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Table of Contents
Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 42-46

Balance and agility testing in normal and hearing-impaired children: A Case–Control study

Department of Pediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission10-Nov-2018
Date of Acceptance05-Apr-2019
Date of Web Publication3-Jul-2019

Correspondence Address:
Dr. Deepa C Metgud
Department of Pediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_14_19

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Background: Hearing is one of the most important sensation that collect the information of surrounding environment. Impairment in this sensation can affect the development of the motor skills such as balance and agility. Balance impairment can lead to fall and impairment in agility leads to poor movement efficiency and may be associated with unbalanced posture, lack of coordination and poor reaction time.
Materials and Methods: A case control study done on children aged 9-14 years were recruited from special schools for hearing impaired and regular schools from Belagavi. Out of 198 children, 130 were normal hearing children and 65 were hearing impaired children. The balance and agility was measured with the help of Pediatric Berg [Add about agility test][]Balance Scale (PBBS) and T- test respectively.
Results: The mean scores for PBBS was 55.81 ± 0.68 for normal hearing children and 47.11 ± 4.05 in hearing impaired children which was compared using independent t-test which was statistically significant (P = 0.0001). The mean of agility scores was 11.14±1.47 seconds in normal hearing children and 17.86 ±1.72 seconds in hearing impaired children and it was also compared using independent t-test which showed highly significant difference (P = 0.0001).
Conclusion: The present study concludes that hearing impaired children have poor balance and agility as compared to the normal children.

Keywords: Agility, Balance, Hearing impairment, Pediatric Berg balance scale, T-test

How to cite this article:
Metgud DC, Topkar P. Balance and agility testing in normal and hearing-impaired children: A Case–Control study. Indian J Phys Ther Res 2019;1:42-6

How to cite this URL:
Metgud DC, Topkar P. Balance and agility testing in normal and hearing-impaired children: A Case–Control study. Indian J Phys Ther Res [serial online] 2019 [cited 2021 Oct 21];1:42-6. Available from: https://www.ijptr.org/text.asp?2019/1/1/42/261989

  Introduction Top

Hearing is one of the most important sensations for communication among individuals. Hearing impairment is characterized by insufficiency in the perception of sounds.[1] It is one of the leading causes of disability in the world. Globally, the prevalence of hearing impairment in 2008 for children aged 5–14 years was 1.4% and for children aged >15 years was 9.8% in females whereas in males was 12.2%. The hearing impairment is more common in males and other factors such as age and poor socioeconomic status.[1] Language and vocabulary are the abilities which help in development of child's personality.[2] Hearing, vision, tactile, etc., are responsible in giving inputs to produce a motor response. Impairments in these sensations can affect the development of the motor skills.[3]

The hearing loss can be classified as congenital or acquired. It can be conductive or sensorineural hearing loss. In conductive hearing loss, there is any damage to ear canal, tympanic membrane, or ossicles. The most common cause can be otitis media with effusion other congenital abnormalities such as Apert, Crouzon, and Treacher–Collins syndromes. In sensorineural hearing loss, it can be congenital or acquired. The common postnatal cause is meningitis. Sixty-five genes are identified associated with hearing loss.[4]

Since auditory stimuli guide visual behavior, orientation of eyes, head, and body is difficult in children with hearing impairment due to which they exhibit balance and coordination issues. Motor development and learning rely on the various stimuli received from the environment. Any deficits in perceiving these stimuli can lead to motor developmental issues which also affect balance.[1]

Balance or postural stability is dynamic process by which the body maintains the center of gravity over the base of support in equilibrium. Balance is a complex task which involves detection and integration of sensory information of position of the body and movements and use of different strategies to maintain body position. To maintain balance, nervous and musculoskeletal system should interact with each other. The other factors which influence balance are environment, support surface, amount of lighting, inertia, and character of task. Balance is influenced by visual, auditory, and somatosensory inputs. Balance impairment has a significant impact on the physical, psychological, and social functioning of an individual. In case of children, this impairment will be in terms of attending school, playing and interacting with peers, participation in various activities, etc.[5],[6],[7]

Agility is a motor skill that enables an individual to rapidly and efficiently decelerate to change direction and accelerate in an effort to react appropriately to task-relevant cues, and it has subsequently been defined as the ability to respond to stimuli changing velocity and direction.[8] It will also help in motor skill function and neuromuscular control. Poor agility levels in children lead to poor movement efficiency, or the movement is always associated with unbalanced posture, lack of coordination, and timing and sometimes presents with awkward hand movements.[8],[9]

  Materials and Methods Top

Ethical clearance was obtained from the institutional ethical committee. Permission was obtained from special schools for hearing-impaired and normal schools in Belagavi city. Children aged between 9 and 14 years of either gender with and without hearing impairment were included. The exclusion criteria were (1) children with physical disabilities other than hearing impairment (e.g., blindness, mental retardation), (2) children with head injury, (3) cerebral palsy, (4) children with heart problems, and (5) epilepsy.

