Ways to Improve Balance in Cerebral Palsy

Patients
By Tara Shakti, eHow Contributor

In patients with cerebral palsy, the brain (cerebral) has difficulty communicating with the
muscles of the body (palsy). As a result, poor muscle coordination and movement control
often result, and depending on the severity of the condition, symptoms can range from mild
(clumsiness) to severe (not being able to walk at all). In most cases, balance is
compromised. Here a few therapies used to help improve balance in patients with cerebral
palsy.

Yoga
1. Practicing yoga poses will not only help to loosen and stretch tight muscles, which is
so often characteristic of children with cerebral palsy, but will also help to balance
both sides of the body and improve core strength, which is necessary for good
balance and posture.
Hippotherapy
2. A horse's gait provides a sense of rhythm to a patient with cerebral palsy and
encourages the patient to align his torso and hips correctly. This alignment improves
posture and balance, not to mention core strength and coordination, all of which aids
in sitting and eventually standing and walking. A physical therapist will often have
your child sit in a variety of positions and reach for items to help increase her
balance.
Using an Exercise Ball
3. In 1965, physical therapists in Switzerland started using an exercise ball (also called
a gym ball, stability ball, fitness ball, therapy ball, balance ball, or medicine ball) for
children with cerebral palsy. Use an exercise ball to increase flexibility, stretch and
tone different muscles, as well as improve balance and posture. Have your child sit
on the ball. Hold her thighs for support and then gently tilt her to one side. Wait a
beat and then tilt her to the next side. All the while, encourage her to place each
opposite hand on the ball for support.
Using a Balance Board
4. According to a study published in the Developmental Medicine & Child Neurology
(2003), balance training in children with cerebral palsy demonstrated an overall
improvement in their ability to recover stability, indicating that balance board training
may be an effective tool to use in treating patients with cerebral palsy.

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Developmental Medicine & Child Neurology

Volume 45, Issue 9, pages 591–602, September 2003

Effect of balance training on recovery of stability in children with cerebral palsy

1. Anne Shumway-Cook PhD PT1,*,

2. Susan Hutchinson MS PT2,

3. Deborah Kartin PhD PT3,

4. Robert Price MSME4,

5. Marjorie Woollacott PhD5

Article first published online: 13 FEB 2007

DOI: 10.1111/j.1469-8749.2003.tb00963.x

This study examined the effect of massed practice in balance recovery of stability in six children (four males,
two females; mean age 9 years 2 months, SD 2 years, range 7 years 5 months to 12 years 11 months) with
cerebral palsy (CP). Four children were diagnosed with spastic diplegia (Gross Motor Function Classification
System [GMFCS] level II) and two with spastic hemiplegia (GMFCS level I). A single-subject, multiple-
baseline experimental design involving three pairs of children matched for diagnosis was used. A moveable
forceplate system was used to test and train reactive balance control. Area per second (i.e. area covered by
the center of pressure over a one second period) and time to stabilization from center of pressure measures
were calculated following perturbations. The intervention phase consisted of massed practice on the moving
platform (100 perturbations/day for 5 days). Analysis included hierarchical linear modeling and a repeated
measures ANOVA. All children demonstrated a significant improvement in their ability to recover stability as
demonstrated by reduced center of pressure area and time to stabilization following training. These
improvements were still present 30 days following completion of training. Results suggest that postural
control mechanisms in school-age children (7 to 13 years) with CP are modifiable.

Effect of balance training on muscle activity used in recovery of stability in children with cerebral palsy :
a pilot study
Résumé / Abstract
This study explored possible neural mechanisms that contribute to improvements in balance control
produced by reactive balance training in children with cerebral palsy (CP). Six children with CP (four
males, two females; mean age 9y 4mo), two with spastic hemiplegia (Gross Motor Function Classification
System [GMFCS] level I) and four with spastic diplegia (GMFCS level II,) were given 5 days of intensive
training in reactive balance control (100 perturbations per day on a moveable force platform). Surface
electromyography was used to characterize changes in neuromuscular responses pretraining, immediately
posttraining, and 1 month posttraining. Training in reactive balance control resulted in improvements in
directional specificity of responses (a basic level of response organization) and other spatial/temporal
characteristics including: (1) faster activation of muscle contraction after training, allowing children to
recover stability faster; (2) emergence of a distal-proximal muscle sequence; and (3) improved ability to
modulate the amplitude of muscle activity (increased amplitude of agonist and decreased amplitude of
antagonist, reducing coactivation). Each child with spastic hemiplegia or diplegia showed a different
combination of factors that contributed to improved performance; the level of change in neural factors
depended on the severity of involvement of the child: hemiplegia vs diplegia, and level of involvement
within each diagnostic category.

http://cat.inist.fr/?aModele=afficheN&cpsidt=16874890

American Journal of Physical Medicine & Rehabilitation:

July/August 1999 - Volume 78 - Issue 4 - pp 336-343
Research Articles
Performance of Static Standing Balance in Children With Spastic
Diplegic Cerebral Palsy Under Altered Sensory
Environments1
Cherng, Rong-Ju MA, PT2; Su, Fong-Chin PhD; Chen, Jia-Jin Jason PhD; Kuan, Ta-Shen MS, MD

Abstract
Seven children with spastic diplegic cerebral palsy and 14 age- and gender-matched nondisabled
children participated in the present study for an investigation and comparison of their static
standing balance under altered sensory environments. The type of visual input (full, occluded, or
sway referenced vision) and the type of somatosensory input (fixed or compliant foot support)
were varied factorially to give six sensory environments. Each participant was tested barefooted
for 30 s under all six conditions. A force platform collected the ground reaction force, from which
standing balance was calculated as the sway area of the center of pressure. The results showed
that when somatosensory information was reliable (fixed foot support), there was no significant
difference in stance stability between the children with spastic diplegic cerebral palsy and their
matched controls, and both types of children were equally affected by the type of visual input.
However, when somatosensory information was unreliable (compliant foot support), the
difference in stance stability between the children with spastic diplegic cerebral palsy and their
matched controls was significantly greater when the visual input was deprived (occluded) or
unreliable (sway referenced) than when it was reliable. These results suggest that the children
with spastic diplegic cerebral palsy may have difficulties in resolving intersensory conflicts for
maintenance of standing balance, or the demands of motor control in sensory conflict conditions
outweigh the motor ability of children with spastic diplegic cerebral palsy.

http://journals.lww.com/ajpmr/Abstract/1999/07000/Performance_of_Static_Standing_B
alance_in_Children.8.aspx