WN children was significantly higher compared with those with MAM (p < 0.001). The mean (SD) of fat mass of MAM children was 4.23 ± 0.72 kg, 4.36 ± 0.88 kg and 4.08 ± 0.89 kg for 5, 6 and 7-year-olds, respectively. For WN children, the mean (SD) of fat mass was 4.92 ± 0.88 kg for 5 years old, 5.64 ± 1.01 kg for 6 years old and 5.75 ± 1.26 kg for 7 years old (p < 0.001). On the multivariable linear regression analysis after controlling for background variables, WN children exhibited 1.51 times higher fat-free mass compared with MAM children (ß = 1.51, p = 0.003). A unit increase in age of the study participants was associated with a 1.37 increment in fat-free mass (ß = 1.37, p < 0.001). WN children had 1.07 times higher fat mass compared with children with MAM (ß = 1.07, p < 0.001). A unit increase in the age of the child resulted in 0.15 times increment in fat mass (ß = 0.15, p = 0.020), and being female was associated with a 0.37 increase in fat mass (ß = 0.37, p < 0.001). The results showed that the mean fat mass and fat-free mass were significantly lower among moderately acute malnourished children than in WN children showing the loss of both body compartments due to malnutrition. The body mass index for age, age of the child and sex of the child were significantly linked to both fat-free mass and fat mass.

Effects of a highly intensive balance therapy camp in children with developmental coordination disorder - An intervention protocol.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) often (<87 %) experience postural control problems, impacting all levels of the International Classification of Functioning, Disability and Health (ICF) including their daily participation, self-esteem and mental health. Due to the multisystemic nature of postural control, comprehensive therapy should target all systems which is currently not the case. Highly intensive therapy is effective and commonly used in pediatric populations, but has not been explored yet to train postural control in children with DCD. AIMS: To investigate the effects of a highly intensive functional balance therapy camp at all ICF levels in children with DCD. METHODS AND PROCEDURES: The effects on postural control, muscle activity, brain alterations, self-perceived competence, self-identified goals, gross motor activities and participation are evaluated. Participants are assessed pre- and post-intervention, including a 3 months follow-up. Forty-eight children with DCD, aged 6-12 years old, receive 40 h of comprehensive balance training. This intervention is fun, individually tailored, targets all postural control systems, implements different motor learning strategies and includes both individual and group activities. CONCLUSION: Novel insights into the effects of a highly intensive comprehensive balance therapy camp designed for children with DCD will be gained at all levels of the ICF.

Do Girls Have an Advantage Compared to Boys When Their Motor Skills Are Tested Using the Movement Assessment Battery for Children, 2nd Edition?

This study aims to investigate sex-related differences in raw item scores on the Movement Assessment Battery for Children, 2nd Edition (MABC-2) in a large data set collected in different regions across the world, seeking to unravel whether there is an interaction effect between sex and the origin of the sample (European versus African). In this retrospective study, a secondary analysis was performed on anonymized data of 7654 children with a mean age of 8.6 (range 3 to 16; SD: 3.4), 50.0% of whom were boys. Since country-specific norms were not available for all samples, the raw scores per age band (AB) were used for analysis. Our results clearly show that in all age bands sex-related differences are present. In AB1 and AB2, girls score better on most manual dexterity and balance items, but not aiming and catching items, whereas in AB3 the differences seem to diminish. Especially in the European sample, girls outperform boys in manual dexterity and balance items, whereas in the African sample these differences are less marked. In conclusion, separate norms for boys and girls are needed in addition to separate norms for geographical regions.

A Critical View on Motor-based Interventions to Improve Motor Skill Performance in Children With ADHD: A Systematic Review and Meta-analysis.

OBJECTIVE: To map the effect of motor-based interventions on motor skills in children with ADHD. METHOD: A systematic literature search was performed in Pubmed, Web of Science, and the SCOPUS database (last search: October 30th 2022). Methodological quality was assessed using the PEDro-scale and the quality of evidence was determined with the GRADE-method. Meta-analysis was performed when at least five studies were available. RESULTS: Thirteen studies (7 RCTs) satisfied the inclusion criteria, five of which were eligible for meta-analysis. Only one of the included studies reached the low risk of bias threshold. Comparing different motor-based interventions to any non-motor control intervention showed large motor skill improvements (SMD = 1.46; 95% CI = [1.00;1.93]; I² = 47.07%). The most effective type of motor-based intervention and the optimal treatment parameters could not be determined yet. CONCLUSION: Motor-based interventions in general seem to improve motor skills in children with ADHD. Additional RCTs are needed to increase current low GRADE confidence.

