How Does Postural Control of Children with CP Deal with Manipulations on Base of Support and Support Surface? A Systematic Review.

AIMS: Systematically review literature addressing the effects of changes in base of support (BoS) configuration and characteristics of support surface (SS) on postural control of children with cerebral palsy (CP). METHODS: We conducted a tailored electronic database search in PubMed/Web of Science/SCOPUS/Embase. RESULTS: We identified 15 studies meeting inclusion criteria. CONCLUSION: The extant literature suggests that when children with CP experience changes in BoS and SS, they engage in fewer adaptive postural control responses than typically developing children. Documented response patterns of children with CP in the literature might guide the selection and development of rehabilitation strategies to appropriately facilitate or challenge postural control in children with CP.

Effectiveness and Evidence Level of Dance on Functioning of Children and Adolescents with Neuromotor Impairments: A Systematic Review.

OBJECTIVES: The aim of this paper is to investigate the effects of dance therapy in children with neuromotor impairments (CNI), organizing the outcomes according to International Classification of Functioning Disability and Health (ICF) domains, and to investigate if there is adequate evidence of effectiveness to recommend dance as a therapy. METHODS: Electronic searches were conducted in December 2021. We include studies assessing the effects of dance in CNI up to 18 years. Data extraction included studies' populations, intervention features, and main outcomes. We classified outcomes according to the ICF framework. We used the Cochrane collaboration's tool, modified by effective practice and organization of care (EPOC), to assess the methodological quality. The GRADE synthesized the body of evidence. RESULTS: Twelve studies were included, with most of them addressing the body structure and function and activity components of ICF. Only three studies addressed components of participation, and four of personal factors. All these studies reported the positive effects of dance. Nevertheless, all of them presented high risk of bias. We found very low evidence level for improvement of body structure and function and activity components. CONCLUSION: Dance therapy presents low evidence level for improvements of body structure and function and activity in CNI. Further studies with low risk of bias and larger samples are needed.

Effects of sensory manipulations on the dynamical structure of center-of-pressure trajectories of children with cerebral palsy during sitting.

AIM: To investigate the effects of manipulating visual information and the compliance of the support surface on the area of sway and dynamical trajectories of center-of-pressure (CoP) in children with CP and children with typical development during static sitting. METHODS: 32 typical children, 14 children with mild CP and 12 with moderate-to-severe CP were tested for CoP sway during static sitting under four sensory conditions: (1) eyes open on a rigid surface; (2) eyes closed on a rigid surface; (3) eyes open on foam; (4) eyes closed on foam. RESULTS: Children with moderate-to-severe CP showed greater regularity and local stability of dynamical CoP trajectories and lower complexity in their motor patterns than typical children and children with mild CP. Moreover, removing vision and sitting on a compliant surface reduced the regularity of CoP trajectories. CONCLUSION: Children with CP were able to adjust the structure and complexity of their postural control responses to sensory challenges, although the structure of their postural responses was poorer than in typical children.

Effect of the severity of manual impairment and hand dominance on anticipatory and compensatory postural adjustments during manual reaching in children with cerebral palsy.

AIM: To investigate the role of the severity of manual impairment and of hand dominance on postural sway during anticipatory [APA] and compensatory [CPA] postural adjustments in a seated manual reaching task performed by children with cerebral palsy (CP) and typical children (TC). METHODS: We tested 26 TC (mean age 9.5 ± 2.1 years) and 29 children with CP (age 9.6 ± 3 years) classified based on manual impairment levels as mild (Manual Ability Classification System [MACS] I; n = 18) or moderate-to-severe (MACS II-III, n = 11). Participants were instructed to reach towards a target using their dominant vs. non-dominant arm while sitting on a force-plate. Center of pressure (CoP) sway was analyzed during APA and CPA. RESULTS: For all groups, using the non-dominant arm determined greater amplitude and velocity of CoP sway in CPA. Children with moderate-to-severe manual impairment showed greater sway during APA and CPA compared to mild impairment and TC groups. CONCLUSION: More severe manual impairment resulted in higher sway during the anticipatory and compensatory phases of the reaching task. Using the non-dominant arm resulted in greater compensatory adjustments during reaching.

