The Interaction Between Executive Attention and Postural Control in Dual-Task Conditions: Children With Cerebral Palsy

Alpha oscillations during visual selective attention are aberrant in youth and adults with cerebral palsy

Our understanding of the neurobiology underlying cognitive dysfunction in persons with cerebral palsy is very limited, especially in the neurocognitive domain of visual selective attention. This investigation utilized magnetoencephalography and an Eriksen arrow-based flanker task to quantify the dynamics underlying selective attention in a cohort of youth and adults with cerebral palsy (n = 31; age range = 9 to 47 yr) and neurotypical controls (n = 38; age range = 11 to 49 yr). The magnetoencephalography data were transformed into the time-frequency domain to identify neural oscillatory responses and imaged using a beamforming approach. The behavioral results indicated that all participants exhibited a flanker effect (greater response time for the incongruent compared to congruent condition) and that individuals with cerebral palsy were slower and less accurate during task performance. We computed interference maps to focus on the attentional component and found aberrant alpha (8 to 14 Hz) oscillations in the right primary visual cortices in the group with cerebral palsy. Alpha and theta (4 to 7 Hz) oscillations were also seen in the left and right insula, and these oscillations varied with age across all participants. Overall, persons with cerebral palsy exhibit deficiencies in the cortical dynamics serving visual selective attention, but these aberrations do not appear to be uniquely affected by age.

Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder

Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.

Heterogeneity of Tasks and Outcome Measures in Dual Tasking Studies in Children With Cerebral Palsy: A Scoping Review

OBJECTIVE

The aims of this scoping review are to examine the available literature regarding dual tasking in children with cerebral palsy (CP) and to identify and categorize both the motor and cognitive tasks and outcome measures used primarily through the International Classification of Functioning, Disability, and Health model.

METHODS

Five electronic databases were searched. Studies were included if they: (1) were published in English; (2) included at least 1 group of children or adolescents with a diagnosis of CP; (3) assessed dual tasking as part of the study; (4) reported the method for performing the dual task; and (5) reported the outcome measures utilized.

RESULTS

Twenty-three studies with 439 children with CP were included. All studies utilized motor activities as the primary task, including walking, balance, and a functional transition. Motor secondary tasks occurred in 10 studies, cognitive secondary tasks in 12 studies, and 1 study used both. Forty-one outcome measures over 23 studies assessed the body structure and function domain, 7 measures over 6 studies assessed activity limitations, and 2 outcomes over 2 studies assessed participation.

CONCLUSION

The 23 included studies demonstrated heterogeneity in the age and function of participants, secondary tasks, and outcome measures. Future studies on dual tasking in children with CP should consider the difficulty of the primary motor or cognitive task and compare secondary tasks to establish this contribution to motor performance. Studies should incorporate activity and participation measures to assess meaningful functional outcomes.

IMPACT

Children with CP experience challenges when exposed to dual task situations. This scoping review highlights the importance of considering multiple factors when designing dual tasking studies involving children with CP to facilitate results translation, improved participation, and enhanced function. Similarly, studies should utilize activity and participation outcomes to assess quality of life.

Biological and environmental factors may affect children's executive function through motor and sensorimotor development: Preterm birth and cerebral palsy

Disruptive biological and environmental factors may undermine the development of children's motor and sensorimotor skills. Since the development of cognitive skills, including executive function, is grounded in early motor and sensorimotor experiences, early delays or impairments in motor and sensorimotor processing often trigger dynamic developmental cascades that lead to suboptimal executive function outcomes. The purpose of this perspective paper is to link early differences in motor/sensorimotor processing to the development of executive function in children born preterm or with cerebral palsy. Uncovering such links in clinical populations would improve our understanding of developmental pathways and key motor and sensorimotor skills that are antecedent and foundational for the development of executive function. This knowledge will allow the refinement of early interventions targeting motor and sensorimotor skills with the goal of proactively improving executive function outcomes in at-risk populations.

Effects of Dual Task Training and Transcranial Direct Current Stimulation in Children with Spastic Cerebral Palsy: A Pilot Randomized Control Trial

OBJECTIVE

Compare the effectiveness of active and sham transcranial direct current stimulation (tDCS) during the training of a dual task in children with spastic cerebral palsy (CP).

METHODS

Thirty children with CP were submitted to ten sessions of either active (n = 15) or sham (n = 15) tDCS over the motor cortex for 20 minutes during the training of a dual task. Pre-intervention, post-intervention and follow-up evaluations involved measures of functional performance, intellectual performance, functional mobility and cortical excitability.

RESULTS

The combination of active tDCS and dual task training led to improvements in functional mobility as well as functional and intellectual performances one month after the end of the intervention.

CONCLUSION

The combination of active tDCS and dual task training demonstrated promising effects for children with spastic CP.

Muscular and Prefrontal Cortex Activity during Dual-Task Performing in Young Adults

Postural control depends on attentional resources besides automatic processes. The dual-task paradigm is a possible approach to analyzing the interference and performance between motor and/or cognitive tasks. Various studies showed that, when individuals simultaneously perform two tasks, the postural stability can decline during a dual-task compared with a single-task due to the attentional resources required performing the tasks. However, little is known about the cortical and muscular activity pattern during dual-task performance. Therefore, this study aims to analyze the muscular and prefrontal activity under dual-task performance in healthy young adults. Thirty-four healthy young adults (mean age ± SD = 22.74 ± 3.74 years) were recruited to perform a postural task (standing posture) and a dual-task (maintaining standing posture while performing a cognitive task). Lower-limb muscle activity was bilaterally collected from five muscles using surface electromyography (sEMG), and the co-contraction index (CCI) was also calculated for selected muscle pairings. The oxy- and deoxyhemoglobin concentrations (prefrontal cortex activity) were recorded using functional near-infrared spectroscopy (fNIRS). Data were compared between single- and dual-task performance. Prefrontal activity increased (p < 0.05), and muscle activity decreased in most analyzed muscles (p < 0.05), from the single-task to cognitive dual-task performing. The co-contraction index patterns changed from single- to dual-task conditions in most selected muscle pairs (p < 0.05). We conclude that the cognitive task negatively interfered with motor performance once the muscle activity decreased and the prefrontal cortex activity increased under a dual-task, suggesting that young adults prioritized cognitive task performance, and they allocated more attentional resources to the cognitive task over the motor performance. Understanding the neuromotor changes can help adopt a better clinical practice to prevent injuries. However, future studies are recommended to assess and monitor muscular and cortical activity during the dual-task performance to provide additional information about the cortical and muscular activity patterns in postural control while performing a dual-task.

