Clinical balance assessment tools for children with hearing loss: A scoping review

Clinical balance assessment tools for children with hearing loss: A scoping review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical balance assessment tools for children with hearing loss: A scoping review Sphilile Mbhele, Christine Rogers, Yougan Saman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4610058/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Mar, 2025 Read the published version in BMC Pediatrics → Version 1 posted 15 You are reading this latest preprint version Abstract Balance dysfunction exists in children with hearing loss, especially sensorineural loss, impacting on cognitive development, socio-emotional development and literacy. However, there is limited assessment of balance in this population, which has further impedes childhood development. The objective of this review was to identify clinical, low- technology and inexpensive tools used to evaluate balance in children with hearing loss. Methods: A scoping review method with reference to the JBI, was used where a search was conducted on electronic databases including EBSCOHost, MEDLINE, PubMED, Web of Science and Wiley. In addition, gray literature and hand searches were also used. The review included children between 3 – 15 years of age with hearing loss. Results: A total of 53 articles were found where 53% of the tests were norm-referenced tests, 44% were criterion referenced tests and 2% could not be identified. Conclusion: Tests such as the Tandem gait test, Pediatric Balance Scale (PBS), Clinical Test of Sensory Interaction for Balance (mCTSIB)/Pediatric Version of Clinical Test for Sensory Interaction of Balance (P-CTSIB), Dynamic Gait Index and the Timed-up-and-Go were identified to be relatively inexpensive and low-technology based clinical tools and have thus, been summarized in this review. Paediatric balance assessment motor development hearing loss vestibular deficit Figures Figure 1 Introduction The balance system is a complex system that facilitates multisensory integration of vestibular, visual, proprioceptive input as well as cognitive input to maintain balance and equilibrium ( 1 ). Throughout childhood, this system continues to develop such that it reaches a stage of adult-like sensory integration by the age of 12 years ( 2 ). Furthermore, spatial cues received from the auditory system assist with maintaining posture and balance ( 3 ). In children, balance is assists in maintaining postural control, motor development, and the coordination and accuracy of motor movements ( 4 ). Thus, injury or defect to either the auditory or vestibular system can result in balance dysfunction ( 3 , 5 , 6 ). Due to the anatomical and physiological relationship between hearing and the vestibular system, children with hearing loss have been noted to present with motor and balance deficits ( 7 ). Hearing loss is often accompanied by debilitating effects on children such as impaired language, communication, socio-emotional, psychological and academic difficulties ( 8 ). In addition, it has been found that children with severe to profound hearing loss usually present with significant delays in fine and gross motor development ( 9 ), postural and balance deficits ( 10 ), and poor visual and spatial orientation ( 11 ). Psychological issues such as hyperactivity and increased risk to anxiety-related disorders have also been noted in children with more severe forms of hearing impairment ( 12 ). Moreover, negative impact on cognitive development, socio-emotional development and literacy may also be noted; such that hearing-impaired children may later experience learning difficulties, developmental delays and poor academic performance (Martens et al., 2020; Rine & Wiener-Vacher, 2013). Due to such difficulties, children have increased risk of falls and injuries ( 13 ). Falls are the most common cause of hospitalizations (30%) and 15% visits to the emergency department in children ( 14 ). In a low-middle income country like South African, falls were the found to be the second cause of unintentional injury to children ( 15 ). Regardless of the aforemetioned evidence, vestibular and balance dysfunction in the paediatric population have been historically underdiagnosed ( 16 ). Although caregivers and teachers may report clumsiness and coordination difficulties, healthcare professionals who service this population often lack the appropriate training and time to effectively screen for both balance and developmental issues during routine clinic visits ( 17 ). High patient caseload, expensive equipment and lack of competence in training have contributed to balance dysfunction going unheeded ( 17 – 19 ). Assessment tools such as dynamic posturography, electrophysiological measures and other high-technology equipment may not be readily available to audiologists, especially those in low- and middle-income countries (LMIC) ( 20 ). Thus, further restricting access to balance assessment services. Therefore, the need to collate a battery of clinical tools for balance assessment may address such an issue, as they may be relatively inexpensive and easily available. Although hearing screening programmes have been able to provide early identification of hearing; the screening is limited in its inclusion of balance and motor assessments ( 19 , 21 ). Although some countries like Belgium have initiated vestibular screening in neonates, it is not routinely performed on all children with hearing loss; unless obvious vertigo and balance disorders are noted or for cochlear implant candidacy ( 19 ). Consequently, limitations in the management of the adverse effects of vestibular and resultant balance deficits can be noted as assessments are not incoporated as part of a standard healthcare service ( 22 , 23 ). There is evidently a significant gap in practice and it necessitates a need for vestibular and balance screening and assessment of all children with hearing loss, especially those presenting with severe to profound SNHL, and psychological disorders such as hyperactivity and anxiety disorders ( 9 , 12 ). Therefore, the main objective of this review was to develop a literature map of clinical balance assessment tools for children between the ages of three to fifteen years with hearing loss. Thereafter, it also aimed to identify gaps in literature for future research. A scoping review was an appropriate method to achieve these objectives as it is necessary to uncover the existing and available body of literature regarding a particular topic, so to provide clarity and create a valuable platform for the development of a systematic review ( 24 ). A preliminary search was conducted in the JBI Database of Systematic Reviews, Cochrane Database of Systematic Reviews and PROSPERO on the 10th of July 2021 to determine the existence of similar scoping reviews. At the time, there were no scoping reviews or systematic reviews that comprehensively detail the balance assessment instruments suitable for the paediatric population with hearing loss. Methods A scoping review was conducted. Scoping reviews are necessary to uncover the existing and available body of literature regarding a particular topic, so to provide clarity and create a valuable platform for the development of a systematic review (Munn et al., 2018). The methodology followed the Arksey and O’Malley’s framework for scoping reviews (Arksey & O'Malley, 2005). Arksey and O’Malley (2005) recommend following a five-step process for scoping reviews, that was the method used for this study and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting the data. 1.1 Selection criteria The review included studies involving 1) children older than 3 years to 15 years of age, by this age children should have received intervention for hearing impairment ( 25 ), also taking into account late diagnosis of hearing loss. Furthermore, the function of the vestibular system is present from birth and continually matures until the age of fifteen years ( 26 ) 2) clinical assessment tools that measure paediatric balance function 3) all research methodological frameworks written in English. The Joanna Briggs Institute (JBI) recommendations for pilot testing was followed using two randomly sampled databases (Cochrane Library PROSPERO and MEDLINE). The researcher screened titles and abstracts of 25 randomly sampled literature and thereafter, consultation with supervisor was done (M.D.J. Peters et al., 2021). 1.2 Search Strategy A qualified librarian was consulted to assist in developing search terms and an appropriate strategy. The following keywords were used: Population : child/paediatric/pediatric AND balance dysfunction/balance deficits/motor deficits/ instability, Concepts : balance assessment/balance tests/balance scales/functional balance test AND balance performance, Context : hearing loss/HL. Literature published in EBSCO Host, Google Scholar, PubMed, Scopus, Web of Science, Wiley Online was searched. In addition, OpenGrey was searched to account for grey literature. Although it is recommended that literature must not be older than 10 years (Cronin, Ryan, & Coughlan, 2008); however, for this review, a stipulated time frame was not used due to the novelty of the area of interest. 