Psychometric properties of functional postural control tests in children: A systematic review.

BACKGROUND: Postural control deficits are one of the most common impairments treated in pediatric physiotherapeutic practice. Adequate evaluation of these deficits is imperative to identify postural control deficits, plan treatment and assess efficacy. Currently, there is no gold standard evaluation for postural control deficits. However, the number of studies investigating the psychometric properties of functional pediatric postural control tests has increased significantly. OBJECTIVE: To facilitate the selection of an appropriate pediatric functional postural control test in research and clinical practice. METHODS: Systematic review following the PRISMA guidelines. PubMed, Web of Science and Scopus were systematically searched (last update: June 2022; PROSPERO: CRD42021246995). Studies were selected using the PICOs-method (pediatric populations (P), functional assessment tools for postural control (I) and psychometric properties (O). The risk of bias was rated with the COSMIN checklist and the level of evidence was determined with GRADE. For each test, the postural control systems were mapped, and the psychometric properties were extracted. RESULTS: Seventy studies investigating 26 different postural control tests were included. Most children were healthy or had cerebral palsy. Overall, the evidence for all measurement properties was low to very low. Most tests (95%) showed good reliability (ICC>0.70), but inconsistent validity results. Structural validity, internal consistency and responsiveness were only available for 3 tests. Only the Kids-BESTest and FAB covered all postural control systems. CONCLUSION: Currently, 2 functional tests encompass the entire construct of postural control. Although reliability is overall good, validity results depend on task, age and pathology. Future research should focus on test batteries and should particularly explore structural validity and responsiveness in different populations with methodologically strong study designs.

Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis.

Moderate acute malnutrition (MAM) is defined by a weight-for-height Z-score (WHZ) between -3 and -2 of the WHO reference or by a mid-upper arm circumference (MUAC) of ≥11⋅5 and <12⋅5 cm. This study aimed to synthesise the evidence for the effectiveness of Ready-to-Use Supplementary Food (RUSF) compared to other dietary interventions or no intervention on functioning at different levels of the International Classification of Functioning, Disability, and Health (ICF) among children with MAM between 2 and12 years old. Three databases (PubMed, Scopus, and Web of Science) were systematically searched (last update: 20 November 2022). Pooled estimates of effect were calculated using random-effects meta-analyses. The level of evidence was estimated with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. Seven studies were included. RUSF had a significant small-sized better effect (pooled mean: 0⋅38; 95 % CI = [0⋅10, 0⋅67], P = 0⋅01, I² = 97 %) on different anthropometric measurements compared to other dietary interventions among MAM children (n 6476). Comparing RUSF with corn-soy blend Plus Plus (CSB++) showed that RUSF had a small-sized but significantly better effect on the children's anthropometric measures compared to children who received CSB++ (pooled mean: 0⋅16; 95 % CI = [0⋅05, 0⋅27], P = 0⋅01; I2 = 35 %). MAM children treated with RUSF had a better recovery rate compared to those treated with CSB++ (pooled risk difference: 0⋅11; 95 % CI = [0⋅06, 0⋅11], P < 0⋅001; I2 = 0 %). The RUSF intervention seems promising in improving MAM children's nutritional outcomes and recovery rate compared to other dietary interventions.

Underweight children are agile but lack power.

Given the knowledge gap in literature on the impact of undernutrition on muscular power and agility in school-aged children, the aim of this study was to compare physical fitness in such underweight- and normal weight children. In this cross-sectional study, 853 children were included (459 boys; mean age: 9.2 (1.8) years). The children were grouped according to their BMI-for-age-and-sex: normal weight (- 1 ≤ z-score < 2) and underweight (z-score < - 1). Within the underweight group, three thinness subgroups were composed: grade 1 (- 2 ≤ z-score < - 1), grade 2 (- 3 ≤ z-score < - 2) and grade 3 (z-score < - 3). Their agility, muscular endurance and power were assessed with the Performance and Fitness test battery (PERF-FIT). Regardless the country they lived in, the underweight children showed better agility (p = 0.012) and muscular endurance (p = 0.004) than those with normal weight. They presented with lower muscular power than the normal weight group, shown by significantly shorter overhead throwing distances (p = 0.017) and less standing long jump peak power (p < 0.001). The standing long jump peak power decreased further with increasing thinness grade (p = 0.027).Conclusion: Underweight children are more agile, but have lower muscular power compared to their normal weight peers. Its relationship with motor competence and physical activity, necessitates attention for tackling muscular strength deficiencies in these children, enabling them to meet the basic requirements for a healthy lifestyle later in life.

