From a set of experimental studies showing how intersegmental coordination develops during childhood in various posturokinetic tasks, we have established a repertoire of equilibrium strategies in the course of ontogenesis. The experimental data demonstrate that the first reference frame used for the organization of balance control during locomotion is the pelvis, especially in young children. Head stabilization during posturokinetic activities, particularly locomotion, constitutes a complex motor skill requiring a long time to develop during childhood. When studying the emergence of postural strategies, it is essential to distinguish between results that can be explained by biomechanical reasons strictly and those reflecting the maturation of the central nervous system (CNS). To address this problem, we have studied our young subjects in situations requiring various types of adaptation. The studies dealing with adaptation of postural strategies aimed at testing short and long-term adaptation capacity of the CNS during imposed transient external biomechanical constraints in healthy children, and during chronic internal constraints in children with skeletal pathologies. In addition to maintenance of balance, another function of posture is to ensure the orientation of a body segment. It appears that the control of orientation and the control of balance both require the trunk as an initial reference frame involving a development from egocentric to exocentric postural control. It is concluded that the first step for children consists in building a repertoire of postural strategies, and the second step consists in learning to select the most appropriate postural strategy, depending on the ability to anticipate the consequence of the movement in order to maintain balance control and the efficiency of the task.

Christine Assaiante

Sophie Mallau

Sébastien Viel

Marianne Jover

Christina Schmitz

Development of Postural Control in Healthy Children: A Functional Approach

In this review we explore studies related to constraints on balance and walking in children with cerebral palsy (CP) and the efficacy of training reactive balance (recovering from a slip induced by a platform displacement) in children with both spastic hemiplegic and diplegic CP. Children with CP show (a) crouched posture, contributing to decreased ability to recover balance (longer time/increased sway); (b) delayed responses in ankle muscles; (c) inappropriate muscle response sequencing; (d) increased coactivation of agonists/antagonists. Constraints on gait include (a) crouched gait; (b) increased co-activation of agonists/antagonists; (c) decreased muscle activation; (d) spasticity. The efficiency of balance recovery can be improved in children with CP, indicated by both a reduction in the total center of pressure path used during balance recovery and in the time to restabilize balance after training. Changes in muscle response characteristics contributing to improved recovery include reductions in time of contraction onset, improved muscle response organization, and reduced co-contraction of agonists/antagonists. Clinical implications include the suggestion that improvement in the ability to recover balance is possible in school age children with CP.

Marjorie Hines Woollacott

Anne Shumway-Cook

Postural Dysfunction During Standing and Walking in Children With Cerebral Palsy: What are the Underlying Problems and What New Therapies Might Improve Balance?

Albert Gramsbergen

Mijna Hadders-Algra

Posture In The Picture: On The Relevance Of Postural Control In Children With Developmental Motor Disorders

The recent developments of a particular approach to analyzing motor synergies based on the principle of motor abundance has allowed a quantitative assessment of multieffector coordination in motor tasks involving anticipatory adjustments to self-triggered postural perturbations and in voluntary posturalsway. This approach, the uncontrolled manifold (UCM) hypothesis, is based on an assumption that the central nervous system organizes covariation of elemental variables to stabilize important performance variables in a task-specific manner. In particular, this approach has been used to demonstrate and to assess the emergence of synergies and their modification with motor practice in typical persons and persons with Down syndrome. The framework of the UCM hypothesis allows the formulation of testable hypotheses with respect to developing postural synergies in typically and atypically developing persons.

