Department of Physical Therapy, Mercer University, Atlanta, GA 30341 (USA).
Rehabilitation Medicine, University of Washington, Seattle, Washington.
Phys Ther. 2019 Feb 1;99(2):217-228. doi: 10.1093/ptj/pzy132.
Children with cerebral palsy (CP) characteristically present with impairments in balance. Currently, the pattern and timing of the development of balance ability have not been described for children with CP of varying Gross Motor Function Classification System (GMFCS) levels.
The purpose of this study was to document longitudinal developmental trajectories in a measure of balance, the Early Clinical Assessment of Balance (ECAB) scores, along with age-specific reference percentiles and the amount of change typical over a 1-year period for children within different GMFCS levels.
The design was a longitudinal cohort study.
Participants included 708 children with CP, aged 18 months through their 12th birthday, and their families. Children participated in 2 to 5 assessments using the GMFCS and ECAB.
Longitudinal trajectories describing the average change in the ECAB score with respect to age were created by fitting separate nonlinear mixed-effect models for children in each GMFCS level. Reference percentiles were constructed using quantile regression of ECAB data from the first visit (baseline) and 12-month and 24-month visits. Using these reference points, the amount of change in percentiles was calculated for all children by subtracting the baseline percentile score from the 12-month percentile score. Children whose percentile changes are within the 80% limits can usually be described as "developing as expected" for their age and GMFCS levels.
Limitations of this study included use of a convenience sample, a ceiling effect of the ECAB for some children in GMFCS levels I and II, and the use of both a 12-month and 24-month study protocol that impacted the number of children available for each assessment session.
When used appropriately to monitor development and change over time for children with CP, the ECAB longitudinal trajectories, reference percentiles, and the associated change scores presented here should assist therapists and families in collaborative interaction to proactively plan services and interventions relative to balance ability.
脑瘫儿童（CP）的特征是平衡受损。目前，不同粗大运动功能分类系统（GMFCS）水平的 CP 儿童的平衡能力发展模式和时间尚未描述。
本研究旨在记录平衡能力的早期临床评估（ECAB）评分的纵向发展轨迹，以及特定年龄的参考百分位数，以及在不同 GMFCS 水平的儿童中，1 年内典型的变化量。
该设计为纵向队列研究。
参与者包括 708 名年龄在 18 个月至 12 岁之间的 CP 儿童及其家庭。儿童使用 GMFCS 和 ECAB 进行 2 至 5 次评估。
通过为每个 GMFCS 水平的儿童拟合单独的非线性混合效应模型，创建了描述 ECAB 分数随年龄变化的纵向轨迹。参考百分位数是使用 ECAB 数据的分位数回归从第一次就诊（基线）和 12 个月和 24 个月就诊构建的。使用这些参考点，通过从 12 个月的百分位数中减去基线百分位数来计算所有儿童的百分位数变化量。百分位数变化在 80%限制内的儿童通常可以被描述为在他们的年龄和 GMFCS 水平上“按预期发展”。
本研究的局限性包括使用方便样本、GMFCS 水平 I 和 II 中一些儿童的 ECAB 天花板效应，以及使用 12 个月和 24 个月的研究方案，这影响了每个评估时段可用的儿童数量。
当适当地用于监测 CP 儿童随时间的发展和变化时，这里呈现的 ECAB 纵向轨迹、参考百分位数和相关的变化分数应有助于治疗师和家庭在平衡能力方面进行协作互动，主动计划服务和干预措施。
