3nd “CHAPTER” – ASSESSMENT OF GROSS MOTOR SKILLS VIDEOS

Pediatric Balance Scale 

Pediatric Balance Scale is a version of the Berg Balance Scale adapted for children, designed to assess and measure balance and stability in school age children – school age children (5-15) for children with mild to moderate motor impairments; typically developing children plateau around age 7-8.Administration and scoring takes less than 15 minutes. Verbal instructions for each item are given. The child may receive one practice trial per item. If the child is unable to understand the directions, a second trial may be given. Verbal and visual instructions are given to clarify. 

Equipment required: adjustable height bench, chair with back support and arm rest, stopwatch or watch with a second hand, masking tape, – 1 inch wide (1 inch = 2,54 centimetres), a step stool 6 inches (15,24 cm) in height, chalkboard eraser, ruler or yardstick, a small level. Optional equipment that may be helpful includes: 2 child size footprints, blindfold, brightly coloured object at least 2 inches (5,08 cm) in size, flash cards, 2 inches (5,08 cm) of adhesive-backed hook, two 1 foot (30,48 cm) strips of loop. 

14 item test – each item is scored 0 – 4 (max. 56 points) 

1. Sitting to standing 
2. Standing to sitting 
3. Transfers 
4. Standing unsupported 
5. Sitting unsupported 
6. Standing with eyes closed 
7. Standing with feet together 
8. Standing with one foot in front 
9. Standing on one foot 
10. Turning 360 degrees 
11. Turning to look behind 
12. Retrieving object from floor 
13. Placing alternate foot on stool 
14. Reaching forward with outstretched arm 

Test 1 – Sitting to standing 

Equipment: a bench of appropriate height to allow the child’s feet to rest supported on the floor with the hips and knees maintained in 90 degrees of flexion. 

Instructions: child is asked to “Hold arms up and stand up.” The child is allowed to select the position of his/her arms. 

Best of three trials.  

4 points -able to stand without using hands and stabilize independently 

3 points – able to stand independently using hands 

2 points – able to stand using hands after several tries 

1 point – needs minimal assist to stand or to stabilize 

0 point – needs moderate or maxima assist to stand 

Test 1 and 2 may be tested simultaneously if, in the determination of the examiner, it will facilitate the best performance of the child.  

Test 2 – Standing to sitting 

Equipment: a bench of appropriate height to allow the child’s feet to rest supported on the floor with the hips and knees maintained in 90 degrees of flexion. 

Instructions: child is asked to sit down slowly, without use of hands. The child is allowed to select the position of his/her arms.  

Best of three trials.  

4 points – sits safely with minimal use of hands 

3 points – controls descent by using hands 

2 points – uses back of legs against chair to control descent 

1 point – sits independently, but has uncontrolled descent 

0 point – needs assistance to sit 

Test 3 – Transfers 

Equipment: two chairs, or one chair and one bench. One seating surface must have armrest. One chair/bench should be of standard adult size and the other should be of an appropriate height to allow the child to conformably sit with feet supported on the floor and ninety degrees of hip and knee flexion.   

Instructions: arrange chair(s) for a stand pivot transfer, touching at a forty-five degree angle. Ask the child to transfer one way toward a seat with armrests and one way toward a seat without armrests.  

4 points – able to transfer safely with minor use of hands 

3 points – able to transfer safely; definite need of hands 

2 points – able to transfer with verbal cueing and/or supervision (spotting) 

1 point – needs one person to assist 

0 point – needs two people to assist or supervise (close guard) to be safe 

Test 4 – Standing unsupported 

Equipment: a stop watch or watch with a second hand, a twelve inch long masking tape line or two footprints placed shoulder width apart 

Instructions: the child is asked to stand for 30 seconds without holding on or moving his/her feet. A taped line or footprints may be placed on the floor to help the child maintain a stationary foot position. The child may be engaged in non-stressful conversation to maintain attention span for thirty seconds. Weight shifting and equilibrium responses in feet are acceptable; movement of the foot in space (off the support surface) indicates end of the timed trial.  