1.3 Data extraction The data were extracted from the literature search using the draft data charting tool recommended by the JBI (M.D.J. Peters et al., 2021). Figure 1 demonstrates the data extraction process. A search through the abovementioned databases yielded a total of 553 studies. A total of 218 duplicates were removed, leaving 335 studies for abstract screening. Of these studies, 208 articles were selected for full-text review and 127 articles were removed. Full-text review yielded 53 articles which met the selection criteria. Results The findings of this review reflect instruments used in both high-income countries and LMIC. In total, 34 different assessment tools were used in the researchers’ protocols to examine balance in children with hearing loss (Table 1). These tools evaluated static balance, dynamic balance, functional balance and motor development. A total of 35% of these tests were norm-referenced tests, 53% were criterion referenced tests and 12% could not be identified. The assessment tools that were most commonly used were the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), Bruininks-Oseretsky Test of Motor Proficiency Second edition (BOT-2), Movement Assessment Battery for Children (2nd edition) and the Single Leg Stance in evaluating static and dynamic balance, as well as motor performance. There is a range of low-technology, clinical tools which have been used to assess for balance deficits in children with hearing loss. The researcher further classified assessment tools according to costs as seen in Table 2. Ten assessment tools were noted to have cost implications and copyrighted, 17 tests were easily available and required minimal equipment, while 6 could not be identified. Table 2: Classification of assessment tools according to cost Cost associated Freely available Not identified Test Peabody Developmental Motor Scales (approx. $193.59) Lincoln-Oseretsky Motor Development Scale (approx. $15- $90) Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) and Second edition (BOT-2) (approx. $954 - $1,060) Zurich Neuromotor Assessment (ZNA) (query via email) Movement Assessment Battery for Children (MABC) and Second Edition (M ABC-2) (approx. $1,971.40) Koperkoördinationstest für Kinder Test of Gross Motor Development Test (TGMD) and (TGMD)-2 (approx. $350) Tandem gait test Balance beam test Heath Rail walking Test The Paediatric Balance Scale (PBS) Pediatric/Functional Reach Test One-leg stand tests Modified Clinical Test of Sensory Interaction for Balance (mCTSIB) Dynamic Gait Index (DGI) Romberg test Fournier test Sharpened Romberg/tandem stand Unterberg Walk on Floor Berg Balance Scale (BBS) Flamingo balance test Pediatric Version of Clinical Test for Sensory Interaction of Balance (P-CTSIB) Timed Up and Go Test (TUG) Cratty's test The Meeting Street School Screening Test ChAS-T Geddes Psychomotor Inventory Touwen test Southern California Sensory Integration Test Discussion Recent technological advances have allowed for the quantification of balance, however, some of these assessments are costly and may therefore, be inaccessible in many clinical settings ( 27 ). The objective of this review was to explore clinical balance assessment tools administered with hearing-impaired children between the ages of 3 to 15 years of age. The findings of this review reflect that there is an assortment of balance tools, assessing different aspects of balance function, which can be used for balance assessment of children with hearing loss. For the purpose of this review, only the inexpensive and easily available clinical assessment tools (Table 2 ) will be discussed. Furthermore, the reliability, validity and applicability of these tools will also be discussed. The Paediatric Balance Scale (PBS) is an adaptation of the Berg Balance Scale and it is a criterion-referenced test assessing functional balance in children 2 years − 7 years and older (Franjoine, Darr, Held, Kott, & Young, 2010). It is a valid and reliable balance tool that assesses for functional balance using 14 tasks which are similar to activities of daily living ( 28 ). Within the tasks, the PBS incorporates the conditions similar to the Romberg, Sharpened Romberg, Functional Reach Test and Standing on One Leg test. These tasks can be scored from 0–4 where a high score indicates good performance and the test can be completed in approximately 20 minutes with the aid of easily accessible equipment e.g., chair, bench, stopwatch etc. ( 29 ). The PBS has an interrater reliability of (ICC [3,2] = 0.90–0.92), test-retest (ICC [2,1] = 0.923), and intra-rater reliability (ICC [2,1] = 0.895–0.998) allowing for adequately identifying children with balance dysfunction ( 29 ). The Tandem gait test is an assessment procedure used for dynamic postural control ( 30 ). It is a simple test and easy to administer, requiring minimal equipment ( 31 ). It can be conducted in different conditions including eyes open, eyes closed or with dual tasking. This test requires children to walk barefoot along a 3 metre line in an alternating heel-to-toe motion, make a turn of 180°, repeat the same action back to the starting line ( 30 ). Four trials are conducted and each trial is timed. The child passes the test if they can walk along the line without stepping over the it, deviating from line or having gait of < 14 seconds ( 32 ). The tandem gait test has good reliability (intraclass correlation coefficient; ICC [3,1] = 0.86; 95% confidence interval [CI] = 0.73–0.93) ( 31 ). The modified Clinical Test of Sensory Interaction for Balance (mCTSIB) and Pediatric Version of Clinical Test for Sensory Interaction of Balance (P-CTSIB) are modifications of the Clinical Test of Sensory Interaction in Balance (CTSIB) test. The mCTSIB assesses the impact of sensory integration in maintaining balance and postural ability (Lotfi, Javanbakht, Sayaf, & Bakhshi, 2018). The m-CTSIB can be used to evaluate all age groups from 2 years (Horn et al., 2015), while the P-CTSIB shows good reliability for children 4–6 years (Lotfi, Kahlaee, Sayadi, Afshari, & Bakhshi, 2017). It is a criterion reference test that requires minimal equipment that assesses balance in four conditions; eyes open on firm surface, eyes closed on firm surface, eyes open on foam surface and eyes closed on foam surface and each condition is held for 30 seconds ( 33 ). Three trials are given with performance on each trial timed and recorded. In the P-CTSIB, children are given one-minute rest between each test condition ( 34 ). Maturation is a great factor in these tests. For 6–12year olds, the reliability of the m-CTSIB has good sensitivity (88%) and specificity (85%); and reliability was high (0.78), except for condition 4 (0.56) ( 35 ). For the P-CTSIB for 4–6 years, the interrater reliability was also good (standing duration, antero-posterior sway, and lateral sway = 0.92, 0.77, and 0.84, respectively). The intraclass correlation coefficient (ICC) ranged from 0.70 to 0.92 for standing duration ( 36 ). The Dynamic Gait Index (DGI) is a criterion-based test used to assess postural control and dynamic balance. It measures functionality using 8 items; with a total score of 24, scored from 3 (independent walking) to 0 (severe impairment) ( 37 ). Furthermore, Evkaya (2020) found that the DGI has an internal consistency with a Cronbach's alpha coefficient of 0.969, a test-retest reliability of (ICC = 0.970 Cl (0.915-0990)) and an inter-rater reliability of DGI was excellent (ICC = 0.983 Cl (0.882-0990). These results are applicable for children 6- 14years of age. The Timed Up and Go Test (TUG) is another measure which can be used to assess dynamic balance in children ( 38 ). It is a fairly reliable test of dynamic balance that can be conducted with children as young as 3 years (Williams, Carroll, Reddihough, Phillips, & Galea, 2005). A standard chair (approx. height of 46cm) with backrest or armrest can be used ( 39 ). The test requires the child to sit on a chair, get up and walk along a 3 metre line, turn around and walk back to the starting position and sit down ( 40 ). The entire process is timed, three trials are conducted and the best of the three is recorded ( 38 , 40 ). The TUG is a reliable test with a test-retest, intra-rater, and interrater reliability (intraclass correlation coefficient [ICC] ≥ 0.85) for children between 3–18years of age ( 38 ). These tools were primarily designed for adults; however, researchers have made strides to develop normative data applicable for children of different ages. The findings of this review reflect a heterogenous nature of balance