Relationship Between Dual-Task Walking and Level of Conflict Between Gait and Concurrent Tasks in Adolescents

This study aimed to determine the role of resource conflict in dual-task (DT) effects on gait and concurrent tasks in children and adolescents. Gait was evaluated with and without concurrent tasks (visual-manual, visual-vocal and auditory-vocal). The roles of condition (single vs dual) and type of concurrent task in DT effect were tested by Repeated Measured of ANOVA. Relative changes from single to DT conditions were compared using One-Way ANOVA. There were significant reductions in gait speed, cadence, and stride length, and increases in double support time, step time and variability in step time, and no change in variability in stride length, step width, and concurrent task performance from single to DT conditions. DT effects on gait parameters and concurrent tasks were comparable across DT conditions.

Gait stability in ambulant children with cerebral palsy during dual tasks

Aim

The aim of this cross-sectional study was to measure the effect of dual tasks on gait stability in ambulant children with cerebral palsy (CP) compared to typically developing (TD) children.

Methods

The children of the CP (n = 20) and TD groups (n = 20) walked first without a dual task, then while counting forward and finally while alternatively naming fruits and animals (DTf/a). They then completed the same cognitive exercises while sitting comfortably. We calculated the distance between the foot placement estimator (FPE) and the real foot placement in the anterior direction (DFPEAP) and in the mediolateral direction (DFPEML) as a measure of gait stability, in a gait laboratory using an optoelectronic system. Cognitive scores were computed. Comparisons within and between groups were analysed with linear mixed models.

Results

The dual task had a significant effect on the CP group in DFPEAP and DFPEML. The CP group was more affected than the TD group during dual task in the DFPEML. Children in both groups showed significant changes in gait stability during dual tasks.

Interpretation

The impact of dual task on gait stability is possibly due to the sharing of attention between gait and the cognitive task. All children favoured a ‘posture second’ strategy during the dual task of alternatively naming animals and fruits. Children with CP increased their mediolateral stability during dual task.

Dual-task training effect on gait parameters in children with spastic diplegic cerebral palsy: Preliminary results of a self-controlled study

BACKGROUND

Children with cerebral palsy (CP) may have difficulties under dual-task conditions. Spatiotemporal gait parameters have deteriorated with concurrent tasks in children with CP. However, how dual-task training affects gait parameters in children with spastic diplegic CP has not been clarified.

RESEARCH QUESTION

How does dual-task training program effect gait, functional skills, and health-related quality of life in children with spastic diplegic CP?

METHODS

Eleven children with spastic diplegic CP (median age 11 y, range 7-16 y; 4 female; 7 male) Gross Motor Function Classification System level 1-2 and obtained 27 and higher scores from Modified Mini Mental Test included in the study. The study was planned as a self-controlled clinical research design. Children were recruited to conventional physiotherapy program for 8 weeks and dual-task training program added to conventional physiotherapy program for following 8 weeks. Children were evaluated at baseline, after conventional physiotherapy program, and after dual-task training program. Children's gait was evaluated with Zebris™ FDM-2 device and Edinburgh Visual Gait Score, functional mobility skills with 1 min Walk Test (1MWT), and health-related quality of life with the Pediatric Quality of Life Inventory (PedsQL) - CP module.

RESULTS

The difference in step length, step time, stride time, cadence and gait speed of spatiotemporal parameters of gait during dual-task performance were found statistically significant in children with spastic diplegic CP, after dual-task training program (p < 0,05). After dual-task training, statistically significant gains were found in 1MWT, movement and balance subtitle of PedsQL-CP module Parent Form (p < 0,05).

SIGNIFICANCE

Dual-task training program added to a conventional physiotherapy program provides more gains in terms of functionality of children with spastic diplegic CP will contribute to the improvement of the motor functional level.

Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial

The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children's experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant's experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.

Analysis of dynamic elbow flexion deformity in children with hemiplegic cerebral palsy

BACKGROUND

Cerebral palsy affects 1 per 1.000 children, and in 83% of the cases upper extremity is involved. Dynamic elbow flexion deformity is a movement disorder observed in individuals with hemiparesis secondary to cerebral palsy. We sought to determine whether children with hemiplegic cerebral palsy exhibit dynamic elbow flexion deformity during daily activities and its influence to reaching function.

METHODS

Sixteen children with upper limb hemiparesis and cerebral palsy (age 11y 7mo (SD 3y 2mo); 11 boys, 5 girls; Gross Motor Function Classification System level I or II) were included in this observational descriptive study. Manual Ability Classification System, Children's Hand-use Experience Questionnaire and Shriners Hospital for Children Upper Extremity Evaluation were used to evaluate affected upper extremity function. Spasticity was assessed with Modified Ashworth scale. Involuntary elbow flexion was recorded in eight daily activities. Elbow motion during reach function was measured.

FINDINGS

Fifteen out of 16 individuals showed dynamic elbow flexion deformity. There was a significative increase of involved median elbow flexion in all the activities studied, except for "high speed stairs climbing" evaluation. Children's Hand-use Experience Questionnaire showed that children were independent in most of the daily activities (21 out of 29). Correlation between dynamic elbow flexion deformity and Shriners Hospital for Children Upper Extremity Evaluation was observed only in sitting-standing activity (Spearman's ρ 0.549, P = 0.028).

INTERPRETATION

Dynamic elbow flexion deformity is very common in hemiplegic cerebral palsy and occurs proportionally to the degree of the effort demanded by the activities. Despite of presenting this movement disorder, it does not affect in children participation in daily activities.

The effect of dual-task conditions on gait and balance performance in children with cerebral palsy: A systematic review and meta-analysis of observational studies

Dual-task conditions are commonly experienced in daily routines. The aim of the present systematic review is to investigate the effect of dual-task conditions on gait and balance performance in children with cerebral palsy (CP) and to perform meta-analyses where applicable. Five databases, "ProQuest", "PubMed", "OTSeeker", "Scopus", and "PEDro" from the incipient date of databases up to Aug 24, 2020 were searched for studies focusing on the effects of dual-task conditions on gait and balance performance in children with CP. After removing irrelevant articles and applying inclusion and exclusion criteria, nine articles were included in the present systematic review and meta-analysis. The results of the meta-analysis showed that walking speed was slower during dual-task conditions compared to single-task conditions in children with CP (WMD = -0.29 m/s, 95% CI = -0.34, -0.24, P ≤ 0.001) and walking speed decreased in children with CP during dual-task conditions in comparison with the typical development (TD) control group (WMD = -0.19 m/s, 95% CI = -0.23 to -0.15, P ≤ 0.001). The results of subgroup analysis based on the type of task indicated that adding concurrent tasks to walking degrades walking speed under varied dual-task conditions. Additionally, theoretical synthesis of the literature demonstrated that other gait and balance variables are changed by performing cognitive and motor secondary tasks differently. Although these changes may be compensatory strategies to retain their stability, there was not sufficient evidence to reach a firm conclusion. Research gaps and recommendations for future studies are discussed.