Mark L. Latash

Vijaya Krishnamoorthy

John P. Scholz

Vladimir M. Zatsiorsky

Postural Synergies and Their Development

The movement control of articulated limbs in humans has been explained in terms of equilibrium points and moving equilibrium points or virtual trajectories. One hypothesis is that the nervous system controls multi-segment limbs by simply planning in terms of these equilibrium points and trajectories. The present paper describes a planar computer simulation of an articulated three-segment limb, controlled by pairs of muscles. The shape of the virtual trajectory is analyzed when the limb is required to make fast movements with endpoint movements along a straight line with bell-shaped velocity profiles. Apparently, the faster the movement, the more the virtual trajectory deviates from the real trajectory and becomes up to eight times longer. The complexity of the shape of the virtual trajectories and its length in these fast movements makes it unlikely that the nervous system plans using these trajectories. it seems simpler to set up the required bursts of muscle activation, coupled in the nervous system to the direction of movement, the s peed, and the place in workspace. Finally, it is argued that the two types of explanation do not contradict each other: when a relation is established in the nervous system between muscle activation and movements, equilibrium points and virtual trajectories are necessarily part of that relation.

E. Otten

Multi-Joint Dynamics and the Development of Movement Control

Motor behaviors of some species, such as the rat and the human baby, are quite immature at birth. Here we review recent data on some of the mechanisms underlying the postnatal maturation of posture in the rat, in particular the development of pathways descending from the brain stem and projecting onto the lumbar enlargement of the spinal cord. A short-lasting depletion in serotonin affects both posture and the excitability of motoneurons. Here we try to extrapolate to human development and suggest that the abnormalities in motor control observed in childhood&#8212;e.g, deficits in motor coordination&#8212;might have their roots in the prenatal period, in particular serotonin depletion due to exposure to several environmental and toxicological factors during pregnancy.

Laurent  Vinay

Fa&#239;za  Ben-Mabrouk

Fr&#233;d&#233;ric  Brocard

Fran&#231;ois  Clarac

C&#233;line  Jean-Xavier

Edouard  Pearlstein

Jean-Fran&#231;ois  Pflieger

Perinatal Development of the Motor Systems Involved in Postural Control

The present paper gives an overview of the knowledge currently available on muscular dyscoordination underlying postural problems in children with cerebral palsy (CP). Such information is a prerequisite for developing successful therapeutic interventions in children with CP. Until now, three children with CP functioning at GMFCS (Gross Motor Function Classification System) level V have been documented. The children totally or partially lacked direction specificity in their postural adjustments and could not sit independently for more than 3 seconds. Some children functioning at GMFCS level IV have intact direction-specific adjustments, whereas others have problems in generating consistently direction-specific adjustments. Children at GMFCS levels I to III have an intact basic level of control but have difficulties in fine-tuning the degree of postural muscle contraction to the task-specific conditions, a dysfunction more prominently present in children with bilateral spastic CP than in children with spastic hemiplegia. The problems in the adaptation of the degree of muscle contraction might be the reason that children with CP, more often than typically developing children, show an excess of antagonistic coactivation during difficult balancing tasks and a preference for cranial-caudal recruitment during reaching. This might imply that both stereotypies might be regarded as functional strategies to compensate for the dysfunctional capacity to modulate subtly postural activity.

Jolanda C. van der Heide

Postural Muscle Dyscoordination in Children With Cerebral Palsy

The development of static balance is a basic characteristic of normal motor development. Most developmental motor tests include a measure of static balance. Children with Developmental Coordination Disorder (DCD) often fail this item. This study reviews the balance problems of children with DCD. The general conclusion is drawn that under normal conditions static balance control is not a problem for children with DCD. Only in difficult, unattended, or novel situations such children seem to suffer from increased postural sway. These findings raise the question of what happens when balance is lost. The present study addresses the strength of correlation between the electromyography (EMG) and force plate signals in one-leg stance over epochs of stable and unstable balance. Four groups of children were involved in the study: two age groups and a group of children with DCD and balance problems and their controls. The results show a clear involvement of tibialis anterior and peroneus muscles in the control of lateral balance in all conditions and groups. The group of children with DCD and balance problems,however, showed a weaker coupling between EMG and corrective force compared with control children, indicating non-optimal balance control. An evaluation of the existing data in terms of evidence of specific structural deficits associated with DCD provided converging evidence that suggests cerebellar involvement.

