Segmental Contributions to Trunk Control in Children With Moderate-to-Severe Cerebral Palsy

Abstract

Objective To examine postural constraints in children with moderate-to-severe cerebral palsy using a segmental approach. Design quasi-experimental repeated measure study; case series Setting Motor control research laboratory Participants Fifteen children (4–16 years) with moderate (Gross Motor Function Classification System (GMFCS) IV; n=8; 4 males) or severe (GMFCS V; n=7; 4 males) cerebral palsy. Interventions Each child participated in three data collection sessions. During each session, we evaluated postural control for sitting using kinematics and clinical assessments. Main Outcome Measures Kinematic data were used to document head alignment and stabilization with external support at four levels (axillae, mid-rib, waist, and hip). Two clinical assessments, the Segmental Assessment of Trunk Control (SATCo) and behavioral assessment for stage of trunk control were also used to compare results for children with cerebral palsy to previous longitudinal data from typically developing (TD) infants (3–9 months of age). Results Children with GMFCS V had difficulty aligning and stabilizing their head along the medial-lateral and anterior-posterior axes. External support improved postural control for GMFCS V but not for children with GMFCS IV, who had opposite responses to support compared to TD infants. Conclusions Children with GMFCS V have limited trunk control but respond to support similarly to young typically developing infants suggesting delayed postural control. Response to external support for children with GMFCS IV suggests a unique strategy for trunk control not observed in typical infants. Overall a segmental approach offers new insights into development of trunk control in children with moderate-to-severe CP.

Trunk and respiratory motor control in typically developing children and its implications in children with chronic spinal cord injury.

“…The first stage is when infants show no control at all, followed by an attempt to initiate the movement (sitting upright), partial control with large sway (wobble), and functional control with minimum sway (adult-like pattern) (Anne Shumwaycook, 2012; Saavedra & Woollacott, 2015). However, the mechanisms of development of posture control remain an unanswered question.…”

“…Recent study on the acquisition of trunk control by Saavedra and Woollacott investigated spinal segmental contribution to the development of upright trunk control during typical development of sitting balance (Saavedra & Woollacott, 2015). They collected longitudinal sEMG and trunk kinematics data from a group of 8 TD infants with age range between 3 to 9 months.…”

“…Therefore, testing of trunk control in children with low functional level, i.e. those who have not achieved independent sitting, is limited (Saavedra & Woollacott, 2015).…”

“…A first strategy is a cephaliccaudal approach, involving visual, vestibular and neck muscles to stabilize the head in space and the second strategy, a caudal-cephalic approach, involving touch receptors, pressure receptors and feedback from trunk and extremity muscles. The caudal-cephalic approach is necessary to fix or stabilize a portion of the body that will provide a base of support to allow movement at a different portion of the body (Saavedra & Woollacott, 2015).…”

“…Reactive controlled is scored if the participant can maintain the trunk position in neutral after external perturbation (P. B. Butler et al, 2010;Saavedra & Woollacott, 2015).…”