Sitting Postural Control in Infants With Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      The overall goal of this research is to understand the mechanisms underlying the development
      of postural control in sitting using new methodology, in order to provide a scientific basis
      for evaluation and treatment of posture and movement disorders in infants with cerebral
      palsy. The development of early posture control remains poorly understood despite
      considerable therapeutic effort. Infants with cerebral palsy show their first delays in the
      acquisition of sitting, with subsequent problems developing adequate posture and movement
      control. Identifying the delay, determining the nature of the problem, and evaluating the
      effectiveness of treatment quickly, are vital in the early part of an infant's life, since
      this is the time of greatest plasticity. Tools from nonlinear dynamics, which are
      increasingly being used to examine other biological rhythms, are used in this study to
      analyze postural sway from center of pressure data during the development of sitting postural
      control.
    

Detailed description: 
      Background: The ability to sit independently is fundamental for function but delayed in
      infants with cerebral palsy (CP). Studies of intervention directed specifically toward
      sitting in infants with CP have not been reported. Objective: Our purpose was to compare two
      interventions for improving sitting postural control in infants with CP. Design: For this
      randomized longitudinal study, infants under 2 years old and at risk for CP were recruited
      for intervention directed toward sitting independence. Setting: The intervention was
      conducted at home or at an outpatient facility. Patients: Fifteen typically developing
      infants (5 months old, SD .5 months at entry) were followed longitudinally as a comparison
      for postural variables. Thirty-five infants with delays in achieving sitting were recruited.
      Infants with delays were randomly assigned to a home program (1x/week for 8 weeks; mean
      age=15.5 months, SD=7 months), or a perceptual-motor intervention (2x/week for 8 weeks; mean
      age=14.3 months, SD=3 months). Measurements: The primary outcome measure was Center of
      Pressure (COP) data, from which linear and nonlinear variables were extracted. The Gross
      Motor Function Measure (GMFM) sitting subsection was our clinical outcome measure. Results:
      There was a main effect of time in the GMFM sitting subscale and in two of the COP variables.
      Interaction of group by time factors indicated significant differences between intervention
      groups on two COP measures, in favor of the group with perceptual-motor intervention.
      Limitations: The small number of infants limits the ability to generalize the findings.
      Conclusions: Although both groups made progress in the GMFM, the COP measures indicated an
      advantage for the group with perceptual-motor intervention. The COP measures appear sensitive
      for assessment of infant posture control and quantifying intervention response.
    

Intervention name(s): Physical therapy
Intervention type(s): Other
Intervention description(s): Perceptual motor therapy, comparing twice weekly to once weekly home program
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: infant; sitting; postural control