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Pediatric Physical Therapy:
doi: 10.1097/PEP.0b013e318277f17d
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Commentary on “Sitting Postural Control in Infants With Typical Development, Motor Delay, or Cerebral Palsy”

Gannotti, Mary PT, PhD; Nahorniak, Maureen PT, MBA, PPI, DPT

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University of Hartford Hartford, CT

Shriners Hospital for Children Hartford, CT

The authors declare no conflicts of interest.

“What should I be mindful in applying this information?”

The ability to control postural sway in the seated position for children with cerebral palsy (CP) is related to sensory-perceptual dysfunction, motor weakness, biomechanical malignment, and abnormal postural synergies. Seated postural synergies in response to perturbations demonstrated by children with CP are characterized by activating muscles out of sequence, tonic activity, and coactivation of antagonists.14 The crouched sitting posture that limits postural sway has been reported to be a compensation for inadequate postural control.5 It is probable that the limitations in the excursions of center of pressure (COP) reported in this article are a result of multiple factors.

The statistical findings concerning the reduced linear anterior/posterior sway and nonlinear medial/lateral sway in infants with CP as compared with infants with developmental delay must be interpreted with caution due to the small sample size, limited power, and unequal group sizes. A table reporting mean values with standard deviations and ranges or reporting the data as a series of case studies would have been helpful in interpreting the data. In addition, given the hypermetric nature of athetosis, including an infant with athetosis with 5 infants with spasticity may have skewed results for the group with CP.

“What should I be mindful in applying this information?”

The development of postural control in sitting has immense implications for independence in activities of daily living, functional mobility, and spine health in adolescence and adulthood. Physical therapists should be aware of limitations in the excursion of COP in sitting are present in early sitting of infants with CP, and this persists.

Limitations in COP in sitting may require multifaceted intervention strategies. Physical therapists should address muscle weakness, biomechanical malignment, and responses to perturbations. Interventions aimed at improving recruitment patterns for postural synergies and reducing coactivation of antagonists are indicated to promote larger excursions of COP. Introducing variability in surfaces and in reaching challenges may also be of benefit.

Mary Gannotti, PT, PhD

University of Hartford

Hartford, CT

Maureen Nahorniak, PT, MBA, PPI, DPT

Shriners Hospital for Children

Hartford, CT

The authors declare no conflicts of interest.

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REFERENCES

1. Brogren E, Hadders-Algra M, Forssberg H. Postural control in children with spastic diplegia: muscle activity during perturbations in sitting. Dev Med Child Neurol. 1996;38(5):379–388.

2. Brogren E, Hadders-Algra M, Forssberg H. Postural control in sitting children with cerebral palsy. Neurosci Biobehav Rev. 1998;22(4):591–596.

3. van der Heide K, Brand PL. [“Sitting on air” in infants: a sign of simple delay in the gross motor milestones]. Ned Tijdschr Geneeskd. 2004;148(21):1017–1020.

4. Washington K, Shumway-Cook A, Price R, Ciol M, Kartin D. Muscle responses to seated perturbations for typically developing infants and those at risk for motor delays. Dev Med Child Neurol. 2004;46(10):681–688.

5. Brogren E, Forssberg H, Hadders-Algra M. Influence of two different sitting positions on postural adjustments in children with spastic diplegia. Dev Med Child Neurol. 2001;43(8):534–546.

© 2013 Lippincott Williams & Wilkins, Inc.

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