Shuttle balance training is a dynamic exercise program designed to improve balance, gait, and posture, especially beneficial for children with mild cognitive impairment. It includes activities like shuttle runs, lateral steps, single-leg balances, crossovers, figure-8 drills, obstacle courses, and reaction drills-all aimed at enhancing coordination, stability, and agility. The program typically runs for 45-minute sessions, three times a week. Pre-assessments are used to measure baseline abilities, and progress is monitored throughout. This type of training helps improve motor control, body awareness, and functional movement, leading to better balance, more stable gait, and improved postural control in daily activities.

"Baseline treatment" refers to the standard or initial treatment that is provided to a patient.

Baseline treatment sets a foundation for managing the patient's condition effectively. It ensures that the patient receives appropriate care based on current medical knowledge and guidelines, with the goal of improving health outcomes and quality of life. Duration of session will be 45 min and 3 sessions per week.

• Control Group Considerations: Clarifying how participants assigned to the control group will receive standard care or placebo intervention to maintain ethical standards and enable comparison with the intervention group.
• Outcome Measures: Specifying the outcome measures and assessment tools used to evaluate the effects of the intervention on balance, gait, and postural control, both immediately after the intervention period and potentially during follow-up assessments.

Shuttle balance training is a form of dynamic balance exercise that uses a shuttle system-often a platform or track with resistance bands or gliders-to help improve stability, coordination, and strength. In children, this type of training plays a significant role in enhancing gait, balance, and posture by engaging core and lower limb muscles in controlled, functional movements. It encourages proprioceptive development, helping children become more aware of their body's position in space, which is crucial for maintaining upright posture and walking efficiently. Through repetitive and playful activities, shuttle balance training can aid in correcting abnormal gait patterns, improving postural alignment, and boosting confidence in physical activities.

A scale that is used to determine the balance in an individual. It has total 14 items, It takes about 20 minutes to complete each item, which has a five-point ordinal scale from 0 to 4, where 0 represents the lowest level of function and 4 the most. It excludes the evaluation of gait.

TOTAL SCORE (Maximum = 56)

Limits of Stability (LoS) is a key measure for assessing dynamic balance and voluntary motor control by tracking changes in the center of mass (COM). It helps identify postural instability and fall risk by evaluating how far a person can lean or sway without losing balance. LoS Represents the max distance a person can sway intentionally in direction without losing their balance. Normal range is anteroposterior 12.5 degrees, and medio-lateral 16 degrees.

A test of functional motor skills required for day-to-day functioning is the Goal-Oriented Assessment of Lifeskills (GOAL). The GOAL program, which is intended for children aged 7 to 17, includes seven enjoyable and inspiring activities that are based on real-life tasks that kids do on a daily basis. The 54 Steps-small units of clearly visible, useful conduct within the seven Activities-are the foundation for the GOAL scores. Three components of successful functional performance-accuracy, independence, and speed-are used to score these. Each Step is graded as pass or fail using the Record Form. The Fine Motor and Gross Motor Standard Scores and the Progress Score are then calculated by adding the Step scores.

The timed Up and Go test (TUG) is a relatively simple test used to assess a person's mobility and requires both static and dynamic balance. The patient sits on a standard armchair back against it and resting arm position, regular footwear is used, the patient walks to a line that is 3meters away turns around the line, walks back to the chair and sits down. When the patient's buttocks touches the seat, the test ends there. A stopwatch is used to measure the time. Higher time score indicates high fall risks and less functional independence.