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BMC Neurology

, 16:151

Child neurology


BackgroundIn 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.

MethodsThree 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.

ResultsAll 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.

ConclusionsVisual 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.

KeywordsCerebral palsy Muscle activity Postural orientation Sensory disturbances Standing ability Visual function AbbreviationsCPCerebral palsy

CP-SwoSChildren with CP standing without support

CP-SwSChildren with CP requiring support for standing

GMFCSGross motor function classification system

MGMedial gastrocnemius muscle

RFRectus femoris muscle

RMSRoot mean square

sEMGSurface electromyography

TATibialis anterior muscle


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Autor: Cecilia Lidbeck - Åsa Bartonek - Priti Yadav - Kristina Tedroff - Per Åstrand - Kerstin Hellgren - Elena M. Gutierrez-Fa


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