Infants at high risk of developing cerebral palsy have delayed development of posture control and may benefit from early postural training, a study has found.
The study also suggests that children who develop cerebral palsy due to a specific type of brain lesion may benefit from different postural interventions that target postural control.
Cerebral palsy is caused by injury to the developing brain. It is characterized by motor impairments and postural dysfunctions with variable outcome in severity, in part depending on the type of injury and its extension.
To date, there is little information on postural problems in this patient population. However, this information can be fundamental to ensure proper care of these children and prevent serious functional limitations due to inadequate posture.
To expand knowledge on postural development in children with cerebral palsy, a research team at the University of Groningen in the Netherlands evaluated 38 infants at high risk of cerebral palsy — with severe brain lesions or clear neurological signs (NTR1428).
Of these infants, 18 were diagnosed with cerebral palsy at 21 months old, and eight had cystic periventricular leukomalacia (cPVL) — the brain lesion accounting for the highest risk of developing cerebral palsy. The remaining children were found to have had neonatal brain lesions that resulted in minor neurological dysfunctions.
Researchers assessed postural control at four different stages: in the beginning of the study (ages 4.7 to 9 months), at six and 12 months after enrollment, and around 21 months of age. They focused on evaluating the activity of muscles required to support the sitting position.
Contrary to what they expected, the team found that children who developed cerebral palsy had a similar pattern of postural muscle response throughout infancy as that in children who did not develop cerebral palsy. Still, the postural muscles’ response was lower than in typically developing children, which suggests that infants at high risk of developing cerebral palsy have delayed development of the basic level of postural control.
One exception was direction-specific neck control, where cerebral palsy infants had stable rates throughout development, while in infants without cerebral palsy, it decreased as they got older.
The subgroup of infants with cPVL had better postural performance of the trunk and neck with increasing age than cerebral palsy children without cPVL. However, they had worse capacity to fine-tune the postural adjustments that allowed them to control their posture.
These results suggest that “infants with cPVL do not grow into a postural deficit with increasing age,” but “postural control is impaired from early age onwards,” the researchers wrote.
Researchers believe that “high risk infants without cPVL may benefit from early postural training, since their major postural problem is a delayed development.”
Head balance exercises during the first months post term and training the body’s balance in a sitting position in older children may be beneficial for improving their posture.
“If postural training is incorporated into daily life situations in a playful way, the infant will presumably benefit most,” the researchers wrote.
For infants with cPVL, use of adaptive seating systems may “compensate the postural deficit and promote the child’s ability to perform goal directed actions, such as needed for eating and playing,” they said.