Muscle Force and Range of Motion as Predictors of Standing Balance in Children with Cerebral Palsy

Abstract

Children with cerebral palsy frequently receive therapeutic intervention to remediate standing balance deficits. Evaluation of the impairments associated with poor balance could facilitate more effective treatment programs. This study evaluated the relationship between lower extremity force production, range of motion and standing balance in thirty-five children between the ages of 6 and 14 years of age with spastic cerebral palsy. Standing balance was evaluated using the Pediatric Clinical Test of Sensory Interaction (P-CTSIB). Hand-held dynamometry was used to assess force production and goniometry was used to assess range of motion. The results indicated that force production and range of motion are highly related to standing balance. Blocked, hierarchical multiple regression analysis revealed that force production explained 41% of the variance in P-CTSIB scores in this sample, while range of motion explained an additional 13%. Therefore, the total variance explained by these variables was 54%. Results of this study suggest that impairment level testing may allow the development of more effective individualized intervention programs to remediate balance deficits. Clinical suggestions are provided.

Feasibility of Computer-Based Videogame Therapy for Children with Cerebral Palsy

“…7 This therapeutic videogame was specifically designed for children with spastic CP who have slow and limited movement ability and often demonstrate compensatory motions not seen in normal children. [2][3][4] Commercially available videogames that are not adapted for these functional limitations may prevent children from being successful in playing the games. This videogame allowed the subjects to be successful in manipulating the airplane by using therapeutic movements to reach the target and score points.…”

“…1 Standing and gait balance problems in spastic CP result from impaired muscle force production, limited joint range of motion, inappropriate muscle responses, muscle timing abnormalities, and inaccurate somatosensory processing in the lower extremities and trunk. [2][3][4] Thus, children with CP who have impaired standing and gait balance frequently lose their balance and fall and may experience injuries. 2 Because the majority of children with CP survive into adulthood, these deficits limit their ability to live independently and to participate in family, societal, and employment activities.…”

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.…”

The effect of contralateral training: Influence of unilateral isokinetic exercise on one-legged standing balance of the contralateral lower extremity in adults

“…This improvement in balance performance following resistance training exercises has been attributed in other studies to increases in strength [26,27], supporting the concept of cross training of the unilateral lower limb in supine and sidelying to improve the OSI stability score with less fatigue of the contralateral lower limb. Further support comes from studies that have shown that balance is highly related to lower extremity force production and range of motion [28], and strength [29]. Horlings et al [30] demonstrated that proximal muscle weakness led to significant postural instability during backwards perturbations.…”