Balance confidence and physical activity participation of independently ambulatory youth with cerebral palsy: an exploration of youths' and parents' perspectives

AIM

Youth with cerebral palsy generally participate in less physical activity than typically developing peers. In adults with physical disabilities, balance confidence is a strong predictor of participation and community re-integration. However, balance confidence has not been studied in youth with cerebral palsy.

METHOD

Qualitative descriptive methodology with interviews of eight youth with cerebral palsy (9-17 years old, three girls) in Gross Motor Function Classification System Levels I-III, and eight parents (five mothers) of youth with cerebral palsy (9-17 years old, two girls) in Levels I-III.

RESULTS

Three themes arose: (1) youth in Gross Motor Function Classification System Levels I-II are more concerned about losing their balance during physical activities than those in Level III; (2) when balance is lost, embarrassment and frustration are more common than fear, especially for those in Levels I-II; and (3) social factors can create a favorable participation environment when balance confidence is low, especially for youth in Levels I-II.

CONCLUSION

Balance confidence may have greater influence on physical activity participation for youth in Gross Motor Function Classification System Levels I-II than those in Level III. Youth in Levels I-II may draw greater benefit from interventions targeting balance confidence when addressing physical activity goals.IMPLICATIONS FOR REHABILITATIONBalance confidence may have a greater influence on activity avoidance for youth with cerebral palsy in Gross Motor Function Classification System Levels I and II (who are independently ambulatory without walkers or cane(s)) than for those in Level II (who use walkers or cane(s) to ambulate).Youth who are independently ambulatory without walkers or cane(s) may benefit more from interventions directed at balance confidence (e.g., enactive mastery and verbal persuasion) to address their physical activity participation goals.For youth who are independently ambulatory without walkers or cane(s), addressing factors that could reduce the influence of balance confidence on physical activity participation, such as providing a positive and supportive social environment in which to participate, may be beneficial.

Cognitive-Motor Interference Heightens the Prefrontal Cortical Activation and Deteriorates the Task Performance in Children With Hemiplegic Cerebral Palsy

OBJECTIVE

To compare the prefrontal cortex (PFC) activation and task performance during single- and dual-task conditions between typically developing (TD) children and children with hemiplegic cerebral palsy (HCP).

DESIGN

A prospective, comparative design.

SETTING

Research laboratory.

PARTICIPANTS

Participants (N=21) included 12 TD children (age, 6.0±1.1y) and 9 children with HCP (age, 7.2±3.1).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

PFC activation was assessed by measuring the concentration of oxygenated hemoglobin while the children performed a shape-matching task with their more affected arm while sitting on a stable (single task) vs dynamic surface (dual task). The task performance was assessed with the total number of shapes matched, dual-task cost, and reaction time (RT).

RESULTS

For both conditions, the children with HCP exhibited greater PFC activation, matched a fewer shapes, and had slower RT than the TD children. These differences were accentuated during the dual-task condition and the dual-task cost was greater. An increase in the PFC activation during the dual-task condition was tightly correlated with a higher dual-task cost in children with HCP (r=0.77, P=.01).

CONCLUSIONS

Children with HCP appear to have a heightened amount of PFC activity while performing a dual task. The greater cortical activity may be a result of the finite attentional resources that are shared between both the motor as well as cognitive demands of the task. The cognitive-motor interference is likely exacerbated in children with HCP because of the structural and functional brain changes as a result of an insult to the developing brain.

Impact of dual task on postural sway during sit-to-stand movement in children with unilateral cerebral palsy

BACKGROUND

To verify the effect of dual-task on postural oscillation during sit-to-stand movement in children with Cerebral Palsy.

METHODS

17 children with spastic unilateral cerebral palsy and 20 typically-developing children, aged 5 to 12 years, performed the following tasks: Simple task: sit-to-stand with arms crossed against the chest; bimanual dual-task: sit-to-stand while carrying a tray; unimanual dual-task: sit-to-stand while holding a plastic cup with one hand. For data analysis, sit-to-stand was divided in three phases: preparation (phase 1), rising (phase 2), and stabilization (phase 3). Postural control was measured using a force plate, and the variables analyzed were: area, anterior-posterior and medial-lateral velocity, and STS duration. Analysis of variance was applied to test the effects of group; task conditions and interactions.

FINDINGS

Children with cerebral palsy presented higher values of postural oscillation when compared to their typical pairs. Bimanual and Unimanual dual tasks presented greater postural oscillation values in sit-to-stand phase 1 compared to simple task. In bimanual dual-task, children with cerebral palsy presented lower values of velocity in phases 3, and greater postural oscillation and duration of the task when compared to single-task and unimanual dual-tasks. I.

INTERPRETATION

The insertion of a secondary task seems to interfere differently children with cerebral palsy, depending on the specific demands of each task. Thus, the importance of inserting dual tasks in the interventions is emphasized, considering that they are executed extensively in the day to day, and can act as facilitators or challenge in the execution of functional tasks.

Working memory is a core executive function supporting dual-task locomotor performance across childhood and adolescence

Most daily-life ambulatory tasks involve dual tasking, for example, talking while walking. In children, the evidence supporting the effects of age on dual tasking is confounded by the difficulty of the cognitive task and lack of adjustment to suit individual cognitive abilities. To address this issue, the current study examined the effects of age, cognitive load, and executive functioning on the degree of dual-task gait interference across childhood and adolescence. We tested 120 typically developing children aged 6-11 years, adolescents aged 12-16 years, and young adults aged 18-25 years. Participants were asked to walk while performing a visuospatial working memory task at two levels of cognitive load (easy and difficult) adjusted to suit each participant's cognitive ability. Spatiotemporal characteristics and intra-individual variability of gait were measured using a GAITRite electronic walkway. Irrespective of the cognitive load level, children aged 6 to 11 years showed greater dual-task gait interference for selective spatiotemporal gait characteristics; however, the younger children showed a trade-off pattern in gait variability whereby they prioritized gait stability at the expense of cognitive performance. Our results also showed that age and working memory capacity were significant predictors of dual-task interference for a range of complementary gait parameters in the combined sample. Importantly, working memory capacity was part of a moderating relationship between age and dual-task gait interference. These findings emphasize the importance of dual-task prioritization strategies in younger children and highlight the role of individual differences in working memory capacity in performance in dual-task gait situations.

