University of Groningen, University Medical Center Groningen, Department of Paediatrics - Division of Developmental Neurology, Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
Eur J Paediatr Neurol. 2019 Sep;23(5):723-732. doi: 10.1016/j.ejpn.2019.07.001. Epub 2019 Aug 1.
To evaluate the effect of 15° forward (FW) seat inclination and foot-support in children with cerebral palsy (CP) on postural adjustments during reaching.
Observational study repeated-measures design; step two of two-step-project.
Laboratory unit within University Hospital and two special education schools.
19 children (ten unilateral spastic CP (US-CP); nine bilateral spastic CP (BS-CP); Gross Motor Function Classification System levels I-III; 6-12 years old). Participants were able to take part for one one-hour session.
Reaching while sitting in four seating conditions (FW or horizontal seat; with or without foot-support) applied in randomized order.
Simultaneously, surface electromyography (EMG) of neck, trunk and arm muscles and kinematics of head and reaching arm (step one of two-step-project) were recorded. Primary outcome parameters were the ability to modulate EMG-amplitudes at baseline and during reaching (phasic muscle activity). Other EMG-parameters were direction-specificity (1st control level), and 2nd level of control parameters: recruitment order, and anticipatory postural activity. Motor behaviour measures: ability to modulate EMG-amplitudes to kinematic characteristics of reaching and head stability.
Only foot-support was associated with increased tonic background EMG-amplitudes and decreased phasic EMG-amplitudes of the trunk extensors in children with US-CP and BS-CP (mixed-models analyses; p-values <0.01). The foot-support effect was also associated with better kinematics of reaching (Spearman's Rho; p-values <0.01).
In terms of postural adjustments during forward reaching, foot-support enhanced the children's capacity to modulate trunk extensor activity, which was associated with improved reaching quality. FW-tilting did not affect postural muscle activity.
评估 15°前倾（FW）座椅倾斜度和足部支撑对脑瘫（CP）儿童在伸展过程中的姿势调整的影响。
重复测量观察研究；两步项目的第二步。
大学医院的实验室单元和两所特殊教育学校。
19 名儿童（10 名单侧痉挛性 CP（US-CP）；9 名双侧痉挛性 CP（BS-CP）；粗大运动功能分类系统 I-III 级；6-12 岁）。参与者可以参加一个小时的会议。
随机顺序应用四种坐姿条件（FW 或水平座椅；有或没有足部支撑）进行伸展。
同时记录颈部、躯干和手臂肌肉的表面肌电图（EMG）以及头部和伸展手臂的运动学（两步项目的第一步）。主要的结果参数是在基线和伸展过程中调节 EMG 幅度的能力（相位肌肉活动）。其他 EMG 参数包括方向特异性（第一控制水平）和第二控制参数水平：募集顺序和预测性姿势活动。运动行为测量：调节 EMG 幅度以适应伸展和头部稳定性的运动学特征的能力。
仅足部支撑与 US-CP 和 BS-CP 儿童的躯干伸肌的紧张性背景 EMG 幅度增加和相位 EMG 幅度减少相关（混合模型分析；p 值<0.01）。足部支撑的效果也与更好的伸展运动学相关（Spearman 的 Rho；p 值<0.01）。
就向前伸展时的姿势调整而言，足部支撑增强了儿童调节躯干伸肌活动的能力，这与改善伸展质量有关。FW 倾斜度没有影响姿势肌肉活动。
