Effects of forward tilted seating and foot-support on postural adjustments in children with spastic cerebral palsy: An EMG-study. (September 2019)

• Record Type: Journal Article
• Authors: Angsupaisal, Mattana; Dijkstra, Linze-Jaap; la Bastide-van Gemert, Sacha; van Hoorn, Jessika F.; Burger, Karine; Maathuis, Carel G.B.; Hadders-Algra, Mijna
• Is Part Of: European journal of paediatric neurology. Volume 23:Number 5(2019:Sep.)
• Page Start: 723
• Page End: 732
• Publication Date: 2019-09
• Subjects: Cerebral palsy -- Seat inclination -- Foot-support -- Postural muscle activity -- Reaching movement -- Electromyography; BS-CP bilateral spastic CP -- CP cerebral palsy -- EMG (surface) electromyography -- FW-tilting forward tilting of seat surface -- GMFCS Gross Motor Function Classification System -- LE lumbar extensor muscle -- NF neck flexor or sternocleidomastoid muscle -- NE neck extensor muscle -- MUs number of Movement Unit (kinematic reaching parameter) -- RA rectus abdominis muscle -- TE thoracic extensor muscle -- US-CP unilateral spastic CP; Pediatric neurology -- Periodicals; Nervous System Diseases -- Periodicals; Child -- Periodicals; Infant -- Periodicals; Neurologie pédiatrique -- Périodiques; Pediatric neurology; Electronic journals; Periodicals; Electronic journals; 618.928
• DOI: 10.1016/j.ejpn.2019.07.001
• Languages: English
• ISSNs: 1090-3798

Abstract

Abstract: Objective: To evaluate the effect of 15° forward (FW) seat inclination and foot-support in children with cerebral palsy (CP) on postural adjustments during reaching. Design: Observational study repeated-measures design; step two of two-step-project. Setting: Laboratory unit within University Hospital and two special education schools. Participants: 19 children (ten unilateral spastic CP (US-CP); nine bilateral spastic CP (BS-CP); Gross Motor Function Classification System levels I-III; 6–12 years old). Participants were able to take part for one one-hour session. Intervention: Reaching while sitting in four seating conditions (FW or horizontal seat; with or without foot-support) applied in randomized order. Outcome measures: Simultaneously, surface electromyography (EMG) of neck, trunk and arm muscles and kinematics of head and reaching arm (step one of two-step-project) were recorded. Primary outcome parameters were the ability to modulate EMG-amplitudes at baseline and during reaching (phasic muscle activity). Other EMG-parameters were direction-specificity (1st control level), and 2nd level of control parameters: recruitment order, and anticipatory postural activity. Motor behaviour measures: ability to modulate EMG-amplitudes to kinematic characteristics of reaching and head stability. Results: Only foot-support was associated with increased tonic background EMG-amplitudes and decreased phasic EMG-amplitudes of the trunk extensors in children with US-CP and BS-CP (mixed-models analyses; p-values <0.01). The foot-support effect was also associated with better kinematics of reaching (Spearman's Rho; p-values <0.01). Conclusion: In terms of postural adjustments during forward reaching, foot-support enhanced the children's capacity to modulate trunk extensor activity, which was associated with improved reaching quality. FW-tilting did not affect postural muscle activity. Highlights: FW seat inclination does not affect postural EMG of reaching children with CP. Foot-support in seated children with CP increases tonic trunk extensor activity regardless of CP type or seat inclination. Increased tonic trunk extensor activity was associated with improved kinematics of reaching.