title: Segmental Contributions to Trunk Control in Children With Moderate-to-Severe Cerebral Palsy.
abstract: OBJECTIVE
  To examine postural constraints in children with moderate-to-severe cerebral palsy (CP) using a segmental approach.
  
  
  METHODS
  Quasi-experimental repeated-measures study; case series.
  
  
  METHODS
  Motor control research laboratory.
  
  
  METHODS
  Children (N=15; age range, 4-16y) with moderate (Gross Motor Function Classification System [GMFCS] IV; n=8; 4 boys) or severe (GMFCS V) (n=7; 4 boys) CP.
  
  
  METHODS
  Each child participated in 3 data collection sessions. During each session, we evaluated postural control for sitting using kinematics and clinical assessments.
  
  
  METHODS
  Kinematic data were used to document head alignment and stabilization with external support at 4 levels (axillae, midrib, waist, hip). Two clinical assessments, the Segmental Assessment of Trunk Control and behavioral assessment for stage of trunk control, were also used to compare results for children with CP to previous longitudinal data from typically developing (TD) infants (3-9mo of age).
  
  
  RESULTS
  Children with GMFCS V had difficulty aligning and stabilizing their head along the medial-lateral and anterior-posterior axes. External support improved postural control for children with GMFCS V but not for those classified as GMFCS IV, who had opposite responses to support compared with TD infants.
  
  
  CONCLUSIONS
  Children with GMFCS V have limited trunk control but respond to support similarly to young TD infants, suggesting delayed postural control. Response to external support for children with GMFCS IV suggests a unique strategy for trunk control not observed in typical infants. Overall a segmental approach offers new insights into development of trunk control in children with moderate-to-severe CP.
authors: Department of Human Physiology and Institute of Neuroscience, University of Oregon, Eugene, OR. Electronic address: saavedra@hartford.edu.
authors: Sandra L
authors: SL
authors: Saavedra
authors: Department of Human Physiology and Institute of Neuroscience, University of Oregon, Eugene, OR.
authors: Marjorie H
authors: MH
authors: Woollacott
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena / Q000502:physiology; D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D004856:Postural Balance / Q000502:physiology*; D011782:Quadriplegia / Q000503:physiopathology; D012720:Severity of Illness Index; D060726:Torso / Q000503:physiopathology*
keywords: Posture; Rehabilitation
references: Am J Phys Med Rehabil. 2003 Aug;82(8):622-6
references: 12872019
references: Dev Med Child Neurol. 2004 Apr;46(4):253-66
references: 15077703
references: Pediatr Phys Ther. 2010 Fall;22(3):246-57
references: 20699770
references: JAMA. 2002 Sep 18;288(11):1357-63
references: 12234229
references: Exp Brain Res. 2010 Feb;201(1):13-23
references: 19756550
references: Dev Med Child Neurol. 2010 Feb;52(2):e48-54
references: 19811516
references: Dev Med Child Neurol. 2001 Aug;43(8):534-46
references: 11508919
references: Dev Med Child Neurol. 2001 Jun;43(6):364-70
references: 11409824
references: Dev Med Child Neurol. 1999 Nov;41(11):766-76
references: 10576641
references: J Neurophysiol. 2012 Oct;108(8):2215-29
references: 22832568
references: Phys Ther. 2007 Nov;87(11):1495-510
references: 17895351
references: Dev Med Child Neurol. 2008 Oct;50(10):744-50
references: 18834387
references: J Neurophysiol. 2005 Jan;93(1):189-200
references: 15331614
references: Pediatrics. 2004 Nov;114(5):1264-71
references: 15520106
references: Clin Rehabil. 1998 Aug;12(4):281-93
references: 9744664
references: Neurosci Biobehav Rev. 1998 Jul;22(4):591-6
references: 9595574
references: Prosthet Orthot Int. 1991 Dec;15(3):203-16
references: 1838148
references: Phys Ther. 1991 Dec;71(12):981-93
references: 1946630
references: Dev Med Child Neurol. 1991 Mar;33(3):246-56
references: 1760002
references: Phys Ther. 2010 Dec;90(12):1823-37
references: 20966209