Effects of forward tilted seating and foot-support on postural adjustments in children with spastic cerebral palsy: An EMG-study |
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Authors: | Mattana Angsupaisal Linze-Jaap Dijkstra Sacha la Bastide-van Gemert Jessika F. van Hoorn Karine Burger Carel G.B. Maathuis Mijna Hadders-Algra |
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Affiliation: | 1. University of Groningen, University Medical Center Groningen, Department of Paediatrics – Division of Developmental Neurology, Groningen, the Netherlands;2. University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands;3. University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, the Netherlands;4. Vogellanden Rehabilitation Center, Zwolle, the Netherlands |
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Abstract: | ObjectiveTo evaluate the effect of 15° forward (FW) seat inclination and foot-support in children with cerebral palsy (CP) on postural adjustments during reaching.DesignObservational study repeated-measures design; step two of two-step-project.SettingLaboratory unit within University Hospital and two special education schools.Participants19 children (ten unilateral spastic CP (US-CP); nine bilateral spastic CP (BS-CP); Gross Motor Function Classification System levels I-III; 6–12 years old). Participants were able to take part for one one-hour session.InterventionReaching while sitting in four seating conditions (FW or horizontal seat; with or without foot-support) applied in randomized order.Outcome measuresSimultaneously, surface electromyography (EMG) of neck, trunk and arm muscles and kinematics of head and reaching arm (step one of two-step-project) were recorded. Primary outcome parameters were the ability to modulate EMG-amplitudes at baseline and during reaching (phasic muscle activity). Other EMG-parameters were direction-specificity (1st control level), and 2nd level of control parameters: recruitment order, and anticipatory postural activity. Motor behaviour measures: ability to modulate EMG-amplitudes to kinematic characteristics of reaching and head stability.ResultsOnly foot-support was associated with increased tonic background EMG-amplitudes and decreased phasic EMG-amplitudes of the trunk extensors in children with US-CP and BS-CP (mixed-models analyses; p-values <0.01). The foot-support effect was also associated with better kinematics of reaching (Spearman's Rho; p-values <0.01).ConclusionIn terms of postural adjustments during forward reaching, foot-support enhanced the children's capacity to modulate trunk extensor activity, which was associated with improved reaching quality. FW-tilting did not affect postural muscle activity. |
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Keywords: | Cerebral palsy Seat inclination Foot-support Postural muscle activity Reaching movement Electromyography BS-CP bilateral spastic CP CP cerebral palsy EMG (surface) electromyography FW-tilting forward tilting of seat surface GMFCS Gross Motor Function Classification System LE lumbar extensor muscle NF neck flexor or sternocleidomastoid muscle NE neck extensor muscle MUs number of Movement Unit (kinematic reaching parameter) RA rectus abdominis muscle TE thoracic extensor muscle US-CP unilateral spastic CP |
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