How can instructions and feedback with external focus be shaped to enhance motor learning in children? A systematic review.

AIM: This systematic review investigates the effectiveness of instructions and feedback with external focus applied with reduced frequency, self-controlled timing and/or in visual or auditory form, on the performance of functional gross motor tasks in children aged 2 to 18 with typical or atypical development. METHODS: Four databases (PubMed, Web of Science, Scopus, Embase) were systematically searched (last updated May 31st 2021). Inclusion criteria were: 1. children aged 2 to 18 years old; 2. Instructions/feedback with external focus applied with reduced frequency, self-controlled timing, and/or visual or auditory form as intervention, to learn functional gross motor tasks; 3. Instructions/feedback with external focus applied with continuous frequency, instructor-controlled timing, and/or verbal form as control; 4. performance measure as outcome; 5. (randomized) controlled studies. Article selection and risk of bias assessment (with the Cochrane risk of bias tools) was conducted by two reviewers independently. Due to heterogeneity in study characteristics and incompleteness of the reported data, a best-evidence synthesis was performed. RESULTS: Thirteen studies of low methodological quality were included, investigating effectiveness of reduced frequencies (n = 8), self-controlled timing (n = 5) and visual form (n = 1) on motor performance of inexperienced typically (n = 348) and atypically (n = 195) developing children, for acquisition, retention and/or transfer. For accuracy, conflicting or no evidence was found for most comparisons, at most time points. However, there was moderate evidence that self-controlled feedback was most effective for retention, and limited evidence that visual analogy was most effective for retention and transfer. To improve quality of movement, there was limited evidence that continuous frequency was most effective for retention and transfer. CONCLUSION: More methodologically sound studies are needed to draw conclusions about the preferred frequency, timing or form. However, we cautiously advise considering self-controlled feedback, visual instructions, and continuous frequency. TRIAL REGISTRATION: Registration: Prospero CRD42021225723. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021225723.

Exploring Cultural Bias in Two Different Motor Competence Test Batteries When Used in African Children.

Both the Movement Assessment Battery for Children second edition (M-ABC-2) and Bruininks-Oseretsky Test of Motor Proficiency second edition short form (BOT-2-SF) are frequently used in research and in the clinical practice to evaluate motor competence in children. Despite its widespread use in research, no studies have reported the results of case identification in African children. Comparing these two motor assessment tools for a different target group is important in order to select the most appropriate clinical and research tool. Methods. A total of 444 children performed MABC-2, 165 children also performed the BOT-2-SF and subsamples were tested on specific subtests of the BOT-2 (Running and Agility, Balance, and Strength). Tests were administered to randomly selected children between 6 and 10 years of age. Results: 36% for the children scored at or below the 16th percentile of the MABC-2, while this was 43%, 27%, and 23% for the component score in Manual Dexterity, Aiming and Catching, and Balance, respectively. Of the children 16% scored at or below the 17th percentile of the BOT-2-SF total score, while this was 3%, 9% and 22% for the subtest scores Running and agility, Balance, and Strength, respectively. A moderate correlation (r = 0.44) was found between total scores of the two tests. No significant correlations were found between the dynamic MABC-2 item (Jumping/Hopping) standard scores and any of the 9 balance items of the BOT-2. Conclusion: Far more children scored in the clinical "at risk" range (<16th percentile) when tested with the MABC-2 than with the BOT-2-SF. Overall, these children seemed not to be limited in motor performance measured by the BOT-2-SF, Running and Agility, and Balance. South African children did show lower levels of strength and explosive power. Children from different cultures will need tests for the specific motor skills that are representative for optimal functioning in their own setting. Thus, adapting reference norms and cut-off values may not be the optimal solution.

