Comparison of center-of-pressure displacement during sit-to-stand according to chair height in children with cerebral palsy

Influence of handrail height and knee joint support on sit-to-stand movement

Handrail height and knee joint support both significantly influence sit-to-stand (STS) movement. However, research on the associations between handrail height, knee joint support, and their cumulative effect on STS kinematics and changes in plantar pressure distribution during STS under different handrail heights and knee joint support is still unclear. The main objective of this study was to examine the influence of handrail height and knee joint support on the kinematics and the distribution of plantar pressure in healthy adults during STS. Twenty-six healthy adult subjects aged 23 to 58 years participated in this experiment. The subjects carried out STS movement experiments under 7 conditions: 6 experimental conditions of 3 different heights of handrail, with and without knee joint support, and 1 control condition of standing up naturally. The motions of the markers were recorded using cameras operating at 60 Hz, and total movement time, the percentage of movement time of each phase, trunk tilt angle, joint angle, plantar pressure, and the time from hindfoot to forefoot peak pressure were analyzed and compared. Handrail height significantly influences the percentage of movement time at phase I (P = .015) and the maximum trunk tilt angle (P < .05), knee joint support significantly influences the maximum trunk tilt angle and ankle angle (P = .033), and handrail height and knee joint support have an interaction on the time from hindfoot to forefoot peak pressure (P < .001). Subjects' STS performance was improved with the use of assistant devices but showed particular improvement under the condition of with knee joint support when the handrail height was middle handrail.

Characteristics of sit-to-stand movement are associated with trunk and lower extremity selective control in children with cerebral palsy: a cross-sectional study

Even though the effect of several factors on sit-to-stand (STS) performance of children with CP has been previously explored, the potential role of lower extremity selective control, trunk control and sitting function on the performance of STS has not been examined. This study aimed to investigate the association of trunk control and lower extremity selective motor control with STS performance in children with CP. We recruited 28 children with CP aged between 4 and 10 years whose Gross Motor Function Classification System levels were I and II and 32 age-matched typically developing (TP) children. Trunk control, sitting function, selective control of the lower extremities and STS were evaluated with Trunk Control Measurement Scale (TCMS), sitting section of Gross Motor Function Measure-88 (GMFM-88), Selective Control Assessment of the Lower Extremity (SCALE) and the STS outcomes of a force platform [weight transfer time, rising index, and center of gravity (COG) sway velocity], respectively. In all evaluations, children with CP demonstrated lower scores than TD children. A moderate correlation was found between total scores of TCMS, GMFM-88 sitting section scores and COG sway velocity during STS and a fair correlation between SCALE total scores and COG sway velocity in the CP group (r = -0.51, r = -0.52, r = -0.39, respectively). A fair correlation was found between SCALE total scores and the weight transfer time during STS in children with CP (r = -0.39). Based on these results, improving trunk and lower extremity selective control may enhance STS performance in children with CP.

Effect of different handrail types and seat heights on kinematics and plantar pressure during STS in healthy young adults

Handrail type and seat height both significantly influence sit-to-stand (STS) movement. However, research on the associations between handrail type, seat height, and their cumulative effect on STS kinematics and changes in plantar pressure distribution during STS under different handrail types and seat heights is insufficient.The main objective of this study was to investigate the effect of different handrail types and seat heights on the kinematics and plantar pressure in healthy adults during STS.The study was conducted on 26 healthy young adults. Six conditions were tested: low seat (LS) and vertical handrail; LS and horizontal handrail (HH); LS and bilateral handrail; high seat (HS) and vertical handrail; HSHH; HS and bilateral handrail. The movement time, trunk tilt angle, and time from hindfoot to forefoot peak pressure were analyzed and compared.A significant difference was found in handrail type (P < .001) and seat height (P < .02) for the total movement time of STS. A significant difference was also found for the maximum trunk tilt angles (P < .001) in handrail types. There was an interaction between handrail type and seat height for the time from hindfoot to forefoot peak pressure of STS (P = .003).Using HSHH could take less time to accomplish STS movement; it also reduced the maximum trunk tilt angle and thus reduce the risk of falling; the time from hindfoot to forefoot peak pressure when using HSHH was short and subjects could accomplish STS movement easier.

Sit-to-stand movement in childrenwith cerebral palsy and relationships with the International classification of functioning, disability and health: A systematic review

BACKGROUND

Studying sit-to-stand (STS) in children with Cerebral Palsy addressing the domains of ICF allows determining the factors influencing STS in this population.

AIMS

To systematically review the literature on STS in children with CP, identifying which ICF domains have been assessed and how they relate to sit-to-stand.

METHODS AND PROCEDURES

A literature search was conducted in electronic databases by combining the keywords (child OR children OR adolescent) AND ("Cerebral Palsy") AND (sit-to-stand). We included cross-sectional articles published in English, that assessed STS movements in children with CP up to 18 years old.

OUTCOMES AND RESULTS

25 articles met the inclusion criteria. All of them assessed Body Functions and Structure. According to them, body alignment, muscle strength and postural sway affect STS movement. Six studies related Activity and Participation with STS, demonstrating that worse scores in scales that evaluate activities and participation are related to the poorer STS execution. Contextual factors were addressed in 15 studies: children's age, bench height, manipulation of sensory information and mechanical restriction impact the way children execute STS.