Benefits of a Dance Intervention on Balance in Adolescents with Cerebral Palsy

AIMS

Cerebral palsy (CP) impacts motor functions such as balance, limits of stability and walking, and may also affect other functions such as attention and rhythm production. Motor and non-motor deficits lead to difficulties in daily life activities. The main objective of this study was to evaluate the effects of a dance intervention on balance in adolescents with CP. The secondary objectives were to evaluate the effects of this intervention on walking speed, attention, and rhythm production.

METHODS

A pre-post design study with a double baseline was conducted on ten adolescents with CP in order to assess the effects of a 10-week dance intervention. The dance intervention focused on improving balance and limits of stability. Outcomes on static and dynamic balance were evaluated with clinical and laboratory tests before and after the intervention. Walking speed, attention, and rhythm production were also evaluated before and after the intervention.

RESULTS

Balance improved after the dance intervention as assessed with both the clinical tests and a laboratory test. Rhythm production also improved after the dance intervention.

CONCLUSIONS

Results suggest that a 10-week dance intervention is an effective activity to improve static and dynamic balance as well as rhythmic production in adolescents with CP.

Shared neural recruitment across working memory and motor control tasks as a function of task difficulty and age

Past research suggests that working memory (WM) and motor control may engage similar cognitive and neural mechanisms in older adults, particularly when task difficulty increases. However, much of this evidence arises from comparisons across behavioral and imaging studies that test only one of the foregoing functional domains. The current study used fMRI within the same group of older adults to investigate whether WM and motor control recruit common mechanisms, and whether recruitment increased with task demand and age. A conjunction analysis across WM and motor tasks revealed engagement of several frontoparietal regions as a function of increasing task demand. A separate conjunction analysis which included age as a predictor showed comparable regions exhibit increased recruitment with both increasing task demand and age. Results suggest that the recruitment of common frontoparietal regions across WM and motor tasks in response to task difficulty is maintained across the older adult lifespan.

Dynamic stability during walking in children with and without cerebral palsy

BACKGROUND

Cerebral palsy (CP) is associated with a high risk of falling during walking. Many gait abnormalities associated with CP likely alter foot placement and center of mass (CoM) movement in a way that affects anterior or lateral dynamic stability, in turn influencing fall risk.

RESEARCH QUESTION

Do children with CP demonstrate altered anterior or lateral dynamic stability compared to typically-developing (TD) children?

METHODS

In this case-control, observational study, we measured gait kinematics of two groups of children (15 CP, 11 GMFCS level I, 4 GMFCS level II; 14 TD; age 5-12) in walking conditions of a preferred speed, a fast speed, and a preferred speed while completing a cognitive task. For dominant and non-dominant limbs, the margin of stability (MoS), a spatial measure of dynamic stability, was calculated as the distance between the edge of the base of support and the CoM position after accounting for scaled velocity. Statistical comparisons of were made using mixed factorial ANOVAs. Post hoc comparisons were Sidak adjusted.

RESULTS

The anterior MoS before foot strike and at mid-swing differed between each condition but not between groups. Based on the minimum lateral MoS, children with CP had more stability when bearing weight on their non-dominant limb compared to TD children. These differences were not apparent when on the dominant limb.

SIGNIFICANCE

This high-functioning group of children with CP exhibited a more conservative lateral stability strategy during walking when bearing weight with the non-dominant limb. This strategy may be protective against lateral falls. We observed no between-group differences in anterior stability. Because CP has been previously associated with impaired anterior balance reactions, and there was no observed compensation in anterior gait stability, this lack of group differences could contribute to a higher risk of falling in that direction.

Performance of stair negotiation in patients with cerebral palsy and stiff knee gait

BACKGROUND

Due to the limited knee range of motion, achieving adequate foot clearance while walking on level ground constitutes a major problem for patients with cerebral palsy and stiff knee gait. Stair negotiation as an activity of daily life requires a considerably higher knee range of motion than level ground walking, but little is known yet as to whether such patients are able to walk stairs.

RESEARCH QUESTION

The aim of this study was to investigate how patients with a limited knee range of motion negotiate stairs. Do they increase their peak knee flexion and use the same pattern as in walking on level ground? How do the muscles act during stair negotiation?

METHODS

In this explorative study, 17 adults with bilateral, spastic cerebral palsy and stiff knee gait and 25 healthy subjects were examined. 3D motion analysis, including electromyography, was performed while walking on level ground, upstairs, and downstairs. A linear mixed model was used for between- and within-group comparisons.

RESULTS

Walking upstairs and downstairs, patients increased their peak knee flexion by around 30° compared to level walking. Thus, increased knee flexion may be seen as the main mechanism for maintaining foot clearance on stairs. An increased pelvic obliquity (elevation) and hip flexion were also found and involved subjects showed a slight increase in rectus femoris activity when walking on stairs compared to level walking within the phases of high knee flexion.

SIGNIFICANCE

This study showed that patients with cerebral palsy and stiff knee gait are able to flex their knees more than would be required for level walking. Hence, the patients are able to adapt their rectus activity to stair walking to some extent. Therefore, further investigations might help to open up new therapeutic options to facilitate level walking and stair negotiation in patients with stiff knee gait.

The effects of dual tasks on gait in children with cerebral palsy

AIM

To assess the gait and cognitive performances of children with cerebral palsy (CP) during dual tasks (DT) in comparison to typically developing (TD) children.

METHOD

This prospective, observational, case-control study included 18 children with CP (7 girls, 11 boys; median age 12 [10:13] years and 19 controls (9 girls, 10 boys; median age 12 [10:13y6mo] years). Performances were recorded during a simple walking task, 5 DT (walking + cognitive tasks with increasing cognitive load), and 5 simple cognitive tasks (while sitting). Gait parameters were computed using an optoelectronic system during walking tasks. Six parameters were selected for analysis by a principal component analysis. Cognitive performance was measured for each cognitive task. The dual-task cost (DTC) was calculated for each DT.

RESULTS

Gait performance decreased in both groups as DT cognitive load increased (e.g., walking speed normalized by leg length, in simple task: 1.25 [1.15:1.46] s^-1 for CP, 1.53 [1.38:1.62] s^-1 for TD; DT with highest load: 0.64 [0.53:0.80] s^-1 for CP, 0.95 [0.75:1.08] s^-1 for TD). The CP group performed significantly worse than TD group in every task (including the simple task), but DTC were similar in both groups. A task effect was found for the majority of the gait parameters.

INTERPRETATION

The reduced gait performance induced by DT may generate underestimated difficulties for children with CP in daily-life situations, where DT are common. This should be considered in clinical assessments.