assessments available, thus, allowing clinicians the opportunity to select the appropriate tool to use based on the child’s age and aspect of balance they would like to assess. The tools (DGI, TUG, m-CTSIB) are also clinically recommended by VEDGE Task Force ( 41 ) as tools which can be used to assess balance function; and literature supports the clinical utility in children ( 42 , 43 ). Furthermore, due to limited cost implications and low-technological nature of these tools, they could be easily adopted into clinical practice by professionals from different contexts and disciplines. Ultimately, making the integration of balance assessments across a continuum of care for children with hearing loss feasible. Conclusion The finding of this review demonstrates a robustness in clinical balance assessments used to assess children with hearing loss. Tests such as the Tandem gait test, Paediatric Balance Scale, Modified/ Pediatric Clinical Test of Sensory Interaction for Balance (mCTSIB/PCTSIB), Dynamic Gait Index (DGI) or Timed Up and Go Test (TUG) can be used to evaluate different aspects of balance which can be vital for the identification of balance dysfunctions. Balance dysfunction plays a detrimental role in childhood development and may contribute to global developmental delay as well as a delay cognitive development ( 44 ). Therefore, assessment and management of such dysfunctions becomes imperative. The abovementioned instruments that are reliable, quick and easy to administer and can be suitable for any clinical context. More importantly, these tools may be appropriate for use in primary healthcare settings as they require minimal equipment and are easily accessible. However, there is room to further explore paediatric balance assessment tools in both research and clinical practice to aid in the development of a standardized protocol for balance assessment in children with hearing loss. This could, inform policy makers and relevant stakeholders in healthcare institutions about the need to review current practices and protocols regarding the management of children with hearing loss. Declarations Ethical approval and Consent to participate Not applicable for this review. Clinical Trial Number Not applicable Conflict of interest The author declares no conflict of/competing interest. Funding Study was funded by the National Research Foundation: Thuthuka Grant (TTK23031783533). Author Contribution All authors contributed equally to the conceptualization and revision and editing of this manuscript. Acknowledgements Not applicable. Data Availability and materials References Morita H, Kaji H, Ueta Y, Abe C. Understanding vestibular-related physiological functions could provide clues on adapting to a new gravitational environment. J Physiol Sci. 2020;70(1):17. Varedi M, Lu L, Phillips NS, Partin RE, Brinkman TM, Armstrong GT, et al. Balance impairment in survivors of pediatric brain cancers: risk factors and associated physical limitations. J Cancer Surviv. 2021;15(2):311–24. Horowitz G, Ungar OJ, Levit Y, Himmelfarb M, Handzel O. The impact of conductive hearing loss on balance. Clin Otolaryngol. 2020;45(1):106–10. Walicka-Cupryś K, Przygoda Ł, Czenczek E, Truszczyńska A, Drzał-Grabiec J, Zbigniew T, et al. Balance assessment in hearing-impaired children. Res Dev Disabil. 2014;35(11):2728–34. Vitkovic J, Le C, Lee SL, Clark RA. The Contribution of Hearing and Hearing Loss to Balance Control. Audiol Neurootol. 2016;21(4):195–202. Sokolov M, Gordon KA, Polonenko M, Susan I, Blaser SI, Papsin BC, Cushing SL. Vestibular and balance function is often impaired in children with profound unilateral sensorineural hearing loss. Hear Res. 2019;372:52–61. Karakoc K, Mujdeci B. Evaluation of balance in children with sensorineural hearing loss according to age. Am J Otolaryngol. 2021;42(1):102830. Mulwafu W, Kuper H, Ensink RJ. Prevalence and causes of hearing impairment in Africa. Trop Med Int Health. 2016;21(2):158–65. Hazen M, Cushing LS. Implications of Concurrent Vestibular Dysfunction in Pediatric Hearing Loss. Curr Otorhinolaryngol Rep. 2020;8:267–75. Yassin O, Elshafey M, Hamdy B, Gamal R, Abdelazeim F. Comprehensive evaluation of vestibular dysfunction in deaf children. J Crit Reviews. 2020;7(18):3586–94. Ionescu E, Reynard P, Gouleme N, Becaud C, Spruyt K, Ortega-Solis J, et al. How sacculo-collic function assessed by cervical vestibular evoked myogenic Potentials correlates with the quality of postural control in hearing impaired children? Int J Pediatr Otorhinolaryngol. 2020;130:109840. Antoine MW, Vijayakumar S, McKeehan N, Jones SM, Hebert JM. The Severity of Vestibular Dysfunction in Deafness as a Determinant of Comorbid Hyperactivity or Anxiety. J Neurosci. 2017;37(20):5144–54. Soylemeza E, Ertugrulb S, Doganc E. Assessment of balance skills and falling risk in children with congenital bilateral profound sensorineural hearing loss. Int J Pediatr Otorhinolaryngol. 2019;116:75–8. Grivna M, Al-Marzouqi HM, Al-Ali MR, Al-Saadi NN, Abu-Zidan FM. Pediatric falls from windows and balconies: incidents and risk factors as reported by newspapers in the United Arab Emirates. World J Emerg Surg. 2017;12(1):45. Lack V, Fru PN, Van Rensburg C, Van Rensburg K, Loveland JA. The epidemiology of traumatic brain injuries sustained by children under 10 years of age presenting to a tertiary hospital in Soweto, South Africa. South Afr Med J. 2021;111(Electronic):2078–5135. Kelly A, Liu Z, Leonard S, Toner F, Adams M, Toner J. Balance in children following cochlear implantation. Cochlear implant Int. 2017. Said EAF. Clinical balance tests for evaluation of balance dysfunction in children with sensorineural hearing loss. Egypt J Otolaryngol. 2013;29(3):189–201. Zhou G, Kenna MA, Stevens K, Greg Licameli G. Assessment of Saccular Function in Children With Sensorineural Hearing Loss. Arch Otolaryngol Head Neck Surg. 2009;135(1):40–4. Martens S, Dhooge I, Dhondt C, Leyssens L, Sucaet M, Vanaudenaerde S, et al. Vestibular Infant Screening - Flanders: The implementation of a standard vestibular screening protocol for hearing-impaired children in Flanders. Int J Pediatr Otorhinolaryngol. 2019;120(Electronic):1872–8464. Seedat T, Khoza-Shangase K, Sebothoma B. Vestibular assessment and management in adults: current practice by South African audiologists. Hear Balance Communication. 2018;16:1–13. Rajendran V, Roy FG. An overview of motor skill performance and balance in hearing impaired children. Ital J Pediatr 2011;37(33). Callahan AJ, Lass NJ, Reed S, Willis M. Pediatric vestibular evaluation/balance assessment: Audiologists’ perceived skills and clinical practices. Audiol Today. 2012;24(5):28–37. Martens S, Dhooge I, Dhondt C, Vanaudenaerde S, Sucaet M, Rombaut L et al. Vestibular Infant Screening (VIS)-Flanders: results after 1.5 years of vestibular screening in hearing-impaired children. Sci Rep. 2020;10(2045–2322 (Electronic)):21011. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. Joint Committee on Infant Hearing. Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. J Early Hear Detect Intervention. 2019;4:1–44. O'Reilly R, Grindle C, Zwicky EF, Morlet T. Development of the vestibular system and balance function: differential diagnosis in the pediatric population. Otolaryngol Clin North Am. 2011;44(2):251–. – 71, vii. Ghai S, Hakim M, Dannenbaum E, Lamontagne A. Prevalence of Vestibular Dysfunction in Children With Neurological Disabilities: A Systematic Review. Front Neurol. 2019;10:1294. Wardani NK, Kusumawardani MK, Mayangsari JA, Wulan S. Correlation between One Leg Stand Test and Paediatric Balance Scale in children aged 7–12 years. Sri Lanka J Child Health. 2022;51(2):204–8. Franjoine MR, Darr N, Held SL, Kott K, Young BL. The performance of children developing typically on the pediatric balance scale. Pediatr Phys Ther. 2010;22(4):350–9. Howell DR, Brilliant AN, Meehan WP. 3rd. Tandem Gait Test-Retest Reliability Among Healthy Child and Adolescent Athletes. ournal athletic Train. 2019;54:1254–9. 1938-162X (Electronic). Galea OA, Bristow HD, Chisholm SM, Mersch ME, Nullmeyer J, Reid CR, et al. Single and dual tandem gait assessment post concussion: What performance time is clinically relevant across adult ages and what can influence results? Musculoskelet Sci Pract. 2019;42:166–72. Oldham JR, DIFABIO MS, KAMINSKI TW, DEWOLF RM, HOWELL DR. Efficacy of Tandem Gait to Identify Impaired Postural Control after Concussion. Med Sci Sports Exerc. 2018;50(6):1162–8. Van Hecke R, Deconinck FJA, Wiersema JR, Clauws C, Danneels M, Dhooge I et al. Balanced Growth project: A protocol of a single-centre observational study on the involvement of the vestibular system in a child's motor and cognitive development. BMJ Open. 2021;11(6). Wong TPS, Leung EYW, Poon CYC, Leung CYF, Lau BPH. Balance performance in children with unilateral and bilateral severe-to-profound-grade hearing impairment. Hong Kong Physiother J. 2013;31(2):81–7. Christy JB, Payne J, Azuero A, Formby C. Reliability and diagnostic accuracy of clinical tests of vestibular function for children. Pediatr Phys therapy: official publication Sect Pediatr Am Phys Therapy Association. 