The growth of stability: postural control from a development perspective.
This study compared central nervous system organizational processes underlying balance in children of three age groups: 15-31 months, 4-6 years, and 7-10 years, using a movable platform capable of antero-posterior (A-P) displacements or dorsi-plantar flexing rotations of the ankle joint. A servo system capable of linking platform rotations to A-P sway angle allowed disruption of ankle joint inputs, to test the effects of incongruent sensory inputs on response patterns. Surface electromyography was used to quantify latency and response patterns. Surface electromyography was used to quantify latency and amplitude of the gastrocnemius, hamstrings, tibialis anterior, and quadriceps muscle responses. Cinematography provided biomechanical analysis of the sway motion. Results demonstrated that while directionally specific response synergies are present in children under the age of six, structured organization of the synergies is not yet fully developed since variability in timing and amplitude relationships between proximal and distal muscles is high. Transition from immature to mature response patterns was not linear but stage-like with greatest variability in the 4- to 6- year-old children. Results from balance tests under altered sensory conditions (eyes closed and/or ankle joint inputs altered) suggested that: (a) with development a shift in controlling inputs to posture from visual dependence to more adult-like dependence on a combination of ankle joint and visual inputs occurred in the 4- to 6-year-old, and reached adult form in the 7- to 10-year-old age group. It is proposed that the age 4-6 is a transition period in the development of posture control. At this time the nervous system (a) uses visual-vestibular inputs to fine tune ankle-joint proprioception in preparation for its increased importance in posture control and (b) fine tunes the structural organization of the postural synergies themselves.
Shumway-Cook
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Department of Physical Medicine and Rehabilitation, Good Samaritan Hospital and Medical Center, 1015 N.W. 22nd Avenue, Portland, OR 97210, USA.
Woollacott
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