Abstract
Deficits in movement and postural control are defining characteristics of cerebral palsy. Postural control is defined as the ability to align and adjust body segments against gravity without falling or collapsing. Posture involves complex neural processes that must be coupled to biomechanical and environmental constraints and can be categorized in terms of static, active (or anticipatory), and reactive control. Because ability to control posture is an integral part of all movement, deficits in the posture system contribute to challenges in body structure and function, daily activities, and participation. There is a very high burden of care for those with severe posture deficits. This chapter (1) defines postural stability from a systems perspective, (2) reviews the impact of posture deficits on body structure and function, daily activities, and participation across levels of the Gross Motor Function Classification Scale (GMFCS), (3) summarizes assessments of postural control for sitting and standing, and (4) describes current interventions from the perspective of motor learning principles. The number of published interventions directly aimed at improving postural control is limited. Moreover, the type of intervention, outcome measures, and quality of studies vary significantly between ambulatory and nonambulatory children. For those at GMFCS levels I and II, interventions refine the existing posture. For those at GMFCS level III, children must often choose between task performance and postural control and typically prioritize the functional task. Children at GMFCS levels IV–V have undeveloped postural control and require contextual modifications to enable opportunities for basic acquisition and practice of head and trunk control.
Similar content being viewed by others
References
Ahl LE, Johansson E, Granat T, Carlberg EB (2005) Functional therapy for children with cerebral palsy: an ecological approach. Dev Med Child Neurol 47:613–619
Bañas BB, Gorgon EJR (2014) Clinimetric properties of sitting balance measures for children with cerebral palsy: a systematic review. Phys Occup Ther Pediatr 34:313–334
Brogren E, Hadders-Algra M, Forssberg H (1998) Postural control in sitting children with cerebral palsy. Neurosci Biobehav Rev 22:591–596
Burtner PA, Woollacott MH, Qualls C (1999) Stance balance control with orthoses in a group of children with spastic cerebral palsy. Dev Med Child Neurol 41:748–757
Butler PB (1998) A preliminary report on the effectiveness of trunk targeting in achieving independent sitting balance in children with cerebral palsy. Clin Rehabil 12:281–293
Butler PB, Thompson N, Major RE (1992) Improvement in walking performance of children with cerebral-palsy – preliminary-results. Dev Med Child Neurol 34:567–576
Butler PB, Saavedra S, Sofranac M, Jarvis SE, Woollacott MH (2010) Refinement, reliability, and validity of the segmental assessment of trunk control. Pediatr Phys Ther 22:246–257
Carlberg EB, Hadders-Algra M (2005) Postural dysfunction in children with cerebral palsy: some implications for therapeutic guidance. Neural Plast 12:221–228; discussion 263-72
Curtis DJ, Woollacott M, Bencke J, Lauridsen HB, Saavedra S, Bandholm T, Sonne-Holm S (2016) The functional effect of segmental trunk and head control training in moderate-to-severe cerebral palsy: A randomized controlled trial. Dev Neurorehabil 21(2):91–100
da Costa CS, Saavedra SL, Rocha NA, Woollacott MH (2017) Effect of biomechanical constraints on neural control of head stability in children with moderate to severe cerebral palsy. Phys Ther 97:374–385
Dewar R, Love S, Johnston LM (2015) Exercise interventions improve postural control in children with cerebral palsy: a systematic review. Dev Med Child Neurol 57:504–520
Goodworth AD, Peterka RJ (2012) Sensorimotor integration for multisegmental frontal plane balance control in humans. J Neurophysiol 107:12–28
Goodworth AD, Wu YH, Felmlee D, Dunklebarger E, Saavedra S (2017) A trunk support system to identify posture control mechanisms in populations lacking independent sitting. IEEE Trans Neural Syst Rehabil Eng 25:22–30
Hadders-Algra M (2008) Reduced variability in motor behaviour: an indicator of impaired cerebral connectivity? Early Hum Dev 84:787–789
Harris SR, Roxborough L (2005) Efficacy and effectiveness of physical therapy in enhancing postural control in children with cerebral palsy. Neural Plast 12:229–243; discussion 263-72
Hodges PW, Gurfinkel VS, Brumagne S, Smith TC, Cordo PC (2002) Coexistence of stability and mobility in postural control: evidence from postural compensation for respiration. Exp Brain Res 144:293–302
Hubel DH, Wiesel TN (1970) The period of susceptibility to the physiological effects of unilateral eye closure in kittens. J Physiol 206:419–436
