Anticipatory postural adjustments associated with a loading perturbation in children with hemiplegic and diplegic cerebral palsy

Abstract

Anticipatory postural adjustments (APAs) in preparation for predictable externally induced loading perturbation were studied in children with typically development (TD), hemiplegic (HEMI), and diplegic (DIPL) cerebral palsy. Twenty-seven children (n = 9 in each group) were asked to stand and catch a load dropped from a pre-specified height. Electrical activity of the leg and trunk muscles and center of pressure (COP) displacements were recorded to quantify the APAs. All groups were able to generate APAs prior to the perturbation, but the magnitude was smaller and the onset was delayed in the dorsal (agonist) postural muscles in both HEMI and DIPL as compared to TD. HEMI and DIPL also generated APAs in the antagonist postural muscles. Anticipatory backward COP displacement was significantly different from the baseline value only in the TD and HEMI. HEMI and DIPL displayed a different postural control strategy; HEMI showed no difference in background postural activity from TD, but with diminished APAs in the agonist postural muscles compared to TD, while DIPL showed a higher background postural activity and diminished APAs in the agonist postural muscles compared to TD. These differences are important to consider when designing rehabilitation programs to improve posture and movement control in children with hemiplegic and diplegic cerebral palsy.

Accelerometric Assessment of Postural Balance in Children: A Systematic Review

“…Furthermore, the quality of the selected articles was established under the following scale: low (<33.3%), medium (33.4-66.7%), and high (>66.8%) [29,30]. Of the 18 articles analyzed, 7 showed medium quality [31][32][33][34][35][36][37] and 10 showed high quality [38][39][40][41][42][43][44][45][46][47] (Table S1-Supplementary Materials).…”

“…The objectives of the analyzed studies were varied. Those which employed a crosssectional observational methodology were focused on estimating the normative assessment data through the Sway Balance System (SBS) method [31], evaluating the magnitude of anticipatory postural adjustments [42] and quantifying accelerations during gait (during normal gait [33,37], with trajectory and velocity changes [39], and while performing a cognitive task [35]). One study combined the analysis of static balance and balance during gait in order to determine the reliability and validity of accelerometry to evaluate balance in children [46].…”

Distribuição da pressão plantar e morfologia do pé de crianças com paralisia cerebral e crianças com desenvolvimento típico

“…Besides these compensatory strategies, recent studies indicate that, although children with CP can produce anticipatory postural adjustment activities for movements, this activation is delayed, mainly in lower limb muscles, and their magnitude is smaller when compared with children with TD 21,22 . During the baropodometric evaluation, the pressures of right and left foot are registered, which allows the determination of weight percentage supported by each foot 8 .…”

Effect of Action Observation Training on Spasticity, Gross Motor Function, and Balance in Children with Diplegia Cerebral Palsy

“…Prolonged spasticity causes abnormal posture, limitation of movement, and limitation and construction of active or passive joint movement [8]. In order to improve the spasticity and balance in children with cerebral palsy, various treatment intervention methods have been used; these include botulinum toxin injection [9,10], anticipatory postural adjustments [11], dynamic ankle-foot orthosis [12], whole-body vibration [13], and extracorporeal shock wave therapy [14]. Recently, a new method of treating upper limb motor deficits using action observation training has been proposed for patients with stroke [15,16] and cerebral palsy [17][18][19].…”