Balance and Posture in Adults With Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Paralysis; Cerebral Palsy
Study type: Observational

Summary: 
      The results of this study will have an impact upon public heath policy as adults with
      cerebral palsy (CP) present a growing and underserved population in the United States. At the
      conclusion of this study, we will have identified the means by which the adult with CP
      maintains their upright position, which is essential for activities of daily living and for
      movement. With this knowledge, it will be possible to develop clinical and rehabilitation
      interventions that will improve their arm and leg function, and reduce the risk of falls for
      the adult with CP.
    

Detailed description: 
      Individuals with Cerebral Palsy (CP) present with considerable functional heterogeneity, and
      demonstrate a marked decrease in functional status with age due to the development of
      disturbances in somatosensory function, secondary neuromuscular impairments, and poor control
      over the trunk muscles. These factors promote balance instability, result in an increased
      fall risk, and contribute to lost functional capabilities. Little is known about the
      progression of neuromotor and somatosensory impairments as individuals with CP age, thus a
      knowledge gap exists concerning postural control and balance in the adult with CP,
      particularly which those associated with aging (primary) and those associated with
      compensatory behaviors. The objective of this proposal is to explore mechanisms behind
      abnormal motor response in postural control in the adult with CP. We HYPOTHESIZE that
      somatosensory reliance, as well as muscle passive and active properties, change with aging
      and functional adaptation. In order to address our central hypothesis, we propose the
      following specific aims: SPECIFIC Aim 1: To examine the central disturbances of sensory
      processing and sensorimotor integration that contribute to abnormal postural control in young
      adults with CP. We will: a) determine the effect of visual dependence on postural control in
      the adult with CP as directly measured with a test for visual dependence; and b)relate the
      presence of visual dependence to the effect of disturbances of the visual flow field on the
      center of mass (CoM) and center of pressure (CoP) responses in the adult with CP; and c)
      determine the relationship between central disturbances of sensory processing and
      sensorimotor integration on functional balance as measured by standardized clinical
      assessments of balance and fall risk. SPECIFIC Aim 2: To examine the peripheral alterations
      in passive muscle-tendon properties that could contribute to abnormal postural control in
      young adults with CP. We will determine the effects of a disturbance of the base of support,
      a disturbance to the visual flow field, and a combined disturbance of the two on joint
      kinematics,CoP, and CoM responses in the adult with CP using functional principal component
      (time-series) analyses. SPECIFIC Aim 3: To examine the impaired muscle activation and loss of
      selectivity over muscle control that contributes to abnormal postural control in young adults
      with CP. We will determine the effects of a disturbance of the base of support, a disturbance
      to the visual flow field, and a combined disturbance of the two on the surface
      electromyographic (sEMG) activity of lower limb and trunk muscles using wavelet analyses. At
      the conclusion of this study, we will have characterized postural control strategies employed
      by adults with CP in the presence of somatosensory and biomechanical perturbations. The
      combination of our innovative methodology to challenge all aspects of the sensorimotor
      system, with our analytical approach of both time series and wavelet analysis of the data,
      will allow us to separate the primary dynamic postural deficits from compensatory actions, a
      critical distinction for optimizing treatment interventions.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The proposed investigation will be a cross-sectional study conducted with adolescents and
        young adults with typical development, and adolescents and young adults classified as
        having spastic diplegic or spastic quadriplegic CP between 15 and 30 years of age.
      
Keywords: Balance; Posture; Virtual Environment; Cerebral Palsy; Adults