Case Series_Targeted Training for Trunk Control Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      Little is known about how children with cerebral palsy (CP) use their sensory systems (touch,
      sense of body position, balance organs in the inner ear, vision) to help them achieve trunk
      control for independent sitting. If a child with CP does not achieve trunk control by 4 years
      of age their prognosis for motor skill development including walking is poor. Clinical
      researchers at The Movement Centre in Oswestry, England have developed a method called
      Targeted Training in which children train trunk control in small segments from the top down
      using a custom fit training device. This study aims to examine how children with moderate to
      severe CP use sensory information for trunk control before, during and after a program of
      Targeted Training.
    

Detailed description: 
      One of the major challenges of motor control is to understand how the central nervous system
      controls the degrees of freedom of the body. This is particularly evident in cerebral palsy
      (CP), which is the most prevalent chronic childhood motor disability and is one of the most
      disabling and costly chronic disorders of children and adults. Deficits in postural control
      and sensorimotor integration are hallmarks of CP. Although postural control of the trunk for
      independent sitting creates the foundation for all other motor tasks, surprisingly little is
      known about how children with CP use sensory input to guide their development of upright
      control (which occurs in typically developing infants by 8 months of age). This lack of
      knowledge limits our ability to effectively assess and treat children with neuromotor
      deficits in trunk control.

      The objectives of this project are to identify sensory reliance and sensory re-weighting in a
      study of children with moderate-to-severe CP (4-12 years of age) before and after Targeted
      Training for Trunk Control. A novel trunk support device will enable testing of participants
      who lack (or are still developing) stable sitting. In experiments, kinematics of the head and
      trunk will be measured. Sensory reliance and re-weighting will be identified from postural
      trunk responses to sensory conflict stimuli consisting of tilts of a visual surround and/or
      tilts of a surface which participants sit upon. Generally, participants with a high reliance
      on vestibular feedback will remain upright with respect to gravity during all tests; whereas
      a high reliance on cutaneous or visual feedback will produce trunk sway away from upright and
      toward the surface or visual surround tilt, respectively. To tease apart biomechanical,
      physical, and neurological contributions to trunk sway, sensorimotor integration modeling
      will be used to complement data interpretation.
    

Intervention name(s): Targeted Training for trunk control
Intervention type(s): Device
Intervention description(s): Orthotics Research and Locomotor Research Unit (ORLAU) standers will be custom fit to help the child train at the segmental level of the trunk where they begin to lose control of posture. The typical course of treatment involves loaning the customized equipment to each family for use in their home or in their child's educational setting. Training occurs once daily usually for 30-45 minutes. This is done 5 or 6 days per week. Training programs typically involve playing with balls or balloons or video games that motivate the child to hold the head erect and to wave the arms and hands and move the upper body. The researchers evaluate children every 8 weeks and adjust the stander to lower levels of support as the child gains control.
Other intervention name(s): Segmental training for trunk control
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: postural control; Targeted Training; cerebral palsy; sensorimotor control; trunk segments