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14.13 Balance training with visual feedback in childrenwith hemiplegic cerebral palsy
Chapter 14. Developmental sensory, motor and mental disorders
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action in particular might be preserved in these children. Anticipatory Postural Adjustments (APA) were investigated in children with DMD by the mean of the bimanual load lifting task [2]. M e t h o d s : This task involves the coordination between a manual movement, lifting a load placed on the controlateral forearm, and the stabilization of the postural forearm that supports the load. Eight children with DMD from 4 to 11 years of age were compared to 8 healthy children. Elbow angle and multiple surfaces EMG were recorded on the postural forearm. Results: The early onset of the EMG patterns assessed the use of APA in children with DMD. However, the forearm stabilization was less efficient in this group than in the control one. At the same time, the muscular strategy exploited by DMD children was in favor of a superior use of the adult-like inhibition pattern, which requires a low cost of energy. Discussion and c o n c l u s i o n : Despite the integrity of the feedforward control of posture, the muscle weakness induces a less efficient postural stabilization in children with DMD. Interestingly, these children used the inhibition pattern, which cost in energy is lower, more frequently than control children [2]. This raises the question of the plasticity of the selection process, which is fundamental during development.
References [1] Di Lazzaro V, Restuccia D, Servidei S, Nardone R, Oliviero A, Profice P, Mangiola F, Tonali P, Rothwell JC. Functional involvement of cerebral cortex in Duchenne muscular dystrophy. Muscle Nerve 1998; 21:662 664. [2] Schmitz C, Martin N, Assaiante C. Building anticipatory postural adjustment during childhood: a kinematic and electromyographic analysis of unloading in children from 4 to 8 years of age. Exp Brain Res 2002; 142:354 364.
[•2]
Anticipatory postural adjustments in a bimanual load-lifting task in children with developmental coordination disorder
M. Jover1, L. Centelles1, C. Schmitz1, F. Brun 2, B. Chabrol 1,2, C. Assaiante 1 . 1 Groupe Ddveloppement et Pathologie de l'Action.
CNRS Marseille, France," 2 Unitd de Mddecine Infantile. CHU Timone Enfants, Marseille, France
[2] Johnston LM, Burns YR, Brauer SG, Richardson CA. Differences in postural control and movement performance during goal directed reaching in children with developmental coordination disorder. Human Movement Science 2002; 21:583 601. [3] Geuze RH. Static balance and developmental coordination disorder. Human Movement Science 2003; 22:527 548.
I1~
Balance training with visual feedback in children with hemiplegic cerebral palsy
A. Ledebt 1, J. Becher2, G.J.P. Savelsbergh1'3. 1Institute for Fundamental and Clinical Human Movement Sciences', Faculty of Human Sciences, Vrije Universiteit, Amsterdam, The Netherlands'," eDepartment of Rehabilitation, Vrije Universiteit Medical Center Amsterdam, The Netherlands'," 3Institute for Biophysical and Clinical Research into Human, Manchester Metropolitan University, UK I n t r o d u c t i o n : The aim of the present study was to examine the effects
of balance training with visual feedback on stance and gait in schoolage children with hemiplegic cerebral pasly. M e t h o d s : Ten participants between 5 and 11 years were allocated to either the training or the control group according to an aged-stratified randomization. The training corresponded to three sessions per week during six weeks. Stance and gait were assessed three times in both groups: at the beginning of the study (before training); after six weeks (end of the training); and after ten weeks. Stance assessment included spatial and temporal parameters calculated from the displacement of the center of pressure (COP) such as the voluntary CoP shifts forward, backward, on the affected and non-affected side (called limits of stability), and the time the CoP spent in a symmetrical position during quiet stance. Gait assessment included the calculation of step length and of the vertical acceleration of the center of mass at moment of foot contact (Zfc), both for the affected and non affected side; and average step velocity. R e s u l t s : In the training group the limits of stability increased for all directions, as well as the symmetry of stance when visual feedback was available. The asymmetry between the affected and non-affected side decreased for step length and Zfc after the training. C o n c l u s i o n : The results for stance showed that the training improved the performances at the tasks that were trained. More interesting, the results for gait showed that the walking pattern became more symmetrical after the training.
