Children with CHARGE syndrome have impairments that lead to less than average balance and control over their bodies. Haibach and Lieberman (2013) investigated the self-efficacy of balance in these children using the Activities-Specific Balance Confidence Scale. In order to do this, children with CHARGE syndrome were matched by gender and age to children who did not have CHARGE syndrome in order to quantify that difference. It is therefore not surprising that the control group displayed better balance than those with CHARGE syndrome. Children without the condition have no or low risks for falls, whereas more than half of those with the condition have a high risk of falls and related complications. Neither gender nor age was found to be related to different outcomes. The study was successful in displaying the important relationship between the self-efficacy of balance and actual balance capacity and the impact that this can have on the risk of falls and other issues. This study was able to show that not only do children with CHARGE syndrome have decreased balance and control, they also have decreased confidence in their posture and balance, and this has implications for motor development along the typical developmental timeline. In particular, it appears to result in a less participation in physical activities which further suppresses development. One of the possible mitigation strategies which are discussed for children with CHARGE syndrome is an increased physical activity regimen which focuses on tasks, skills and sports which lead to increased balance and therefore confidence of the children in their ability to balance and not fall.
There were strengths and weaknesses to the methodology of this research. The methodology of the study had strengths in terms of the application of techniques to ensure that there were well defined and valid controls. This involved finding, for each participant who was part of the dependent variable or intervention group, in this case children with CHARGE syndrome, a matching child who did not have CHARGE syndrome. The children were matched according to age and gender. With only thirty one (31) matched pairs, and little known about other similarities or differences between the matched pairs, it is difficult to see the results as anything more than an initial exploration of differences.
The researchers established the importance of the problem area by describing in the introduction the details of CHARGE syndrome and the impacts it can have on development. The researchers noted many gaps in terms of the current status of the body of research relating to CHARGE syndrome in children, in particular the contributing factors that mitigate the secondary complications that further suppress motor development and mobility. Unfortunately, due to the small sample size, despite the use of controls, it is not of a volume that would provide validity to the results, nor is it appropriate for generalization. Further refinement of the matching could have occurred by ensuring that any other health conditions were also matched, as well as ensuring a similar fitness level however these steps were not taken. An additional problem was the size of the sample population. In this case there was no treatment or intervention of the subject group, their CHARGE syndrome served that role.
In this case, rather than receiving an intervention, the non-control group had the participants who suffer from CHARGE syndrome. Apart from this, other conditions remained the same in the experimental and control groups, including ensuring that there was a match for age and gender between the groups. The researcher refers back to the research purpose in making the connection between the research question and the difficulties that children with CHARGE syndrome and their caregivers face.
a. The research question was clearly stated, and further the underlying assumptions that were involved in the question were always made clear. It was defined in terms of the real life problem as well as theoretically constructed, and the research question and research design was constructed with reference to the real life application to children with CHARGE syndrome.
While the authors did report the results that directly answered the proposed research question and the hypothesis, what remains in question is the validity of the results given that such a small sample size was used. The application of the question was well described through the introduction and background with regard to CHARGE syndrome and the developmental difficulties faced by the children with the condition. The methodology tested the concepts which were applied to the difficulty, that being the self-efficacy of balance, by measuring actual balance, self-efficacy, and the comparison between the child with CHARGE and similarly aged child of the same gender who did not have CHARGE syndrome.
The authors could have done more to control for or reduce threats to internal validity and statistical significance, as the study that was conducted used only twenty one children with CHARGE matched to an equal number of children who did not have CHARGE syndrome. The authors should have done more to ensure that the results of this carefully designed and implemented study had application by having a much higher sample population in the study. Further, it would have been possible to match children using more refined details, such as other health conditions, height and other factors. In this way the authors could have controlled for or substantially reduced threats to the statistical significance of the study, despite meeting all criteria to ensure the internal validity of the study.
- Haibach, P. S., & Lieberman, L. J. (2013). Balance and Self-efficacy of Balance in Children with CHARGE Syndrome. Journal of Visual Impairment & Blindness, 107(4), 297.