Effects of Visual Manipulation in Sit-to-Stand Movement in Children With Cerebral Palsy

The authors sought to verify the effects of vision on sit-to-stand (STS) movement performance by means of postural sway in children with cerebral palsy (CP) and typical children (TC). Participants were 42 TC and 21 children with CP. STS movement was assessed with eyes open and with eyes closed. Area and velocity of center of pressure sway were analyzed in each of the 3 STS phases. We observed greater postural sway during STS movement with eyes closed. Children with CP presented greater postural sway than TC did. Both groups exhibited greater postural instability with absence of vision expressing the role of vision to keep postural stability. Moreover, the greater postural instability was observed in children with CP.     

Age-related Changes in Postural Sway During Sit-to-stand in Typical Children and Children with Cerebral Palsy

Objective: To assess age-related changes in postural sway during sit-to-stand (STS) in typical children (TC) and children with mild cerebral palsy (CP). Methods: Thirty-five TC and 23 children with mild CP were allocated in four different age groups: 5–6, 7–9, 10–12, and 13–15 years; they all performed STS movements over a force plate. Anterior-posterior and medial-lateral amplitude of center of pressure (CoP) displacement, area and velocity of CoP sway were analyzed and compared between the age groups for TC and children with CP. Results: TC at 5 to 6 years of age showed higher values of anterior-posterior CoP displacement and Area of CoP sway than at 10–12 years, during the stabilization phase. There were no age-related changes for CP. Conclusion: TC change their postural sway during the last STS phase over the years, reducing their body sway. Children with CP did not show age-related changes in sway during STS, reflecting a distinct rhythm of postural control development in this population.     

Lower Extremity Kinetics for Balance Control in Children With Cerebral Palsy

The authors examined and compared the effect of support-surface perturbations of various magnitudes on lower extremity kinetics of 7 children with cerebral palsy (CP) and 8 typically developing (TD) children. Results showed that the highest velocity tolerated without stepping was slower in children with CP than in either age-matched TD or younger TD children. Multimodal torque profiles were more frequent in children with CP than in TD controls. TD groups temporally and spatially organized torque activation, whereas children with CP activated all joints simultaneously and showed altered torque contribution patterns among joints. Those results suggest that impairments in reactive postural control in children with CP result not only from developmental delay but also from pathology. Evidence for pathology included increased numbers of torque bursts required to regain stability and less efficient temporal and spatial organization of torque activation patterns.     

Coping Strategies and Resolution in Mothers of Children With Cerebral Palsy

“Parental resolution” represents parents coming to terms with their child’s health condition. Differences in the use of coping strategies between mothers who were resolved versus unresolved to their child’s diagnosis was investigated, and a possible moderating effect of these strategies was explored. A strategy aimed at mobilizing the family to acquire and accept help (institutional, formal support) was shown to be a significant moderating variable, in a way that its more frequent use allowed mothers of children with better functional status (but not mothers of children with poorer functional status) to reach resolution.     

Motor Cortex Plasticity in Children With Spastic Cerebral Palsy: A Systematic Review

A review of the literature was performed to answer the following questions: Does motor cortex excitability correlate with motor function? Do motor cortex excitability and cortex activation change after a rehabilitation program that results in improvements in motor outcomes? Can the 10–20 electroencephalography (EEG) system be used to locate the primary motor cortex when employing transcranial direct current stimulation? Is there a bihemispheric imbalance in individuals with cerebral palsy similar to what is observed in stroke survivors? the authors found there is an adaptation in the geometry of motor areas and the cortical representation of movement is variable following a brain lesion. The 10–20 EEG system may not be the best option for locating the primary motor cortex and positioning electrodes for noninvasive brain stimulation in children with cerebral palsy.     

Predictors of Reading Comprehension in Children with Cerebral Palsy and Typically Developing Children

Predictors of reading comprehension were evaluated in 41 children with cerebral palsy and 74 typically developing children between the ages of 6 and 12 years. Regression analyses were conducted to determine the relative contributions of measures of phonemic awareness, receptive vocabulary, and general reasoning to variance in reading comprehension. All three independent variables were statistically significant predictors of reading comprehension in both groups of participants. The impact of phonemic awareness on reading comprehension was moderated by age, but only in the typically developing group. Within the group with cerebral palsy, there was an indirect effect of functional expressive ability on reading comprehension, mediated by phonemic awareness. It is concluded that largely the same variables predict reading comprehension in children with cerebral palsy as in typically developing children, but that children with cerebral palsy continue to rely on phonological processing for a more protracted period of time.     

