Increased muscle responses to balance perturbations in children with cerebral palsy can be explained by increased sensitivity to center of mass movement.
J Willaert, G Martino, K Desloovere and 3 others
PMID 36990910WHAT IT FOUND
Children with cerebral palsy react to balance perturbations with much stronger muscle activation than typically developing peers.
Their nervous systems are hypersensitive to body movement, causing stiff, co-contracted responses that make them step to avoid falling even at low speeds.
Key findings
01Children with cerebral palsy had higher feedback gains (sensitivity) for center of mass displacement and velocity in both agonist and antagonist muscles compared to typically developing children.
02Children with cerebral palsy performed fewer perturbation levels without stepping and showed smaller center of mass displacement in milder perturbations, indicating a stiffer balance response.
03The study found no significant difference in how children with and without cerebral palsy modulated their muscle response amplitude as perturbation difficulty increased, contradicting previous reports.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study included only children with GMFCS levels I-III who could stand independently, so findings may not apply to those with more severe motor impairments. The mathematical model assumes center of mass feedback drives muscle activity, but it cannot fully separate balance-correcting responses from stretch reflexes caused by spasticity. Sample size was small, preventing subgroup analysis for hemiplegic versus diplegic presentations or correlations with fall history. Children with poorer balance did not complete higher perturbation levels, which may bias comparisons at those speeds.
Declared interests
The authors declared no conflicts of interest. The work was supported by the Research Foundation Flanders and the European Research Council.
The easy way to misread this
Do not interpret the smaller body sway in children with cerebral palsy during mild perturbations as better balance control. The study shows this stiffness results from hypersensitive muscle responses that likely contribute to their inability to handle stronger perturbations without stepping.