Abstract
Deficits in postural control are one of the hallmarks of disability in children with cerebral palsy (CP). Yet, much remains unknown regarding the etiology of postural deficits in these children. Here we evaluated postural control at a simplified task level by measuring head stability during quiet sitting while systematically manipulating the level of trunk support and vision in 15 children with CP (6–16 years), 26 typically developing (TD) children (4–14 years), and 11 adults. While TD children did not differ significantly from adults, children with CP had greater head movement than adults in both the sagittal and frontal planes under all conditions except frontal plane movement with Torso Support. Vision did not affect head stability in the sagittal plane for any group while it had differential effects on head stability in the frontal plane. Lack of vision improved head stability in adults and older TD children while destabilizing the head in young children (TD and CP) during the most unstable sitting position. Moreover, vision affected children with CP differently depending on their movement disorder. Children with spastic CP performed worse with eyes closed while those with dyskinetic CP had improved head stability with eyes closed. Our results demonstrate that children with mild to moderate CP have deficits in head stability even during quiet sitting.
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Abbreviations
- CP:
-
Cerebral palsy
- TD:
-
Typically developing
References
Assaiante C (1998) Development of locomotor balance control in healthy children. Neurosci Biobehav Rev 22(4):527–532
Assaiante C, Amblard B (1993) Ontogeny of head stabilization in space during locomotion in children- influence of visual cues. Exp Brain Res 93(3):499–515
Assaiante C, Amblard B (1995) An ontogenetic model for the sensorimotor organization of balance control in humans. Hum Mov Sci 14:13–43
Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, Jacobsson B, Damiano D (2005) Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 47:571–576
Bernstein NA (1984) The co-ordination and regulation of movement. In: Whiting HTA (ed) Human motor actions Bernstein reassessed. Elsevier, Amsterdam
Bertenthal BI, Boker SM, Xu M (2000) Analysis of the perception–action cycle for visually induced postureal sway in 9-month-old infants. Infant Behav Dev 23:299–315
Blouin J, Teasdale N, Mouchnino L (2007) Vestibular signal processing in a subject with somatosensory deafferentation: the case of sitting posture. BMC Neurol 7:25
Bodensteiner JB, Smith SD, Schaefer GB (2003) Hypotonia, congenital hearing loss, and hypoactive labyrinths. J Child Neurol 18(3):171–173
Braswell J, Rine RM (2006) Evidence that vestibular hypofunction affects reading acuity in children. Int J of Pediatr Otorhinolaryngol 70(11):1957–1965
Brogren E, Hadders-Algra M, Forssberg H (1996) Postural control in children with spastic diplegia: muscle activity during perturbations in sitting. Dev Med Child Neurol 38(5):379–388
Brogren E, Forssberg H, Hadders-Algra M (2001) Influence of two different sitting positions on postural adjustments in children with spastic diplegia. Dev Med Child Neurol 43(8):534–546
Buchanan JJ, Horak FB (1999) Emergence of postural patterns as a function of vision and translation frequency. J Neurophysiol 81(5):2325–2339
Chee RKW, Kreutzberg JR, Clark DL (1978) Semicircular canal stimulation in cerebral palsied children. Phys Ther 58(9):1072–1075
Chen LC, Metcalfe JS, Chang TY, Jeka JJ, Clark JE (2008) The development of infant upright posture: sway less or sway differently? Exp Brain Res 186:293–303
Cherng RJ, Su FC, Chen JJ, Kuan TS (1999) Performance of static standing balance in children with spastic diplegic cerebral palsy under altered sensory environments. Am J Phys Med Rehabil 78:336–343