Effect of age on treatment outcomes in benign paroxysmal positional vertigo: A systematic review.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) can lead to an increased fall risk in older adults. Therefore, we examined the influence of age on the effectiveness of canalith-repositioning procedures (CRPs) for the treatment of BPPV. METHODS: Pubmed, Web of Science, and the bibliographies of selected articles were searched for studies conducted before September 2020 that examined the effectiveness of treatments for BPPV in various age groups. Meta-analyses were performed to compare treatment effectiveness and recurrence rates for younger and older adults. Odds ratios were calculated in a random-effects model. Mean differences were calculated using a fixed-effects model. A significance level of p < 0.05 (95% confidence interval) was set. The risk of bias and the methodological quality of all included articles were examined. RESULTS: Forty-five studies were retrieved after full-text screening, of which 29 studies were included for a qualitative review. The remaining 16 studies were eligible for inclusion in the meta-analysis (3267 participants with BPPV). The success rate of a single CRP was higher in the younger group (72.5% vs. 67%, p < 0.001). An average of 1.4 and 1.5 CRPs was needed for complete recovery in the younger and older groups, respectively (p = 0.02). However, global treatment success did not differ between these groups (97.5% vs. 94.6%, p = 0.41). The recurrence rate was higher in the older population (23.2% vs. 18.6%, p = 0.007). CONCLUSIONS: Although more CRPs are needed, the rate of complete recovery in older adults is similar to that observed in younger adults.

Pediatric care for children with developmental coordination disorder, can we do better?

This paper adopts a method of narrative critical review based on a non-systematic search of the literature to provide insights into the trends of developmental coordination disorder (DCD) treatment and to point out some future alternative approaches to prevent secondary health implications in children with DCD. The cause of DCD is unknown, but evidence suggests that these children have atypical brain structure and function. Interventions to help children cope with their activity limitations are effective in improving motor competence and motor skill related fitness in the short term. Although activity-orientated interventions can improve motor outcomes in children with DCD, high quality intervention trials and evaluation of long-term effects are urgently needed. Importantly, motor coordination problems associated with DCD extend to exercise-related activities leading to reduced participation in play and sports, which causes secondary problems in muscular fitness and body composition. Hence, treatment goals should not be limited to the improvement of motor skills (in ADL), but should also focus on health-related quality of life. We therefore propose when noticing motor problems in a child, already before enrolling but also during intervention, to explore ways to adapt everyday physical activities to optimally match the child's skill level. Hence, such activities will not only train the skills and improve physical fitness but will lead to positive engagement, thereby preventing the child from opting out of active play and sports. This provides the child with chances for exercise-dependent learning and will also positively impact social-emotional well-being.

High BMI and Low Muscular Fitness Predict Low Motor Competence in School-Aged Children Living in Low-Resourced Areas.

Childhood obesity is a relatively new problem for Sub-Saharan developing countries. Especially in children with a low socioeconomic background, the link between motor competence, muscular fitness, and body mass index (BMI) remains poorly investigated. Due to the interrelatedness of BMI and physical fitness, the aim of this study is to determine the predictive value of these factors in relation to low motor competence in school-aged children living in low-resourced areas. Motor competence and physical fitness were assessed in 1037 school-aged Ghanaian and South African children using the Performance and Fitness test battery (PERF-FIT). "Low motor competence" was predicted using odds ratios calculated from backward logistic regression analyses. Low motor competence was less prevalent in Ghanaian children (3.7-11.1%) compared to the South African children (21.9-24.2%). Increased BMI and decreased muscular fitness predicted low motor competence in both Ghanaian and South African children. For example, the chance for a Ghanaian child to have low static balance increased by 22.8% (OR = 1.228, p < 0.001) with a 1-point increase in BMI, whereas this decreased by 30.0% (OR = 0.970, p < 0.001) with a 10-cm increase on the standing long jump. In the case of the South African children, if their BMI increased by 1 point, the chance for those children of having low static balance increased by 7.9%, and if their SLJ performance decreased by 10 cm, their chance of low performance increased by 13%. Clearly, motor competence is associated with both BMI and muscular fitness. Policy makers can use this information to counteract the establishment of childhood obesity by promoting weight control through physical activity and stimulating motor competence at school.

The construct of balance control in primary school-aged children: Unidimensional and task-specific.

