Adapted Frenkle Exercises Versus Dynamic Balance Training in School Going Children

Balance, gait, mobility, and motor coordination are essential for the physical and functional development of school-going children and influence their participation in academic, recreational, and daily activities. The ages of 6-12 years represent a critical period for neuromuscular and postural maturation, making early motor interventions particularly effective. Deficits in these skills may result in reduced physical activity, poor posture, and social withdrawal. This study compares Adapted Frenkel Exercises (AFE), which focus on slow, visually guided, and controlled movements to enhance coordination and proprioception, with Dynamic Balance Training (DBT), which uses functional, task-specific activities such as balance beam walking, multidirectional stepping, and hopping to improve stability during movement. A randomized clinical trial will be conducted at Realm Educational School over 10 weeks (2 sessions per week). Each session will be of 40 minutes. Children aged 6-12 years will be randomly assigned to either the AFE or DBT group using convenient sampling. Participants must be physically active and free from neurological, orthopedic, or cognitive impairments, while those with sensory impairments or recent musculoskeletal injuries will be excluded. Outcome measures will include the Pediatric Balance Scale (PBS), Y-Balance Test, Observational Gait Scale (OGS), Timed Up and Go (TUG) test, and BOT-2. Pre- and post-intervention assessments will evaluate the effectiveness of both interventions on balance, gait, mobility, and motor coordination.

• Adapted Frenkle Exercises (Behavioral): Participants will receive adapted Frenkel exercises progressing from simple to complex movements, focusing on controlled, precise lower-limb movements to improve coordination and balance. Sitting: Controlled leg movements (side leg placement to floor markers, drawing shapes with toes, slow leg lifts). Standing: Marching in place, side leg lifts, and controlled weight shifting. Walking drills: Straight-line walking with visual cues, step-and-stop walking, and figure-8 walking to negotiate obstacles.
• Dynamic Balance Training (Behavioral): Participants will receive dynamic balance training emphasizing postural control, coordination, strength, and functional balance through varied movement tasks. Mat-based balance exercises Rope activities (e.g., jumping) Balance equipment and ground-based balance tasks Paired movements, rhythm and coordination activities, stepping stones, and non-dominant limb tasks

Primary outcomes

• Pediatric Balance Scale [10 weeks]: Assesses functional balance in children through 14 task-based items. Scale Range: 0-56 Interpretation: Higher scores indicate better balance performance.
• Y Balance Test - Pediatric version [10 weeks]: The Y Balance Test is a dynamic balance assessment that measures a child's ability to maintain single-leg stance while reaching in three directions: anterior, posteromedial, and posterolateral. Scale Range: Reach distance measured in centimeters (%) normalized to limb length. Interpretation: Higher reach distances indicate better dynamic balance and postural control.
• Observational Gait Scale [10 weeks]: Evaluates gait parameters, including stance, swing, and foot placement during walking. Scale Range: 0-22 Interpretation: Higher scores indicate better gait performance.
• Timed Up and Go Test [10 weeks]: Measures functional mobility and dynamic balance during sit-to-stand, walking, turning, and sitting. Scale Range: Measured in seconds (no fixed minimum or maximum score). Interpretation: Lower completion times indicate better functional mobility and balance performance.
• Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) - Selected subtests [10 weeks]: Assesses gross motor coordination, bilateral coordination, and balance in children.

Sex: All, ages: 8 Years to 10 Years, accepts healthy volunteers

Inclusion Criteria:

1. Healthy school-going children aged 8-10 years
2. Both male and female participants
3. No history of neurological, orthopedic, or developmental disorders
4. Informed parental consent and child assent obtained
5. MMSE score ≥ 24
6. TUG score < 20 seconds
7. Pediatric Berg Balance Scale score ≥ 40

Exclusion Criteria:

1. History of diagnosed balance or coordination issues.
2. Children with orthopedic and motor impairments.
3. Behavior or attention disorders limiting participation.
4. Neuromuscular conditions, Visual and mental disorders

• Mani H, Miyagishima S, Kozuka N, Inoue T, Hasegawa N, Asaka T. Development of the Relationships Among Dynamic Balance Control, Inter-limb Coordination, and Torso Coordination During Gait in Children Aged 3-10 Years. Front Hum Neurosci. 2021 Oct 28;15:740509. doi: 10.3389/fnhum.2021.740509. eCollection 2021. PMID 34776908

• Mehwish Javed, MS-PPT, Principal investigator, Riphah International University