Aberrant Interhemispheric Functional Organization in Children with Dyskinetic Cerebral Palsy

Background

Hemispheric asymmetry is one fundamental principle of neuronal organization. Interhemispheric connectivity and lateralization of intrinsic networks in the resting-state brain demonstrate the interhemispheric functional organization and can be affected by disease processes. This study aims to investigate the interhemispheric organization in children with dyskinetic cerebral palsy (DCP) based on resting-state functional MRI (fMRI).

Methods

24 children with DCP and 20 healthy children were included. Voxel-mirrored homotopic connectivity (VMHC) was calculated to detect the interhemispheric connectivity, and the lateralization of the resting-state networks was performed to examine the asymmetry of the intrinsic networks of brain.

Results

Decreased interhemispheric connectivity was found at visual, motor, and motor-control related regions in children with DCP, while high cognitive related networks including the central executive network, the frontoparietal network, and the salience network represented decreased asymmetry in children with DCP. Abnormal VMHC in visual areas, as well as the altered lateralization in inferior parietal lobule and supplementary motor area, showed correlation with the gross motor function and activities of daily living in children with DCP.

Conclusion

These findings indicate that the interhemispheric functional organization alteration exists in children with DCP, suggesting that abnormal interhemispheric interaction may be a pathophysiological mechanism of motor and cognitive dysfunction of CP.

Influence of accuracy constraints on bimanual coordination and gait performance in children with unilateral spastic cerebral palsy

BACKGROUND

Children with unilateral spastic cerebral palsy (USCP) have both upper and lower extremities movement impairments of their more affected side. Many daily activities require whole body movement control. However, most studies for children with USCP only evaluated either upper or lower extremity impairments.

RESEARCH QUESTION

The present study aimed to assess the effects of accuracy constraints on walking and bimanual coordination for children with USCP during a whole body task.

METHODS

Ten children with USCP (age: 7-12 years; GMFCS levels: I - II) and ten age-matched typically-developed children (TDC) participated in the study. They were asked to walk and carry a water bottle with and without a cap using a tray at a preferred speed while 3-D kinematic analyses were performed. The two tasks of carrying a water bottle with and without a cap were each performed 5 trials with randomized order between participants.

RESULTS

TDC significantly decreased their walking speed, stride length, height differences between the two hands (symmetric bimanual coordination), vertical hand movement, and elbow joint excursion under higher accuracy constraints with no water bottle cap. Children with USCP showed significantly decreased walking speed, vertical hand movement, and elbow joint excursion under higher accuracy constraints. Children with USCP also significantly decreased walking deviation of line of progression.

SIGNIFICANCE

It is exciting to see that children with USCP GMFCS levels I and II were able to maintain their bimanual coordination and modify their gait performance under higher accuracy constraints. Therefore, future treatments or assessments could consider manipulating accuracy constraints even during complex whole body tasks for children with USCP.

Dual-task effects in children with neuromotor dysfunction: a systematic review

INTRODUCTION

Based on the assumption that motor actions result from the interaction between cognitive, perceptual, mechanical and neurological mechanisms, neuromotor dysfunctions are expected to impair central coordination processes required to perform dual-tasks. The aim of the present work was to systematically review the literature concerning the effects of dual-task in the activities performed by children with neuromotor dysfunctions.

EVIDENCE ACQUISITION

A tailored search strategy in relevant databases was conducted by two independent reviewers in August 2018 seeking for online articles published in English evaluating dual-task (motor-motor, cognitive-cognitive or cognitive-motor) effects on activities in subjects with neuromotor dysfunctions younger than 18 years. The following data were extracted: category of dual-task paradigm (motor-motor; cognitive-cognitive; cognitive-motor), primary and secondary tasks, study methods, methodological quality of the studies, and research gaps in the literature.

EVIDENCE SYNTHESIS

We identified 13 full-text reports that fulfilled the predefined inclusion and exclusion criteria.

CONCLUSIONS

There are a few high-quality studies addressing dual-task effects on activities performed by children with neuromotor dysfunctions. These children show greater susceptibility to dual-task costs than typical ones. There is a lack of studies addressing children with CP and Down Syndrome, which are highly prevalent and commonly seen in clinical settings. Thus, dual-task effects in children with neuromotor dysfunctions remain a wide research field, with need for further studies to fill in the existing gaps.

Dual-task training of children with neuromotor disorders during robot-assisted gait therapy: prerequisites of patients and influence on leg muscle activity

BACKGROUND

Walking in daily life is complex entailing various prerequisites such as leg strength, trunk stability or cognitive and motor dual task (DT) activities. Conventional physiotherapy can be complemented with robot-assisted gait therapy (RAGT) and exergames to enhance the number of step repetitions, feedback, motivation, and additional simultaneously performed tasks besides walking (e.g., dual-task (DT) activities). Although DT gait training leads to improvements in daily ambulation in adult patient groups, no study has evaluated RAGT with a DT exergame in children with neurological gait disorders. Therefore, we investigated children's functional and cognitive prerequisites to walk physiologically during RAGT with a DT exergame and analysed the influence of DT on leg muscle activity.

METHODS

Children and adolescents (6-18 years) with neurological gait disorders completed RAGT with and without a DT exergame in this quasi-experimental study. We assessed several measures on the body function and activity domains (according to the International Classification of Functioning, Disability, and Health (ICF)) and determined whether these measures could distinguish well between children who walked physiologically during the DT RAGT or not. We measured leg muscle activity with surface electrodes to identify changes in EMG-amplitudes and -patterns.

RESULTS

Twenty-one children participated (7 females, 6.5-17.3 years, Gross Motor Function Classification System (GMFCS) levels I-IV). Most activity measures distinguished significantly between participants performing the DT exergame physiologically or not with moderate to good sensitivity (0.8 ≤ sensitivity≤1.0) and specificity (0.5 ≤ specificity≤0.9). Body function measures differentiated less well. Despite that the EMG-amplitudes of key stance muscles were significantly lower during DT versus no DT exergaming, the mean activation patterns of all muscles correlated high (ρ > 0.75) between the conditions.

CONCLUSION

This study is the first that investigated effects of a DT exergame during RAGT in children with neurological gait disorders. Several performance measures could differentiate well between patients who walked with physiological versus compensatory movements while performing the DT exergame. While the DT exergame affected the leg muscle activity amplitudes, it did not largely affect the activity patterns of the muscles.

