Visual Cues Can Aid Posture in Children with Cerebral Palsy

Posture in children with cerebral palsy (CP) improves through visual cues, new research from Sweden indicates, suggesting that muscle quality is not the only contributor to better posture in kids with CP.

The article,“The role of visual stimuli on standing posture in children with bilateral cerebral palsy,“ appeared Aug. 17 in the journal BMC Neurology.

Children with bilateral CP often have a hard time maintaining a standing posture. It might seem that standing is a property of good muscle tone, but much more is involved. Interaction between the sense of balance, visual cues and sensory cues are also needed to remain upright. Although CP is often thought of as a motor disorder, difficulties with sensation and perception also occur. Taken together, these issues can additively contribute to problems with standing and posture.

Led by Cecilia Ludbeck of the Department of Women’s and Children’s Health, Karolinska Institute, the study sought to understand the importance of visual information in maintaining a standing position in children with CP.

The scientists studied body position, body movement, and muscle activity of children in self-selected positions, when blindfolded, or during a task that demanded visual attention. The study enrolled 27 children without CP and 36 with bilateral CP, of whom 17 needed support for standing and 19 could stand without support.

Overall, researchers found that children with CP had a more flexed body position when standing than typically developing children, and the flexed position was more pronounced in those with CP who needed support while standing. Being blindfolded increased flexing even more in kids needing support while standing, but did not effect those children who did not need standing support.

The attention-demanding task (watching a short film sequence) was found to improve posture in CP children not using support to stay standing. As the researchers reported, “they stood more still, with less knee movement and with less activity in the knee extensors and calf muscles. The presence of the intensified visual attention cues seemed to improve posture, at least to some extent, in the children who could adapt to the new environment with muscle activity.”

The results supported the need for multiple inputs, including visual information, in order for children with CP to stand upright.

“Visual input was important for children with CP to maintain a standing position. Without visual input the children who required support dropped into a further crouched position. The somatosensory and vestibular systems alone could not provide enough information about the body position in space without visual cues as a reference frame,” the investigators concluded. “In the children who stood without support, an intensified visual stimulus enhanced the ability to maintain a quiet standing position. It may be that impairments in the sensory systems are major contributors to the difficulties to stand erect in children with CP.”

Based on the results, the team suggests that it is important for clinicians treating kids with CP to consider not only the motor problems that occur in this disease, but also problems in sensory systems and the positive contribution of visual input, in particular.