Johnson Charlotte, Hallemans Ann, Meyns Pieter, Velghe Silke, Jacobs Nina, Verbecque Evi, Klingels Katrijn
Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium -
Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Diepenbeek, Belgium -
Eur J Phys Rehabil Med. 2024 Dec;60(6):956-969. doi: 10.23736/S1973-9087.24.08472-7. Epub 2024 Oct 23.
Balance deficits are one of the most common impairments in developmental coordination disorder (DCD) and cerebral palsy (CP), with shared characteristics between both groups. However, balance deficits in DCD are very heterogeneous, but unlike in CP, they are poorly understood.
To unravel the heterogeneity of balance performance in children with DCD by comparing them with CP and typical development (TD).
Cross-sectional case-control study.
Different outpatient settings and the community.
Children aged 5-10.9 years with TD (N.=64, boys: 34, mean [SD] age: 8.1 [1.6]), DCD (N.=39, boys: 32, mean [SD] age: 8.1 [1.5], formal diagnosis [N.=27]), and CP (N.=24, boys: 14, mean [SD] age: 7.5 [1.4], GMFCS level I [N.=14]/II [N.=10], unilateral [N.=13]/bilateral [N.=11]).
We evaluated balance performance with the extended version of the Kids-Balance Evaluation Systems Test (Kids-BESTest). Between-group differences in domain and total scores (%) were assessed via ANCOVA (covariate: age), with Tukey post-hoc analyses (P≤0.01).
Children with DCD and CP performed poorer than TD children on total and domain scores with large effects (domains: η=0.25-0.66 [P<0.001], total: η=0.71 [P<0.001]). Still, post hoc comparisons revealed that DCD children scored significantly better than CP on the total score and four domains (P≤0.009), while performing similarly on tasks related to stability limits (P=0.999) and gait stability (P=0.012).
There is a continuum of balance performance between children with TD, DCD and CP, but with great inter- and intra-individual heterogeneity in DCD and CP. DCD and CP children have difficulties with tasks requiring anticipatory postural adjustments, fast reactive responses, and with tasks that require complex sensory integration, suggesting an internal modeling deficit in both groups. This implies that these children must rely on slow conscious feedback-based control rather than fast feedforward control and fast automatic feedback. The performance of both DCD and CP children on their stability limits/verticality is similarly poor which further emphasizes a potential deficit in their sensory input and/or integration. Future research must focus on unraveling the control mechanisms, to further understand the heterogeneity of these balance deficits.
The heterogeneous balance performances in both children with DCD and CP underscore the importance of comprehensively evaluating balance deficits in both groups. This comprehensive assessment contributes to a better understanding of individual balance deficits, thereby facilitating more tailored treatment programs.
平衡功能障碍是发育性协调障碍（DCD）和脑瘫（CP）最常见的损伤之一，两组具有共同特征。然而，DCD中的平衡功能障碍非常异质性，与CP不同的是，人们对其了解甚少。
通过将患有DCD的儿童与CP和正常发育（TD）儿童进行比较，揭示DCD儿童平衡能力的异质性。
横断面病例对照研究。
不同的门诊机构和社区。
5至10.9岁的TD儿童（N = 64，男孩34名，平均[标准差]年龄：8.1 [1.6]岁）、DCD儿童（N = 39，男孩32名，平均[标准差]年龄：8.1 [1.5]岁，确诊[N = 27]）和CP儿童（N = 24，男孩14名，平均[标准差]年龄：7.5 [1.4]岁，粗大运动功能分级系统（GMFCS）I级[N = 14]/II级[N = 10]，单侧[N = 13]/双侧[N = 11]）。
我们使用儿童平衡评估系统测试扩展版（Kids-BESTest）评估平衡能力。通过协方差分析（协变量：年龄）评估组间在各领域和总分（%）上的差异，并进行Tukey事后分析（P≤0.01）。
DCD和CP儿童在总分和各领域得分上均低于TD儿童，差异有统计学意义（各领域：η = 0.25 - 0.66 [P < 0.001]，总分：η = 0.71 [P < 0.001]）。然而，事后比较显示，DCD儿童在总分和四个领域的得分显著高于CP儿童（P≤0.009），而在与稳定性极限（P = 0.999）和步态稳定性（P = 0.012）相关的任务上表现相似。
TD、DCD和CP儿童的平衡能力呈连续变化，但DCD和CP儿童个体间和个体内差异很大。DCD和CP儿童在需要预期姿势调整、快速反应以及需要复杂感觉整合的任务上存在困难，提示两组均存在内部模型缺陷。这意味着这些儿童必须依赖基于缓慢意识反馈的控制，而不是快速前馈控制和快速自动反馈。DCD和CP儿童在稳定性极限/垂直度方面的表现同样较差，这进一步强调了他们感觉输入和/或整合方面可能存在的缺陷。未来研究必须聚焦于揭示控制机制，以进一步理解这些平衡功能障碍的异质性。
DCD和CP儿童平衡能力的异质性凸显了全面评估两组平衡功能障碍的重要性。这种全面评估有助于更好地理解个体平衡功能障碍，从而制定更具针对性的治疗方案。
