Reducing spasticity and enhancing postural control for the creation of a functional sitting position in children with cerebral palsy: A pilot study

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Abstract
With the aim of creating a functional sitting position and a method to identify factors which reduce spasticity and enhance postural control, a pilot study was conducted of two girls with severe cerebral palsy. The girls were photographed and videotaped seated in six various positions, including their original adapted chairs as well as after different interventions and even a hypothetical functional sitting position. These positions were varied by changing the inclination of the seat, either with or without an abduction orthosis and with or without a table in front of the child. The total time required for postural control was recorded. The children's pathologic/spastic movements were identified and counted. The children's upper bodies relative to the rotational axis at the ischial tuberosities were analysed from photographs. The greatest reduction of spasticity was gained and postural control was markedly superior when three factors were combined: the symmetrical fixation of the child by a belt anchored under the seat; the use of an abduction orthosis; and the placement of the line of gravity of the upper body anterior to the axis of rotation at the ischial tuberosities. These factors were combined with the seat inclined forwards or placed level with the child's forearms supported against a table. Changing the inclination of the seat alone showed no discernible effect.