Cherng RJ, Chen JJ, Su FC (2001) Vestibular systems in performance of standing balance of children and young adults under altered sensory conditions. Percept Mot Skills 92(3):1167–1179
Cooper J, Majnemer A, Rosenblatt B, Birnbaum R (1995) The determination of sensory deficits in children with hemiplegic cerebral-palsy. J Child Neurol 10(4):300–309
Dan B, Bouillot E, Bengoetxea A, Noel P, Kahn A, Cheron G (2000) Head stability during whole body movements in spastic diplegia. Brain Dev 22:99–101
de Seze M, Falgairolle M, Viel S, Assaiante C, Cazalets JR (2008) Sequential activation of axial muscles during different forms of rhythmic behavior in man. Exp Brain Res 185:237–247
Donker SF, Ledebt A, Roerdink M, Savelsbergh GJP, Beek PJ (2008) Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children. Exp Brain Res 184:363–370
Ferdjallah M, Harris GF, Smith P, Wertsch JJ (2002) Analysis of postural control synergies during quiet standing in healthy children and children with cerebral palsy. Clin Biomech 17:203–210
Good WV, Jan JE, Burden SK, Skoczenski A, Candy R (2001) Recent advances in cortical visual impairment. Dev Med Child Neurol 43:56–60
Hadders-Algra M, van der Heide JC, Fock JM, Stremmelaar E, van Eykern LA, Otten B (2007) Effect of seat surface inclination on postural control during reaching in preterm children with cerebral palsy. Phys Ther 87:861–871
Hay L (1981) The effects of amplitude and accuracy requirements on movement time in children. J Mot Behav 13:177–186
Hsu WL, Scholz JP, Shoner G, Jeka JJ, Kiemel T (2007) Control and estimation of posture during quiet stance depends on multijoint coordination. J Neurophysiol 97(4):3024–3025
Jacobson LK, Dutton GN (2000) Periventricular leukomalacia: an important cause of visual and ocular motility dysfunction in children. Surv Opthalmol 45:1–13
Jan JE, Lyons CJ, Heaven KB (2001) Visual impairment due to a dyskinetic eye movement disorder in children with dyskinetic cerebral palsy. Dev Med Child Neurol 43(2):108–112
Jeka JJ, Lackner JR (1994) Fingertip contact influences human postureal control. Exp Brain Res 100:495–502
Keshner EA, Hain TC, Chen KJ (1999) Predicting control mechanisms for human head stabilization by altering the passive mechanics. J Vestib Res 9:423–434
Kirschenbaum N, Riach CL, Starkes JL (2001) Non-linear development of postural control and strategy use in young children: a longitudinal study. Exp Brain Res 140:410–431
Ledebt A, Bril B, Wiener-Vacher S (1995) Trunk and head stabilization during the first months of independent walking. Neuroreport 6:1737–1740
Lesny I, Stehlik A, Tomasek J, Tomankova A, Havlicek I (1993) Sensory disorders in cerebral palsy: 2-point discrimination. Dev Med Child Neurol 35(5):402–405
Liao HF, Hwang AW (2003) Relations of balance function and gross motor ability for children with cerebral palsy. Percept Mot Skills 96:1173–1184
Liao H-F, Jeng S-F, Lai J-S, Cheng C-K, Hu M-H (1997) The relation between standing balance and walking function in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 39:106–112
Liao S-F, Yang TF, Hsu TC, Chan RC, Wei TS (2003) Differences in seated postural control in children with spastic cerebral palsy and children who are typically developing. Am J Phys Med Rehabil 82(8):622–626
Maurer C, Peterka RJ (2005) A new interpretation of spontaneous sway measures based on a simple model of human postural control. J Neurophysiol 93:189–200
Nadeau S, Amblard B, Mesure S, Bourbonnais D (2003) Head and trunk stabilization strategies during forward and backward walking in healthy adults. Gait Posture 18:134–142
Nashner LM (1985) Strategies for organization of human posture. In: Igarashi M, Black FO (eds) Vestibular and visual control of posture and locomotor equilibrium. Karger, Basel
