Anticipatory postural adjustments in children with hemiplegia and diplegia

Abstract

Anticipatory postural adjustments (APAs) play an important role in the performance of many activities requiring the maintenance of standing posture. However, little is known about if and how children with cerebral palsy (CP) generate APAs. Two groups of children with CP (hemiplegia and diplegia) and a group of children with typical motor development performed arm flexion and extension movements while standing on a force platform. Electromyographic activity of six trunk and leg muscles and displacement of center of pressure (COP) were recorded. Children with CP were able to generate anticipatory postural adjustments and produce directionally specific APAs and COP displacements similar to those described in adults and typically developing children. However, children with diplegia were unable to generate APAs of the same magnitude as children with typical development and hemiplegia and had higher baseline muscle activity prior to movement. In children with diplegia, COP was posteriorly displaced and peak acceleration was smaller during bilateral extension compared to children with hemiplegia. The outcomes of the study highlight the role of APAs in the control of posture of children with CP and point out the similarities and differences in anticipatory control in children with diplegia and hemiplegia. These differences may foster ideas for treatment strategies to enhance APAs in children with CP.

Reproducibility of the Balance Evaluation Systems Test (BESTest) and the Mini-BESTest in school-aged children

“…For example, children with cerebral palsy have demonstrated deficits in anticipatory mechanisms (feedforward postural adjustments) [14][15][16][17][18], adaptive mechanisms (feedback postural adjustments) [3,14,[19][20][21], musculoskeletal systems (muscle force and range of motion required for standing balance) [22] and sensory systems (visual and proprioceptive function required for balance) [23,24]. This research illustrates well how one population can experience a broad range of postural control problems, and also that there is an absence of a comprehensive clinical assessment for children.…”

Deficits in anticipatory inhibition of postural muscle activity associated with load release while standing in individuals with spastic diplegic cerebral palsy

“…However, the EMG amplitudes of MH and GcM in the background range were not smaller in the SDCP group than in the control group, although these values were not normalized. A previous study reported that individuals with SDCP exhibit greater background activity before voluntary arm movement than individuals without disability (Girolami et al 2011). It is thus unlikely that the lack of anticipatory inhibition of dorsal lower limb muscles in the SDCP group was due to muscle activities in the background range.…”

Assessment of postural control in children with cerebral palsy: A review

“…This is clearly related to the fact that children must be able to perform certain tasks independently so that these studies can be carried out. This classification was based either on GMFCS levels (Burtner, Woollacott, Craft, & Roncesvalles, 2007; Chen & Woollacott, 2007; Corrêa et al, 2007; Girolami, Shiratory, & Aruin, 2011; Ju et al, 2012; Liu, Zaino, & McCoy, 2007; Reilly, Woollacott, & Donkelaar, 2008; Rha, Kim, & Park, 2010; Saavedra et al, 2010; Zaino & McCoy, 2008) or other criteria, such as topography of the lesion (Barela et al, 2011; Bigongiari et al, 2011; Burtner, Qualls, & Woollacott, 1998; Cherng, Su, Chen, & Kuan, 1999; Liao, Jeng, Lai, Cheng, & Hu, 1997; Rose et al, 2002). …”