I n t r o d u c t i o n : Developmental Coordination Disorder (DCD) consists
in an important clumsiness without any sign of neurological injury or mental retardation that seems to result from a central dysfunction of motor control. Anticipatory control of posture allows the body or one of its segments to maintain stability when performing a movement or manipulating an object. Thus, anticipatory postural adjustments (APA) are a fundamental component of action achievement. This study focuses on APA in children with DCD in a bimanual load lifting task. M e t h o d : Children with DCD were compared to control children (6 11 years) in a bimanual load lifting task. This task requires maintenance of an horizontal forearm position despite imposed or voluntary bimanual unloading of the forearm supporting the load [1 ]. Forearm stabilization was assessed using electromyography, force and kinematics analysis. Results: The preliminary results show lower postural forearm stabilisation during voluntary unloading in the group of children with DCD than in the control one. The analysis of the muscular responses should help to determine if this alteration depends on an immature muscular strategy or on a deficit in the precise mastering of the timing parameters. C o n c l u s i o n : As it was already reported at a global level in children with DCD [2,3], APA appears also impaired at the segmental level.
References [1] Schmitz C, Martin N, Assaiante C. Building anticipatory postural adjustment during childhood: a kinematic and electromyographic analysis of unloading in children from 4 to 8 years of age. Experimental Brain Research 2002; 142:354 64.
I•
Balance strategies during walking in young patients with idiopathic scoliosis
S. M a l l a u 1 , M. Jover 1 , G. Bollini 1,2, J.-L. Jouve 2, E. Viehweger1,2, C. Assaiante 1. 1DPA, CNRS, UMR 6196, Marseille, France," 2Service
de Chirurgie Orthopddique Infantile, Marseille, France The goal of this study was to investigate long-term adaptability of the CNS in controlling upper body segments in eight idiopathic scoliotic subjects (ISS) (median age 13 years 6 months) during various locomotor tasks: walking on flat ground or on narrow supports (straight line or beam). The idiopathic scoliosis subjects were characterized by a left-lumbar and/or right-thoracic curve (10°
$86
action in particular might be preserved in these children. Anticipatory Postural Adjustments (APA) were investigated in children with DMD by the mean of the bimanual load lifting task [2]. M e t h o d s : This task involves the coordination between a manual movement, lifting a load placed on the controlateral forearm, and the stabilization of the postural forearm that supports the load. Eight children with DMD from 4 to 11 years of age were compared to 8 healthy children. Elbow angle and multiple surfaces EMG were recorded on the postural forearm. Results: The early onset of the EMG patterns assessed the use of APA in children with DMD. However, the forearm stabilization was less efficient in this group than in the control one. At the same time, the muscular strategy exploited by DMD children was in favor of a superior use of the adult-like inhibition pattern, which requires a low cost of energy. Discussion and c o n c l u s i o n : Despite the integrity of the feedforward control of posture, the muscle weakness induces a less efficient postural stabilization in children with DMD. Interestingly, these children used the inhibition pattern, which cost in energy is lower, more frequently than control children [2]. This raises the question of the plasticity of the selection process, which is fundamental during development.
References [1] Di Lazzaro V, Restuccia D, Servidei S, Nardone R, Oliviero A, Profice P, Mangiola F, Tonali P, Rothwell JC. Functional involvement of cerebral cortex in Duchenne muscular dystrophy. Muscle Nerve 1998; 21:662 664. [2] Schmitz C, Martin N, Assaiante C. Building anticipatory postural adjustment during childhood: a kinematic and electromyographic analysis of unloading in children from 4 to 8 years of age. Exp Brain Res 2002; 142:354 364.
[•2]
Anticipatory postural adjustments in a bimanual load-lifting task in children with developmental coordination disorder
M. Jover1, L. Centelles1, C. Schmitz1, F. Brun 2, B. Chabrol 1,2, C. Assaiante 1 . 1 Groupe Ddveloppement et Pathologie de l'Action.
