Sit-to-stand movement changes in preschool-aged children with spastic diplegia following one neurodevelopmental treatment session – a pilot study

Abstract

Purpose: This study was designed to provide a better understanding of how a single neurodevelopmental treatment (NDT) session affects sit-to-stand (STS) movements in children with cerebral palsy (CP). Methods: Eight children with spastic diplegia and five typically developing children, aged 4–6 years, participated in this study. The CP participants performed STS movements immediately before and after a 40-min NDT session. Using a three-dimensional, four-camera analysis system, angular movements involving the hip, knee and ankle joints of the participants were obtained. Results: During forward tilt of the trunk, the maximum and final angles after the NDT session significantly decreased compared with those before the session (p?<?0.05, p?<?0.01). Moreover, the final hip flexion after the session also significantly decreased compared with that before the session (p?<?0.01). On the other hand, the initial, maximum and final ankle dorsiflexion angles after the session were significantly greater (p?<?0.05, p?<?0.01 and p?<?0.05, respectively) than before the session. Conclusions: These findings suggest that a single NDT session enables children with CP to stand from a seated position without using some atypical movement patterns.

• Implications for Rehabilitation

• Preschool-aged children with spastic diplegia, with limited ability to independently transfer from a sitting position, and dependent on a wheelchair for mobility experience obstacles to enhanced activities of daily life and social participation.

• A single neurodevelopmental treatment session would enable children with spastic diplegia to perform sit-to-stand movements more efficiently, with selective muscle control.

• Understanding how a single neurodevelopmental treatment session affects sit-to-stand movements in children with spastic diplegia is invaluable for therapists planning more efficient therapeutic programs and may enable children with spastic diplegia to develop improved mobility

     

Impact of dual task on postural sway during sit-to-stand movement in children with unilateral cerebral palsy

BackgroundTo verify the effect of dual-task on postural oscillation during sit-to-stand movement in children with Cerebral Palsy.Methods17 children with spastic unilateral cerebral palsy and 20 typically-developing children, aged 5 to 12 years, performed the following tasks: Simple task: sit-to-stand with arms crossed against the chest; bimanual dual-task: sit-to-stand while carrying a tray; unimanual dual-task: sit-to-stand while holding a plastic cup with one hand. For data analysis, sit-to-stand was divided in three phases: preparation (phase 1), rising (phase 2), and stabilization (phase 3). Postural control was measured using a force plate, and the variables analyzed were: area, anterior-posterior and medial-lateral velocity, and STS duration. Analysis of variance was applied to test the effects of group; task conditions and interactions.FindingsChildren with cerebral palsy presented higher values of postural oscillation when compared to their typical pairs. Bimanual and Unimanual dual tasks presented greater postural oscillation values in sit-to-stand phase 1 compared to simple task. In bimanual dual-task, children with cerebral palsy presented lower values of velocity in phases 3, and greater postural oscillation and duration of the task when compared to single-task and unimanual dual-tasks. I.InterpretationThe insertion of a secondary task seems to interfere differently children with cerebral palsy, depending on the specific demands of each task. Thus, the importance of inserting dual tasks in the interventions is emphasized, considering that they are executed extensively in the day to day, and can act as facilitators or challenge in the execution of functional tasks.     

Effects of Kinesio taping in rectus femoris activity and sit-to-stand movement in children with unilateral cerebral palsy: placebo-controlled,repeated-measure design

Background: Although it has been commonly used in rehabilitation sets, there is a lack of studies verifying the effects of Kinesio taping to improve functionality in children with Cerebral Palsy (CP). This information would promote evidence-based practice.

Purpose: To verify the effects of Kinesio taping in the performance of sit-to-stand movement in children with unilateral CP.

Methods and materials: A blinded, single placebo-controlled and repeated-measure design. The setting was the rehabilitation clinic of the university and care facilities. A total of 11 children from 6 to 12 years of age (mean: 10.5 years; standard deviation: 2.8 years) and classified as levels I and II by the Gross Motor Function Classification System were included. Kinesio taping was applied over the rectus femoris of the affected limb. Three taping conditions were used: Kinesio taping, without Kinesio taping and placebo. Three seat heights were used: neutral (100%), lowered (80%), and elevated (120%). Muscle activity (electromyography) and trunk and lower limb alignment (kinematics) were evaluated as body structures and function measures. The time required to perform sit-to-stand was used as a functionality measure. Mixed analysis of variation (ANOVA) measured angular variables of the hip, knee, ankle, and rectus femoris activity. Repeated ANOVA measured angular variables of trunk and pelvis and total duration. Significance was accepted for values of p?≤?0.05.

