The relationship between dynamic balance and walking in children

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)


Physical Therapy

First Committee Member

Rose Marie Rine, Committee Chair


The primary objective was to examine the relationship between a clinical measure of dynamic standing balance and walking ability in children. Two investigations were performed to: (1) develop a clinically reliable and valid measure of dynamic balance that reflects the balance requirements necessary for independent ambulation, and (2) examine the relationship between dynamic balance and walking ability in children with and without cerebral palsy (CP).In both investigations dynamic balance ability was measured as the subject performed a forward lean under two testing conditions: arms crossed and forward. Concurrently, measures of center of pressure excursion (COPE), forward displacement of the shoulder and pelvis, and muscle latency and amplitude were obtained. In the second investigation, subjects additionally participated in walking trials during which they walked across a 10 meter walkway at a self determined pace while temporal-spatial data was collected. Functional ambulation levels were determined using the Gross Motor Classification System (GMFCS).Based on the results from these investigations, dynamic balance ability can be measured using a retractable tape measure while the subject performs a forward lean. Group differences impacted the location from which the displacement measures should be taken, the position in which the test should be performed, the amount of forward lean, and the muscle activation pattern utilized. In children younger than 7 years of age and children diagnosed with CP, the clinical measure should be taken from the shoulder with the arms in the forward position. In adults, older than 17 years of age, the clinical measure should be taken from the pelvis with the arms in the crossed position.Dynamic balance ability was related to functional ambulation level (i.e., GMFCS) and temporal-spatial gait parameters. Group differences were demonstrated between the most involved children with CP and the typically developing children. Dynamic balance ability was observed to decrease as the GMFCS rank increased. In addition, dynamic balance ability as measured using the force platform was related to walking velocity, cadence, and step width in children with and without CP. When measured using the clinical shoulder measure, step and stride length also demonstrated a significant relationship.


Health Sciences, Rehabilitation and Therapy

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