Postural Control in Children and Youth with Cerebral Palsy

Abstract

Deficits in movement and postural control are defining characteristics of cerebral palsy. Postural control is defined as the ability to align and adjust body segments against gravity without falling or collapsing. Posture involves complex neural processes that must be coupled to biomechanical and environmental constraints and can be categorized in terms of static, active (or anticipatory), and reactive control. Because ability to control posture is an integral part of all movement, deficits in the posture system contribute to challenges in body structure and function, daily activities, and participation. There is a very high burden of care for those with severe posture deficits. This chapter (1) defines postural stability from a systems perspective; (2) reviews the impact of posture deficits on body function and structure, daily activities, and participation across levels of the Gross Motor Function Classification Scale (GMFCS); (3) summarizes assessments of postural control for sitting and standing; and (4) describes current interventions from the perspective of motor learning principles. The number of published interventions directly aimed at improving postural control is limited. Moreover, the type of intervention, outcome measures, and quality of studies vary significantly between ambulatory and nonambulatory children. For those at GMFCS levels I and II, interventions refine the existing posture. For those at GMFCS level III, children must often choose between task performance and postural control and typically prioritize the functional task. Children at GMFCS levels IV–V have undeveloped postural control and require contextual modifications to enable opportunities for basic acquisition and practice of head and trunk control.