People with cerebral palsy (CP) often have problems with postural control, which can interfere with basic activities of daily life such as reaching, sitting, or walking. A lack of information on the developmental trajectory of these postural issues has made it difficult for medical professionals to optimize interventions. However, recent research provides some answers, which may influence therapeutic strategies.
Research on Infants at Very High Risk of Cerebral Palsy
Anke G. Boxum and colleagues from Germany and the Netherlands recently conducted a study on postural control in infants at very high risk of developing cerebral palsy. Their subjects were 38 infants between 4.7 and 22.6 months old (21 months corrected age), who had severe brain lesions (such as those in cystic periventricular leukomalacia [cPVL]) or clear neurological signs of being at risk of cerebral palsy. The authors conducted longitudinal electromyography recordings on their subjects and calculated developmental trajectories by using linear mixed effect models. They aimed to assess postural control four times throughout the study.
Findings: Early Signs of Postural Deficits, Especially in Infants with cPVL
Boxum et al. found that infants who were classed as very high-risk for developing cerebral palsy showed early signs of postural deficits. This included subjects who did not actually develop cerebral palsy by 21 months corrected age. Most of these infants still had minor neurological dysfunction (MND), however. Those with CP and those with MND both had more postural problems than typically-developing infants. The authors suggest that they may benefit from postural control exercises that could be incorporated into daily life. For example, it may be helpful to bathe these young infants in a sitting position.
As compared to their other subjects, infants with cPVL (the most severe type of neonatal brain lesion) showed greater dysfunction with fine-tuning of postural adjustments at an early age, but their direction-specificity continued to improve throughout infancy. The authors explain that these infants are likely “shifting focus of postural control to the first level” (direction-specificity is typically used for more basic functions, and develops earlier in infancy). Therefore, they may require a different type of early postural intervention than other very high-risk infants. Boxum et al. suggest that these infants may benefit most from adaptive seating systems.
Boxum, Anke G., et al. “Development of postural control in infancy in cerebral palsy and cystic periventricular leukomalacia.” Research in developmental disabilities 78 (2018): 66-77.