Anticipatory postural adjustments associated with a loading perturbation in children with hemiplegic and diplegic cerebral palsy
Anticipatory postural adjustments (APAs) in preparation for predictable externally induced loading perturbation were studied in children with typically development (TD), hemiplegic (HEMI), and diplegic (DIPL) cerebral palsy. Twenty-seven children (n = 9 in each group) were asked to stand and catch a load dropped from a pre-specified height. Electrical activity of the leg and trunk muscles and center of pressure (COP) displacements were recorded to quantify the APAs. All groups were able to generate APAs prior to the perturbation, but the magnitude was smaller and the onset was delayed in the dorsal (agonist) postural muscles in both HEMI and DIPL as compared to TD. HEMI and DIPL also generated APAs in the antagonist postural muscles. Anticipatory backward COP displacement was significantly different from the baseline value only in the TD and HEMI. HEMI and DIPL displayed a different postural control strategy; HEMI showed no difference in background postural activity from TD, but with diminished APAs in the agonist postural muscles compared to TD, while DIPL showed a higher background postural activity and diminished APAs in the agonist postural muscles compared to TD. These differences are important to consider when designing rehabilitation programs to improve posture and movement control in children with hemiplegic and diplegic cerebral palsy.
KeywordsCerebral palsy Anticipatory postural adjustments Posture External perturbation
We are thankful to the children and families who generously participated in this study. We thank D. Tan, PT, PCS and S. Joshi, PT, MS, PCS for assistance with data collection, and Ilyse Zultowski, DPT, PT for assistance with manuscript editing. This study was supported in part by a Grant from the Neuro-Developmental Treatment Association and by Pathways.org.
Compliance with ethical standards
Conflict of interest
None of the authors have potential conflicts of interest to disclose.
- Aruin AS, Latash ML (1996) Anticipatory postural adjustments during self-initiated perturbations of different magnitude triggered by a standard motor action. Electroencephalogr Clin Neurophysiol Electromyogr 101:497–503Google Scholar
- Damiano D, Abel M, Romness M, Oeffinger D, Tylkowski C, Gorton G, Bagley A, Nicholson D, Barnes D, Calmes J, Kryscio R, Rogers S (2006) Comparing functional profiles of children with hemiplegic and diplegic cerebral palsy in GMFCS Levels I and II: are separate classifications needed? Dev Med Child Neurol 48(10):797–803CrossRefPubMedGoogle Scholar
- Geertsen SS, Kirk H, Lorentzen J, Jorsal M, Johansson CB, Nielsen JB (2015) Impaired gait function in adults with cerebral palsy is associated with reduced rapid force generation and increased passive stiffness. Clin Neurophysiol http://www.ncbi.nlm.nih.gov/pubmed/25757398