A total of 65 children with hearing impairment were included in the study. As the children were in residential schools, the procedure was explained to the guardian in their vernacular language and written informed assent was obtained. 130 children from normal schools were included in the study. Written informed assent was taken from parents of the participants. For children with hearing impairment, the procedure was explained with the help of teacher who was trained to communicate with hearing-impaired children. The teacher was available full time while doing the examination. All these children were assessed for balance and agility with the help of pediatric Berg balance scale and T-test, respectively.

The pediatric Berg balance scale consists of 14 tasks related to activities of daily living. The items are scored on a five-point scale ranging from zero denoting an inability to perform the activity without assistance to four denoting the ability to perform the task with complete independence. The maximum score is 56 points.[6]

In T-test, from the starting point, the subjects run a linear distance of 10 yards from cone A to cone B. Then, they slide 5 yards to the left to cone C and then 10 yards to the right to cone D. Finally, they run again 5 yards to the left to cone B and run backward to the start position. The best score out of three trials were recorded for analysis.[9],[10]

  Results Top

Statistical analysis was done using the SPSS version 20 (IBM, Armonk, NY, United States of America) to verify the results obtained. Statistical measures such as mean, standard deviation, and tests of significance such as independent “t”-test and unpaired t-test were utilized for comparison of scores between the hearing-impaired children and the normal children.

The mean age of normal-hearing children group was 11.47 ± 1.81 years and of hearing impaired was 11.68 ± 1.97 years [Table 1].
Table 1: Gender distribution of subjects

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In normal-hearing children group, there were 69 (53.08%) males and 61 (46.92%) females, whereas in hearing-impaired group, there were 21 (32.31%) males and 44 (67.69%) females.

The mean body mass index of the normal-hearing children was 15.13 ± 2.41 and in hearing-impaired children was 17.86 ±2.41 [Table 2].
Table 2: Demographic variables of subjects

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The mean score of pediatric Berg balance scale in the normal children group was 55.81 ± 0.68 and in hearing-impaired children group was 47.11 ± 4.05, which showed a highly significant difference between the groups as analyzed by independent t-test (*P ≤ 0.05).

In the pediatric Berg balance scale, the normal children showed better performance as compared to hearing-impaired children in the components of sitting to standing, standing with eyes closed, standing with feet together, standing with one foot in front, standing on one foot, turning 360°, turning to look behind, retrieving object from floor, placing alternate foot on stool, and reaching forward with outstretched arm (P < 0.05) [Table 3] and [Figure 1].
Table 3: Comparison of mean pediatric Berg balance scale scores between groups by unpaired t-test

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Figure 1: Comparison of mean pediatric Berg balance scale scores in controls and cases

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In normal children, the mean of agility scores in seconds was 11.14 ± 1.47 as compared to hearing-impaired children which was 17.86 ± 1.72 s that showed a highly significant difference as analyzed by unpaired t-test (P = 0.0001*) [Table 4] and [Figure 2].
Table 4: Comparison of mean agility T-test scores between groups by unpaired t-test

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Figure 2: Comparison of mean agility scores (s) in controls and cases

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  Discussion Top

This case–control study was done to evaluate the balance and agility in normal and hearing-impaired children. We found that the hearing-impaired children had significantly lower scores on the pediatric Berg balance scale as compared to the normal controls. They had poor scores in the components that mainly challenged the vestibular system such as sitting to standing, standing with eyes closed, standing with feet together, standing with one foot in front, standing on one foot, turning 360°, turning to look behind, retrieving object from floor, placing alternate foot on stool, and reaching forward with outstretched arm. The hearing-impaired children required a longer time to complete the T-test for agility as compared to their controls.

Otolith organs contribute to postural control particularly through vestibulospinal system. Damage to these structures may be responsible for apparent immaturity of motor function and can lead to impairment in balance. A study was done to evaluate the balance in hearing-impaired and normal children in relation with vestibulospinal system, which concluded that children with hearing impairment had significant deficits in oculo-auditory reflex and static balance but not in vestibular function and dynamic balance.[11]

A study that assessed the motor proficiency in hearing-impaired children concluded that children with abnormal peripheral vestibular function have impaired motor proficiency only in terms of balance which suggests that balance is significantly affected in hearing-impaired children with abnormal vestibular function.[12]

Gross motor performance tasks were significantly affected in the hearing-impaired children in our study. Our results were in accordance to a study which stated that hearing-impaired children have poor performance in terms of gross motor and fine motor functions which was evaluated using Bruininks-Oseretsky test of motor proficiency.[13],[14]

The reason for poor performance in balance and agility could be that these children had profound hearing impairment and did not use hearing aids. Impaired hearing can lead to abnormal vestibular function as well. Since they had hearing impairment, components performed with eyes closed were difficult to perform as they could not get a visual feedback on which they rely the most. They may also have vestibular system deficits which led to poor performance. Hearing-impaired children rely on their other senses such as visual, somatosensory, and proprioceptive feedback, substituting for their lack of hearing.