Functional Connectivity Alterations in Children with Spastic and Dyskinetic Cerebral Palsy

Cerebral palsy (CP) has long been investigated to be associated with a range of motor and cognitive dysfunction. As the two most common CP subtypes, spastic cerebral palsy (SCP) and dyskinetic cerebral palsy (DCP) may share common and distinct elements in their pathophysiology. However, the common and distinct dysfunctional characteristics between SCP and DCP on the brain network level are less known. This study aims to detect the alteration of brain functional connectivity in children with SCP and DCP based on resting-state functional MRI (fMRI). Resting-state networks (RSNs) were established based on the independent component analysis (ICA), and the functional network connectivity (FNC) was performed on the fMRI data from 16 DCP, 18 bilateral SCP, and 18 healthy children. Compared with healthy controls, altered functional connectivity within the cerebellum network, sensorimotor network (SMN), left frontoparietal network (LFPN), and salience network (SN) were found in DCP and SCP groups. Furthermore, the disconnections of the FNC consistently focused on the visual pathway; covariance of the default mode network (DMN) with other networks was observed both in DCP and SCP groups, while the DCP group had a distinct connectivity abnormality in motor pathway and self-referential processing-related connections. Correlations between the functional disconnection and the motor-related clinical measurement in children with CP were also found. These findings indicate functional connectivity impairment and altered integration widely exist in children with CP, suggesting that the abnormal functional connectivity is a pathophysiological mechanism of motor and cognitive dysfunction of CP.

Whole body organization during a symmetric bimanual pick up task for children with unilateral cerebral palsy

BACKGROUND

Information on whole-body coordination involving bimanual coordination for children with unilateral spastic cerebral palsy (USCP) is limited.

RESEARCH QUESTION

The purpose of the current study is to test the hypothesis that during a whole-body pick up task, children with USCP will organize their whole- body movements and bimanual coordination differently than typically-developing children (TDC).

METHODS

Twelve children with USCP (average age: 8.3; MACS levels: I-II) and twelve age-matched TDC participated in the study. Children were asked to reach down, grasp, and pick up an empty box to waist height while Kinematic and Kinetic data were recorded and analyzed using a VICON system and two AMTI force plates.

RESULTS

Children with USCP had longer overall movement time, reaching down time, and grasping movement time (all P < 0.05) than TDC. Less bimanual coordination was indicated by greater finger vertical position differences and movement onset and offset timing differences (all P < 0.05). Additionally, greater bilateral joint position on differences were found for shoulder, elbow, hip, and knee when reaching down and for shoulder and elbow at the end of the task (all P < 0.05). Greater asymmetric bilateral ground reaction force and greater lateral and anterior center of pressure excursion were also found in children with USCP (all P < 0.05).

SIGNIFICANCE

Impairments in both bimanual and whole-body coordination were found during a simple whole-body task in children with USCP. Future treatments or assessments should consider whole-body tasks involving dual task constraints.

How Executive Functions Are Evaluated in Children and Adolescents with Cerebral Palsy? A Systematic Review

Aims: The aim of the present study was to examine how executive functions are assessed in children and adolescents with Cerebral Palsy.

Method: A systematic literature review was conducted using four bibliographic databases (WebScience, Scopus, PubMed, and Psycinfo), and only studies that evaluated at least one executive function were selected. Both the research and reporting of results were based on Cochrane's recommendations and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.

Results: The instrument most frequently used was the D-KEFS. All studies point to the existence of impairments in the executive functions among children and adolescents with Cerebral Palsy with an impact on several cognitive and life domains.

Interpretation: There is a need to further systematize the research protocols to study the executive functions and their assessment in the intervention context. Findings of this review presented a diversity of tests (e.g., D-KEFS) or tasks (e.g., The inhibitory ability task) used with children with Cerebral Palsy. However, no information was given about adaptations performed to the test/task to meet Cerebral Palsy's specificities. Future research could consider including this information, which is key both to researchers and practitioners. The results of this study have important implications and suggestions for future avenues and guidelines for research and practice.

Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis

Auditory entrainment can influence gait performance in movement disorders. The entrainment can incite neurophysiological and musculoskeletal changes to enhance motor execution. However, a consensus as to its effects based on gait in people with cerebral palsy is still warranted. A systematic review and meta-analysis were carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal and kinematic parameters of gait in people with cerebral palsy. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and American Academy for Cerebral Palsy and Developmental Medicine guidelines, from inception until July 2017, on online databases: Web of Science, PEDro, EBSCO, Medline, Cochrane, Embase and ProQuest. Kinematic and spatiotemporal gait parameters were evaluated in a meta-analysis across studies. Of 547 records, nine studies involving 227 participants (108 children/119 adults) met our inclusion criteria. The qualitative review suggested beneficial effects of rhythmic auditory cueing on gait performance among all included studies. The meta-analysis revealed beneficial effects of rhythmic auditory cueing on gait dynamic index (Hedge's g=0.9), gait velocity (1.1), cadence (0.3), and stride length (0.5). This review for the first time suggests a converging evidence toward application of rhythmic auditory cueing to enhance gait performance and stability in people with cerebral palsy. This article details underlying neurophysiological mechanisms and use of cueing as an efficient home-based intervention. It bridges gaps in the literature, and suggests translational approaches on how rhythmic auditory cueing can be incorporated in rehabilitation approaches to enhance gait performance in people with cerebral palsy.

Three Faces of Fragile X

Fragile X syndrome (FXS) is the first of 3 syndromes identified as a health condition related to fragile X mental retardation (FMR1) gene dysfunction. The other 2 syndromes are fragile X-associated primary ovarian insufficiency syndrome (FXPOI) and fragile X-associated tremor/ataxia syndrome (FXTAS), which together are referred to as fragile X-associated disorders (FXDs). Collectively, this group comprises the 3 faces of fragile X. Even though the 3 conditions share a common genetic defect, each one is a separate health condition that results in a variety of body function impairments such as motor delay, musculoskeletal issues related to low muscle tone, coordination limitations, ataxia, tremor, undefined muscle aches and pains, and, for FXTAS, a late-onset neurodegeneration. Although each FXD condition may benefit from physical therapy intervention, available evidence as to the efficacy of intervention appropriate to FXDs is lacking. This perspective article will discuss the genetic basis of FMR1 gene dysfunction and describe health conditions related to this mutation, which have a range of expressions within a family. Physical therapy concerns and possible assessment and intervention strategies will be introduced. Understanding the intergenerational effect of the FMR1 mutation with potential life-span expression is a key component to identifying and treating the health conditions related to this specific genetic condition.

