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Published on: August 30, 2016
Development of postural responses during standing in healthy children and children with spastic diplegia
M H Woollacott1, P Burtner, J Jensen
1Department of Exercise and Movement Science, University of Oregon, Eugene 97403, USA. mw001@oregon.uoregon.edu
Insights
Children with cerebral palsy (CP) exhibit delayed muscle response patterns in balance control, resembling younger typically developing children. This suggests both central nervous system deficits and biomechanical factors contribute to their balance challenges.
Area of Science:
- Developmental neuroscience
- Motor control research
- Pediatric rehabilitation
Background:
- Balance control development shows a progression in muscle response patterns.
- Early adaptive postural responses are evident by 1 year of age.
- Children with spastic diplegia display atypical muscle activation patterns.
Purpose of the Study:
- To investigate the developmental progression of muscle response patterns in balance control.
- To compare the balance control strategies of children with spastic diplegia to typically developing children.
- To elucidate the contributions of central nervous system (CNS) deficits and biomechanical factors in CP balance control.
Main Methods:
- Analysis of muscle response patterns during balance tasks in children.
- Comparison of muscle activation in typically developing children and those with spastic diplegia.
- Experimental manipulation of posture (crouched stance) in typically developing children.
Main Results:
- Typically developing children show decreasing tonic activity and emerging phasic bursts in agonist muscles before independent stance.
- Children with spastic diplegia exhibit poorly organized muscle responses (proximal before distal) and significant antagonist co-activation.
- Normal children in a crouched posture mimicked the muscle activation patterns seen in CP children.
Conclusions:
- Balance control deficits in children with cerebral palsy stem from a combination of CNS impairments and altered biomechanics.
- Atypical muscle activation patterns in CP are characterized by delayed proximal-to-distal sequencing and increased co-contraction.
- Biomechanical constraints, such as altered postural alignment, can exacerbate underlying neurological deficits in balance control.
Abstract:
Studies on the development of balance control show a clear developmental progression of the emergence of organized muscle response patterns, with tonic background muscle activity decreasing and phasic bursts of activity emerging in all three agonist muscles in a synergic group (gastrocnemius-hamstrings-trunk extensors or tibialis anterior-quadriceps-abdominals) just prior to the onset of independent stance. The rudimentary ability to adapt postural responses to changing task conditions is present in children as young as 1 year of age. Older children with spastic diplegia have muscle activation patterns typically seen in normal children who are at the pull-to-stand stage of development, including poorly organized (proximal activated before distal muscles) responses with a high degree of antagonist co-activation. When normal children were asked to stand in a crouched posture like the CP children, the additional constraint caused muscle response patterns to resemble those of CP children, suggesting that differences in balance control in CP children are due to both CNS deficits and biomechanical changes in postural alignment.
