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Published on: August 30, 2016
Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems
Marjorie Hines Woollacott1, Anne Shumway-Cook
1Department of Human Physiology, University of Oregon, Eugene 97403, USA.
Insights
Children with cerebral palsy (CP) experience balance and walking challenges due to specific motor impairments. Reactive balance training can improve their ability to recover stability, enhancing overall mobility.
Area of Science:
- Neuroscience
- Pediatrics
- Rehabilitation Medicine
Background:
- Children with cerebral palsy (CP) exhibit impaired balance and walking due to motor control deficits.
- Key constraints include crouched posture, delayed muscle responses, abnormal muscle sequencing, and increased co-contraction.
- These factors limit their ability to recover from unexpected balance perturbations.
Purpose of the Study:
- To review studies on balance and walking constraints in children with CP.
- To evaluate the efficacy of reactive balance training in improving balance recovery in children with CP.
- To identify changes in muscle response characteristics following training.
Main Methods:
- Review of existing literature on balance and gait in children with CP.
- Analysis of studies involving reactive balance training, specifically platform displacement-induced slips.
- Examination of kinematic and electromyographic data related to balance recovery and muscle activation patterns.
Main Results:
- Children with CP demonstrate impaired reactive balance, characterized by longer recovery times and increased sway.
- Reactive balance training led to significant improvements in balance recovery efficiency.
- Training reduced the time to restabilize and the path of the center of pressure.
- Improvements were associated with faster muscle response onset, better organization, and reduced co-contraction.
Conclusions:
- Reactive balance training is an effective intervention for improving balance recovery in children with CP.
- Improvements in muscle response characteristics underlie enhanced balance control.
- These findings suggest that school-aged children with CP can improve their ability to recover balance through targeted training.
Abstract:
In this review we explore studies related to constraints on balance and walking in children with cerebral palsy (CP) and the efficacy of training reactive balance (recovering from a slip induced by a platform displacement) in children with both spastic hemiplegic and diplegic CP. Children with CP show (a) crouched posture, contributing to decreased ability to recover balance (longer time/increased sway); (b) delayed responses in ankle muscles; (c) inappropriate muscle response sequencing; (d) increased coactivation of agonists/antagonists. Constraints on gait include (a) crouched gait; (b) increased co-activation of agonists/antagonists; (c) decreased muscle activation; (d) spasticity. The efficiency of balance recovery can be improved in children with CP, indicated by both a reduction in the total center of pressure path used during balance recovery and in the time to restabilize balance after training. Changes in muscle response characteristics contributing to improved recovery include reductions in time of contraction onset, improved muscle response organization, and reduced co-contraction of agonists/antagonists. Clinical implications include the suggestion that improvement in the ability to recover balance is possible in school age children with CP.