Physical activity is important as it promotes growth and development in children. Regular physical activity can help in improving strength and endurance. Studies have observed that hearing-impaired children lack significantly in physical fitness components such as running speed, agility, bilateral coordination activities, upper limb speed, and dexterity as compared to normal children. However, both groups follow same trends of maturation. Fault in vestibulo-ocular reflex can be the cause for poor performance in balance.[15]

The literature suggests that hearing-impaired children have poor performance in terms of agility, speed, and sociability when compared to normal girls, but deaf and dumb girls are more flexible than the normal girls. This study is in favor of the present study, as hearing-impaired children were lacking in agility performance.[16]

The reason for the decreased agility scores in hearing-impaired children can be attributed to the lack of motivation and competitiveness which was seen in normal children. Another reason can be the lack of regular physical education classes in the special schools in contrast to regular schools which could have affected performance in hearing-impaired children.

In activities of daily living, we require balance and agility as it helps in performing motor skills. Deficits in balance and agility will lead to poor motor performance and lead to falls. A study concluded that agility and balance were not dependent on their age but was frequently dependent on flexibility, speed, and reaction time. Low self-esteem and social-emotional issues can arise in children due to inefficient motor performance.[17] This can further affect their academic performance. Thus, balance and agility strategies should be planned efficiently for the hearing-impaired children in competence with normal children to enable proper functional activities.

  Conclusion Top

The present study concluded that hearing-impaired children have poor balance and agility as compared to the normal children.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Atasavun Uysal S, Erden Z, Akbayrak T, Demirtürk F. Comparison of balance and gait in visually or hearing impaired children. Percept Mot Skills 2010;111:71-80.  Back to cited text no. 1
Gkouvatzi AN, Mantis K, Pilianidis T. The impact of hearing loss degree and age on upper limb coordination ability in hearing, deaf and hard of hearing pupils. Stud Phys Culture Tourism 2010;17:2.  Back to cited text no. 2
Stevens G, Flaxman S, Brunskill E, Mascarenhas M, Mathers CD, Finucane M, et al. Global and regional hearing impairment prevalence: An analysis of 42 studies in 29 countries. Eur J Public Health 2013;23:146-52.  Back to cited text no. 3
Ghai O, Gupta P, Pandav CS. Essential preventive medicine. Indian J Pediatr 2000;67:333-344.  Back to cited text no. 4
Kisner C, Colby LA, Borstad J. Therapeutic Exercise: Foundations and Techniques: Fa Davis; 2017. p. 260-89.  Back to cited text no. 5
Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: A modified version of the Berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther 2003;15:114-28.  Back to cited text no. 6
O'Sullivan S, Schmitz T, Fulk G. Physical Rehabilitation. FA Davis; 2013:193-221.  Back to cited text no. 7
Yanci J, Arcos AL, Salinero JJ, Mendiguchia J, Gil E, Santesteban D, et al. Effects of different agility training programs among first-grade elementary school students. Coll Antropol 2015;39:87-92.  Back to cited text no. 8
Rahimatul E, Srinivas M. Comparison of agility training programs for injury prevention in Malaysian school children. Int Res J Med Sci 2005;3:15-22.  Back to cited text no. 9
Pauole K, Madole K, Garhammer J, Lacourse M, Rozenek R. Reliability and validity of the T-test as a measure of agility, leg power, and leg speed in college-aged men and women. J Strength Cond Res 2000;14:443-50.  Back to cited text no. 10
Patel H, Malawade M, Butte-Patil S, Khairnar P, Gawade S. Comparison of balance in children with and without hearing impairment. Int J Healthc Biomed Res 2017;5:19-27.  Back to cited text no. 11
Crowe TK, Horak FB. Motor proficiency associated with vestibular deficits in children with hearing impairments. Phys Ther 1988;68:1493-9.  Back to cited text no. 12
Wong TP, Leung EY, Poon CY, Leung CY, Lau BP. Balance performance in children with unilateral and bilateral severe-to-profound-grade hearing impairment. Hong Kong Physiother J 2013;31:81-7.  Back to cited text no. 13
Butterfield SA. Gross motor profiles of deaf children. Percept Mot Skills 1986;62:68-70.  Back to cited text no. 14
Shaikh AA, Sadhale A. Motor proficiency in hearing impaired and healthy children: A comparison. Int J Curr Res Rev 2013;5:57-63.  Back to cited text no. 15
Ghosh S, Banerjee S. A comparative study on selected physical fitness components and personality traits between deaf & dumb and normal school girls of West Bengal. Int J Phys Educ Sports Health 2015;1:59-63.  Back to cited text no. 16
Tetik S, Koç H, Atar O. An analysis of selected motor characteristics according to age groups in hearing-impaired individuals. Stud Ethno Med 2016;10:295-300.  Back to cited text no. 17


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4]


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