Results: Kinesio taping increased rectus femoris activity, decreased peak flexion of the trunk, knee, hip, and ankle, and increased trunk extension in the end of sit-to-stand when compared with without Kinesio taping and placebo. Total duration was decreased with lower effect sizes.

Conclusions: Immediate application of Kinesio taping modified body structures and function measures during sit-to-stand in children with unilateral CP, but it did not alter functionality.

• Implications for Rehabilitation

• Evidence-based practice about the use of Kinesio taping in Cerebral Palsy.

• Knowledge about alternative rehabilitation techniques in Cerebral Palsy.

• Knowledge about sensory stimulation in Cerebral Palsy.

• Effectiveness of Kinesio taping in muscle activation.

     

Continuous inter-limb coordination deficits in children with unilateral spastic cerebral palsy

BackgroundContinuous inter-limb coordination and the ability to offset perturbations to a movement pattern (i.e., stability) are important factors in efficient motor performance. Patients with movement disorders often show deficits in coordination and stability, although little is known about these features in children with cerebral palsy. The purpose of this study was to identify the continuous inter-limb coordination and stability deficits in children with cerebral palsy and determine if improvement occurs with upper extremity intervention.MethodsChildren with cerebral palsy participated in bimanual or unimanual intensive therapy. Continuous inter-limb coordination between the arms and between the more-affected arm and leg was evaluated using relative phase analysis during four gross motor tasks, including in-place marching and standing with asymmetric and symmetric arm swing. A control group of children with cerebral palsy and a group of typically developing children were also evaluated.FindingsChildren with cerebral palsy displayed coordination deficits compared to typically developing children (p<0.01), yet both groups presented similarly poor levels of stability (p=0.39). Compared to standing, adding legs to the task negatively impacted the coordination (p<0.01) and stability (p<0.01) of all children. Both groups improved coordination between the arms post-intervention (p<0.05 for all cases), however neither group improved stability (p>0.05 for all cases).InterpretationRelative phase analysis successfully provided a sensitive measurement of coordination and stability in pathologic and non-pathologic populations. Findings indicate that all children have difficulty producing consistent movement patterns and suggest that both bimanual and unimanual interventions can improve continuous coordination in children with cerebral palsy.     

Construction of an artifact to the suitability of sitting posture in children with cerebral palsy and multiple disabilities

Abstract

Introduction: Cerebral palsy (CP) may involve muscle imbalance between the spastic muscles and their antagonists leading to weak postural changes, decreased mobility and chest deformities. Objective: To improve postural condition in children with CP using physiotherapy and assistive technology (AT). Materials and methods: Five children with CP and multiple disabilities and postural changes like scoliosis were included in this study. AT involved the use of low-cost custom made cushion seat and backrest for the wheelchairs to achieve 90° of trunk flexion. This was performed in 10 sessions after the beginning of physiotherapy. As evaluation-intervention tool, photographs were taken at the beginning and end of each session, and then analyzed using software for postural assessment (SAPO). Results: Twenty-five per cent of the participants had an improvement of trunk angulations at the end of the treatment program. Conclusion: The use of AT with physiotherapy treatment proved efficient in the postural alignment of children with CP children in a wheelchair.

• Implications for Rehabilitation

• Wheelchairs are manufactured in standard size, which makes difficult the adaptation of individuals with peculiar postures. Even the most sophisticated, with adjustments and special accessories, not always allow adjustments to shape up properly to deformities in children with cerebral palsy.

• It is hoped that this research will be useful in order to show rehabilitation professionals the ability to minimize the difficulties of keeping children with cerebral palsy and multiple disabilities properly seated in the wheelchair, facilitating posture, movement, breathing and swallowing.

• The construction of these artifacts has the advantage of being low cost, and must pass through stages of adequacy and modeling in order to replace the seat and side of the wheelchair.

