The effect of classification on the discriminative abilities of the Berg Balance scale
GAYATRI KEMBHAVI BSC PT*, JOHANNA DARRAH PHD PT **
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Objective
To evaluate the ability of the Berg Balance scale (BBS) to discriminate between four groups of children with differing balance abilities, and to evaluate the effect of two different classification schemes on the discriminative abilities of the BBS.

Design: Observational, cross-sectional

Setting: Rehabilitation hospital
Participants
Fifty children between the ages of 8 and 12 years participated in the study: 36 with a diagnosis of cerebral palsy (CP) and 14 without physical limitations. The participants with a diagnosis of CP were recruited from clinic lists and the children without physical limitations were acquaintances of the first author. A non-random, quota sampling technique was used. Measurements and Main Results: All the children in the study were ambulatory with or without aids. The children were divided into four diagnostic categories: children without physical limitations, children with spastic hemiplegia, children with spastic diplegia who do not use ambulatory aids, and children with spastic diplegia who use ambulatory aids. A hierarchy of balance abilities was assumed across the four diagnostic categories. All participants were evaluated on the BBS by a physical therapist unaware of the research questions. Using these traditional diagnostic categories, mean group BBS scores were only significantly different among children with spastic diplegia who use ambulatory aids compared to all other groups. Children with CP were then reclassified using the Gross Motor Function Classification System (GMFCS) and the children without physical limitations were put into a separate level. All but one of the children with spastic hemiplegia were reclassified into Level I. Nearly half of the children with spastic diplegia who walk without aids were reclassified into Level I, while the other half were reclassified into Level II. All the children with spastic diplegia who use ambulatory aids were reclassified into Level III. Using this classification scheme, the mean group scores on the BBS were significantly different among all levels of children with CP. Only the mean scores of children in Level I and the group of children without physical limitations were not significantly different. Conclusion: Classification schemes affected the discriminative abilities of the BBS when used to assess children with CP. This result suggests that the GMFCS may more accurately group children by their balance abilities than the traditional classification using muscle tone and distribution.
Acknowledgement
This study was completed as a requirement of the MSc. PT program at the University of Alberta with funding from Glenrose Rehabilitation Hospital Research Grants and Alberta Physiotherapy Association.
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