2014;26(Electronic):1538–X005. Yones L, Kahlaee AH, Sayadi N, Jalilzadeh Afshari P, Bakhshi E. Test-retest reliability of the pediatric clinical test of sensory interaction for balance in 4–6 years old children. Auditory Vestib Res. 2017;26(4). Evkaya A, Karadag-Saygi E, Karali Bingul D, Giray E. Validity and reliability of the Dynamic Gait Index in children with hemiplegic cerebral palsy. Gait Posture. 2020;75:28–33. Verbecque E, Schepens K, Theré J, Schepens B, Klingels K, Hallemans A. The Timed Up and Go Test in Children: Does Protocol Choice Matter? A Systematic Review. Pediatr Phys Ther. 2019;31(1):22–31. Nicolini-Panisson RD, Donadio MV. Timed Up & Go test in children and adolescents. Revista paulista de pediatria: orgao oficial da Sociedade de Pediatria de Sao Paulo. 2013;31:377–83. (1984 – 0462 (Electronic)). Nicolini-Panisson RD, Donadio MV. Normative values for the Timed 'Up and Go' test in children and adolescents and validation for individuals with Down syndrome. Dev Med Child Neurol. 2014;56(5):490–7. Academy of Neurologic Physical Therapy, Vestibular EDGE, Roseville,:. ACADEMY OF NEUROLOGIC PHYSICAL THERAPY 2018 [ https://www.neuropt.org/practice-resources/neurology-section-outcome-measures-recommendations/vestibular-disorders . Sember V, Grošelj J, Pajek MA-O. Balance Tests in Pre-Adolescent Children: Retest Reliability, Construct Validity, and Relative Ability. LID – 10.3390/ijerph17155474 [doi] LID – 5474. Int J Environ Res Public Health. 2020;17:1660–4601. (Electronic)):5474. Sæther R, Helbostad J, Riphagen I, Vik T. Clinical Tools To Assess Balance In Children And Adults With Cerebral Palsy: A Systematic Review. Dev Med Child Neurol. 2013;55. Dasgupta S, Mandala M, Salerni L, Crunkhorn R, Ratnayake S. Dizziness and Balance Problems in Children. Curr Treat Options Neurol. 2020;22(3):8. Tables Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1Findingsofscopingreview.docx Cite Share Download PDF Status: Published Journal Publication published 19 Mar, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 09 Oct, 2024 Reviews received at journal 08 Sep, 2024 Reviews received at journal 30 Aug, 2024 Reviews received at journal 26 Aug, 2024 Reviewers agreed at journal 21 Aug, 2024 Reviewers agreed at journal 21 Aug, 2024 Reviewers agreed at journal 21 Aug, 2024 Reviews received at journal 20 Aug, 2024 Reviewers agreed at journal 14 Aug, 2024 Reviewers agreed at journal 14 Aug, 2024 Reviewers invited by journal 14 Aug, 2024 Editor invited by journal 02 Jul, 2024 Editor assigned by journal 24 Jun, 2024 Submission checks completed at journal 24 Jun, 2024 First submitted to journal 20 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4610058","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":322998188,"identity":"c21e2646-75d8-49f6-8458-20081c6e3063","order_by":0,"name":"Sphilile Mbhele","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIie3SMWsCMRjG8UcC5/LCremiXyFHIKWLfpUcgXNxcBRazoBwXSqufgyhX+AkoMvROaDDTZ0PXDqVUujUId7okP/+e5/lBWKxO0x4AlpglCLpSZ5+iQbkg+1Lpn8k39d9iTpvDq1eloN3X5jrApMxUteGyeXDCN04pnxRyx1MZnEUYeLniudVnSg/s4bANAY2TISfP37l3yXJ3cw6wkqDDbtbRCG3jAteHNYEp5HQjZVLI7k+OsGbT8NInLKKaBEm57es617K1fa1kFdaPo/T9LQPkv8X0PsJYrFYLBboB/8lRNFKgItjAAAAAElFTkSuQmCC","orcid":"","institution":"University of Cape Town","correspondingAuthor":true,"prefix":"","firstName":"Sphilile","middleName":"","lastName":"Mbhele","suffix":""},{"id":322998189,"identity":"cf4b5ace-7b2c-47dc-9830-aa1365a5f01f","order_by":1,"name":"Christine Rogers","email":"","orcid":"","institution":"University of Cape Town","correspondingAuthor":false,"prefix":"","firstName":"Christine","middleName":"","lastName":"Rogers","suffix":""},{"id":322998190,"identity":"a33eae2c-863c-49b3-94cd-155f92049aa8","order_by":2,"name":"Yougan Saman","email":"","orcid":"","institution":"Leicester Royal Infirmary","correspondingAuthor":false,"prefix":"","firstName":"Yougan","middleName":"","lastName":"Saman","suffix":""}],"badges":[],"createdAt":"2024-06-20 07:51:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4610058/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4610058/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-025-05563-2","type":"published","date":"2025-03-19T15:58:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60625551,"identity":"a9d2d479-ce48-4507-b35f-354c52a7c388","added_by":"auto","created_at":"2024-07-18 22:25:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":198609,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA diagram\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4610058/v1/39a44c4aeb42981fca8c58e8.png"},{"id":79120592,"identity":"85ade106-1489-4f43-a4cd-55f3354fc090","added_by":"auto","created_at":"2025-03-24 16:10:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":798083,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4610058/v1/1cf23ef4-a4e5-425a-8209-e9990e7f54cf.pdf"},{"id":60624775,"identity":"8472645a-3ab1-48d5-839c-cf9e2c2c8a8b","added_by":"auto","created_at":"2024-07-18 22:17:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25998,"visible":true,"origin":"","legend":"","description":"","filename":"Table1Findingsofscopingreview.docx","url":"https://assets-eu.researchsquare.com/files/rs-4610058/v1/9432733770a4ddf5cc8740cc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical balance assessment tools for children with hearing loss: A scoping review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe balance system is a complex system that facilitates multisensory integration of vestibular, visual, proprioceptive input as well as cognitive input to maintain balance and equilibrium (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Throughout childhood, this system continues to develop such that it reaches a stage of adult-like sensory integration by the age of 12 years (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Furthermore, spatial cues received from the auditory system assist with maintaining posture and balance (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In children, balance is assists in maintaining postural control, motor development, and the coordination and accuracy of motor movements (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Thus, injury or defect to either the auditory or vestibular system can result in balance dysfunction (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDue to the anatomical and physiological relationship between hearing and the vestibular system, children with hearing loss have been noted to present with motor and balance deficits (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Hearing loss is often accompanied by debilitating effects on children such as impaired language, communication, socio-emotional, psychological and academic difficulties (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In addition, it has been found that children with severe to profound hearing loss usually present with significant delays in fine and gross motor development (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), postural and balance deficits (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and poor visual and spatial orientation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Psychological issues such as hyperactivity and increased risk to anxiety-related disorders have also been noted in children with more severe forms of hearing impairment (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Moreover, negative impact on cognitive development, socio-emotional development and literacy may also be noted; such that hearing-impaired children may later experience learning difficulties, developmental delays and poor academic performance (Martens et al., 2020; Rine \u0026amp; Wiener-Vacher, 2013). Due to such difficulties, children have increased risk of falls and injuries (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Falls are the most common cause of hospitalizations (30%) and 15% visits to the emergency department in children (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In a low-middle income country like South African, falls were the found to be the second cause of unintentional injury to children (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegardless of the aforemetioned evidence, vestibular and balance dysfunction in the paediatric population have been historically underdiagnosed (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Although caregivers and teachers may report clumsiness and coordination difficulties, healthcare professionals who service this population often lack the appropriate training and time to effectively screen for both balance and developmental issues during routine clinic visits (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). High patient caseload, expensive equipment and lack of competence in training have contributed to balance dysfunction going unheeded (\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Assessment tools such as dynamic posturography, electrophysiological measures and other high-technology equipment may not be readily available to audiologists, especially those in low- and middle-income countries (LMIC) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Thus, further restricting access to balance assessment services. Therefore, the need to collate a battery of clinical tools for balance assessment may address such an issue, as they may be relatively inexpensive and easily available.