Reint H. Geuze

Postural Control in Children With Developmental Coordination Disorder

Introduction: Deficient postural control is one of the key problems in cerebral palsy (CP). Little, however, is known about the specific nature of postural problems of children with CP, nor of the relation between abnormal posture and dysfunction of the visual system. Aim of the study: To provide additional information on the association of abnormalities in postural control and visual dysfunction of the anterior or posterior part of the visual system. Methods: Data resulting from ophthalmologic, orthoptic, neurological, neuro-radiological, and ethological investigations of more than 313 neurologically impaired children were retrospectively analyzed. Results: Abnormal postural control related to ocular and ocular motor disorders consisted of anomalous head control and subsequent abnormal head posture and torticollis. The abnormal postural control related to retrochiasmatical damage of the visual system consisted of a torticollis combined with adjustment of the upper part of the body, as if at the same time adapting to a combination of defects and optimizing residual visual functions. Conclusion: Visual dysfunctions play a distinct role in the postural control of children with CP.

G. Porro

D. van der Linden

O. van Nieuwenhuizen

D. Wittebol-Post

Role of Visual Dysfunction in Postural Control in Children With Cerebral Palsy

The purpose of this article was to conduct a systematic review of studies that examined the efficacy and effectiveness of postural control intervention strategies for children with CP. Only physical therapy interventions were included, e.g. adaptive seating devices, ankle foot orthoses, neurodevelopmental treatment. A multifaceted search strategy was employed to identify all potential studies published between 1990 and 2004. The search strategy included electronic databases, reference list scanning, author and citation tracking of relevant studies, and hand searching of pediatric physical therapy journals and conference proceedings. Twelve studies (1991&#8211;2004), comprising ten group design studies and two single subject studies, met our inclusion criteria. A variety of age ranges and severity of children with cerebral palsy (n &#61; 132) participated in the studies. The study quality scores ranged from 2 to 7 (total possible range of 0 to 7) with a median score of 5.5 and a mode of 6. As was true in an earlier systematic review on adaptive seating, most of the 12 &#8216;experimental&#8217; studies published since 1990 that were aimed at evaluating the effectiveness of postural control strategies provided lower levels of evidence, i.e. Sackett Levels III to V. Additional studies with stronger designs are needed to establish that postural control interventions for children with CP are effective.

Susan R. Harris

Lori  Roxborough

Efficacy and Effectiveness of Physical Therapy in Enhancing Postural Control in Children With Cerebral Palsy

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Neural Plasticity is an interdisciplinary journal dedicated to the publication of articles related to all aspects of neural plasticity, with special emphasis on its functional significance as reflected in behavior and in psychopathology.

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Chief Editor, Professor Baudry, is currently University Professor at Western University of Health Sciences in Pomona, CA. His research focuses on understanding the molecular/cellular mechanisms of learning and memory and neurodegeneration.

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A. Gramsbergen

M. Hadders-Algra

Posture in the Picture: On the Relevance of Postural Control in Children with Developmental Motor Disorders

Neural Plasticity

Posture in the Picture: On the Relevance of Postural Control in Children with Developmental Motor Disorders

Posture in the Picture: On the Relevance of Postural Control in Children with Developmental Motor Disorders

Articles

Development of Postural Control in Healthy Children: A Functional Approach

Postural Dysfunction During Standing and Walking in Children With Cerebral Palsy: What are the Underlying Problems and What New Therapies Might Improve Balance?

Posture In The Picture: On The Relevance Of Postural Control In Children With Developmental Motor Disorders

Postural Synergies and Their Development

Multi-Joint Dynamics and the Development of Movement Control

Perinatal Development of the Motor Systems Involved in Postural Control

Postural Muscle Dyscoordination in Children With Cerebral Palsy

Postural Control in Children With Developmental Coordination Disorder

Role of Visual Dysfunction in Postural Control in Children With Cerebral Palsy

Efficacy and Effectiveness of Physical Therapy in Enhancing Postural Control in Children With Cerebral Palsy