Static and dynamic balance in children with congenital heart defects and the effectiveness of training on a stabilometer platform: a prospective comparative study

INTRODUCTION. Children with congenital heart defects (CHD) face a significant risk of experiencing delays in motor development, often highlighted by difficulties with balance. If not addressed, these issues can adversely impact their quality of life. AIM. To study the gender- and age-specific characteristics of balance development in children with congenital heart diseases using stabilometry and to evaluate the effectiveness of a cardiac rehabilitation program supplemented with training on a stabilometer platform with biofeedback (BF). MATERIALS AND METHODS. The study participants were children aged 7–14 years in the long-term follow-up period after surgical treatment for congenital heart defects (radical and hemodynamic correction) who reported complaints of coordination problems, dizziness, motor clumsiness, and motion sickness, who underwent a course of cardiac rehabilitation at the Rehabilitation Center for Children with Heart Defects at the A.N. Bakulev National Medical Research Center for Cardiovascular Surgery of the Russian Ministry of Health in 2023–2024. According to the results of the DCDQ’07 (Developmental Coordination Disorder Questionnaire) and depending on the duration of hospitalization, participants were divided into a control group (standard rehabilitation program: exercise therapy, physical therapy, and sessions with psychologists) and an experimental group (with additional sessions on a stability platform). All children underwent an assessment of static balance using the “One-Leg Stand” test from the Zurich Neuromotor Assessment-2 (ZNA-2) and an assessment of dynamic balance (the stabilometric “Limits of Stability” test) at the beginning and end of the rehabilitation course. The main posturographic indicators of static balance were analyzed based on the results of the “Balance Function Index” test. RESULTS. The study involved 94 patients (47 boys and 47 girls) with a median age of 10.5 [8.0; 12.0] years. The most pronounced deviations in the z-score (standardized score) for static balance on the ZNA-2 were observed in children with cyanotic single-ventricle defects: 29.4 % of them had mild impairments (–1.0 z-score –2.0) whilst 11.8 % had severe impairments (≤ –3.0). Stabilometry data revealed a non-linear development of postural control in patients with CHD as they grew older, as well as a trend towards a deterioration in dynamic balance during adolescence. Girls demonstrated better static stability, whilst boys showed better dynamic balance. Supplementing the cardiac rehabilitation programme with balance therapy on a stabilization platform resulted in a statistically significant increase in the z-score for static balance from –0.5 [–1.11; –0.15] to –0.24 [–0.68; 0.22] (p 0.001) and in stability limit indicators in all directions: forward from 92.7 ± 22.0 % to 101.6 ± 23.3 % (p = 0.006), backward from 60.7 ± 18.3 % to 71.2 ± 21.0 % (p 0.001), to the right from 77.5 ± 20.4 % to 85.6 ± 12.7 % (p = 0.006), to the left from 85.7 ± 14.7 % to 93.4 ± 11.9 % (p 0.001). The article also presents the results of an analysis of the effect of various exercise regimes on improving balance as part of the rehabilitation programme. DISCUSSION. Our stabilometry data represent a generally suboptimal balance ability in children with CHD and also demonstrate that balance function continues to develop during adolescence. These findings may be due to comorbidities (e.g., musculoskeletal disorders), which, nevertheless, are directly related to the underlying cardiac pathology. CONCLUSION. School children with CHD and complaints of postural instability have z-score deviations in static balance tests with visual deprivation, a wave-like pattern of static stability development, and no improvements in dynamic balance with age. Additional training on a stabilometer platform with BF helps to improve postural control.