Best seating condition in children with spastic cerebral palsy: One type does not fit all

Area of Science:

• Pediatric Rehabilitation
• Biomechanics
• Neurology

Background:

• The impact of seating modifications on motor function in children with spastic cerebral palsy (CP) remains a subject of debate.
• Understanding optimal seating is crucial for enhancing functional abilities in children with CP.

Purpose of the Study:

• To investigate the effects of forward-tilted seating and foot support on head stability and reaching kinematics in children with CP.
• To differentiate the impact of these seating interventions between unilateral spastic CP (US-CP) and bilateral spastic CP (BS-CP).

Main Methods:

• Nineteen children (6-12 years) with Gross Motor Function Classification System levels I-III participated.
• Kinematic data of head sway and reaching were collected in four seating conditions: horizontal and 15° forward-tilted, with and without foot support.
• Participants included ten with US-CP and nine with BS-CP.

Main Results:

• Seating conditions did not influence head stability during reaching.
• Forward-tilting positively impacted reaching parameters (movement unit proportion and size) in children with US-CP.
• Conversely, forward-tilting negatively affected reaching in children with BS-CP, while a horizontal seat was more beneficial.

Conclusions:

• A 15° forward-tilted seat with foot support does not enhance head stability in children with CP.
• Forward-tilting seating benefits reaching in US-CP but impairs it in BS-CP, independent of foot support.
• These findings suggest tailored seating strategies are necessary for different CP subtypes.