Control of grip force and vertical posture while holding an object and being perturbed

We investigated motor control perspectives of coordinating maintenance of posture and application of grip force when holding an object and being perturbed. Ten subjects stood on the force platform holding an instrumented object in their dominant hand and were exposed to an external perturbation applied to their shoulders. Task demands were manipulated by positioning a slippery cap on top of the instrumented object. Grip force applied to the object, the object acceleration and the center of pressure (COP) were recorded and analyzed during the time intervals typical for the anticipatory (APA) and compensatory (CPA) components of postural control. Onsets of grip force were seen before the onsets of the COP displacement and initiation of movements of the handheld object during the APA phase of postural control, while the onsets of maximum grip force preceded the maximum COP displacement during the CPA phase. When the task demands increased by holding a handheld object with the slippery cap, subjects tended to generate grip force earlier and of a smaller magnitude; also, the COP displacement in the APA phase was smaller as compared to holding a handheld object only. The outcome provides a foundation for future studies of maintenance of vertical posture in people with impairments of balance and grip force control when holding an object and being perturbed.

Walking-induced muscle fatigue impairs postural control in adolescents with unilateral spastic cerebral palsy

BACKGROUND

Fatigue is likely to be an important limiting factor in adolescents with spastic cerebral palsy (CP).

AIMS

To determine the effects of walking-induced fatigue on postural control adjustments in adolescents with unilateral CP and their typically developing (TD) peers.

METHODS

Ten adolescents with CP (14.2 ± 1.7 yr) and 10 age-, weight- and height-matched TD adolescents (14.1 ± 1.9 yr) walked for 15 min on a treadmill at their preferred walking speed. Before and after this task, voluntary strength capacity of knee extensors (MVC) and postural control were evaluated in 3 conditions: eyes open (EO), eyes closed (EC) and with dual cognitive task (EODT).

RESULTS

After walking, MVC decreased significantly in CP (-11%, P<0.05) but not in TD. The CoP area was only significantly increased in CP (90%, 34% and 60% for EO, EC and EODT conditions, respectively). The CoP length was significantly increased in the EO condition in CP and TD (20% and 21%) and was significantly increased in the EODT condition by 18% in CP only.

CONCLUSIONS

Unlike TD adolescents, treadmill walking for 15 min at their preferred speed lead to significant knee extensor strength losses and impairments in postural control in adolescents with unilateral spastic CP.

Functional balance and gross motor function in children with cerebral palsy

AIMS

To compare scores of children with cerebral palsy (CP) at different levels of Gross Motor Function Classification System (GMFCS), using the Pediatric Balance Scale (PBS) and to assess whether it can be used to predict GMFCS levels in children with CP.

METHODS

Fifty-eight children with CP levels I-V of GMFCS were assessed by PBS and grouped according to their GMFCS level.

RESULTS

It was observed differences in PBS scores between GMFCS I and II and between GMFCS II and III groups. Discriminant analysis indicated a 67% accuracy for the PBS instrument in assessing the GMFCS level of children with CP.

INTERPRETATION

PBS is able to detect differences among GMFCS levels I, II, and III of mild and moderate impairment. Accordingly, PBS can be used reliably in clinical practice to indicate the motor impairment level of such children. The results enable specify the expected tasks that are expected to be accomplished by the children in each GMFCS level, contributing with therapeutic planning and monitoring.

Postural control impairments in individuals with autism spectrum disorder: a critical review of current literature

CONTEXT

Motor impairments in individuals with autism spectrum disorder (ASD) have been frequently reported. In this review, we narrow our focus on postural control impairments to summarize current literature for patterns, underlying mechanisms, and determinants of posture in this population.

EVIDENCE ACQUISITION

A literature search was conducted through Medline, ISI web of Knowledge, Scopus and Google Scholar to include studies between 1992 and February 2013.

RESULTS

Individuals with ASD have problems in maintaining postural control in infancy that well persists into later years. However, the patterns and underlying mechanisms are still unclear.

CONCLUSIONS

Examining postural control as an endophenotype or early diagnostic marker of autism is a conceptual premise which should be considered in future investigations. At the end of the review, methodological recommendations on the assessment of postural control have also been provided.

Clinimetric properties of sitting balance measures for children with cerebral palsy: a systematic review

Assessment of sitting balance in children and youth with cerebral palsy (CP) is critical in order to design appropriate interventions to enhance activities and participation. This systematic review synthesized research evidence on the reliability, validity, responsiveness to change, and clinical utility of sitting balance measures for children and youth with CP. A two-tiered search in August 2012 using nine peer-reviewed electronic databases yielded nine articles with relevant information on seven clinical measures. Four of seven clinical measures: the Pediatric Reach Test (PRT), Sitting Assessment for Children with Neuromotor Dysfunction (SACND), Segmental Assessment of Trunk Control (SATCo), and Trunk Control Measurement Scale (TCMS), demonstrate acceptable overall applicability (at least one study supporting clinical utility, reliability, and validity) and are thus recommended for use in practice. Ongoing research on responsiveness to change, however, is warranted to support validity for outcomes measurement.

Influence of dual task constraints on gait performance and bimanual coordination during walking in children with unilateral cerebral palsy

The purpose of the current study was to evaluate the effects of dual task constraints on walking and bimanual coordination for children with and without unilateral Cerebral Palsy (CP). Ten children with unilateral CP (age 7-11 years; MACS levels I-II) and ten age-matched typically developed children were asked to first stand still while holding a box level (standing condition), second, to walk along a path (baseline condition), and third to walk again while carrying a box steady and level (dual task condition) at a preferred speed. The results showed that children with unilateral CP decreased their walking speed, stride length, step width, and toe clearance from the floor under dual task constraints when compared to the baseline condition (all p's<0.05), however, typically developing children did not change. Children with unilateral CP also had less level box carrying, larger vertical box movement, and larger elbow movements when compared to typically developing children under dual task condition (all p's<0.05). Dual task constraints with a secondary motor task like the current walking with a box task seemed challenging for children with unilateral CP. Therefore, future treatments or assessments should consider using dual task constraints to manipulate the difficulty of tasks.

Functionality level and its relation to postural control during sitting-to-stand movement in children with cerebral palsy

In this study we studied functional performance and functional balance in children with cerebral palsy (CP) and typically developing (TD) children. The relationship between these components and postural control during sit-to-stand movement (STS) was also investigated. Ten children with CP (GMFCS I and II) and 27 TD children, ages 5-12 years, were included in the study. The Pediatric Evaluation of Disability Inventory (PEDI) and the Pediatric Balance Scale (PBS) were used to measure functional performance and functional balance, respectively. Postural control during STS was assessed by means of a force plate. Participants were asked to stand from a chair with feet over a force plate. Children with CP exhibited lower scores than TD children in the PBS and in the mobility Functional Skills and Caregiver Assistance domains of the PEDI (p≤0.05). In both groups postural control during STS movement was correlated with mobility Caregiver Assistance scores of the PEDI. The results demonstrate that although the participants had mild to moderate motor impairment, they exhibit deficits in their level of functional performance and functional balance compared to typical children. Moreover, it was observed that impairments in postural control during the STS movement are related to functional performance in both groups. This result demonstrates the importance of the structure and function components to the level of activity in children.

