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, 201 (1), 13-23

Head Stability During Quiet Sitting in Children With Cerebral Palsy: Effect of Vision and Trunk Support

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Head Stability During Quiet Sitting in Children With Cerebral Palsy: Effect of Vision and Trunk Support

Sandra Saavedra et al. Exp Brain Res.

Abstract

Deficits in postural control are one of the hallmarks of disability in children with cerebral palsy (CP). Yet, much remains unknown regarding the etiology of postural deficits in these children. Here we evaluated postural control at a simplified task level by measuring head stability during quiet sitting while systematically manipulating the level of trunk support and vision in 15 children with CP (6-16 years), 26 typically developing (TD) children (4-14 years), and 11 adults. While TD children did not differ significantly from adults, children with CP had greater head movement than adults in both the sagittal and frontal planes under all conditions except frontal plane movement with Torso Support. Vision did not affect head stability in the sagittal plane for any group while it had differential effects on head stability in the frontal plane. Lack of vision improved head stability in adults and older TD children while destabilizing the head in young children (TD and CP) during the most unstable sitting position. Moreover, vision affected children with CP differently depending on their movement disorder. Children with spastic CP performed worse with eyes closed while those with dyskinetic CP had improved head stability with eyes closed. Our results demonstrate that children with mild to moderate CP have deficits in head stability even during quiet sitting.

Figures

Figure 1
Figure 1
Experimental setup: Children sat in front of a computer monitor in a darkened room, hands folded across their shoulders. Torso Support included hip straps that keep the pelvis aligned vertically and a rigid support around the thoracic spine ~ 1 inch below arm pit. The support bar was removed for Pelvic Support and the straps were released for No Support. Magnetic sensor was attached to a headband.
Figure 2
Figure 2
Group effects. Group means (across all levels of support and both visual conditions) for all sway parameters in sagittal (left) and frontal (right) planes. Head movement for control group (light gray bars) and children with CP grouped by age (dark gray bars) or grouped by movement disorder (white bars). Error bars, intersubject SE. * indicates p < .05.
Figure 3
Figure 3
Vision by support interaction. Mean sway velocity across all groups, with eyes open (unfilled circles) and with eyes closed (filled squares) at each level of support. Error bars, intersubject SE.
Figure 4
Figure 4
Group means for head displacement (RMS) during a) No Support, b) Pelvic Support and c) Torso Support with eyes open (dark bars) and eyes closed (light bars). Error bars, intersubject SE. * indicates p < .05.
Figure 5
Figure 5
Group means showing effect of vision on sway amplitude across all levels of support. Comparing children with CP grouped by diagnosis with TD children and adults. Eyes open (light bars) and eyes closed (dark bars). Children with CP grouped by movement disorder, spastic CP (S_CP), ataxic CP (A_CP) and mixed CP with dyskinesia (D_CP). Error bars, intersubject SE. * indicates p < .05.

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