title: The role of visual stimuli on standing posture in children with bilateral cerebral palsy.
abstract: BACKGROUND
  In children with bilateral cerebral palsy (CP) maintaining a standing position can be difficult. The fundamental motor task of standing independently is achieved by an interaction between the visual, somatosensory, and vestibular systems. In CP, the motor disorders are commonly accompanied by sensory and perceptual disturbances. Our aims were to examine the influence of visual stimuli on standing posture in relation to standing ability.
  
  
  METHODS
  Three dimensional motion analysis with surface electromyography was recorded to describe body position, body movement, and muscle activity during three standing tasks: in a self-selected position, while blindfolded, and during an attention-demanding task. Participants were twenty-seven typically-developing (TD) children and 36 children with bilateral CP, of which 17 required support for standing (CP-SwS) and 19 stood without support (CP-SwoS).
  
  
  RESULTS
  All children with CP stood with a more flexed body position than the TD children, even more pronounced in the children in CP-SwS. While blindfolded, the CP-SwS group further flexed their hips and knees, and increased muscle activity in knee extensors. In contrast, the children in CP-SwoS maintained the same body position but increased calf muscle activity. During the attention-demanding task, the children in CP-SwoS stood with more still head and knee positions and with less muscle activity.
  
  
  CONCLUSIONS
  Visual input was important for children with CP to maintain a standing position. Without visual input the children who required support dropped into a further crouched position. The somatosensory and vestibular systems alone could not provide enough information about the body position in space without visual cues as a reference frame. In the children who stood without support, an intensified visual stimulus enhanced the ability to maintain a quiet standing position. It may be that impairments in the sensory systems are major contributors to the difficulties to stand erect in children with CP.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden. Cecilia.Lidbeck@ki.se.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Lidbeck
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Bartonek
authors.affiliation: Royal Institute of Technology, KTH Mechanics, Stockholm, Sweden.|Royal Institute of Technology, KTH BioMEx Center, Stockholm, Sweden.
authors.forename: Priti
authors.initials: P
authors.lastname: Yadav
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Tedroff
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Åstrand
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hellgren
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, SE-171 76, Stockholm, Sweden.|Royal Institute of Technology, KTH Mechanics, Stockholm, Sweden.|Royal Institute of Technology, KTH BioMEx Center, Stockholm, Sweden.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Gutierrez-Farewik
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D003463:Cues; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D009068:Movement; D011187:Posture / Q000502:physiology*; D016059:Range of Motion, Articular
keywords: Cerebral palsy; Muscle activity; Postural orientation; Sensory disturbances; Standing ability; Visual function