4 points – able to stand safely for 30 seconds 

3 points – able to stand 30 seconds with supervision (spotting) 

2 points – able to stand 15 seconds unsupported 

1 point – needs several tries to stand 10 seconds unsupported 

0 point – unable to stand 10 seconds unassisted 

____ Time in seconds 

Special instructions: if a subject is able to stand 30 seconds unsupported, score full points for sitting unsupported. Proceed to item #6 

Test 5 – Sitting with back unsupported and feet supported on the floor 

Equipment: a stop watch or watch with a second hand, a bench of appropriate height to allow the feet to rest supported on the floor with the hips and knees maintained in ninety degrees of flexion 

Instructions: please sit with arms folded on your chest for 30 seconds. Child may be engaged in non-stressful conversation to maintain attention span for thirty seconds. Time should be stopped if protective reactions are observed in trunk or upper extremities. 

4 points – able to sit safely and securely 30 seconds 

3 points – able to sit 30 seconds under supervision (spotting) or may require definite use of upper extremities to maintain sitting position 

2 points – able to sit 15 seconds 

1 point – able to sit 10 seconds 

0 point -unable to sit 10 seconds without support 

____ Time in seconds 

Test 6 – Standing unsupported with eyes closed 

Equipment: a stop watch or watch with a second hand, a twelve-inch long masking tape line or two footprints placed shoulder width apart, blindfold 

Instructions: the child is asked to stand still with feet shoulder width apart and close his/her eyes for ten seconds. Direction: „When I say close your eyes, I want you to stand still, close your eyes, and keep them closed until I say open.” If necessary, a blindfold may be used. Weight shifting and equilibrium responses in the feet are acceptable; movement of the foot in space (off the support surface) indicates end of timed trial. A taped line or footprints may be placed on the floor to help the child maintain a stationary foot position.   

Best of 3 trials. 

4 points – able to stand 10 seconds safely 

3 points – able to stand 10 seconds with supervision (spotting) 

2 points -able to stand 3 seconds 

1 point – unable to keep eyes closed 3 seconds but stays steady 

0 point-needs help to keep from falling 

____ Time in seconds 

Test 7 – Standing unsupported with feet together 

Equipment: a stop watch or watch with a second hand, a twelve-inch long masking tape line or two footprints placed together 

Instructions: the child is asked to place his/her feet together and stand still without holding on. The child may be engaged in non-stressful conversation to maintain attention span for thirty seconds. Weight shifting and equilibrium responses in the feet are acceptable; movement of the foot in space (off the support surface) indicates end of timed trial. A taped line or footprints may be placed on the floor to help the child maintain a stationary foot position.   

Best of 3 trials. 

4 points – able to place feet together independently and stand 30 seconds safely 

3 points – able to place feet together independently and stand 30 seconds with supervision (spotting) 

2 points – able to place feet together independently but unable to hold for 30 seconds  

1 point – needs help to attain position but able to stand 30 seconds with feet together 

0 point – needs help to attain position and/or unable to hold for 30 seconds 

____ Time in seconds 

Test 8 – Standing unsupported one foot in front  

Equipment: a stop watch or watch with a second hand, a twelve-inch long masking tape line or two footprints placed heel to toe 

Instructions: the child is asked to stand with one foot in front of the other, heel to toe. If the child cannot place feet in a tandem position (directly in front), they should be asked to step forward far enough to allow the heel of one foot to be placed ahead of the toes of the stationary foot. A taped line and/or footprints may be placed on the floor to help the child maintain a stationary foot position. In addition to a visual demonstration, a single physical prompt (assistance with placement) may be given. The child may be engaged in non-stressful conversation to maintain his/her attention span for 30 seconds. Weight shifting and/or equilibrium reactions in the feet are acceptable. Timed trials should be stopped if either foot moves in space (leaves the support surface) and/or upper extremities support is utilized.  

Best of 3 trials. 

4 points – able to place feet tandem independently and hold 30 seconds  

3 points – able to place foot ahead of other independently and hold 30 seconds  

Note: The length of the step must exceed the length of the stationary foot and the width of the stance should approximate the subject’s normal stride width.  

2 points – able to take small step independently and hold 30 seconds, or required assistance to place foot in front, but can stand for 30 seconds  

1 point – needs help to step, but can hold 15 seconds 

0 point – loses balance while stepping or standing 

____ Time in seconds 

Test 9 – Standing on one leg 

Equipment: a stop watch or watch with a second hand, a twelve-inch long masking tape line or two footprints placed heel to toe 

Instructions: the child is asked to stand on one leg for as long as he/she is able to without holding on. If necessary the child can be instructed to maintain his/her arms (hands) on his/her hips (waist). A taped line or footprints may be placed on the floor to help the child maintain a stationary foot position. Weight shifting and/or equilibrium reactions in the feet are acceptable. Timed trials should be stopped if the weight-bearing foot moves in space (leaves the support surface), the up limb touches the opposite leg or the support surface and/or upper extremities are utilized for support. 

