Habilitation of reactive balance control
Research on habilitation strategies for reactive posture control has shown that this type of
balance control can be improved with training (Shumway-Cook et al. 2003, Woollacott and
Shumway-Cook 2005, Woollacott et al. 2005). Children with cerebral palsy (bilateral and
unilateral spastic CP) were given 5 days of intensive training in reactive balance control,
consisting of 100 trials of variable forward and backward platform movements. Reactive
balance training led to improvements in postural performance, as measured by time to
recover stability after a balance threat (see Fig. 5.1). In addition, training improved the
directional specificity of postural responses and other spatial–temporal muscle response
characteristics, including (1) faster activation of muscle responses, associated with faster
recovery of stability; (2) an increase in distal–proximal postural muscle response patterns;
and (3) decreased coactivation of agonist and antagonist muscles. Training-related
improvements also remained at 1 month post-training. Interestingly, each child with CP
showed a unique combination of these changes that contributed to an improvement in their
balance performance (as measured by total COP movement and time taken to recover
stability in response to the perturbation). In addition the level of improvement was associated
with the severity of involvement of the CP: children with unilateral CP showed increased
improvements compared to those with bilateral CP.
In summary, reactive postural response characteristics for children with all forms of
cerebral palsy show delays in the onset of contraction of distal (ankle) muscles. In addition,
Habilitation of reactive balance controlResearch on habilitation strategies for reactive posture control has shown that this type ofbalance control can be improved with training (Shumway-Cook et al. 2003, Woollacott andShumway-Cook 2005, Woollacott et al. 2005). Children with cerebral palsy (bilateral andunilateral spastic CP) were given 5 days of intensive training in reactive balance control,consisting of 100 trials of variable forward and backward platform movements. Reactivebalance training led to improvements in postural performance, as measured by time torecover stability after a balance threat (see Fig. 5.1). In addition, training improved thedirectional specificity of postural responses and other spatial–temporal muscle responsecharacteristics, including (1) faster activation of muscle responses, associated with fasterrecovery of stability; (2) an increase in distal–proximal postural muscle response patterns;and (3) decreased coactivation of agonist and antagonist muscles. Training-relatedimprovements also remained at 1 month post-training. Interestingly, each child with CPshowed a unique combination of these changes that contributed to an improvement in theirbalance performance (as measured by total COP movement and time taken to recoverstability in response to the perturbation). In addition the level of improvement was associatedwith the severity of involvement of the CP: children with unilateral CP showed increasedimprovements compared to those with bilateral CP.In summary, reactive postural response characteristics for children with all forms ofcerebral palsy show delays in the onset of contraction of distal (ankle) muscles. In addition,
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