CONCLUSION AND IMPLICATIONS

Contextual factors and Body Functions and Structure impact the STS in children with CP. However, few studies have evaluated the participation of these children. Based on the theoretical framework of the ICF, it is important that future studies evaluate functional tasks in children with CP and the components that can affect them. The adoption of the biopsychosocial model strengthens the understanding of functioning, which can contribute to rehabilitation planning.

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

BACKGROUND

To verify the effect of dual-task on postural oscillation during sit-to-stand movement in children with Cerebral Palsy.

METHODS

17 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.

FINDINGS

Children 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.

INTERPRETATION

The 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.

Modified desk height helps children with cerebral palsy perform sit-to-stand

Aim: Children with cerebral palsy (CP) have difficulties performing activities that require the use of fundamental motor skills such as sit-to-stand (STS). In this study, we used a height adjustable chair and desk to investigate the role of desk support in STS and how it might benefit children with CP. Methods: Seventeen typically developing children (TDC), average age = 9.7 years, and 28 children with CP (Gross Motor Function Classification System [GMFCS] I and II), average age = 10.3 years, participated in the test. Elapsed time and body sway were measured using a pressure mat and load cell while each child performed a STS task. Two different desk heights were tested for time consumption and sway under the condition of hands-on-desk and arms-crossed. Results: We found that the elapsed time of hands-on-desk with the elbow flexion height was the shortest (p < 0.05). Sway amount was also significantly reduced for all children when they used the table for STS (p < 0.05). Conclusion: Results of this study may be a useful reference in rehabilitation training and designing a desk height beneficial for children with CP.Implications for RehabilitationBetter performance of sit-to-stand for a child with cerebral palsy could be made by a desk supportElapsed time during preparation period for sit-to-stand could be reduced by desk support for all CP childrenSway amount during sit-to-stand could be reduced by desk support, especially for the CP children with GMFCS level IIDesk height is an important parameter and should be studied in detail.

Asymmetry in children with unilateral cerebral palsy during sit-to-stand movement: Cross-sectional, repeated-measures and comparative study

BACKGROUND

We aimed to compare motor strategies adopted by children with unilateral Cerebral Palsy and typically developing children during the performance of sit-to-stand.

METHODS

Eleven children with unilateral cerebral palsy and 20 typically developing children were evaluated. Kinematic and kinetic analysis of the sit-to-stand movement was performed. Three seat heights were evaluated: neutral (90° of hip-knee-ankle flexion), elevated to 120% of the neutral height, and lowered to 80% of the neutral height. As outcome variables, we considered sit-to-stand duration (temporal); initial, final and maximal sagittal angles and range of motion of trunk, pelvis, hip, knee, and ankle (kinematics); the peak of vertical ground reaction force (kinetics), and asymmetric index. Effect size is represented by η₂p.

FINDINGS

We found that for the lowered seat, all groups presented increased flexion of lower limbs and trunk to initiate sit-to-stand (p≤0.012; η₂p = 0.41-0.84), increased peak flexion of trunk, hip and knee (p≤0.01; η₂p = 0.39-0.88), increased range of motion of knee and trunk (p≤0.01; η₂p = 0.45-0.85) and the duration of sit-to-stand (p≤0.05 η₂p = 0.23-0.56). Children with unilateral cerebral palsy presented increased posterior pelvic tilt (p≤0.01) and decreased hip flexion of both lower limbs (p≤0.01) for all seat heights and moved their non-affected limb backward in the lowered seat (p≤0.01). Asymmetry was observed for the final and the maximal angles of the ankle in neutral and lowered seats in unilateral cerebral palsy (asymmetry index = 3.3-5.8%).

INTERPRETATION

The lowered seat height led to adaptive motor strategies in children with unilateral cerebral palsy, which should be considered in clinical practice.

Impact of loaded sit-to-stand exercises at different speeds on the physiological cost of walking in children with spastic diplegia: A single-blind randomized clinical trial

PURPOSE

In the present study, we aimed to determine whether similarly loaded sit-to-stand exercises at different speeds improve the physiological cost of walking in children with spastic diplegia.

METHODS

This design was a single-blind randomized clinical trial. Sixteen children with cerebral palsy (CP), aged 12-18 years, with a diagnosis of spastic diplegia, were randomly allocated to a slow loaded sit-to-stand exercise group (n=8) and a self-paced loaded sit-to-stand exercise group (n=8). Loaded sit-to-stand exercise was conducted at home for 15min, 4 sets per day, 3-4days per week, for 6 weeks. The patients were evaluated immediately before the intervention and after the training. Lower limb muscle strength using a hand-held dynamometer, selective voluntary motor control using SCALE, 6-min walk distance (6MWD), and Physiological Cost Index (PCI) were measured.

RESULTS

The 6MWD showed a significant difference before and after intervention. PCI showed a significant difference between the two groups and the two time points. 6MWD and the PCI improved after intervention in the slow sit-to-stand exercise group.

CONCLUSIONS

Compared to loaded sit-to-stand exercise at a regular speed, slow low-loaded sit-to-stand exercise improved the 6MWD and PCI in children with CP, suggesting that this decrease in speed during exercise improves the physiological cost of walking in these children.