Postural control during sit-to-stand movement and its relationship with upright position in children with hemiplegic spastic cerebral palsy and in typically developing children

OBJECTIVE: The purpose of this study was to compare postural control in typically developing (TD) children and children with cerebral palsy (CP) during the sit-to-stand (STS) movement and to assess the relationship between static (during static standing position) and dynamic postural control (during STS movement) in both groups. METHOD: The center of pressure (CoP) behavior of 23 TD children and 6 children with spastic hemiplegic CP (Gross Motor Function Classification System [GMFCS] I and II) was assessed during STS movement performance and during static standing conditions with the use of a force plate. The data obtained from the force plate were used to calculate CoP variables: anteroposterior (AP) and mediolateral (ML) amplitudes of CoP displacement and the area and velocity of CoP oscillation. RESULTS: According to the Mann-Whitney test, children with CP exhibited higher CoP values in all of the analyzed variables during the beginning of STS movement. Pearson's correlation verified a positive correlation between the CoP variables during both static conditions and the performance of STS movement. CONCLUSIONS: Children with spastic hemiplegic CP present major postural oscillations during the beginning of STS movement compared with typical children. Moreover, the observed relationship between postural control in static and dynamic conditions reveals the importance of body control in the static position for the performance of functional activities that put the body in motion, such as STS movement. .

Relationship between static postural control and the level of functional abilities in children with cerebral palsy / Relação entre o controle postural estático e o nível de habilidades funcionais na paralisia cerebral

Background: Postural control deficits can impair functional performance in children with cerebral palsy (CP) in daily living activities. Objective: To verify the relationship between standing static postural control and the functional ability level in children with CP. Method: The postural control of 10 children with CP (gross motor function levels I and II) was evaluated during static standing on a force platform for 30 seconds. The analyzed variables were the anteroposterior (AP) and mediolateral (ML) displacement of the center of pressure (CoP) and the area and velocity of the CoP oscillation. The functional abilities were evaluated using the mean Pediatric Evaluation of Disability Inventory (PEDI) scores, which evaluated self-care, mobility and social function in the domains of functional abilities and caregiver assistance. Results: Spearman's correlation test found a relationship between postural control and functional abilities. The results showed a strong negative correlation between the variables of ML displacement of CoP, the area and velocity of the CoP oscillation and the PEDI scores in the self-care and caregiver assistance domains. Additionally, a moderate negative correlation was found between the area of the CoP oscillation and the mobility scores in the caregiver assistance domain. We used a significance level of 5% (p <0.05). Conclusions: We observed that children with cerebral palsy with high CoP oscillation values had lower caregiver assistance scores for activities of daily living (ADL) and consequently higher levels of caregiver dependence. These results demonstrate the repercussions of impairments to the body structure and function in terms of the activity levels of children with CP such that postural control impairments in these children lead to higher requirements for caregiver assistance. .

Contextualização: Os déficits de controle postural em crianças com PC podem comprometer suas atividades na rotina diária. Objetivo: Verificar a relação entre o controle postural em ortostatismo de crianças com PC e suas habilidades funcionais. Método: O controle postural de dez crianças PC (GMFCS I e II) foi avaliado em ortostatismo na plataforma de força por 30 segundos. Variáveis analisadas: deslocamento ântero-posterior e médio-lateral do centro de pressão (CoP), área e velocidade de oscilação do CoP. As habilidades funcionais foram avaliadas por meio do Pediatric Evaluation of Disability Inventory (PEDI), considerando-se escores de autocuidado, mobilidade e função social nos domínios habilidades funcionais e assistência do cuidador. Resultados: O teste de correlação de Spearman verificou a relação entre controle postural e funcionalidade. Constatou-se correlação negativa forte entre as variáveis amplitude ML de deslocamento do CoP, área de oscilação do CoP e entre a variável de velocidade média de oscilação do CoP e os escores do domínio de autocuidado. Observou-se também correlação negativa moderada entre área de oscilação do CoP e mobilidade. O nível de significância adotado foi de 5% (p<0,05). Conclusões: Crianças com maiores oscilações do CoP em ortostatismo apresentam maiores escores de assistência do cuidador para a realização de AVDs, indicando maiores níveis de dependência. Isso demonstra as repercussões dos componentes de estrutura e função do corpo sobre o nível de atividade em crianças com PC, uma vez que o comprometimento do controle postural pode levar a uma maior dependência das crianças em relação ...

Reliability of isokinetic evaluation in passive mode for knee flexors and extensors in healthy children

BACKGROUND: The isokinetic dynamometer has been considered the gold-standard measurement of muscle performance. However, the reliability for the passive mode in children has not been reported to date. OBJECTIVES: The purpose was to evaluate the reliability of the isokinetic dynamometer in passive mode in children. METHOD: Twenty-one healthy children (ten girls, eleven boys), aged 5 to 12 years (age: 8.5±2.2 years), were evaluated using an isokinetic dynamometer. Each participant was tested twice with a one-week interval and performed five consecutive cycles of knee extension and flexion. The test was performed at 60º/s in the concentric passive mode and the children performed maximal contractions. The measured variables were peak torque, average peak torque, total work, and average power, time to peak torque and angle of peak torque for dominant and non-dominant lower limbs. Reliabilities were determined using intraclass correlation coefficient (ICC3,1), standard error of measurement (SEM and SEM%), and coefficient of variation (CV). RESULTS: We found good reliability in both lower limbs for peak torque, average peak torque, total work and average power of knee flexors and extensors, with ICC3,1 values greater than 0.80; SEM ranging from 6.7 to 79.2; SEM% ranging from 10.4% to 16.8%; CV lower than 15%. Bland-Altman analysis showed that the bias was low than 10% and limits of agreement (LOAs) ranging from 33.9% to 59.2%, and -28.8% and -52.8%, showing that measures tended to disagree. However, time to peak torque (ICC3,1<0.68; SEM > 0.34; SEM%>37.4%; CV>41.7%; bias >24.0%; LOA>101.0%) and angle of peak torque (ICC3,1<0.76; SEM>9.3; SEM%>27.6%; CV>15.3%; bias>11.0%; LOA>61.0%) were not reliable. CONCLUSIONS: The findings indicate that isokinetic evaluation in passive mode for knee extensors ...