Nashner LM, Shumway-Cook A, Marin O (1983) Stance posture control in select groups of children with cerebral palsy: deficits in sensory organization and muscular coordination. Exp Brain Res 49:393–409
Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH (2008) Construct validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol 50:744–750
Pozzo T, Berthoz A, Lefort L (1990) Head stabilization during various locomotor tasks in humans: I. Normal subjects. Exp Brain Res 82:97–106
Pozzo T, Berthoz A, Vitte E, Lefort L (1991) Head stabilization during locomotion. Perturbations induced by vestibular disorders. Acta Otolaryngol Suppl 481:322–327
Prince F, Winter DA, Stergiou P, Walt SE (1994) Anticipatory control of upper body balance during human locomotion. Gait Posture 2:19–25
Reeves NP, Everding VQ, Cholewicki J, Morrisette DC (2006) The effects of trunk stiffness on postural control during unstable seated balance. Exp Brain Res 174:694–700
Riach CL, Hayes KC (1987) Maturation of postural sway in young children. Dev Med Child Neurol 29(5):650–658
Rose J, Wolff DR, Jones VK, Bloch DA, Oehlert JW, Gamble JG (2002) Postural balance in children with cerebral palsy. Dev Med Child Neurol 44:58–63
Rosenbaum PL, Walter SD, Hanna SE, Palisano RJ, Russell DJ, Raina P, Wood E, Bartlett DJ, Galuppi BE (2002) Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA 288(11):1357–1363
Saavedra S, Joshi A, Woollacott M, van Donkelaar P (2009) Eye–hand coordination in children with cerebral palsy. Exp Brain Res 192(2):155–165
Secretan JP (1972) Vestibular function in cerebral-palsy children. J Otorhinolaryngol 34(2):111–116
Shumway-Cook A, Woollacott MH (1985) The growth of stability: postural control from a developmental perspective. J Mot Behav 17(2):131–147
Silvies SP, Cholewicki J, Radebold A (2003) The effects of visual input on postural control of the lumbar spine in unstable sitting. Hum Mov Sci 22(3):237–252
SPSS FAQ (2009) How can I explain a three-way interaction in ANOVA? UCLA: Academic Technology Services, Statistical Consulting Group. From http://www.ats.ucla.edu/stat/faq/threeway_hand.htm. Accessed 9 January 2009
Steindl R, Kunz K, Schrott-Fischer A, Scholtz AW (2006) Effect of age and sex on maturation of sensory systems and balance control. Dev Med Child Neurol 48:477–482
Stoffregen TA, Smart LJ, Bardy BG, Pagulayan RJ (1999) Postural stabilization of looking. J Exp Psychol Hum Percept Perform 25(6):1641–1658
Thelen E, Spencer JP (1998) Postural control during reaching in young infants: A dynamic systems approach. Neurosci Biobehav Rev 22:507–514
Vaugoyeau M, Viel S, Amblard B, Axulay JP, Assaiante C (2008) Proprioceptive contribution of postural control as assessed from very slow oscillations of the support in healthy humans. Gait Posture 27:294–302
Viel S, Vaugoyeau M, Assaiante C (2009) Adolescence: a transient period of proprioceptive neglect in sensory integration of postural control. Motor Control 13(1):25–42
Winter DA (1995) A.B.C. (Anatomy, biomechanics and control) of balance during standing and walking. Waterloo Biomechanics, bound at Graphic Services, University of Waterloo
Acknowledgments
The authors wish to thank Cooper Boydston for providing computer support, Claudia Vincent for providing statistical consultation and Robert Nickel, MD, for neurologic evaluation of subjects. This work was supported by NIH Grant R01NS038714, Marjorie Woollacott, PI.
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Saavedra, S., Woollacott, M. & van Donkelaar, P. Head stability during quiet sitting in children with cerebral palsy: effect of vision and trunk support. Exp Brain Res 201, 13–23 (2010). https://doi.org/10.1007/s00221-009-2001-4
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DOI: https://doi.org/10.1007/s00221-009-2001-4