     

超声检查先天性马蹄内翻足患儿跟腱

目的 探讨超声检查在先天性马蹄内翻足(CCF)跟腱检查中的应用价值。方法 收集33例CCF患儿,按照病变累及范围分为单侧CCF组(18例)和双侧CCF组(15例);选取同期20名健康婴儿作为对照组。行双足跟腱超声检查,测量自然位、背屈位、跖屈位下的跟腱长度(AL),计算3组自然位与背屈位、自然位与跖屈位、背屈位与跖屈位AL的差值,并进行统计学分析。结果 超声发现全部CCF患足跟腱形态及AL异常,自然位时跟腱不平直,中部不同程度凹陷,长度较健足短。双侧CCF组患足与对照组健足、单侧CCF组患足与对侧健足自然位时AL及自然位与背屈位、自然位与跖屈位、背屈位与跖屈位AL的差值均有统计学意义(P均<0.05),背屈位、跖屈位时AL的差异无统计学意义(P>0.05)。结论 超声可直观显示CCF患儿不同体位下跟腱形态及AL改变,动态观察并评估患足背屈、跖屈活动异常。     

Knee extensor torque and BMI differently relate to sit-to-stand strategies in obesity

BackgroundObesity alters whole body kinematics during activities of daily living such as sit-to-stand (STS), but the relative contributions of excess body mass and decreased relative strength are unknown.MethodsThree-dimensional motion analysis data was collected on 18 obese subjects performing sit-to-stand (chair height: 52 cm). Isometric knee extensor strength was measured at 90⁰ knee flexion. Forward stepwise linear regression was used to determine the association between the independent variables BMI and the knee extensor torque with the dependent variables: foot position and trunk kinematics.FindingsBMI, but not knee extensor torque, was inversely related to shank angle and positively related to stance width. Relative knee extensor torque, but not BMI, was inversely associated with initial trunk angle, peak trunk flexion angle, and peak trunk extension velocity (r² = 0.470–0.495). BMI was positively associated with peak trunk flexion velocity, but no other parameters of trunk kinematics. In the final regression model, BMI was the primary predictor (r² = 0.423) and relative knee extensor strength served as a secondary predictor (r² = 0.118) of peak trunk flexion velocity.InterpretationBMI and knee extensor strength differently contribute to sit-to-stand performance strategies in obese subjects. Muscle strength may be an important determinant of whole-body kinematics during activities of daily living such as STS.     

Explicit and implicit motor learning in children with unilateral cerebral palsy

Abstract

Objectives: The current study aimed to investigate the capacity for explicit and implicit learning in children with unilateral cerebral palsy.

Participants: Children with left and right unilateral cerebral palsy and typically developing children shuffled disks toward a target.

Design: A prism-adaptation design was implemented, consisting of pre-exposure, prism exposure, and post-exposure phases. Half of the participants were instructed about the function of the prism glasses, while the other half were not.

Measures: For each trial, the distance between the target and the shuffled disk was determined. Explicit learning was indicated by the rate of adaptation during the prism exposure phase, whereas implicit learning was indicated by the magnitude of the negative after-effect at the start of the post-exposure phase.

Results No significant effects were revealed between typically developing participants and participants with unilateral cerebral palsy. Comparison of participants with left and right unilateral cerebral palsy demonstrated that participants with right unilateral cerebral palsy had a significantly lower rate of adaptation than participants with left unilateral cerebral palsy, but only when no instructions were provided. The magnitude of the negative after-effects did not differ significantly between participants with right and left unilateral cerebral palsy.

Conclusions: The capacity for explicit motor learning is reduced among individuals with right unilateral cerebral palsy when accumulation of declarative knowledge is unguided (i.e., discovery learning). In contrast, the capacity for implicit learning appears to remain intact among individuals with left as well as right unilateral cerebral palsy.

• Implications for rehabilitation

• Implicit motor learning interventions are recommended for individuals with cerebral palsy, particularly for individuals with right unilateral cerebral palsy

• Explicit motor learning interventions for individual with cerebral palsy – if used – best consist of singular verbal instruction.

     

Kinematic cluster analysis of the crouch gait pattern in children with spastic diplegic cerebral palsy using sparse K-means method

BackgroundCrouch gait pattern is a common gait pattern in children with diplegic cerebral palsy with excessive knee flexion throughout stance phase. Few studies have grouped this pattern of gait and usually have examined only the features of gait in the sagittal plane and mostly lower extremities without considering pelvis and trunk behavior. Studies usually categorize the gait pattern according to important variables from the researcher's point of view.Sparse K-means is high dimensional clustering methods that perform clustering and variable selection simultaneously even with low sample size and large number of variables. Our aim was to define existing clusters of crouch gait pattern in children with spastic diplegic cerebral palsy.MethodsCluster analysis was applied on the lower extremity, pelvis and trunk gait kinematics data of 64 limbs of children with crouch gait pattern and 64 limbs of typically developing children. Eighty-nine kinematic variables were used as input variables for clustering.FindingsFour clusters of crouch gait pattern were defined. Sparse K-means identified influential variables and identified the knee and hip flexion as a major factor in clustering. Kinematic of the trunk, pelvis and ankle was determined in each cluster. Trunk and pelvis kinematic features were strongly correlated with the knee and hip joint flexion severity.InterpretationObtained clusters were confirmed observationally. With increasing knee flexion, the kinematic of the trunk and pelvis were further away from the patterns of typically developing individuals. The clusters ranking appear to be reasonable based on the crouch severity.     