Jamon M (2014) The development of vestibular system and related functions in mammals: impact of gravity. Front Integr Neurosci 8:11
Kaya Kara O, Atasavun Uysal S, Turker D, Karayazgan S, Gunel MK, Baltaci G (2015) The effects of Kinesio taping on body functions and activity in unilateral spastic cerebral palsy: a single-blind randomized controlled trial. Dev Med Child Neurol 57:81–88
Kyvelidou A, Harbourne RT, Willett SL, Stergiou N (2013) Sitting postural control in infants with typical development, motor delay, or cerebral palsy. Pediatr Phys Ther 25:46–51
Law MC, Darrah J, Pollock N, Wilson B, Russell DJ, Walter SD, Rosenbaum P, Galuppi B (2011) Focus on function: a cluster, randomized controlled trial comparing child-versus context-focused intervention for young children with cerebral palsy. Dev Med Child Neurol 53:621–629
Magill RA, Anderson DI (2014) Motor learning and control: Concepts and applications. 10th edition, New York: McGraw-Hill
Mccoy SW, Bartlett DJ, Yocum A, Jeffries L, Fiss AL, Chiarello L, Palisano RJ (2014) Development and validity of the early clinical assessment of balance for young children with cerebral palsy. Dev Neurorehabil 17:375–383
Novak I (2014) Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. J Child Neurol 29:1141–1156
Ostensjo S, Carlberg EB, Vollestad NK (2005) The use and impact of assistive devices and other environmental modifications on everyday activities and care in young children with cerebral palsy. Disabil Rehabil 27:849–861
Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH (2008) Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol 50:744–750
Peterka RJ (2002) Sensorimotor integration in human postural control. J Neurophysiol 88:1097–1118
Redstone F, West JF (2004) The importance of postural control for feeding. Pediatr Nurs 30:97–100
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B (2007) A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 109:8–14
Roxborough L (1995) Review of the efficacy and effectiveness of adaptive seating for children with cerebral palsy. Assist Technol 7:17–25
Saavedra SL, Woollacott MH (2015) Segmental contributions to trunk control in children with moderate-to-severe cerebral palsy. Arch Phys Med Rehabil 96:1088
Saavedra S, Joshi A, Woollacott M, Van Donkelaar P (2009) Eye hand coordination in children with cerebral palsy. Exp Brain Res 192:155–165
Saavedra S, Van Donkelaar P, Woollacott MH (2012) Learning about gravity: segmental assessment of upright control as infants develop independent sitting. J Neurophysiol 108:2215–2229
Saether R, Helbostad JL, Riphagen II, Vik T (2013) Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review. Dev Med Child Neurol 55:988–999
Santamaria V, Rachwani J, Saavedra S, Woollacott M (2016) Effect of segmental trunk support on posture and reaching in children with cerebral palsy. Pediatr Phys Ther 28:285–293
Shumway-Cook A, Woollacott MH (2016) Motor control: translating research into clinical practice. 5th edition, Philadelphia: Lippincott Williams & Wilkins
Simons DJ, Land PW (1987) Early experience of tactile stimulation influences organization of somatic sensory cortex. Nature 326:694–697
Spencer JP, Vereijken B, Diedrich FJ, Thelen E (2000) Posture and the emergence of manual skills. Dev Sci 3:216–233
Şşimşşek TT, Türkücüoğğlu B, Çokal N, Üstünbaşş G, Şşimşşek İE (2011) The effects of Kinesio® taping on sitting posture, functional independence and gross motor function in children with cerebral palsy. Disabil Rehabil 33:2058–2063
Stevenson RD (1995) Feeding and nutrition in children with developmental-disabilities. Pediatr Ann 24:255–260
Tees RC (1967) Effects of early auditory restriction in the rat on adult pattern discrimination. J Comp Physiol Psychol 63:389–393
Tseng S-H, Chen H-C, Tam K-W (2013) Systematic review and meta-analysis of the effect of equine assisted activities and therapies on gross motor outcome in children with cerebral palsy. Disabil Rehabil 35:89–99
van der Heide JC, Begeer C, Fock JM, Otten B, Stremmelaar E, Van Eykern LA, Hadders-Algra M (2004) Postural control during reaching in preterm children with cerebral palsy. Dev Med Child Neurol 46:253–266
Woollacott MH, Shumway-Cook A (2005) Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance? Neural Plast 12:211–219; discussion 263-72
Zadnikar M, Kastrin A (2011) Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis. Dev Med Child Neurol 53:684–691
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this entry
Cite this entry
Saavedra, S.L., Goodworth, A.D. (2019). Postural Control in Children and Youth with Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-50592-3_161-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-50592-3_161-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-50592-3
Online ISBN: 978-3-319-50592-3
eBook Packages: Springer Reference MedicineReference Module Medicine