\u003c/p\u003e \u003cp\u003eAlthough hearing screening programmes have been able to provide early identification of hearing; the screening is limited in its inclusion of balance and motor assessments (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Although some countries like Belgium have initiated vestibular screening in neonates, it is not routinely performed on all children with hearing loss; unless obvious vertigo and balance disorders are noted or for cochlear implant candidacy (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Consequently, limitations in the management of the adverse effects of vestibular and resultant balance deficits can be noted as assessments are not incoporated as part of a standard healthcare service (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). There is evidently a significant gap in practice and it necessitates a need for vestibular and balance screening and assessment of all children with hearing loss, especially those presenting with severe to profound SNHL, and psychological disorders such as hyperactivity and anxiety disorders (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Therefore, the main objective of this review was to develop a literature map of clinical balance assessment tools for children between the ages of three to fifteen years with hearing loss. Thereafter, it also aimed to identify gaps in literature for future research. A scoping review was an appropriate method to achieve these objectives as it is necessary to uncover the existing and available body of literature regarding a particular topic, so to provide clarity and create a valuable platform for the development of a systematic review (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA preliminary search was conducted in the JBI Database of Systematic Reviews, Cochrane Database of Systematic Reviews and PROSPERO on the 10th of July 2021 to determine the existence of similar scoping reviews. At the time, there were no scoping reviews or systematic reviews that comprehensively detail the balance assessment instruments suitable for the paediatric population with hearing loss.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e A scoping review was conducted. Scoping reviews are necessary to uncover the existing and available body of literature regarding a particular topic, so to provide clarity and create a valuable platform for the development of a systematic review (Munn et al., 2018). The methodology followed the Arksey and O\u0026rsquo;Malley\u0026rsquo;s framework for scoping reviews (Arksey \u0026amp; O'Malley, 2005). Arksey and O\u0026rsquo;Malley (2005) recommend following a five-step process for scoping reviews, that was the method used for this study and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting the data.\u003c/p\u003e \u003cp\u003e1.1 Selection criteria\u003c/p\u003e \u003cp\u003eThe review included studies involving 1) children older than 3 years to 15 years of age, by this age children should have received intervention for hearing impairment (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), also taking into account late diagnosis of hearing loss. Furthermore, the function of the vestibular system is present from birth and continually matures until the age of fifteen years (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) 2) clinical assessment tools that measure paediatric balance function 3) all research methodological frameworks written in English. The Joanna Briggs Institute (JBI) recommendations for pilot testing was followed using two randomly sampled databases (Cochrane Library PROSPERO and MEDLINE). The researcher screened titles and abstracts of 25 randomly sampled literature and thereafter, consultation with supervisor was done (M.D.J. Peters et al., 2021).\u003c/p\u003e \u003cp\u003e1.2 Search Strategy\u003c/p\u003e \u003cp\u003eA qualified librarian was consulted to assist in developing search terms and an appropriate strategy. The following keywords were used: \u003cem\u003ePopulation\u003c/em\u003e: child/paediatric/pediatric AND balance dysfunction/balance deficits/motor deficits/ instability, \u003cem\u003eConcepts\u003c/em\u003e: balance assessment/balance tests/balance scales/functional balance test AND balance performance, \u003cem\u003eContext\u003c/em\u003e: hearing loss/HL. Literature published in EBSCO Host, Google Scholar, PubMed, Scopus, Web of Science, Wiley Online was searched. In addition, OpenGrey was searched to account for grey literature. Although it is recommended that literature must not be older than 10 years (Cronin, Ryan, \u0026amp; Coughlan, 2008); however, for this review, a stipulated time frame was not used due to the novelty of the area of interest.\u003c/p\u003e\u003cp\u003e1.3 Data extraction\u003c/p\u003e \u003cp\u003eThe data were extracted from the literature search using the draft data charting tool recommended by the JBI (M.D.J. Peters et al., 2021). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates the data extraction process. A search through the abovementioned databases yielded a total of 553 studies. A total of 218 duplicates were removed, leaving 335 studies for abstract screening. Of these studies, 208 articles were selected for full-text review and 127 articles were removed. Full-text review yielded 53 articles which met the selection criteria.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe findings of this review reflect instruments used in both high-income countries and LMIC.\u003c/p\u003e\n\u003cp\u003eIn total, 34 different assessment tools were used in the researchers\u0026rsquo; protocols to examine balance in children with hearing loss (Table 1). These tools evaluated static balance, dynamic balance, functional balance and motor development. A total of 35% of these tests were norm-referenced tests, 53% were criterion referenced tests and 12% could not be identified. The assessment tools that were most commonly used were the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), Bruininks-Oseretsky Test of Motor Proficiency Second edition (BOT-2), Movement Assessment Battery for Children (2nd edition) and the Single Leg Stance in evaluating static and dynamic balance, as well as motor performance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is a range of low-technology, clinical tools which have been used to assess for balance deficits in children with hearing loss. The researcher further classified assessment tools according to costs as seen in Table 2. Ten assessment tools were noted to have cost implications and copyrighted, 17 tests were easily available and required minimal equipment, while 6 could not be identified.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2: Classification of assessment tools according to cost\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"707\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.779349363507779%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.42008486562942%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCost associated\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.21923620933522%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFreely available\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.581329561527582%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot identified\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.779349363507779%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTest\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.42008486562942%\" valign=\"top\"\u003e\n \u003cp\u003ePeabody Developmental Motor Scales (approx. $193.59)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLincoln-Oseretsky Motor Development Scale (approx. $15- $90)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBruininks-Oseretsky Test of Motor Proficiency (BOTMP) and Second edition (BOT-2) (approx. $954 - $1,060)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eZurich Neuromotor Assessment (ZNA) (query via email)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMovement Assessment Battery for Children (MABC) and Second Edition (M ABC-2) (approx. $1,971.40)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eKoperko\u0026ouml;rdinationstest f\u0026uuml;r