Walking on uneven ground: How do patients with unilateral cerebral palsy adapt?

BackgroundChildren with cerebral palsy experience movement disorders that influence gait stability. It is likely that gait stability further decreases when walking on uneven compared to even ground. Therefore, the aim of this study was to investigate gait on uneven ground in children with unilateral cerebral palsy.MethodsTwenty children with unilateral cerebral palsy and twenty typically developing children performed a three-dimensional gait analysis when walking on even and uneven ground. Spatio-temporal parameters, full-body joint kinematics and centre of mass displacements were compared.FindingsOn uneven versus even ground, both groups showed decreased cadence, increased stance phase and double support time, increased toe clearance height, and increased knee and hip flexion during swing phase. Whereas only the typically developing children walked slower and had increased dorsiflexion and external foot progression during stance phase, only the patients showed increased stride width, increased elbow flexion (affected and non-affected side), and kept the centre of mass more medial when standing on the affected leg.InterpretationPatients and healthy children use similar adaptation mechanisms when walking on uneven ground. Both groups increased the toe clearance height by increasing knee and hip flexion during swing. However, whereas patients enlarge their base of support by increasing stride width, healthy children do so by increasing their external foot progression angle. Furthermore, patients seem to feel more insecure and hold their arms in a position to prepare for falls on uneven ground. They also do not compensate with their non-affected side for their affected side on uneven ground.     

Individual joint contributions to the total support moment during the sit-to-stand task differentiate mild and moderate knee osteoarthritis

BackgroundKnee osteoarthritis tends to modify the kinematics and kinetics of the sit-to-stand task. However, it is not clear whether the different degrees of knee osteoarthritis differentiate regarding these aspects. The objective was to identify if the trunk flexion, lower limb kinetics, total support moment, and individual joint contributions to the total support moment during the sit-to-stand task are different between patients with mild and moderate knee osteoarthritis.MethodsSixty-two participants were grouped as follows: moderate knee osteoarthritis (n = 16), mild knee osteoarthritis (n = 25), and controls (n = 21). The participants performed a sit-to-stand task, which was analyzed using a 3D-motion system and a force plate.FindingsThe three phases of the sit-to-stand task were analyzed. During Phase₁, the moderate osteoarthritis group decreased the total support moment (P = 0.012). During Phase₂, the moderate osteoarthritis group showed higher trunk flexion (P = 0.023) and lower internal hip and knee extension moments (P ≤ 0.001 and P ≤ 0.040, respectively) when compared to controls. Also in Phase₂, both the mild and moderate groups used lower total support moment (P = 0.019, and P ≤ 0.001, respectively). When compared to the controls and mild osteoarthritis group_, those with moderate osteoarthritis presented higher hip joint contribution to the total support moment (P ≤ 0.001 and P = 0.006, respectively) as well as lower knee joint contribution (P ≤ 0.003 and P = 0,013, respectively).InterpretationThose with moderate osteoarthritis showed modified sit-to-stand movement pattern. While in Phase₃ a higher contribution of the hip joint to the total support moment was observed, during previous phases the individuals were able to decrease the load on the knee without influencing the lower limb load distribution.     

Assessment of bimanual performance in 3-D movement analysis: Validation of a new clinical protocol in children with unilateral cerebral palsy

