Effect of reactive postural adjustment and anticipatory postural adjustment in improving sitting balance in children with spastic diplegic cerebral palsy

Abstract

Background: The purpose of this study was to examine the effect of providing activities which give internal and external perturbations on the static and dynamic trunk balancing abilities of children with cerebral palsy and generate some postural response in the trunk of these children with cerebral palsy. Objectives: To find out the effect of activities providing reactive postural adjustments and anticipatory postural adjustments, in improving sitting balance, in children with spastic diplegic cerebral palsy. Study Design: Pre- and posttest study design. Methods: Children with spastic diplegic cerebral palsy who were fulfilling the inclusion criteria were selected by convenient sampling from the department of occupational therapy, with a sample size of 60. Written informed consent was obtained from the guardians. Ethical permission was taken from the institute. Pediatric balance scale and pediatric reach test were used as instruments for measuring improvement in sitting balance. A frame for reaching and a platform for external perturbation were designed for the study. Therapy for both groups was given for 1 h/session. Children in the experimental group were exposed to 15 min each of reactive postural adjustment and anticipatory postural adjustment along with 1 h of conventional occupational therapy, whereas children in the control group were exposed to 1 h of conventional occupational therapy. Results: The results of the Wilcoxon signed-rank test of pediatric reach test were significant for experimental and control groups (P = 0.004; 95% confidence interval [CI]: 5.34–10.67 and P = 0.014; 95% CI: 4.16–7.89, respectively). There was also significance of the results of the Wilcoxon signed-rank test of pediatric balance scale in the experimental and control groups (P = 0.025; 95% CI: 8.98–11.12 for experimental group and P = 0.005; 95% CI: 8.09–9.54 for control group), with the level of significance set at P ≤ 0.05. This shows that the results were significant for experimental group as well as control group. Furthermore, the results of the Mann–Whitney U-test showed that Z = −3.507 for pediatric balance scale is more, making it more sensitive to capture changes in balances in children than that for pediatric reach test with Z = −3.905 (P = 0.002; 95% CI: 4.14–9.00 for pediatric balance scale and P = 0.001; 95% CI: 7.56–9.70 for pediatric reach test), with the level of significance set at P ≤ 0.05. Conclusion: It can be concluded that activities providing reactive postural adjustment and anticipatory postural adjustment can be used to enhance and improve sitting balance among children with spastic diplegic cerebral palsy, so that they can have the functional balance in sitting, to safely meet the demands of everyday life.