Effects of Suit-Orthosis on Postural Adjustments During Seated Reaching Task in Children With Cerebral Palsy.

AIM: To investigate suit-orthosis effects on postural sway during anticipatory and compensatory postural adjustments (APA and CPA, respectively) in a seated reaching task performed by children with cerebral palsy (CP). METHODS: Twenty-nine children were divided according to Manual Ability Classification System (MACS) I and II-III. Participants were instructed to reach forward toward an object both in a no-suit condition and in a suit-orthosis condition. RESULTS: Using the suit-orthosis, children at MACS II-III decreased velocity of center-of-pressure (CoP) sway during APA, whereas children at MACS I increased the anterior-posterior CoP displacement during CPA. CONCLUSION: Suit-orthosis improved postural stability in children at MACS II-III during APA. The suit may assist with arm function control during postural sway when preparing to reach for objects. CLINICAL IMPLICATIONS: Suit-orthoses in therapy should be individually prescribed considering the intended activity and person's motor impairment.

Dynamical structure of center-of-pressure trajectories with and without functional taping in children with cerebral palsy level I and II of GMFCS.

Postural control during quiet standing was examined in typical children (TD) and children with cerebral palsy (CP) level I and II of GMFCS. The immediate effect on postural control of functional taping on the thighs was analyzed. We evaluated 43 TD, 17 CP children level I, and 10 CP children level II. Participants were evaluated in two conditions (with and without taping). The trajectories of the center of pressure (COP) were analyzed by means of conventional posturography (sway amplitude, sway-path-length) and dynamic posturography (degree of twisting-and-turning, sway regularity). Both CP groups showed larger sway amplitude than the TD while only the CP level II showed more regular COP trajectories with less twisting-and-turning. Functional taping didn't affect sway amplitude or sway-path-length. TD children exhibited more twisting-and-turning with functional taping, whereas no effects on postural sway dynamics were observed in CP children. Functional taping doesn't result in immediate changes in quiet stance in CP children, whereas in TD it resulted in faster sway corrections. Children level II invest more attention in postural control than level I, and TD. While quiet standing was more automatized in children level I than in level II, both CP groups showed a less stable balance than TD.

Clinical tools designed to assess motor abilities in children with cerebral palsy.

OBJECTIVE: This systematic review aimed to list the tools used by rehabilitation professionals to test motor abilities in children with cerebral palsy (CP), to determine if these tools have psychometric properties specifically measured for CP, and to identify the main characteristics of these tools. METHOD: Web of Science, PEDro, PubMed/MEDLINE, Science Direct, and SciELO databases were searched to identify the tools. PubMed/MEDLINE was then searched to identify the studies assessing those tools' psychometric properties. The agreement-based standards for the selection of health measurement tools and the Terwee criteria were used to assess the quality and the results of each included study, respectively. RESULTS: Eighteen tools were identified. The psychometric properties of many of the tools used with children with CP have not been evaluated for this population. CONCLUSION: The psychometric properties evaluated often have a poor methodological quality of measurement. Overall, we suggest the tools with most empirical support to evaluate children with CP.

Evidência da transição de fases no desenvolvimento do controle postural e cervical na postura prona / Evidence of the phases transition in the postural and cervical control development at prone position

O objetivo desse estudo e verificar a evolução do controle cervical e postural na postura prona em lactentes normais nos primeiros 4 meses de vida. Foram estudados 25 lactentes saudáveis, com idade média de 65,36 dias (±36,96). Os lactentes foram filmados e avaliados na postura prona sobre uma mesa de avaliação (Green e colaboradores, 1995). A avaliação foi realizada em duas etapas: a) verificação dos níveis de controle postural; b) freqüência (considerando-se o número de vezes em que o lactente elevava a face da superfície da mesa) e tempo de permanência da elevação da cabeça (a manutenção da cabeça elevada por mais de um segundo). Os níveis de controle postural foram quantificados de 1 a 6, segundo a escala dos Níveis de Habilidades Motoras (Green e colaboradores, 1995). Constatou-se, a partir dos testes de Anova e Duncan, diminuição significativa da freqüência da elevação da cabeça no terceiro e quarto mês. O tempo de permanência da elevação da cabeça teve aumento significativo aos dois meses e o nível de controle postural em prono evoluiu do nível 2 para o 4, diferenciando-se significativamente aos quatro meses. Portanto, através de uma abordagem mais dinâmica, e possível compreender que a evolução do controle cervical em prono nos primeiros 4 meses ocorre por transição de fases, nos quais o lactente seleciona o padrão de movimento preferido com o intuito de descobrir soluções para novas tarefas.