3 trials average score. 

4 points – able to lift leg independently and hold 10 seconds 

3 points – able to lift leg independently and hold 5 to 9 seconds 

2 points – able to lift leg independently and hold 3 to 4 seconds 

1 point – tries to lift leg; unable to hold 3 seconds but remains standing 

0 point – unable to try or needs assist to prevent fall 

Test 10 – Turn 360 degrees 

Equipment: a stop watch or watch with a second hand 

Instructions: the child is asked to turn completely around in a full circle, STOP, and then turn a full circle in the other direction. 

4 points – able to turn 360 degrees safely in 4 seconds or less each way (total of less than eight seconds) 

3 points – able to turn 360 degrees safely in one direction only in 4 seconds or less completes turn in other direction requires more than four seconds  

2 points – able to turn 360 degrees safely but slowly  

1 point – needs close supervision (spotting) or constant verbal cueing 

0 point – needs assistance while turning 

____ Time in seconds 

Test 11 – Turning to look behind left and right shoulders while standing still 

Equipment: a brightly colored object of at least two inches in size, or flash cards, a twelve-inch long masking tape line or two footprints placed shoulder width apart 

Instructions: the child is asked to stand with his/her feet still, fixed in one place. „Follow this object as I move it. Keep watching it as I move it, but don’t move your feet.”  

4 points – looks behind/over each shoulder; weight shifts include trunk rotation 

3 points – looks behind/over one shoulder with trunk rotation; weight shift in the opposite direction is to the level of the shoulder; no trunk rotation  

2 points – turns head to look to level of shoulder; no trunk rotation 

1 point – needs supervision (spotting) when turning; the chin moves greater than half the distance to the shoulder 

0 point – needs assist to keep from losing balance or falling; movement of the chin is less than half the distance to the shoulder 

Test 12 – Pick up object from the floor from a standing position 

Equipment: a chalkboard eraser, a taped line or footprints  

Instructions: the child is asked to pick up a chalkboard eraser placed approximately the length of his/her foot in front of his/her dominant foot. In children, where dominance is not clear, ask the child which hand they want to use and place the object in front of that foot.  

4 points – able to pick up an eraser safely and easily  

3 points – able to pick up eraser but needs supervision (spotting)  

2 points – unable to pick up eraser but reaches 1 to 2 inches from eraser and keeps balance independently 

1 point – unable to pick up eraser; needs supervision (spotting) while attempting 

0 point – unable to try, needs assist to keep from losing balance or falling 

Test 13 – Placing alternate foot on step stool while standing unsupported 

Equipment: a stopwatch or watch with a second hand, a step/stool of four inches in height 

Instructions: the child is asked to place each foot alternately on the step stool and to continue until each foot has touched the step/stool four times.  

4 points – stands independently and safely and completes 8 steps in 20 seconds 

3 points – able to stand independently and complete 8 steps >20 seconds 

2 points – able to complete 4 steps without assistance, but requires close supervision (spotting) 

1 point – able to complete 2 steps; needs minimal assistance 

0 point – needs assistance to maintain balance or keep from falling, unable to try 

____ Time in seconds 

Test 14 – Reaching forward with outstretched arm while standing 

General instruction and set up: a yardstick affixed to a wall via Velcro strips will be used as the measuring tool. A taped line and/or footprints are used to maintain a stationary foot position. The child will be asked to reach as far forward without falling, and without stepping over the line. The MCP joint of the child’s fisted hand will be used as the anatomical reference point for measurement. Assistance may be given to initially position the child’s arm at 90 degrees. Support may not be provided during the reaching process. If 90 degrees of shoulder flexion cannot be obtained, then this item should be omitted.  

Equipment: a yardstick or ruler, a taped line or footprints, a level 

Instructions: The child is asked to lift his/her arm up like this. „Stretch out your fingers, make a fist, and reach forward as far as you can without moving your feet.”  

3 trials average results 

4 points – can reach forward confidently >10 inches (25,4 cm) 

3 points – can reach forward >5 inches, safely (12,7 cm) 

2 points – can reach forward >2 inches, safely (5,08 cm) 

1 point – reaches forward but needs supervision (spotting) 

0 point – loses balance while trying, requires external support 

____ total test score 

Maximum score=56