Effects of severity of gross motor disability on anticipatory postural adjustments while standing in individuals with bilateral spastic cerebral palsy.
In bilateral spastic CP, anticipatory postural adjustments shrink as GMFCS level rises—check and cue the erector spinae and hamstrings before any stand-to-sit or stand-to-walk task.
01Research in Context
What this study did
The team watched how people with bilateral spastic CP got ready to stand still.
They used sticky electrodes on back and leg muscles to spot tiny pre-movement bursts.
Each person was rated with the GMFCS: I-II for mild, III for bigger motor limits.
What they found
The worse the GMFCS level, the weaker and later the muscle prep bursts.
Proximal muscles—erector spinae and hamstrings—showed the biggest drop-off.
Level III riders had almost no ready signal compared with mild CP and controls.
How this fits with other research
Pavão et al. (2018) saw the same pattern during arm reaches: more manual impairment, shakier trunk.
Together the two papers say anticipatory postural adjustments shrink as any form of CP severity grows.
Hattier et al. (2011) found kids with CP could follow visual sway cues but failed to tune them down later.
Hidehito now adds that the ready-to-stand cue itself is smaller in severe CP, so the tuning problem starts even earlier.
Medeiros et al. (2015) showed external support cuts sway in sit-to-stand; Hidehito implies support may also be needed just to create the anticipatory burst.
Why it matters
If proximal muscles are silent before standing, your client is starting each task from behind.
Quick screen: watch the back and hamstrings while they prepare to rise—no flicker means high fall risk.
Add light manual trunk support or a high seat during practice; the burst may return and balance improves.
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02At a glance
03Original abstract
BACKGROUND: Although individuals with bilateral spastic cerebral palsy (BSCP) exhibit several deficits in anticipatory postural adjustments (APAs) while standing, effects of severity of motor disability on their APAs are unclear. AIMS: To determine whether individuals with BSCP exhibit severity-dependent deficits in APAs. METHODS AND PROCEDURES: Seven individuals with level II BSCP (BSCP-II group) and seven with level III BSCP (BSCP-III group) according to the Gross Motor Function Classification System and seven healthy controls lifted a load under two different load conditions. OUTCOMES AND RESULTS: Anticipatory activities of the erector spinae (ES), medial hamstring (MH), and gastrocnemius (GCM) were smaller in the two BSCP groups than in the control group. Although the anticipatory GCM activity was similar between the BSCP groups, the ES and MH activities were larger in the BSCP-II group than in the BSCP-III group. In the BSCP-II group, an increase in anticipatory activity with an increase in load was observed in the MH, but not in the GCM. In the BSCP-III group, load-related modulation was not found in the MH or GCM. CONCLUSIONS AND IMPLICATIONS: The present findings suggest that in individuals with BSCP with severe motor disability, APA deficits extend to more proximal parts of the body.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2016.06.017