The inclusion of postural abnormalities in the clinical picture expressed by children with
cerebral palsy (CP) is clearly underscored in a recent reappraisal, which describes this
condition as ‘a group of disorders of the development of movement and posture causing
activity limitation, that are attributed to non-progressive disturbances that occurred in the
developing foetal or infant brain’, and recommends that ‘all body regions – including trunk,
. . . – be described in terms of any impairment of movement or posture’ (Bax et al. 2005).
Indeed, several lines of evidence point to a potentially relevant role of postural control in
the functional performance of persons with CP. For instance, studies examining the
development of motor skills in children with CP indicate that there are delays both in the
emergence of behavioural motor milestones, and also in subsequent impairments in motor
skills, including standing, walking and manipulation. As efficient postural control is
important for the performance of voluntary skills, postural abnormalities could contribute
to the delays and impairments seen in the motor skills of the child with CP (see Chapter 4).
At the same time, abnormal postural attitudes might result from the need to cope with
specific primary deficits such as poor balance control or muscle weakness, so that adaptive
or substitutory postural changes will become part of the clinical picture of CP.
Although the above notions appear to have remarkable clinical relevance, e.g. for
programming targeted therapeutic interventions, the available data on functional impairment
in CP reveal a limited number of studies aimed at describing the postural conditions and the
possible disturbances of the different types of postural control mechanisms. The present
chapter addresses these points. In particular, the regulation of the postural attitude
maintained during standing by children with CP will be dealt with in the first part, whereas
in the second part analysis will focus on dynamic postural control in relation to the locomotor
function.