BackgroundThe “Be an Airplane Pilot” (BE-API) protocol is a novel 3-D movement analysis (3DMA) protocol assessing the bimanual performance of children during a game.ObjectiveThis study aimed to investigate the reliability and validity of this protocol in children with unilateral cerebral palsy (uCP).MethodsAngular waveforms (WAVE), maximum angles (MAX) and range of motion (ROM) of the trunk, shoulder, elbow and wrist joints were collected in children with uCP and in typically developing children (TDC) during 4 tasks of the BE-API protocol designed to explore specific degrees of freedom (DoF). The inter-trial reliability for children with uCP was assessed with the coefficient of multiple correlation (CMC) for WAVE and the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for MAX and ROM. Clinical performance-based measures, including the Assisting Hand Assessment (AHA) and ABILHAND-Kids scores, were used to explore correlations between clinical measures and kinematic parameters in children with uCP.Results20 children with uCP (13 boys; mean age 12.0 [SD 3.2] years) and 20 TDC (11 boys; mean age 11.9 [SD 3.4] years) were included. In children with uCP, most kinematic parameters showed high reliability (WAVE: CMC ≥ 0.82; MAX and ROM: ICC ≥ 0.85, SEM ≤ 4.7°). Elbow extension, forearm supination, and wrist adduction were reduced and wrist flexion was increased for children with uCP versus TDC (P < 0.01). In children with uCP, MAX and ROM values were moderately correlated with clinical assessments (AHA score: r = 0.48–0.65; ABILHAND-Kids score: r = 0.48–0.49).ConclusionsThe BE-API protocol is a 3DMA-bimanual performance-based assessment that is highly reliable in children with uCP. Children with uCP and TDC significantly differed in some clinically relevant kinematic parameters. The BE-API is a promising playful tool, helpful for better understanding upper-limb motor movement abnormalities in bimanual conditions and for tailoring treatments to individual deficits.     

A comparison of leg stiffness in running between typically developing children and children with cerebral palsy

BackgroundLeg stiffness is important during running to increase velocity and maximise efficiency by facilitating use of the stretch-shortening cycle. Children with cerebral palsy who have neuromuscular impairments may have altered leg stiffness. The aim of this study was to describe leg stiffness during running in typically developing children and those with cerebral palsy in Gross Motor Function Classification Scale levels I and II at a range of speeds.MethodsThis cross-sectional study examined kinematic data collected from typically developing children (n = 21) and children with cerebral palsy (Gross Motor Function Classification Scale level I n = 25, Gross Motor Function Classification Scale level II n = 13) during jogging, running and sprinting. Derived variables were resultant ground reaction force, change in leg length and three-dimensional leg stiffness. Linear mixed models were developed for statistical analysis.FindingsChildren with cerebral palsy had reduced stiffness when jogging (Gross Motor Function Classification Scale level I affected t = 3.81 p < 0.01; non-affected t = 2.19 p = 0.03; Gross Motor Function Classification Scale level II affected t = 2.04 p = 0.04) and running (Gross Motor Function Classification Scale level I affected t = 3.23 p < 0.01) compared to typically developing children. Affected legs were less stiff than non-affected legs only in Gross Motor Function Classification Scale level I during running (t = 2.26 p = 0.03) and sprinting (t = 2.95 p < 0.01).InterpretationChildren with cerebral palsy have atypical leg stiffness profiles which differ according to functional classification.     

Evaluation of biofeedback seat insert for improving active sitting posture in children with cerebral palsy. A clinical report

Biofeedback devices have been used successfully to improve head control and symmetrical standing in children with cerebral palsy. This clinical report describes a biofeedback seat insert developed to improve erect sitting posture in children with cerebral palsy who have inadequate trunk control. The seat insert is easily placed against the back of any seating device. A momentary-contact pressure switch on the seat insert is activated when the child exerts pressure on it by extending his trunk. The pressure switch then activates a videocassette recorder or can be adapted to activate a television or radio. Five children with spastic cerebral palsy participated in this evaluation of the biofeedback seat insert. The results of this evaluation show that the children used the biofeedback seat insert effectively to actively improve their sitting posture by voluntarily extending their trunk against the pressure switch. The biofeedback seat insert offers physical therapists a valuable therapeutic training tool to encourage carry-over of improved sitting posture away from the clinical setting for children with cerebral palsy.     

The effect of joint translation constraint on within-participant variability of kinematics and kinetics during running in cerebral palsy

BackgroundBiomechanical data in cerebral palsy are inherently variable but no optimal model of translational joint constraint has been identified. The primary aim of this study was to determine which model of translational joint constraint resulted in the lowest within-participant variability of lower limb joint angles and moments. The secondary aim was to determine which model best distinguished known functional groups in Cerebral Palsy.MethodsThree models (three degrees of freedom, six degrees of freedom and six degrees of freedom with specified joint translation constraint) were applied to data from running trials of 40 children with cerebral palsy.FindingsJoint angle standard deviations were largest using the six degrees of freedom model and smallest using the constrained six degrees of freedom model (p < 0.050). For all joints in all planes of motion, joint moment standard deviations were largest using the six degrees of freedom model and smallest using the constrained six degrees of freedom model; standard deviations using the constrained model were smaller than the three degrees of freedom model by 10–30% of moment magnitude (0.01–0.03 Nm/kg; p < 0.001). The six degrees of freedom models distinguished functional subgroups with larger effect size than the three degrees of freedom model only for hip power generation in swing.InterpretationA model with specified joint constraint minimized within-participant variability during running and was useful for detecting differences in functional capacity in cerebral palsy.     