Form and Variability During Sit-to-Stand Transitions: Children Versus Adults

In performing the sit-to-stand transition, young children (6- to 7-year-olds) were expected to display a movement form similar to that of adults. However, movement consistency was predicted to be poorer in children than in adults because they lack refinement of motor control processes. Kinematic analysis of 10 repetitions of the sit-to-stand movement was carried out for 6 typically developing children and 6 adults. Supporting the authors' prediction of comparable form, no differences were evident between age groups for sequence of joint onsets, proportional duration of segmental motion, or in angle-angle plots of displacement at 2 segments. In contrast, within-participant variability was found to be higher for children: Coefficients of variation for most kinematic measures were twice those seen for adults. The authors interpret the children's lack of movement consistency as a reflection of inadequate stabilization of an internal model of intersegmental dynamics. Whereas adults have attained a skill level associated with refinement of that model, children have not. Children have an additional control problem because changes in body morphology throughout childhood require ongoing updating of the internal model that controls intrinsic dynamics.     

Interstimulus Intervals and Sensory Modality Modulate the Impact of a Cognitive Task on Postural Control

The present literature not only reveals the use of a wide variety of cognitive tasks but variability in their interaction with postural control. The question then arises, as to, whether postural control is sensitive to specific features of a cognitive task. The present experiment assessed the impact of cognitive tasks with interstimulus intervals (ISI) of varied duration and sensory modality on postural control in young adults. Seventeen participants (23.71 ± 1.99 years old) were instructed to stand on a force platform while concurrently performing cognitive tasks with ISIs of two and 5 s. The tasks were presented both, auditorily and visually. The visual tasks consisted of counting the total occurrence of a single digit. The auditory tasks consisted of counting the total occurrence of a single letter. Performing the cognitive tasks with an ISI of 2 s resulted only in an increase in the anteroposterior mean power frequency. Presenting the tasks visually also significantly reduced area of 95% confidence ellipse and AP and mediolateral sway variability. These results may suggest that ISIs can modify postural performance by altering the allocation of attentional focus. Also, presenting tasks using a visual sensory modality appears to yield lower postural sway.     

Stress and Coping: A Comparison of Self-Report Measures of Functioning in Families of Young Children with Cerebral Palsy or No Medical Diagnosis

We analyzed data from 87 mothers of children ages 15 to 44 months with cerebral palsy (CP) or no diagnosis, who completed the Dyadic Adjustment Scale, Parenting Stress Index, Support Functions Scale, and Inventory of Social Support. Principal components analysis of the 15 subscales from the 5 measures revealed few cross-measure loadings. Mothers of children with CP (severe or mild) reported higher levels of parenting stress than did mothers of controls. However, cluster analysis of self-report measures yielded a 5-cluster solution, with no diagnostic group differences across clusters. That is, there were no overall differences in self-reported family functioning according to presence or severity of the child's disability. The results are discussed in terms of the organization of family systems and their relationship to child diagnosis. Clinical implications for assessing and working with families are noted.     

Self-Optimization of Walking in Nondisabled Children and Children With Spastic Hemiplegic Cerebral Palsy

Children voluntarily adopt a frequency and movement pattern for walking. The force-driven harmonic oscillator (FDHO) model was used in this study for accurate prediction of the preferred walking frequency of nondisabled children and children with spastic hemiplegic cerebral palsy. Four potential optimality criteria with which the preferred walking pattern was forced to comply were examined: minimization of physiological costs, maximization of mechanical energy conservation, minimization of asymmetry in lower limb movements and minimization of variability of interlimb and intralimb coordination. Age and gender-matched nondisabled children (n = 6) and children with spastic hemiplegic cerebral palsy (n = 6) were tested under six frequency conditions of walking at a constant speed on a treadmill. For the nondisabled children, the results indicated that their preferred walking frequency could be accurately predicted by the FDHO model. They freely adopted a walking pattern that minimized physiological costs, asymmetry, and variability of inter- and intralimb coordination. For the children with spastic hemiplegic cerebral palsy, the prediction of preferred overground walking frequency required that the FDHO model be modified to account for muscle mass and leg length discrepancies between limbs and increased stiffness. Most of the children achieved the same optimality goals as the nondisabled when walking at the preferred frequency. However, the children were found to use different mechanisms to attain these goals: for example, a steeper increase observed in physiological cost at higher frequencies; a lowered center of gravity of the body, which allowed for angular symmetry; and greater variability of between-joint coordination in the nonaffected limb and less variability in the affected limb.     

