Effects of sensory manipulations on the dynamical structure of center-of-pressure trajectories of children with cerebral palsy during sitting

AIM

To investigate the effects of manipulating visual information and the compliance of the support surface on the area of sway and dynamical trajectories of center-of-pressure (CoP) in children with CP and children with typical development during static sitting.

METHODS

32 typical children, 14 children with mild CP and 12 with moderate-to-severe CP were tested for CoP sway during static sitting under four sensory conditions: (1) eyes open on a rigid surface; (2) eyes closed on a rigid surface; (3) eyes open on foam; (4) eyes closed on foam.

RESULTS

Children with moderate-to-severe CP showed greater regularity and local stability of dynamical CoP trajectories and lower complexity in their motor patterns than typical children and children with mild CP. Moreover, removing vision and sitting on a compliant surface reduced the regularity of CoP trajectories.

CONCLUSION

Children with CP were able to adjust the structure and complexity of their postural control responses to sensory challenges, although the structure of their postural responses was poorer than in typical children.

Effect of the severity of manual impairment and hand dominance on anticipatory and compensatory postural adjustments during manual reaching in children with cerebral palsy

AIM

To investigate the role of the severity of manual impairment and of hand dominance on postural sway during anticipatory [APA] and compensatory [CPA] postural adjustments in a seated manual reaching task performed by children with cerebral palsy (CP) and typical children (TC).

METHODS

We tested 26 TC (mean age 9.5 ± 2.1 years) and 29 children with CP (age 9.6 ± 3 years) classified based on manual impairment levels as mild (Manual Ability Classification System [MACS] I; n = 18) or moderate-to-severe (MACS II-III, n = 11). Participants were instructed to reach towards a target using their dominant vs. non-dominant arm while sitting on a force-plate. Center of pressure (CoP) sway was analyzed during APA and CPA.

RESULTS

For all groups, using the non-dominant arm determined greater amplitude and velocity of CoP sway in CPA. Children with moderate-to-severe manual impairment showed greater sway during APA and CPA compared to mild impairment and TC groups.

CONCLUSION

More severe manual impairment resulted in higher sway during the anticipatory and compensatory phases of the reaching task. Using the non-dominant arm resulted in greater compensatory adjustments during reaching.

Proposta de atuação fisioterapêutica em uma criança com síndrome de Angelman, enfatizando o equilíbrio postural: estudo de caso

A síndrome de Angelman (SA) é caracterizada por alterações neuromotoras como marcha atáxica e atraso na aquisição de habilidades motoras, porém são escassos os estudos investigando o efeito de intervenções aplicadas a essa população. O objetivo do estudo foi verificar o efeito de um treino de equilíbrio em uma criança com SA. Participou do estudo uma criança de nove anos de idade com diagnóstico de SA, sexo feminino. Foi aplicado um protocolo para treino de equilíbrio por oito semanas, com frequência de duas vezes por semana. O treino consistiu em atividades envolvendo equilíbrio estático sob diversas condições de dificuldade. Após o treino, a análise de biofotogrametria computadorizada do equilíbrio estático revelou redução do grau de oscilação, que passou de 38° para 13,78°. A pontuação na escala de Berg passou de 27 pontos, na avaliação, para 37 pontos na reavaliação. No teste Timed Up & Go, a criança realizou a tarefa em 15 segundos, na avaliação, e, na reavaliação, em 12 segundos. Em conjunto, os resultados sugerem que o treino favoreceu melhora no equilíbrio estático e dinâmico, bem como na mobilidade funcional.