must tools used in rehabilitation be reliable and valid, but
they must also be appropriate for clinical use. Tools that are
prohibitively expensive, time-consuming, or require laboratory
testing have little clinical use. In addition, tools used
in rehabilitation must be sensitive enough to detect clinically
important changes in function.
Children with cerebral palsy experience muscle coordination
problems, difficulties with the organization of
sensory information and functional limitations that may be
influenced by increased tone in their upper and lower extremities.
These factors affect postural control.2 Balance
strategies of children with cerebral palsy are different than
the strategies used by children without a neurological impairment.
Children with cerebral palsy demonstrate increased
co-contractions of distal and proximal muscles and
do not have a smooth distal-to-proximal pattern of muscle
activation.3 Nashner et al.4 found that, unlike subjects developing
typically, children with cerebral palsy demonstrated
a reversed order of activation of distal and proximal
muscle synergies in response to a moving platform. In children
with spastic hemiplegia, Nashner et al.4 also found