Kinder\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTest of Gross Motor Development\u0026nbsp;Test (TGMD) and (TGMD)-2 (approx. $350)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.21923620933522%\" valign=\"top\"\u003e\n \u003cp\u003eTandem gait test\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBalance beam test\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHeath Rail walking Test\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThe Paediatric Balance Scale (PBS)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePediatric/Functional Reach Test\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOne-leg stand tests\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eModified Clinical Test of Sensory Interaction for Balance (mCTSIB)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDynamic Gait Index (DGI)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRomberg test\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFournier test\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSharpened Romberg/tandem stand\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUnterberg\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWalk on Floor\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBerg Balance Scale (BBS)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFlamingo balance test\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePediatric Version of Clinical Test for Sensory Interaction of Balance (P-CTSIB)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTimed Up and Go Test (TUG)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.581329561527582%\" valign=\"top\"\u003e\n \u003cp\u003eCratty\u0026apos;s test\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThe Meeting Street School Screening Test\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eChAS-T\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGeddes Psychomotor Inventory\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTouwen test\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSouthern California Sensory Integration Test\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eRecent technological advances have allowed for the quantification of balance, however, some of these assessments are costly and may therefore, be inaccessible in many clinical settings (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The objective of this review was to explore clinical balance assessment tools administered with hearing-impaired children between the ages of 3 to 15 years of age. The findings of this review reflect that there is an assortment of balance tools, assessing different aspects of balance function, which can be used for balance assessment of children with hearing loss. For the purpose of this review, only the inexpensive and easily available clinical assessment tools (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) will be discussed. Furthermore, the reliability, validity and applicability of these tools will also be discussed.\u003c/p\u003e \u003cp\u003eThe Paediatric Balance Scale (PBS) is an adaptation of the Berg Balance Scale and it is a criterion-referenced test assessing functional balance in children 2 years \u0026minus;\u0026thinsp;7 years and older (Franjoine, Darr, Held, Kott, \u0026amp; Young, 2010). It is a valid and reliable balance tool that assesses for functional balance using 14 tasks which are similar to activities of daily living (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Within the tasks, the PBS incorporates the conditions similar to the Romberg, Sharpened Romberg, Functional Reach Test and Standing on One Leg test. These tasks can be scored from 0\u0026ndash;4 where a high score indicates good performance and the test can be completed in approximately 20 minutes with the aid of easily accessible equipment e.g., chair, bench, stopwatch etc. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The PBS has an interrater reliability of (ICC [3,2]\u0026thinsp;=\u0026thinsp;0.90\u0026ndash;0.92), test-retest (ICC [2,1]\u0026thinsp;=\u0026thinsp;0.923), and intra-rater reliability (ICC [2,1]\u0026thinsp;=\u0026thinsp;0.895\u0026ndash;0.998) allowing for adequately identifying children with balance dysfunction (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Tandem gait test is an assessment procedure used for dynamic postural control (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). It is a simple test and easy to administer, requiring minimal equipment (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). It can be conducted in different conditions including eyes open, eyes closed or with dual tasking. This test requires children to walk barefoot along a 3 metre line in an alternating heel-to-toe motion, make a turn of 180\u0026deg;, repeat the same action back to the starting line (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Four trials are conducted and each trial is timed. The child passes the test if they can walk along the line without stepping over the it, deviating from line or having gait of \u0026lt;\u0026thinsp;14 seconds (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The tandem gait test has good reliability (intraclass correlation coefficient; ICC [3,1]\u0026thinsp;=\u0026thinsp;0.86; 95% confidence interval [CI]\u0026thinsp;=\u0026thinsp;0.73\u0026ndash;0.93) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe modified Clinical Test of Sensory Interaction for Balance (mCTSIB) and Pediatric Version of Clinical Test for Sensory Interaction of Balance (P-CTSIB) are modifications of the Clinical Test of Sensory Interaction in Balance (CTSIB) test. The mCTSIB assesses the impact of sensory integration in maintaining balance and postural ability (Lotfi, Javanbakht, Sayaf, \u0026amp; Bakhshi, 2018). The m-CTSIB can be used to evaluate all age groups from 2 years (Horn et al., 2015), while the P-CTSIB shows good reliability for children 4\u0026ndash;6 years (Lotfi, Kahlaee, Sayadi, Afshari, \u0026amp; Bakhshi, 2017). It is a criterion reference test that requires minimal equipment that assesses balance in four conditions; eyes open on firm surface, eyes closed on firm surface, eyes open on foam surface and eyes closed on foam surface and each condition is held for 30 seconds (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Three trials are given with performance on each trial timed and recorded. In the P-CTSIB, children are given one-minute rest between each test condition (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Maturation is a great factor in these tests. For 6\u0026ndash;12year olds, the reliability of the m-CTSIB has good sensitivity (88%) and specificity (85%); and reliability was high (0.78), except for condition 4 (0.56) (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). For the P-CTSIB for 4\u0026ndash;6 years, the interrater reliability was also good (standing duration, antero-posterior sway, and lateral sway\u0026thinsp;=\u0026thinsp;0.92, 0.77, and 0.84, respectively). The intraclass correlation coefficient (ICC) ranged from 0.70 to 0.92 for standing duration (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Dynamic Gait Index (DGI) is a criterion-based test used to assess postural control and dynamic balance. It measures functionality using 8 items; with a total score of 24, scored from 3 (independent walking) to 0 (severe impairment) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Furthermore, Evkaya (2020) found that the DGI has an internal consistency with a Cronbach's alpha coefficient of 0.969, a test-retest reliability of (ICC\u0026thinsp;=\u0026thinsp;0.970 Cl (0.915-0990)) and an inter-rater reliability of DGI was excellent (ICC\u0026thinsp;=\u0026thinsp;0.983 Cl (0.882-0990). These results are applicable for children 6- 14years of age.\u003c/p\u003e \u003cp\u003eThe Timed Up and Go Test (TUG) is another measure which can be used to assess dynamic balance in children (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). It is a fairly reliable test of dynamic balance that can be conducted with children as young as 3 years (Williams, Carroll, Reddihough, Phillips, \u0026amp; Galea, 2005). A standard chair (approx. height of 46cm) with backrest or armrest can be used (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The test requires the child to sit on a chair, get up and walk along a 3 metre line, turn around and walk back to the starting position and sit down (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). The entire process is timed, three trials are conducted and the best of the three is recorded (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). The TUG is a reliable test with a test-retest, intra-rater, and interrater reliability (intraclass correlation coefficient [ICC]\u0026thinsp;\u0026ge;\u0026thinsp;0.85) for children between 3\u0026ndash;18years of age (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese tools were primarily designed for adults; however, researchers have made strides to develop normative data applicable for children of different ages. The findings of this review reflect a heterogenous nature of balance assessments available, thus, allowing clinicians the opportunity to select the appropriate tool to use based on the child\u0026rsquo;s age and aspect of balance they would like to assess. The tools (DGI, TUG, m-CTSIB) are also clinically recommended by VEDGE Task Force (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) as tools which can be used to assess balance function; and literature supports the clinical utility in children (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Furthermore, due to limited cost implications and low-technological nature of these tools, they could be easily adopted into clinical practice by professionals from different contexts and disciplines. Ultimately, making the integration of balance assessments across a continuum of care for children with hearing loss feasible.