The aim of this study was verifying the evolution of the cervical and postural control at prone position in normal babies during the first 4 months of life. Twenty-five healthy babies with a medium age of 65,36 days (±36,96) were studied. They were video taped and evaluated at prone position lying on an evaluation table (Green and coworkers, 1995). The evaluation was realized in two steps: a) verification of the levels of postural control; b) frequency (concerning the number of times the baby raised up his face from the table surface) and the time he/she kept his/her head up (keeping the head up for more than a second). The levels of postural control were scored from 1 to 6, according to the Levels of Motor Abilities (Green and coworkers, 1995). From Anova and Duncan tests, it was verified a significant decrease on the frequency of head elevation during the third and fourth months of life. The time they kept their head up had a significant increase from the second month and the level of postural control at prone position evolved from level 2 to level 4, changing significantly at four months. Therefore, assuming a dynamic point o1 view, the evolution of cervical control at prone position during the first 4 months of life occurs by phase transition, in which the baby chooses the preferred pattern of movement aiming at discovering solutions for new tasks.

Evidência da transição de fases no desenvolvimento do controle postural e cervical na postura prona / Evidence of the phases transition in the postural and cervical control development at prone position

O objetivo desse estudo e verificar a evolução do controle cervical e postural na postura prona em lactentes normais nos primeiros 4 meses de vida. Foram estudados 25 lactentes saudáveis, com idade média de 65,36 dias (±36,96). Os lactentes foram filmados e avaliados na postura prona sobre uma mesa de avaliação (Green e colaboradores, 1995). A avaliação foi realizada em duas etapas: a) verificação dos níveis de controle postural; b) freqüência (considerando-se o número de vezes em que o lactente elevava a face da superfície da mesa) e tempo de permanência da elevação da cabeça (a manutenção da cabeça elevada por mais de um segundo). Os níveis de controle postural foram quantificados de 1 a 6, segundo a escala dos Níveis de Habilidades Motoras (Green e colaboradores, 1995). Constatou-se, a partir dos testes de Anova e Duncan, diminuição significativa da freqüência da elevação da cabeça no terceiro e quarto mês. O tempo de permanência da elevação da cabeça teve aumento significativo aos dois meses e o nível de controle postural em prono evoluiu do nível 2 para o 4, diferenciando-se significativamente aos quatro meses. Portanto, através de uma abordagem mais dinâmica, e possível compreender que a evolução do controle cervical em prono nos primeiros 4 meses ocorre por transição de fases, nos quais o lactente seleciona o padrão de movimento preferido com o intuito de descobrir soluções para novas tarefas.(AU)

The aim of this study was verifying the evolution of the cervical and postural control at prone position in normal babies during the first 4 months of life. Twenty-five healthy babies with a medium age of 65,36 days (±36,96) were studied. They were video taped and evaluated at prone position lying on an evaluation table (Green and coworkers, 1995). The evaluation was realized in two steps: a) verification of the levels of postural control; b) frequency (concerning the number of times the baby raised up his face from the table surface) and the time he/she kept his/her head up (keeping the head up for more than a second). The levels of postural control were scored from 1 to 6, according to the Levels of Motor Abilities (Green and coworkers, 1995). From Anova and Duncan tests, it was verified a significant decrease on the frequency of head elevation during the third and fourth months of life. The time they kept their head up had a significant increase from the second month and the level of postural control at prone position evolved from level 2 to level 4, changing significantly at four months. Therefore, assuming a dynamic point o1 view, the evolution of cervical control at prone position during the first 4 months of life occurs by phase transition, in which the baby chooses the preferred pattern of movement aiming at discovering solutions for new tasks.(AU)