Westcott, SL
Lowes, LP, Richardson PK, Crowe TK, and Deitz JC
Medical College of Pennsylvania and Hahnemann University,
Philadelphia, PA 19102
INTRODUCTION: Children with motor disability are routinely treated by physical therapists with a primary objective to improve the children s ability to maintain postural control or balance while completing functional movement activities. Approaching the construct of balance from a systems theory of motor control, the primary purpose of our research has been to develop and examine clinical methods to systematically determine the ability to use sensory information, the motor coordination response to perturbations, and the biomechanical availability of children with motor disability. This information should assist professionals to isolate deficit areas and design more specific and efficacious therapy to improve postural stability and motor function.
MATERIALS AND METHODS: For evaluation of sensory interaction for maintenance of balance, the Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB) has been developed. This test systematically alters sensory input from the visual and somatosensory systems while the examiners monitor duration of standing and amount of sway in each condition. Interrater and test-retest reliability have been tested and found to be similar to other pediatric tests of balance. One hundred children with disabilities (36 children with learning disabilities (LD), 36 children with cerebral palsy (CP), 10 children with Down syndrome (DS), and 18 children with varied developmental disabilities (DD) who were identified by their physical or occupational therapist to have balance dysfunction), age 4 to14 years, and 149 children who were developing in a typical manner (TD), age 4 to 9 years have been tested with the P-CTSIB.
RESULTS: The children with LD were found to score differently on four of the six sensory system conditions than children who were TD (matched for age, sex and ethnic background), with 56 % showing poorer performance on the conditions requiring resolution of sensory conflicts and use of vestibular information. The 36 children with spastic CP showed varied patterns, but overall had difficulty when the somatosensory system was inaccurately reporting their standing position. The children with DS uniformly scored lower than the TD group, but did not show any specific sensory interaction problems, instead the duration of their standing balance was overall very brief. The children with varied DD had several different sensory condition profiles ranging from depressed scores like the children with DS, to specific sensory deficits areas similar to the children with LD and CP.
CONCLUSION: Evaluation of these results will assist professionals in understanding the contribution of the sensory systems to standing balance ability and in designing specific therapies. Efficacy studies comparing treatments developed for specific problems to the general treatment approach used in the clinic today may demonstrate greater improvement in standing balance in children with motor disabilities.
[Return to Table of Contents, Back to Research Symposium Home Page, Orthopaedic Department Home Page]