Houdingsregulatie bij kinderen met cerebrale parese : Een exploratieve pilot-studie

Introduction: Postural control is important for daily activities like reaching and sitting. Children with cerebral palsy (CP) form the largest group of children with disturbances in postural control. Two levels can be distinguished in postural control: 1) a basic level of direction-specificity, meaning that perturbations inducing a forward sway of the body are accompanied by primary muscle activity on the dorsal side of the body and vice versa and 2) fine-tuning of the direction-specific activity on the basis of afferent input. This pilot study explores the influence of different sitting positions on the stability of the head in space, the kinematic quality of reaching and EMG-parameters of postural control in school-aged children with CP. Methods: Four children aged 8-12 years, GMFCS level I-II with unilateral or bilateral spastic CP participated in the study. They were assessed during reaching in four different sitting positions: horizontal seat surface with and without foot support and tilted forward 15° with and without foot support. Postural control was measured using surface EMGs of arm, neck, trunk and leg muscles. Movements were recorded kinematically using the SIMI Motion System. Data analysis was carried out with the PedEMG program and the SIMI Motion 3D program. Data were interpreted by ‘eye balling’ graphs of the effect of sitting condition of the individual children. Results: Overall, posture and reaching of the children with CP was characterized by variation. The data suggested that in the conditions without foot support a forward tilted seat surface in comparison to the horizontal situation was associated with a better quality of reaching and an inconsistent effect on head stability and postural muscle activity. In the horizontal position addition of foot support seemed to be associated with an inconsistent effect on head stability, but a better quality of reaching, and better postural muscle activity. However, foot support in the forward tilted condition seemed not to be associated with improved head stability, reaching and posture. Conclusion: The results of this exploratory study indicate that in the situation of the absence of foot support forward tilting of the seat surface may be associated with a better quality of reaching without affecting postural control. Also the addition of foot support in the horizontal position may have a positive effect on the quality of reaching without a consistent positive effect on posture. A similar positive effect of foot support seemed absent in the forward tilted position. Further research with larger groups is needed for scientific evidence on the effect of the various sitting conditions on reaching and posture of children with CP.