Carlberg Eva Brogren, Hadders-Algra Mijna
Department of Woman and Child Health, Neuropediatric Research Unit, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
Neural Plast. 2005;12(2-3):221-8; discussion 263-72. doi: 10.1155/NP.2005.221.
Postural problems play a central role in the motor dysfunction of children with cerebral palsy (CP). Therefore, they spend more time in sitting than in standing to perform vital tasks of daily life. The focus of this article is to describe the pathophysiology of postural control in sitting and outline some implications for management and treatment. In general, children with CP exhibit muscular activity counteracting forces that disturb equilibrium. Only 'non-sitting' children with severe CP lack such 'direction-specific' adjustments, possibly ruling out achievement of independent sitting. Most frequently, the children display dysfunctions in the adaptation of the adjustment. Typical characteristics of this adaptation in children with CP are a top-down recruitment of postural muscles, an excessive degree of antagonistic coactivation, and an incomplete adaptation of the EMG-amplitude to task specific constraints. Despite our knowledge on the pathophysiology underlying the postural problems in children with CP, little 'high-level' evidence (according to Sackett) exists on how different interventions can affect these problems. Therapeutic attention to promote motor performance in sitting focuses on adaptive seating, tilting of the support surface, and ample, variable training in motivating settings. The challenge facing us now is to provide evidence about the efficacy of specific treatment approaches facilitating that children reach an optimal level of functioning in daily life.
姿势问题在脑瘫（CP）儿童的运动功能障碍中起着核心作用。因此，他们在进行日常生活中的重要任务时，坐着的时间比站立的时间更多。本文的重点是描述坐姿下姿势控制的病理生理学，并概述一些对管理和治疗的启示。一般来说，CP儿童表现出肌肉活动来对抗干扰平衡的力量。只有重度CP的“非坐姿”儿童缺乏这种“特定方向”的调整，这可能排除了实现独立坐姿的可能性。最常见的是，儿童在调整适应方面表现出功能障碍。CP儿童这种适应的典型特征是姿势肌肉自上而下的募集、拮抗肌过度共同激活以及肌电图幅度对特定任务限制的不完全适应。尽管我们了解CP儿童姿势问题背后的病理生理学，但关于不同干预措施如何影响这些问题的“高级”证据（根据萨克特的标准）却很少。促进坐姿运动表现的治疗重点在于适应性座椅、支撑面倾斜以及在有激励作用的环境中进行充分、多样的训练。我们现在面临的挑战是提供证据，证明特定治疗方法的有效性，以促进儿童在日常生活中达到最佳功能水平。