Head and Trunk Movements During Turning Gait in Children with Cerebral Palsy

Thirty children with cerebral palsy (CP) and 22 typical developing (TD) were tested with 3D-gait analysis. At turning, trunk rotation was larger in CP2 (GMFCS II) than in TD and CP1 (GMFCS I), and head flexion was larger in CP3 (GMFCS III) than TD. Maximum head and trunk flexion values during the entire trial were larger in CP3 than in the other groups, and trunk flexion was larger in CP2 than in TD. Trial time increased with GMFCS-level. Less trunk rotation than TD and CP1 reflects spatial insecurity in CP2, which in CP3 is compensated by the walker. The flexed head and trunk in CP3 and trunk in CP2 may reflect deficits in proprioception and sensation requiring visual control of the lower limbs.     

The Influence of Motor Imagery on Postural Sway: Differential Effects of Type of Body Movement and Person Perspective

The present study examined the differential effects of kinesthetic imagery (first person perspective) and visual imagery (third person perspective) on postural sway during quiet standing. Based on an embodied cognition perspective, the authors predicted that kinesthetic imagery would lead to activations in movement-relevant motor systems to a greater degree than visual imagery. This prediction was tested among 30 participants who imagined various motor activities from different visual perspectives while standing on a strain gauge plate. The results showed that kinesthetic imagery of lower body movements, but not of upper body movements, had clear effects on postural parameters (sway path length and frequency contents of sway). Visual imagery, in contrast, had no reliable effects on postural activity. We also found that postural effects were not affected by the vividness of imagery. The results suggest that during kinesthetic motor imagery participants partially simulated (re-activated) the imagined movements, leading to unintentional postural adjustments. These findings are consistent with an embodied cognition perspective on motor imagery.     

Postural Stability in Children with High Sacral Level Spina Bifida: Deviations from a Control Group

Abstract

Objective: To assess static and dynamic postural stability changes in children with high sacral level spina bifida.

Methods: Thirty-five children with high sacral level spina bifida and 35 age-matched healthy controls were enrolled. Their lower extremity muscle strengths and static and dynamic postural stability parameters were measured with the use of a dynamometer and the NeuroCom Balance Master^® device, respectively. Functional gait and balance were evaluated using the five times sit-to-stand test (5STS) and the 6-minute walk test (6MWT). Spinal, hip, and ankle deformities of the patient group were measured by radiologic evaluation.

Results: In comparison with controls, patients were found to have lower ankle dorsiflexion and plantar-flexion strength, increased 5STS duration, and decreased 6MWT distance while both static and dynamic postural stability parameters were significantly different. Bilateral ankle muscle strengths were found to be negatively correlated with postural stability parameters. The presence of hydrocephalus or meningomyelocele in the patient group was found to have negative effects on static postural stability.

Conclusion: Static and dynamic postural stability is affected even in children with high sacral level spina bifida who are expected to have best condition in this patient population. The ankle muscle strength is the main factor influencing these changes.     

Spatial and Temporal Adaptations That Accompany Increasing Catching Performance During Learning

During stance, head extension increases postural sway, possibly due to interference with sensory feedback. The sit-to-stand movement is potentially destabilizing due to the development of momentum as the trunk flexes forward and the body transitions to a smaller base of support. It is unclear what role head orientation plays in the postural and movement characteristics of the sit-to-stand transition. The authors assessed how moving from sitting to standing with head-on-trunk extension compared with moving with the head neutral or flexed, or with moving with the head facing forward in space (which would involve head-on-trunk extension, but not head-in-space extension) in healthy, young participants. Head-on-trunk extension increased center of pressure variability, but decreased movement velocities, movement duration, and trunk flexion compared with flexed and neutral head-on-trunk orientations. Similarities in movement characteristics between head-on-trunk extension and the forward head-in-space orientation suggest that stabilizing the head in space does not fully counteract the postural and movement changes due to head-on-trunk extension. Findings suggest that proprioceptive feedback from the neck muscles contributes to the regulation of posture and movement, and therefore should not be overlooked in research on the role of sensory feedback in postural control.     

