November 4, 2010
Wherever You Go, There You Are
This is the title of the classic book by Jon Kabat-Zinn regarding mindfulness meditation. (For those who may be interested, Kabat-Zinn is the creator of Mindfulness Based Stress Reduction, which originated at the University of Massachusetts Medical School and is now practiced world-wide.) “Wherever you go, there you are” is also my favourite metaphor for life.
At present, I am reflecting on my wish for more research with regards to the function of the Core musculature and its role in postural control in children with motor dysfunction. I am always hopeful that this kind of information can inform our treatment strategies. Make no mistake, there is some excellent research out there. I discussed in my previous post (“The why in assessment”) some of the literature that forms the basis of Core Restoration for Kids. However it has all been done with the adult orthopaedic population.
And there is also some great literature that furthers our understanding of postural control in different pediatric populations. Research on children with CP indicates that they experience difficulty in recruitment order of postural muscles as well as the ability to modulate muscle contractions (1). Further, they show greater variability and significantly shorter amplitude of APA (=anticipatory postural adjustment) excursion (2). This latter study suggests that intervention designed to facilitate APAs may be beneficial to child with CP.
A recent study of children with sensory modulation disorder indicates that these children experience impairment in stance stability control (3). Studies regarding children with autism suggest that children with ASD exhibit atypical posture in the head and trunk as well as increased postural sway (decreased postural stability) in standing as well as atypical gait features (4,5). These are consistent with difficulties with the integration of visual, vestibular and somatosensory input that may be tied to motor dysfunction in the cerebellum and basal ganglia (5).
Authors have also recently documented that APAs are less efficient in unloading of the UE in children with DCD (6). An earlier study of children with DCD documented balance difficulty in this population however EMG was performed on distal LE musculature only (7). Most exciting however is a recent piece of literature that looks at the Core and postural control in children with DCD. Kyra Kane, a Physical Therapist in Regina, has completed a wonderful study as her master’s thesis entitled “Contributions of trunk muscles to anticipatory postural control in children with and without developmental coordination disorder” (8). There are many gems of information in this study. Ms. Kane has demonstrated that the timing of postural muscle recruitment is altered in children with DCD and that this timing is likely associated with the coordination difficulties displayed by children with DCD. The key Core muscle studied here was the transversus abdominis and the bottom line is this – the TA does not come online in preparation for gross motor tasks in these children. So we now have evidence that a central piece of Core musculature does not provide anticipatory postural control in this population. Further research will undoubtedly further our insight.
So, as I read this, I realize the research has indeed come a long way in the last few years. I can always wish for more information, but in this moment, here we are.
1. van der Heide JC, Begeer B, Stremmelaar E et al:Postural control during reaching in preterm children with cerebral palsy.Dev Med Child Neurol 2004;46:253-266.
2. Liu WY, Zaino A, Westcott McCoy S:Anticipatory postural adjustments in children with cerebral palsy and children with typical development.Ped Phys Ther 2007;19:188-195.
3. Su CT, Wu MY, Yang AL et al:Impairment of stance control in children with sensory modulation disorder.Am J Occup Ther 2010;64(3):443-52.
4. Molloy CA, Dietrich KN, Bhattacharya A:Postural stability in children with autism spectrum disorder.J Autism Dev Disord 2003;33(6):643-52.
5. Rinehart NG, Tonge BJ, Iansek R et al:Gait function in newly diagnosed children with autism: cerebellar and basal ganglia related disorder.Dev Med Child Neurol 2006;48(10):819-24.
6. Jover M, Schmitz C, Centelles L et al:Anticipatory postural adjustments in a bimanual load-lifting task in children with developmental coordination disorder.Dev Med Child Neurol
7. Geuze RH: Postural control in children with developmental coordination disorder.Neural Plast 2005;12(2-3):183-92.
8. Kane K, Barden J:Contributions of trunk muscles to anticipatory postural control in children with and without developmental coordination disorder.2010, University of Regina.