Patterns of upper limb muscle activation in children with unilateral spastic cerebral palsy: Variability and detection of deviations

BackgroundThe aim of this study was two-fold: (1) to quantify the variability of upper limb electromyographic patterns during elbow movements in typically developing children and children with unilateral spastic cerebral palsy, and to compare different amplitude normalization methods; (2) to develop a method using this variability to detect (a) deviations in the patterns of a child with unilateral spastic cerebral palsy from the average patterns of typically developing children, and (b) changes after treatment to reduce muscle activation.MethodsTwelve typically developing children ([6.7–15.9yo]; mean 11.0 SD 3.0yo) and six children with unilateral spastic cerebral palsy ([7.9–17.4yo]; mean 12.4 SD 4.0yo) attended two sessions during which they performed elbow extension-flexion and pronation-supination movements. Surface electromyography of the biceps, triceps, brachioradialis, pronator teres, pronator quadratus, and brachialis muscles was recorded. The Likelihood method was used to estimate the inter-trial, inter-session, and inter-subject variability of the electromyography patterns for each time point in the movement cycle. Deviations in muscle patterns from the patterns of typically developing children and changes following treatment were evaluated in a case study of a child with cerebral palsy.FindingsNormalization of electromyographic amplitude by the mean peak yielded the lowest variability. The variability data were then used in the case study. This method detected higher levels of activation in specific muscles compared with typically developing children, and a reduction in muscle activation after botulinum toxin A injections.InterpretationUpper limb surface electromyography pattern analysis can be used for clinical applications in children with cerebral palsy.     

The effect of a running training intervention on ankle power generation in children and adolescents with cerebral palsy: A randomized controlled trial

BackgroundChildren and adolescents with cerebral palsy who are classified as Gross Motor Function Classification Scale level I or II are usually able to run but lack ankle power generation for push-off. The aim of this study was to analyze the efficacy of a running training program in improving ankle power generation in children and adolescents with cerebral palsy.MethodsThis randomized controlled trial compared kinematic and spatiotemporal data collected during running from 38 children and adolescents with unilateral or bilateral cerebral palsy before and after a 12-week running program. Normalized speed, stride length, cadence, foot strike pattern, peak ankle power generation, peak hip flexor power generation in swing and propulsion strategy were calculated. Linear mixed models were developed to analyze differences between groups.FindingsAt follow-up the intervention group had increased normalized speed of running (t = −3.68 p < .01) while the control group got slower (t = 3.17 p < .01). In running, children in Gross Motor Function Classification Scale level II in the intervention group increased ankle power (t = 2.49 p = .01) while the control group did not change (t = 0.38 p = .71). In sprinting, children in Gross Motor Function Classification Scale levels I and II in the intervention group maintained ankle power (level I t = 0.32 p = .75; level II t = 1.56 p = .12) while those in the control group decreased ankle power (level I t = 4.69 p < .01; level II t = 2.52 p = .01). Most within-group differences did not result in significant between-group differences at follow-up.InterpretationPower generation for running may be responsive to targeted intervention in children with cerebral palsy.     

Seat inclinations affect the function of children with cerebral palsy: A review of the effect of different seat inclines

Purpose. An evaluation of the current research evaluating the impact of seat inclinations upon postural control, muscle activity and upper extremity function in children with cerebral palsy.

Method. A literature review searching 13 electronic databases was undertaken. Inclusion criteria were applied to abstracts found; full text research articles were retrieved and a critical review of the eligible articles completed.

Results. Ten studies were reviewed which investigated the effect of seat inclinations. Improved postural control and a reduction in pathological movements were achieved in anterior tilt; reduced postural sway was evident for children with spastic cerebral palsy sitting on anterior incline, and increased sway for those with hypotonia; extensor thrust was evoked when in posterior incline; and there was evidence of improved arm and hand function whilst seated in the functional sitting position as opposed a posterior seat incline.

Conclusions. (i) The current literature is inconclusive, however there are indications that neutral and anterior seat inclines do positively affect function for children with cerebral palsy; (ii) Individual assessment of seating ability and need is advocated for these children rather than the adoption of a universal seat incline.