The aim of this study was to determine the dimensionality and task-specificity of balance control by investigating the relationships between different tasks and the degree to which these tasks belong to the same construct in primary school-aged children. Seventy-four South African children were randomly selected from a sample of convenience. They performed 18 different balance tasks that were grouped into four balance scales: the Performance and Fitness (PERF-FIT) static balance score, the PERF-FIT dynamic balance score, the PERF-FIT moving cans balance score and the Balance Sensory score. Spearman rank correlations were calculated between the scores. Principal component analysis (PCA) was used to investigate the number of factors within the construct. Moderate to good correlations were found between: i) PERF-FIT Moving cans balance score and the Balance Sensory score (r = 0.605, p < 0.001); ii) PERF-FIT static balance score and the PERF-FIT Moving cans (r = 0.586, p < 0.001); iii) PERF-FIT static balance score and the Balance Sensory score (r = 0.541, p < 0.001). All other correlations were low to fair. The PCA revealed one component. The three PERF-FIT items (moving cans-, static- and dynamic balance score) and the Balance Sensory score explained 59.4% of the variance of total balance performance.

Balance control in individuals with developmental coordination disorder: A systematic review and meta-analysis.

BACKGROUND: Although it is recognized that the majority of children with developmental coordination disorder (DCD) have balance deficits, comprehensive insights into which balance domains are affected, are still lacking in literature. RESEARCH QUESTION: To what extent is balance control deficient in individuals with DCD compared to controls? METHODS: Pubmed, Scopus and Web of Science were systematically searched. Risk of bias was assessed with the Scottish Intercollegiate Guidelines Network checklist for case-control studies. Mean and standard deviations characterizing balance control were extracted to calculate standardized mean differences (SMD) and pooled, if possible, using Review Manager. RESULTS: The results of 31 studies (1152 individuals with DCD, 1103 typically developing (TD) peers, mean age 10.4 years old) were extracted of which 17 were used for meta-analysis. The mean SMD for the balance subscale of the Movement Assessment Battery for Children was 1.63 (pooled 95 %CI =[1.30;1.97]), indicating children with DCD to perform significantly poorer than their TD peers. Force plate studies also revealed that children with DCD present with a larger sway path during bipedal stance with eyes closed (pooled mean SMD = 0.55; 95 %CI=[0.32;0.78]). Children with DCD tend to have direction-specific limited stability limits and task-independent delayed onset of anticipatory postural adjustments. INTERPRETATION: Children with DCD perform poorer on different domains of balance compared to TD peers. Future research should focus on comprehensive balance assessment in these children, preferably using a longitudinal design.

The Antwerp Vestibular Compensation Index (AVeCI): an index for vestibular compensation estimation, based on functional balance performance.

PURPOSE: To create an index that is a measure of the amount of vestibular compensation and for which only functional balance performance is needed. METHODS: The medical charts of 62 eligible peripheral vestibular dysfunction (PVD) patients were analyzed retrospectively. To be included, the following vestibulo-ocular reflex (VOR) and balance performance data had to be available: (1) caloric and sinusoidal harmonic acceleration test (SHA) and (2) standing balance sum-eyes closed (SBS-EC), Timed Up and Go Test and Dynamic Gait Index. Patients were divided into three groups: normal caloric- and SHA test (group 1), abnormal caloric- and normal SHA test (group 2, PVD compensated) and abnormal caloric- and SHA test (group 3, PVD uncompensated). Next to the use of non-parametric tests to study the VOR and balance variables, logistic regression was used to identify the balance measures that predict whether PVD patients were compensated or uncompensated. This resulted also in the construction of a continuous measure representing the degree of compensation. RESULTS: Logistic regression identified SBS-EC and age to classify uncompensated from compensated patients with sensitivity of 83.9% and specificity of 72.4%. Then an index was created, called the Antwerp Vestibular Compensation Index, AVeCI = - 50 + age × 0.486 + SBS-EC × 0.421. A patient belongs to the uncompensated group when AVeCI < 0 and to the compensated group when AVeCI > 0, with respective group means of - 5 and 5. CONCLUSION: AVeCI stages the degree of compensation of PVD patients and can serve to evaluate rehabilitation effects.

Aging and the Relationship between Balance Performance, Vestibular Function and Somatosensory Thresholds.