CNRS Marseille, France," 2 Unitd de Mddecine Infantile. CHU Timone Enfants, Marseille, France
[2] Johnston LM, Burns YR, Brauer SG, Richardson CA. Differences in postural control and movement performance during goal directed reaching in children with developmental coordination disorder. Human Movement Science 2002; 21:583 601. [3] Geuze RH. Static balance and developmental coordination disorder. Human Movement Science 2003; 22:527 548.
I1~
Balance training with visual feedback in children with hemiplegic cerebral palsy
A. Ledebt 1, J. Becher2, G.J.P. Savelsbergh1'3. 1Institute for Fundamental and Clinical Human Movement Sciences', Faculty of Human Sciences, Vrije Universiteit, Amsterdam, The Netherlands'," eDepartment of Rehabilitation, Vrije Universiteit Medical Center Amsterdam, The Netherlands'," 3Institute for Biophysical and Clinical Research into Human, Manchester Metropolitan University, UK I n t r o d u c t i o n : The aim of the present study was to examine the effects
of balance training with visual feedback on stance and gait in schoolage children with hemiplegic cerebral pasly. M e t h o d s : Ten participants between 5 and 11 years were allocated to either the training or the control group according to an aged-stratified randomization. The training corresponded to three sessions per week during six weeks. Stance and gait were assessed three times in both groups: at the beginning of the study (before training); after six weeks (end of the training); and after ten weeks. Stance assessment included spatial and temporal parameters calculated from the displacement of the center of pressure (COP) such as the voluntary CoP shifts forward, backward, on the affected and non-affected side (called limits of stability), and the time the CoP spent in a symmetrical position during quiet stance. Gait assessment included the calculation of step length and of the vertical acceleration of the center of mass at moment of foot contact (Zfc), both for the affected and non affected side; and average step velocity. R e s u l t s : In the training group the limits of stability increased for all directions, as well as the symmetry of stance when visual feedback was available. The asymmetry between the affected and non-affected side decreased for step length and Zfc after the training. C o n c l u s i o n : The results for stance showed that the training improved the performances at the tasks that were trained. More interesting, the results for gait showed that the walking pattern became more symmetrical after the training.
I n t r o d u c t i o n : Developmental Coordination Disorder (DCD) consists
in an important clumsiness without any sign of neurological injury or mental retardation that seems to result from a central dysfunction of motor control. Anticipatory control of posture allows the body or one of its segments to maintain stability when performing a movement or manipulating an object. Thus, anticipatory postural adjustments (APA) are a fundamental component of action achievement. This study focuses on APA in children with DCD in a bimanual load lifting task. M e t h o d : Children with DCD were compared to control children (6 11 years) in a bimanual load lifting task. This task requires maintenance of an horizontal forearm position despite imposed or voluntary bimanual unloading of the forearm supporting the load [1 ]. Forearm stabilization was assessed using electromyography, force and kinematics analysis. Results: The preliminary results show lower postural forearm stabilisation during voluntary unloading in the group of children with DCD than in the control one. The analysis of the muscular responses should help to determine if this alteration depends on an immature muscular strategy or on a deficit in the precise mastering of the timing parameters. C o n c l u s i o n : As it was already reported at a global level in children with DCD [2,3], APA appears also impaired at the segmental level.
References [1] Schmitz C, Martin N, Assaiante C. Building anticipatory postural adjustment during childhood: a kinematic and electromyographic analysis of unloading in children from 4 to 8 years of age. Experimental Brain Research 2002; 142:354 64.
I•
Balance strategies during walking in young patients with idiopathic scoliosis
S. M a l l a u 1 , M. Jover 1 , G. Bollini 1,2, J.-L. Jouve 2, E. Viehweger1,2, C. Assaiante 1. 1DPA, CNRS, UMR 6196, Marseille, France," 2Service
de Chirurgie Orthopddique Infantile, Marseille, France The goal of this study was to investigate long-term adaptability of the CNS in controlling upper body segments in eight idiopathic scoliotic subjects (ISS) (median age 13 years 6 months) during various locomotor tasks: walking on flat ground or on narrow supports (straight line or beam). The idiopathic scoliosis subjects were characterized by a left-lumbar and/or right-thoracic curve (10°