Effect of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy

ABSTRACT

Purpose

To compare the effects of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy.

Materials and Methods

Twelve children with hemiplegic cerebral palsy and 12 typically developing children ages 5 to 12 years (GMFCS I–II) were evaluated with the Timed Up and Go (TUG) and Biodex Balance System during three upper extremity (UE) conditions: 1) Free UEs (no constraints), 2) Simple UE constraint (unaffected/dominant UE constrained with a sling), and 3) Difficult UE constraint (Simple constraint plus the other UE holding cup of water).

Results

The UE condition had significant effects on Overall Stability Index (OSI) (F_(2,44) = 24.899, p < .001), Medial-Lateral Stability Index (MLSI) (F_(2,44) = 4.380, p = .018), Anterior-Posterior Stability Index (F_(2,44) = 6.187, p = .004), and TUG scores (F_(2,44) = 113.372, p < .001). Group was significant for OSI (F_(1,22) = 7.906, p = .010), MLSI (F_(1,22) = 13.113, p = .002), and TUG (F_(1,22) = 36.282, p < .001).

Conclusions

The upper extremity appears to have a role in maintaining functional balance and postural stability in children with hemiplegic cerebral palsy and should be considered during intervention programs.

KEYWORDS:

• Cerebral palsy
• hemiplegia
• postural control
• balance reactions
• gait
• upper extremity

Implications For Rehabilitation

• Restricting the unaffected upper extremity (UE) in children with hemiplegic cerebral palsy (HCP) may reduce their functional balance

• Postural control in TD (typically developing) children and children with HCP decreases as UE constraint complexity increases.

• The UE has a more prominent role in postural control of children with HCP than TD.

• Since Constraint Induced Movement Therapy (CIMT) is a common intervention strategy for children with HCP, functional balance should be evaluated and addressed before implementing these programs.

Acknowledgments

We thank the participants for their collaboration in completing the study procedure.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.