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe finding of this review demonstrates a robustness in clinical balance assessments used to assess children with hearing loss. Tests such as the Tandem gait test, Paediatric Balance Scale, Modified/ Pediatric Clinical Test of Sensory Interaction for Balance (mCTSIB/PCTSIB), Dynamic Gait Index (DGI) or Timed Up and Go Test (TUG) can be used to evaluate different aspects of balance which can be vital for the identification of balance dysfunctions.\u003c/p\u003e \u003cp\u003eBalance dysfunction plays a detrimental role in childhood development and may contribute to global developmental delay as well as a delay cognitive development (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Therefore, assessment and management of such dysfunctions becomes imperative. The abovementioned instruments that are reliable, quick and easy to administer and can be suitable for any clinical context. More importantly, these tools may be appropriate for use in primary healthcare settings as they require minimal equipment and are easily accessible. However, there is room to further explore paediatric balance assessment tools in both research and clinical practice to aid in the development of a standardized protocol for balance assessment in children with hearing loss. This could, inform policy makers and relevant stakeholders in healthcare institutions about the need to review current practices and protocols regarding the management of children with hearing loss.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical approval and Consent to participate\u003c/strong\u003e \u003cp\u003eNot applicable for this review.\u003c/p\u003e \u003ch2\u003eClinical Trial Number\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003ch2\u003eConflict of interest\u003c/h2\u003e \u003cp\u003eThe author declares no conflict of/competing interest.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eStudy was funded by the National Research Foundation: Thuthuka Grant (TTK23031783533).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed equally to the conceptualization and revision and editing of this manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e \u003cp\u003eand materials\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMorita H, Kaji H, Ueta Y, Abe C. Understanding vestibular-related physiological functions could provide clues on adapting to a new gravitational environment. J Physiol Sci. 2020;70(1):17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaredi M, Lu L, Phillips NS, Partin RE, Brinkman TM, Armstrong GT, et al. Balance impairment in survivors of pediatric brain cancers: risk factors and associated physical limitations. J Cancer Surviv. 2021;15(2):311\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorowitz G, Ungar OJ, Levit Y, Himmelfarb M, Handzel O. The impact of conductive hearing loss on balance. Clin Otolaryngol. 2020;45(1):106\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalicka-Cupryś K, Przygoda Ł, Czenczek E, Truszczyńska A, Drzał-Grabiec J, Zbigniew T, et al. Balance assessment in hearing-impaired children. Res Dev Disabil. 2014;35(11):2728\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVitkovic J, Le C, Lee SL, Clark RA. The Contribution of Hearing and Hearing Loss to Balance Control. Audiol Neurootol. 2016;21(4):195\u0026ndash;202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSokolov M, Gordon KA, Polonenko M, Susan I, Blaser SI, Papsin BC, Cushing SL. Vestibular and balance function is often impaired in children with profound unilateral sensorineural hearing loss. Hear Res. 2019;372:52\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarakoc K, Mujdeci B. Evaluation of balance in children with sensorineural hearing loss according to age. Am J Otolaryngol. 2021;42(1):102830.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMulwafu W, Kuper H, Ensink RJ. Prevalence and causes of hearing impairment in Africa. Trop Med Int Health. 2016;21(2):158\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHazen M, Cushing LS. Implications of Concurrent Vestibular Dysfunction in Pediatric Hearing Loss. Curr Otorhinolaryngol Rep. 2020;8:267\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYassin O, Elshafey M, Hamdy B, Gamal R, Abdelazeim F. Comprehensive evaluation of vestibular dysfunction in deaf children. J Crit Reviews. 2020;7(18):3586\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIonescu E, Reynard P, Gouleme N, Becaud C, Spruyt K, Ortega-Solis J, et al. How sacculo-collic function assessed by cervical vestibular evoked myogenic Potentials correlates with the quality of postural control in hearing impaired children? Int J Pediatr Otorhinolaryngol. 2020;130:109840.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntoine MW, Vijayakumar S, McKeehan N, Jones SM, Hebert JM. The Severity of Vestibular Dysfunction in Deafness as a Determinant of Comorbid Hyperactivity or Anxiety. J Neurosci. 2017;37(20):5144\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoylemeza E, Ertugrulb S, Doganc E. Assessment of balance skills and falling risk in children with congenital bilateral profound sensorineural hearing loss. Int J Pediatr Otorhinolaryngol. 2019;116:75\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrivna M, Al-Marzouqi HM, Al-Ali MR, Al-Saadi NN, Abu-Zidan FM. Pediatric falls from windows and balconies: incidents and risk factors as reported by newspapers in the United Arab Emirates. World J Emerg Surg. 2017;12(1):45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLack V, Fru PN, Van Rensburg C, Van Rensburg K, Loveland JA. The epidemiology of traumatic brain injuries sustained by children under 10 years of age presenting to a tertiary hospital in Soweto, South Africa. South Afr Med J. 2021;111(Electronic):2078\u0026ndash;5135.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly A, Liu Z, Leonard S, Toner F, Adams M, Toner J. Balance in children following cochlear implantation. Cochlear implant Int. 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaid EAF. Clinical balance tests for evaluation of balance dysfunction in children with sensorineural hearing loss. Egypt J Otolaryngol. 2013;29(3):189\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou G, Kenna MA, Stevens K, Greg Licameli G. Assessment of Saccular Function in Children With Sensorineural Hearing Loss. Arch Otolaryngol Head Neck Surg. 2009;135(1):40\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartens S, Dhooge I, Dhondt C, Leyssens L, Sucaet M, Vanaudenaerde S, et al. Vestibular Infant Screening - Flanders: The implementation of a standard vestibular screening protocol for hearing-impaired children in Flanders. Int J Pediatr Otorhinolaryngol. 2019;120(Electronic):1872\u0026ndash;8464.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeedat T, Khoza-Shangase K, Sebothoma B. Vestibular assessment and management in adults: current practice by South African audiologists. Hear Balance Communication. 2018;16:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajendran V, Roy FG. An overview of motor skill performance and balance in hearing impaired children. Ital J Pediatr 2011;37(33).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCallahan AJ, Lass NJ, Reed S, Willis M. Pediatric vestibular evaluation/balance assessment: Audiologists\u0026rsquo; perceived skills and clinical practices. Audiol Today. 2012;24(5):28\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartens S, Dhooge I, Dhondt C, Vanaudenaerde S, Sucaet M, Rombaut L et al. Vestibular Infant Screening (VIS)-Flanders: results after 1.5 years of vestibular screening in hearing-impaired children. Sci Rep. 2020;10(2045\u0026ndash;2322 (Electronic)):21011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoint Committee on Infant Hearing. Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. J Early Hear Detect Intervention. 