Balance and Walking Rehabilitation for Children Living With Cerebral Palsy Through The Lens of The Adapted Systems Framework for Postural Control: A Systematic Review

Abstract

Objective(s) To explore which components of the Systems Framework of Postural Control (SFPC) are targeted in balance and walking interventions for children living with cerebral palsy (CP). Data Sources MEDLINE, CINAHL and EMBASE databases were searched. Published, full-text articles in English or French were included. Systematic reviews identified were excluded but reference lists were screened for potential additional articles. Study Selection PRISMA guidelines informed this review; protocol registered (PROSPERO CRD42020193454). Inclusion criteria: intervention for balance and/or walking; children ages 6-18; with CP; ≥ 1 outcome measure for function and/or walking and/or balance. 3223 studies were identified: 969 removed with deduplication, 1955 excluded at title/abstract screening, 299 underwent full-text review, 139 were included. Two researchers independently screened and extracted data, a third was used for consensus. Data Extraction The SFPC describes 6 major domains (biomechanical constraints, orientation in space, movement strategies, control of dynamics, sensory strategies, cognitive processing) needed to maintain postural control. Interventions varied greatly in type, length and dosage so were broadly classified into gait, balance, exercise, technology, and ‘other rehabilitation’ for clearer analysis. Within each intervention classification, the targeted domains of the SFPC were identified using a descriptive analysis. Data Synthesis All interventions addressed the biomechanical constraints domain (strength, coordination, joint motion, functional/static stability); 94% addressed movement strategies (anticipatory and reactive postural control). In contrast to this, only 34% addressed cognitive processing as part of their intervention. Only 21% of the interventions addressed all domains. Conclusions These results broaden understanding of which components of postural control are currently targeted in published literature regarding walking and balance interventions for children living with CP. This information can inform the design of interventions in rehabilitation to better address the complexities of postural control in this population. Author(s) Disclosures None To explore which components of the Systems Framework of Postural Control (SFPC) are targeted in balance and walking interventions for children living with cerebral palsy (CP). MEDLINE, CINAHL and EMBASE databases were searched. Published, full-text articles in English or French were included. Systematic reviews identified were excluded but reference lists were screened for potential additional articles. PRISMA guidelines informed this review; protocol registered (PROSPERO CRD42020193454). Inclusion criteria: intervention for balance and/or walking; children ages 6-18; with CP; ≥ 1 outcome measure for function and/or walking and/or balance. 3223 studies were identified: 969 removed with deduplication, 1955 excluded at title/abstract screening, 299 underwent full-text review, 139 were included. Two researchers independently screened and extracted data, a third was used for consensus. The SFPC describes 6 major domains (biomechanical constraints, orientation in space, movement strategies, control of dynamics, sensory strategies, cognitive processing) needed to maintain postural control. Interventions varied greatly in type, length and dosage so were broadly classified into gait, balance, exercise, technology, and ‘other rehabilitation’ for clearer analysis. Within each intervention classification, the targeted domains of the SFPC were identified using a descriptive analysis. All interventions addressed the biomechanical constraints domain (strength, coordination, joint motion, functional/static stability); 94% addressed movement strategies (anticipatory and reactive postural control). In contrast to this, only 34% addressed cognitive processing as part of their intervention. Only 21% of the interventions addressed all domains. These results broaden understanding of which components of postural control are currently targeted in published literature regarding walking and balance interventions for children living with CP. This information can inform the design of interventions in rehabilitation to better address the complexities of postural control in this population.