{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:54:31Z","timestamp":1791262471248,"version":"4.1.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"\n Background<\/jats:title>\n No study has evaluated the Pediatric Balance Scale (PBS), the Scale for the Assessment and Rating of Ataxia (SARA), and the Brief Ataxia Rating Scale (BARS) together in a healthy pediatric sample.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to determine the inter-rater reliability, measurement error, and construct validity of the PBS, SARA, and BARS in healthy children aged 4\u201312\u202fyears and to compare scores between physiotherapists and pediatric neurologists.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Thirty-four healthy children (18 girls and 16 boys; mean age 8.2\u202f\u00b1\u202f1.8\u202fyears) were each scored from standardized video recordings by five independent, mutually blinded raters (two physiotherapists and three pediatric neurologists). Inter-rater reliability was quantified using two-way random-effects and absolute-agreement intraclass correlation coefficients (ICCs), reported as single-rater [ICC (2,1)] and average-of-five-raters [ICC (2, k)] measures. Standard error of measurement (SEM), minimal detectable change (MDC\n 95<\/jats:sub>\n ), Cronbach\u2019s \u03b1, Bland\u2013Altman agreement, Spearman inter-scale correlations, and Kruskal\u2013Wallis tests of rater differences were calculated.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Average-measure reliability was good for the PBS (ICC\n 2k<\/jats:sub>\n \u202f=\u202f0.89, 95% CI 0.81\u20130.94) and the SARA (0.85, 0.74\u20130.92) but moderate for the BARS (0.64, 0.41\u20130.80). Single-rater reliability was moderate for the PBS (0.61) and the SARA (0.53) but poor for the BARS (0.27). The BARS was attenuated by a floor effect (20.6% scored zero) rather than rater disagreement, which Bland\u2013Altman confirmed to be small. Construct validity was supported: The PBS negatively correlated with the SARA (\n \u03c1<\/jats:italic>\n \u202f=\u202f\u22120.76) and the BARS (\n \u03c1<\/jats:italic>\n \u202f=\u202f\u22120.59), and the SARA positively correlated with the BARS (\n \u03c1<\/jats:italic>\n \u202f=\u202f0.87; all\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), which remained unchanged in the non-zero-BARS subgroup. No sex differences emerged.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In healthy children, the PBS, the SARA, and the BARS are reliable when averaged across raters and show coherent construct validity. Single-rater use is adequate for the PBS and the SARA but limited for the BARS in this floor-dominated population. Age-referenced interpretation of the PBS is warranted. Establishing the reliability and normative characteristics of these scales in typically developing children will facilitate more accurate interpretation of pediatric ataxia and balance assessments in both clinical practice and research.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1935671","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:26:01Z","timestamp":1791260761000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["How reliable are clinical balance and ataxia scales in healthy children aged 4\u201312\u202fyears? An inter-rater reliability and construct validity study of the PBS, SARA, and BARS"],"prefix":"10.3389","volume":"17","author":[{"given":"Elif Acar","family":"Arslan","sequence":"first","affiliation":[{"name":"Department of Child Neurology, School of Medicine, Biruni University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ece","family":"G\u00fcltekin","sequence":"additional","affiliation":[{"name":"Department of Child Neurology, School of Medicine, Biruni University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fclsena Utku","family":"Umut","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, School of Health Sciences, Biruni University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130rem","family":"G\u00fcney","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, School of Health Sciences, Biruni University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00fcneyd","family":"Parlayan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Medicine, Biruni University","place":["Istanbul, T\u00fcrkiye"]},{"name":"Biruni Scientific Research Center (B@MER\/BAMER), Faculty of Medicine, Biruni University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Sert","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, Biruni University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fczide","family":"Turanl\u0131","sequence":"additional","affiliation":[{"name":"Department of Child Neurology, School of Medicine, Biruni University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1212\/01.wnl.0000438224.25600.6c","article-title":"Prevalence of ataxia in children: a systematic review","volume":"82","author":"Musselman","year":"2014","journal-title":"Neurology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/s0022-510x(96)00231-6","article-title":"International cooperative Ataxia rating scale for pharmacological assessment of the cerebellar syndrome","volume":"145","author":"Trouillas","year":"1997","journal-title":"J Neurol Sci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1212\/01.wnl.0000219042.60538.92","article-title":"Scale for the assessment and rating of ataxia: development of a new clinical 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