We aimed to review tools used to assess balance in clinical practice in children and adults with cerebral palsy (CP), to describe their content and measurement properties and to evaluate the quality of the studies that have examined these properties. CINAHL, Embase, and PubMed/MEDLINE were searched. The COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) was used to assess the 'quality of studies' and the Terwee criteria were used to assess the 'result of studies'. Twenty-two clinical balance tools were identified from 35 papers. The content and focus of the tools varied significantly. There was moderate or limited levels of evidence for most of the measurement properties of the tools; the strongest level of evidence was found for the Trunk Control Measurement Scale and the Level of Sitting Scale, in the category 'maintain balance', the Timed Up and Go and the Segmental Assessment of Trunk Control in the categories 'achieve balance' and 'restore balance' respectively. Information on responsiveness was scarce. Further studies providing better evidence for reliability and responsiveness for clinical balance tools are needed. In the meantime, results of studies evaluating effects of treatment of balance in individuals with CP should be interpreted with caution.

BackgroundThe aim of this pilot study was to examine the effects of additional resistance training after use of Botulinum Toxin-A (BoNT-A) on the upper limbs in children with cerebral palsy (CP).MethodsTen children with CP (9–17 years) with unilaterally affected upper limbs according to Manual Ability Classification System II were assigned to two intervention groups. One group received BoNT-A treatment (group B), the other BoNT-A plus eight weeks resistance training (group BT). Hand and arm use were evaluated by means of the Melbourne assessment of unilateral upper limb function (Melbourne) and Assisting Hand Assessment (AHA). Measures of muscle strength, muscle tone, and active range of motion were used to assess neuromuscular body function. Measurements were performed before and two and five months after intervention start. Change scores and differences between the groups in such scores were subjected to Mann–Whitney U and Wilcoxon Signed Rank tests, respectively.ResultsBoth groups had very small improvements in AHA and Melbourne two months after BoNT-A injections, without differences between groups. There were significant, or close to significant, short-term treatment effects in favour of group BT for muscle strength in injected muscles (elbow flexion strength, p = .08) and non-injected muscles (elbow extension and supination strength, both p = .05), without concomitant increases in muscle tone. Active supination range improved in both groups, but more so in group BT (p = .09). There were no differences between the groups five months after intervention start.ConclusionsResistance training strengthens non-injected muscles temporarily and may reduce short-term strength loss that results from BoNT-A injections without increasing muscle tone. Moreover, additional resistance training may increase active range of motion to a greater extent than BoNT-A alone. None of the improvements in neuromuscular impairments further augmented use of the hand and arm. Larger clinical trials are needed to establish whether resistance training can counteract strength loss caused by BoNT-A, whether the combination of BoNT-A and resistance training is superior to BoNT-A or resistance training alone in improving active range of motion, and whether increased task-related training is a more effective approach to improve hand and arm use in children with CP.

DSBDynamic sitting balance subscale DSB-R Dynamic sitting balance-reaching subscale score TCMS Trunk Control Measurement Scale TIS Trunk Impairment Scale AIM To assess the relationship between trunk control in sitting and trunk control during gait in children and adolescents with cerebral palsy (CP).METHOD Twenty-six children (17 males, nine females) with spastic CP (Gross Motor FunctionClassification System I-III [15 unilateral, 11 bilateral], mean age 13.5y), were included. Trunk control in sitting was assessed with the Trunk Impairment Scale (TIS) and the Trunk Control Measurement Scale (TCMS), and trunk control during gait by a trunk-worn accelerometer. The Pearson's rank correlation coefficient, partial correlation (r p ), and linear regression analysis were applied to assess the relationship between trunk control in sitting and during gait.RESULTS Trunk control in sitting assessed with the TCMS and the TIS total scores both correlated with trunk accelerations during gait (r p =0.67 and 0.60 respectively). Moreover, some subscale scores correlated equally well with trunk control during gait (the TCMS dynamic sitting balance-reaching subscale score [DSB-R]; r p =0.61) or even higher (TIS dynamic sitting balance subscale [DSB]; r p =0.66).INTERPRETATION Trunk control in sitting has a moderate to good correlation with trunk control during gait. Our results suggest that the subscale DSB-R of the TCMS, being less time consuming, may be applied in clinical assessment to gain information on trunk control during gait. Future studies are needed to explore how this information may be applied in the planning of 'gait interventions'.