OBJECTIVES: The objective of this study was two-fold: (1) To evaluate the impact of the physiological aging process on somatosensory, vestibular, and balance functions, and (2) To examine the extent to which age and somatosensory and vestibular functions can predict balance performance. MATERIALS AND METHODS: In this cross-sectional study, 141 asymptomatic subjects were assessed for touch pressure thresholds (TPT) with Semmes-Weinstein monofilaments (SWF), vibration thresholds (VT) with a neurothesiometer (NT) and a Rydel-Seiffer tuning fork 128Hz (RSTF). Horizontal vestibulo-ocular reflexes (HVOR gain and asymmetry) were assessed using the video Head Impulse Test (vHIT). A modified version of the Romberg test was used to assess standing balance and the Timed Up and Go test (TUG) and tandem gait (TG) to evaluate dynamic balance. RESULTS: Significant age effects were found for TPT, VT, and balance but not for HVOR gain or asymmetry. Standing balance was explained for 47.2% by age, metatarsal 1 (MT1) (NT), and heel (SWF). The variance in TUG performance was explained for 47.0% by age, metatarsal 5 (MT5) (SWF), and medial malleolus (MM) (NT). Finally, the variance in TG performance was predicted for 43.1% by age, MT1 (NT), HVOR gain, and heel (SWF). CONCLUSION: Among asymptomatic adult population, both somatosensation and balance performance deteriorate with aging. In contrast, HVOR remains rather constant with age, which is possibly explained by the process of vestibular adaptation. Furthermore, this study provides evidence that the VT, TPT, HVOR gain, and age partly predict balance performance. Still, further research is needed, especially with bigger samples in decades 8 and 9.

A Systematic Review on Balance Performance in Patients With Bilateral Vestibulopathy.

OBJECTIVE: Patients with bilateral vestibulopathy (BVP) have severe balance deficits, but it is unclear which balance measures are best suited to quantify their deficits and approximate the diversity of their self-reports. The purpose of this study was to explore measures of balance control for quantifying the performance of patients with BVP related to different balance domains, allowing targeted assessment of response to intervention. METHODS: MEDLINE, Web of Science, and Embase were systematically searched on October 9, 2019. The Scottish Intercollegiate Guidelines Network checklist for case-control studies was applied to assess each individual study's risk of bias. Standardized mean differences (SMD) were calculated based on the extracted numeric data and reported according to the type of sensory perturbation in the balance tasks. RESULTS: Twelve studies (1.3%) met the eligibility criteria and were analyzed, including data of 176 patients with BVP, 196 patients with unilateral vestibulopathy, and 205 healthy controls between 18 and 92 years old. In general, patients with BVP were either unable to maintain (or had reduced) balance during tasks with multisensory perturbations compared with healthy controls (range of mean SMD = 1.52-6.92) and patients with unilateral vestibulopathy (range of absolute mean SMD = 0.86-1.66). CONCLUSIONS: During clinical assessment to quantify balance control in patients with BVP, tasks involving multisensory perturbations should be implemented in the test protocol. IMPACT: As patients with BVP show difficulties with movement strategies, control of dynamics, orientation in space, and cognitive processing, clinicians should implement these aspects of balance control in their assessment protocol to fully comprehend the balance deficits in these patients.

Reliability and concurrent validity of a modified timed up and go test for healthy preschoolers.

The purpose of this study was to assess the interrater and test-retest reliability and the concurrent validity of the modified timed up and go test for preschoolers. As such, we aim to determine the most suited outcome of the modified timed up and go test: the best or the average performance. Thirty-two children (age 3-5) performed three timed up and go test trials as fast as possible on two separate occasions. During the first session, two researchers recorded the time to perform the task simultaneously. For reliability analyses, intra-class correlation coefficients (ICCs) and the minimal detectable change were determined. A Pearson correlation coefficient was calculated to determine concurrent validity between the timed up and go test and the balance subscale of the Movement Assessment Battery for Children, 2nd edition. Interrater (ICC > 0.97) and test-retest (ICC > 0.75) reliability were good both for the average and the best timed up and go test performance. A minimal detectable change of 1.86 s was found for the best performance, and 2.30 s for the average performance. Only the best timed up and go test performance correlated significantly with the balance subscale of the Movement Assessment Battery for Children, 2nd edition, though fair (r = -0.347, p = 0.007).Conclusion: The modified timed up and go test for preschoolers using the best performance is reliable and recommended to reduce standard and measurement error. What is Known: • A large variety of timed up and go test protocols is available for children • The protocols differ in the instructions on walking speed (self-selected/fastest), the use of an extra motivation (e.g., touch a star on the wall) and the applied outcome (average/best performance) What is New: • The best timed up and go test performance induces more consistent test results between raters and sessions and also less standard and measurement error in 3- to 5-year-old children • The best timed up and go test performance should be preferred over the average performance to achieve both reliable and valid test results in 3- to 5-year-old children.