Assessment of postural control in children with cerebral palsy: a review

This paper aimed to review studies that assessed postural control (PC) in children with cerebral palsy (CP) and describe the methods used to investigate postural control in this population. It also intended to describe the performance of children with CP in postural control. An extensive database search was performed using the keywords: postural control, cerebral palsy, children, balance and functionality. A total of 1065 papers were identified and 25 met the inclusion criteria. The survey showed that PC is widely studied in children with CP, with reliable methods. The link between postural control and functionality was also evident. However, a lack of studies was observed assessing postural control in these children by means of scales and functional tests, as well as exploring postural control during daily functional activities. Thus research addressing these issues can be a promising field for further research on postural control.

Posturografia na análise do equilíbrio em crianças com paralisia cerebral: revisão de literatura

Crianças com paralisia cerebral (PC) apresentam menor equilíbrio postural pelo comprometimento de funções motoras, sensoriais e centrais. Existem diversos protocolos funcionais para análise do equilíbrio, mas poucos estudos têm utilizado a plataforma de força como instrumento de precisão nessa avaliação. O objetivo desta revisão foi identificar artigos publicados que utilizaram essa avaliação em crianças com PC e analisar os protocolos e parâmetros utilizados. Para tanto, foi realizada uma busca nas seguintes bases de dados: LILACS, IBECS, MEDLINE, Biblioteca Cochrane e SciELO, por meio da Biblioteca Virtual em Saúde. Foram encontrados 165 artigos; a partir dos critérios de inclusão e exclusão, foram selecionados 16 artigos. Os estudos mostraram que os parâmetros lineares de deslocamento médio-lateral e anteroposterior do centro de pressão e a razão desses deslocamentos têm sido utilizados com maior frequência, e que o tempo de avaliação na plataforma de força, na maioria dos estudos, não excede os 20 segundos. Foi demonstrado ainda que crianças com desenvolvimento típico apresentam melhor controle postural, e que crianças com PC podem incrementar seu equilíbrio a partir de intervenções específicas, inclusive em plataforma de força.

Applying motor-control theory to physical therapy practice: a case report

PURPOSE

This case report describes the application of an integrated, systems-based theory of motor control to physical therapy practice.Client Description: The patient was a 5-year-old boy with spastic hemiplegic cerebral palsy who was entering kindergarten. Parent concerns related to the child's safety in playground activities such as playing on the slide.

INTERVENTIONS

Motor-control theory, including factors related to the task, the environment, and the individual, was used to guide and direct physical therapy management related to the patient goal of safely and effectively climbing the ladder to the playground slide.Patient Outcomes: When the child entered kindergarten, he was able to safely ascend the ladder to the playground slide, using a modified movement pattern, when distractions were minimized. However, attentional issues continued to affect task execution when other children were present.

IMPLICATIONS

This case report demonstrates a means by which current knowledge and theory can be integrated into clinical practice.

FUTURE DIRECTIONS

Applying motor-control theory to this case led to the development of clinical questions for future research.

A neurocognitive perspective on developmental disregard in children with hemiplegic cerebral palsy

A common problem in children with hemiplegic cerebral palsy (CP) is the asymmetrical development of arm and hand capacity caused by the lack of use of the affected upper limb, or developmental disregard. In this paper, we provide a neuropsychological model that relates developmental disregard to attentional processes and motor learning. From this model, we hypothesize that high attentional demands associated with the use of the affected upper limb might hinder its use in daily life, and therefore may be a factor in developmental disregard. This can be assessed with a dual-task paradigm. However, until now, this has not been applied to children with CP. We provide recommendations for using a dual-task paradigm in children with CP based on empirical studies in typically developing children and children with developmental coordination disorder. Ultimately, these dual-task studies may be used to improve interventions aimed at reducing developmental disregard.

Executive functions in youth with spastic cerebral palsy

Dependent on criteria used, between 35% and 53% of the participants with cerebral palsy fulfilled the criteria of clinically relevant executive function problems as defined by Conners' (1994) Continuous Performance Test. Executive function problems were noticed mainly in participants with bilateral brain lesions and who had been born preterm. Findings highlight the need to check for attention problems in children with cerebral palsy.

Inspection time and attention-deficit/hyperactivity disorder symptoms in children with cerebral palsy

OBJECTIVE

To examine between-groups differences in the associations between aspects of processing speed assessed with an inspection time task and attention-deficit/hyperactivity disorder (ADHD) symptoms.

RESEARCH DESIGN

Two groups comprising 34 children with cerebral palsy (CP) and 70 nonaffected peers (control), ages 8-16 years, participated in a prospective correlational study. Measures included a visual inspection time task and the Conners' Parent Rating Scale-Revised: Long Version.

RESULTS

Children with CP exhibited significantly slower processing speed and more symptoms of inattention and hyperactivity than controls. Significant associations between inspection time and ADHD symptoms were found only in the control group.

CONCLUSIONS

Findings have implications for clinical assessment and understanding of attentional risks associated with CP.

Postural control and attentional demand during adolescence

In the present study we aimed to determine the attentional cost of postural control during adolescence by studying the influence of a cognitive task on concurrent postural control. 38 teenagers aged 12 to 17years and 13 young adults (mean age=26.1) stood barefoot on a force platform in a semi-tandem position. A dual-task paradigm consisted of performing a Stroop or a COUNTING BACKWARD task while simultaneously standing quietly on a firm or foam support surface. Different centre of pressure (CoP) measures were calculated (90% confidence ellipse area, mean velocity, root mean square on the antero-posterior (AP) and medio-lateral (ML) axes). The number and percentage of correct responses in the cognitive tasks were also recorded. Our results indicate (1) higher values of surface, ML mean velocity and ML RMS in the COUNTING BACKWARD task in adolescents aged 12 to 15 than in teenagers aged 16 to 17 and in adults, regardless of the complexity of the postural task and, (2) better cognitive performances in the Stroop than in the COUNTING BACKWARD task. The difference in the dual-task performance between the different age groups and particularly the existence of a turning point around 14-15years of age might be due to 1) difficulties in properly allocating attentional resources to two simultaneous tasks and/or, 2) the inability to manage increased cognitive requests because of a limited information processing capacity in adolescents aged 14-15years.