2019;4:1\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Reilly R, Grindle C, Zwicky EF, Morlet T. Development of the vestibular system and balance function: differential diagnosis in the pediatric population. Otolaryngol Clin North Am. 2011;44(2):251\u0026ndash;. \u0026ndash;\u0026thinsp;71, vii.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhai S, Hakim M, Dannenbaum E, Lamontagne A. Prevalence of Vestibular Dysfunction in Children With Neurological Disabilities: A Systematic Review. Front Neurol. 2019;10:1294.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWardani NK, Kusumawardani MK, Mayangsari JA, Wulan S. Correlation between One Leg Stand Test and Paediatric Balance Scale in children aged 7\u0026ndash;12 years. Sri Lanka J Child Health. 2022;51(2):204\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranjoine MR, Darr N, Held SL, Kott K, Young BL. The performance of children developing typically on the pediatric balance scale. Pediatr Phys Ther. 2010;22(4):350\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHowell DR, Brilliant AN, Meehan WP. 3rd. Tandem Gait Test-Retest Reliability Among Healthy Child and Adolescent Athletes. ournal athletic Train. 2019;54:1254\u0026ndash;9. 1938-162X (Electronic).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalea OA, Bristow HD, Chisholm SM, Mersch ME, Nullmeyer J, Reid CR, et al. Single and dual tandem gait assessment post concussion: What performance time is clinically relevant across adult ages and what can influence results? Musculoskelet Sci Pract. 2019;42:166\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOldham JR, DIFABIO MS, KAMINSKI TW, DEWOLF RM, HOWELL DR. Efficacy of Tandem Gait to Identify Impaired Postural Control after Concussion. Med Sci Sports Exerc. 2018;50(6):1162\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Hecke R, Deconinck FJA, Wiersema JR, Clauws C, Danneels M, Dhooge I et al. Balanced Growth project: A protocol of a single-centre observational study on the involvement of the vestibular system in a child's motor and cognitive development. BMJ Open. 2021;11(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong TPS, Leung EYW, Poon CYC, Leung CYF, Lau BPH. Balance performance in children with unilateral and bilateral severe-to-profound-grade hearing impairment. Hong Kong Physiother J. 2013;31(2):81\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChristy JB, Payne J, Azuero A, Formby C. Reliability and diagnostic accuracy of clinical tests of vestibular function for children. Pediatr Phys therapy: official publication Sect Pediatr Am Phys Therapy Association. 2014;26(Electronic):1538\u0026ndash;X005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYones L, Kahlaee AH, Sayadi N, Jalilzadeh Afshari P, Bakhshi E. Test-retest reliability of the pediatric clinical test of sensory interaction for balance in 4\u0026ndash;6 years old children. Auditory Vestib Res. 2017;26(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvkaya A, Karadag-Saygi E, Karali Bingul D, Giray E. Validity and reliability of the Dynamic Gait Index in children with hemiplegic cerebral palsy. Gait Posture. 2020;75:28\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerbecque E, Schepens K, Ther\u0026eacute; J, Schepens B, Klingels K, Hallemans A. The Timed Up and Go Test in Children: Does Protocol Choice Matter? A Systematic Review. Pediatr Phys Ther. 2019;31(1):22\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNicolini-Panisson RD, Donadio MV. Timed Up \u0026amp; Go test in children and adolescents. Revista paulista de pediatria: orgao oficial da Sociedade de Pediatria de Sao Paulo. 2013;31:377\u0026ndash;83. (1984\u0026thinsp;\u0026ndash;\u0026thinsp;0462 (Electronic)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNicolini-Panisson RD, Donadio MV. Normative values for the Timed 'Up and Go' test in children and adolescents and validation for individuals with Down syndrome. Dev Med Child Neurol. 2014;56(5):490\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAcademy of Neurologic Physical Therapy, Vestibular EDGE, Roseville,:. ACADEMY OF NEUROLOGIC PHYSICAL THERAPY 2018 [ \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.neuropt.org/practice-resources/neurology-section-outcome-measures-recommendations/vestibular-disorders\u003c/span\u003e\u003cspan address=\"https://www.neuropt.org/practice-resources/neurology-section-outcome-measures-recommendations/vestibular-disorders\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSember V, Grošelj J, Pajek MA-O. Balance Tests in Pre-Adolescent Children: Retest Reliability, Construct Validity, and Relative Ability. LID \u0026ndash;\u0026thinsp;10.3390/ijerph17155474 [doi] LID \u0026ndash;\u0026thinsp;5474. Int J Environ Res Public Health. 2020;17:1660\u0026ndash;4601. (Electronic)):5474.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026aelig;ther R, Helbostad J, Riphagen I, Vik T. Clinical Tools To Assess Balance In Children And Adults With Cerebral Palsy: A Systematic Review. Dev Med Child Neurol. 2013;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDasgupta S, Mandala M, Salerni L, Crunkhorn R, Ratnayake S. Dizziness and Balance Problems in Children. Curr Treat Options Neurol. 2020;22(3):8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Paediatric, balance assessment, motor development, hearing loss, vestibular deficit","lastPublishedDoi":"10.21203/rs.3.rs-4610058/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4610058/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBalance dysfunction exists in children with hearing loss, especially sensorineural loss, impacting on cognitive development, socio-emotional development and literacy. However, there is limited assessment of balance in this population, which has further impedes childhood development. The objective of this review was to identify clinical, low- technology and inexpensive tools used to evaluate balance in children with hearing loss. Methods: A scoping review method with reference to the JBI, was used where a search was conducted on electronic databases including EBSCOHost, MEDLINE, PubMED, Web of Science and Wiley. In addition, gray literature and hand searches were also used. The review included children between 3 – 15 years of age with hearing loss. Results: A total of 53 articles were found where 53% of the tests were norm-referenced tests, 44% were criterion referenced tests and 2% could not be identified. Conclusion: Tests such as the Tandem gait test, Pediatric Balance Scale (PBS), Clinical Test of Sensory Interaction for Balance (mCTSIB)/Pediatric Version of Clinical Test for Sensory Interaction of Balance (P-CTSIB), Dynamic Gait Index and the Timed-up-and-Go were identified to be relatively inexpensive and low-technology based clinical tools and have thus, been summarized in this review.\u003c/p\u003e","manuscriptTitle":"Clinical balance assessment tools for children with hearing loss: A scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 22:16:55","doi":"10.21203/rs.3.rs-4610058/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-09T08:31:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-08T20:02:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-30T21:47:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-26T13:50:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149926823422586955218096622554685417088","date":"2024-08-21T17:34:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83942762865466828793448343127572180473","date":"2024-08-21T06:01:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74483842684308731053855595772297243057","date":"2024-08-21T04:12:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-20T07:02:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64285424549434677615728246816726165676","date":"2024-08-14T10:07:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27793218862952578669370663831353553915","date":"2024-08-14T08:42:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-14T06:57:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-03T02:29:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-24T06:33:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-24T06:31:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2024-06-20T07:49:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bca6ec0f-3e5f-423d-9f02-b8b60dadac89","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-24T16:04:29+00:00","versionOfRecord":{"articleIdentity":"rs-4610058","link":"https://doi.org/10.1186/s12887-025-05563-2","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-03-19 15:58:23","publishedOnDateReadable":"March 19th, 2025"},"versionCreatedAt":"2024-07-18 22:16:55","video":"","vorDoi":"10.1186/s12887-025-05563-2","vorDoiUrl":"https://doi.org/10.1186/s12887-025-05563-2","workflowStages":[]},"version":"v1","identity":"rs-4610058","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4610058","identity":"rs-4610058","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}