Woollacott Marjorie Hines, Shumway-Cook Anne
Department of Human Physiology, University of Oregon, Eugene 97403, USA.
Neural Plast. 2005;12(2-3):211-9; discussion 263-72. doi: 10.1155/NP.2005.211.
In this review we explore studies related to constraints on balance and walking in children with cerebral palsy (CP) and the efficacy of training reactive balance (recovering from a slip induced by a platform displacement) in children with both spastic hemiplegic and diplegic CP. Children with CP show (a) crouched posture, contributing to decreased ability to recover balance (longer time/increased sway); (b) delayed responses in ankle muscles; (c) inappropriate muscle response sequencing; (d) increased coactivation of agonists/antagonists. Constraints on gait include (a) crouched gait; (b) increased co-activation of agonists/antagonists; (c) decreased muscle activation; (d) spasticity. The efficiency of balance recovery can be improved in children with CP, indicated by both a reduction in the total center of pressure path used during balance recovery and in the time to restabilize balance after training. Changes in muscle response characteristics contributing to improved recovery include reductions in time of contraction onset, improved muscle response organization, and reduced co-contraction of agonists/antagonists. Clinical implications include the suggestion that improvement in the ability to recover balance is possible in school age children with CP.
在本综述中，我们探讨了与脑瘫（CP）患儿平衡和行走受限相关的研究，以及训练反应性平衡（从平台位移引起的滑倒中恢复）对痉挛性偏瘫和双瘫型CP患儿的疗效。CP患儿表现出：（a）蹲伏姿势，导致平衡恢复能力下降（时间延长/摇摆增加）；（b）踝关节肌肉反应延迟；（c）肌肉反应顺序不当；（d）主动肌/拮抗肌的共同激活增加。步态受限包括：（a）蹲伏步态；（b）主动肌/拮抗肌的共同激活增加；（c）肌肉激活减少；（d）痉挛。CP患儿平衡恢复效率可得到提高，这表现为平衡恢复过程中总压力中心路径的减少以及训练后重新稳定平衡所需时间的减少。有助于改善恢复的肌肉反应特征变化包括收缩开始时间的减少、肌肉反应组织的改善以及主动肌/拮抗肌的共同收缩减少。临床意义在于提示学龄期CP患儿恢复平衡的能力有可能得到改善。