心理干预对轻中度脑瘫儿童综合功能和生活质量的影响*

采用对照组和干预组前测、后测设计,对80名脑瘫儿童的综合功能和生活质量进行了测量,分析了心理干预对脑瘫儿童康复疗效的影响。结果表明:(1)四组脑瘫儿童后测综合功能评定效果存在显著差异。(2)生活质量问卷中,在使用特殊器具感觉维度上,四个组别间的追踪水平逐级显著递增;在对疼痛和困扰感觉维度上,四个组别间的后测水平、追踪水平均逐级显著递减;在其它四个维度上,四个组别间的后测水平、追踪水平均逐级显著递增。(3)在使用特殊器具感觉维度上,三个干预组内的追踪水平显著高于前测和后测水平;在对疼痛和困扰感觉维度上,三个干预组内的前测、后测和追踪水平均呈逐级显著递减趋势;在其它四个维度上,三个干预组内的前测、后测和追踪水平均逐级显著递增。干预组比对照组能显著提升脑瘫患儿的综合功能和生活质量。     

Postural Asymmetries in Response to Holding Evenly and Unevenly Distributed Loads During Self-Selected Stance

The authors examined postural asymmetries during quiet stance and while holding evenly or unevenly distributed loads. Right-hand dominant subjects preferentially loaded their right lower limb when holding no load or a load evenly distributed in both hands, but no differences in center of pressure (CoP) were observed between the left and right limbs. However, longer CoP displacement was observed under the preferentially loaded limb, which may reflect a functional asymmetry that allows quick movement of one limb in response to a potential perturbation. When a load was held only in the nondominant hand, sample entropy decreased in the left (loaded) limb but increased in the right (unloaded) limb, suggesting the unloaded foot compensated for a loss of control flexibility in the loaded foot.     

Effects of Backpack Carriage on Dual-Task Performance in Children During Standing and Walking

Primary school children perform parts of their everyday activities while carrying school supplies and being involved in attention-demanding situations. Twenty-eight children (8–10 years old) performed a 1-legged stance and a 10 m walking test under single- and dual-task situations in unloaded (i.e., no backpack) and loaded conditions (i.e., backpack with 20% of body mass). Results showed that load carriage did not significantly influence children's standing and walking performance (all p > .05), while divided attention affected all proxies of walking (all p < .001). Last, no significant load by attention interactions was detected. The single application of attentional but not load demand negatively affects children's walking performance. A combined application of both did not further deteriorate their gait behavior.     

Postural Control Complexity and Fatigue in Minimally Affected Individuals with Multiple Sclerosis

This study investigated changes in postural control complexity in people with multiple sclerosis (PwMS) before and after a fatigue protocol. Thirteen minimally affected PwMS (1.53 ± 1.03- Expanded Disability Status Scale) and 12 non-MS controls. Postural test included quiet stance on a force platform under two visual conditions (saccades and fixation) before and after a fatigue protocol. Postural complexity was assessed through the multiscale entropy. A three-way ANOVA showed a main effect of fatigue in the medial-lateral direction (p <0.007), with fatigue protocol reducing postural complexity in both groups. No differences were found between groups or visual conditions. Minimally affected PwMS demonstrated similar postural complexity compared with non-MS controls under both visual tasks and showed similar decrements in postural complexity as a result of fatigue.     

Effects of A Dual-Task Intervention in Postural Control and Cognitive Performance in Adolescents

Abstract

The aim was to assess dual- versus single-task training for motor performance and cognitive performance in adolescents. Two experiments were performed. In the first, 30 adolescents were randomized to three groups to determine the effect of dual-task difficulty on postural control: α-scaling and root mean square (RMS). In the second, 20 adolescents were randomized to two groups to determine the effect of dual-task practice to improve working memory. RMS in the post-test was lower than the pre-test in both dual-task groups, while α-scaling was lower in post-test than pre-test only in the high-difficulty dual-task group. A practice effect was observed on the percentage of correct answers only in the dual-task group (p?=?0.035). Thus, dual-task training could enhance motor and cognitive performance more than single-task training.     

Strength Training Effects on Muscle Forces and Contributions to Whole-Body Movement in Cerebral Palsy

Strength training is often prescribed for children with cerebral palsy (CP); however, links between strength gains and mobility are unclear. Nine children (age 14?±?3?years; GMFCS I-III) with spastic CP completed a 6-week strength-training program. Musculoskeletal gait simulations were generated for four children to assess training effects on muscle forces and function. There were increases in isometric joint strength, but no statistical changes in fast-as-possible walking speed or endurance after training. The walking simulations revealed changes in muscle forces and contributions to body center of mass acceleration, with greater forces from the hip muscles during walking most commonly observed. A progressive strength-training program can result in isometric and dynamic strength gains in children with CP, associated with variable mobility outcomes.