Dissertation Defense: Sitting, Standing & Starting: Detailing Postural Control & Gait Anticipation for Children with Hemiplegic Cerebral Palsy

About this Dissertation

Cerebral Palsy (CP) is the leading cause of motor disability in children and affects between 1.5 and 4 children per 1,000 live births in the US alone. Thirty-40% of children born with CP are diagnosed with Hemiplegic Cerebral Palsy (HCP); meaning they present with one side of the body weaker than the other. The resulting asymmetry impedes the ability of children with HCP to distribute weight evenly between their lower limbs, often creating poor postural control. This is due in part to the observed favoring they have towards their non-paretic side. Limb-loading asymmetry impacts children with HCP’s ability to achieve symmetrical postures during standing, sitting and walking; however, researchers have struggled to measure posture in children with HCP and have yet to investigate the relationship between standing balance and gait initiation in tandem for this population of children.

Through innovative collaboration between the Neuromotor Research Clinic (NMRC) and the Kevin P. Granata Biomechanics lab, Hassan Farah will begin to contextualize these relationships. This dissertation will cover two experiments designed to test a novel method for analyzing and scoring postures that children adopt during therapeutic processes, and compare standing balance and balance while anticipating or preparing for gait in children with no known diagnosis to a case series of children with HCP. The first project retrospectively scored posture characteristics during videotaped therapy sessions with a modified clinical measure called the Posture & Postural Ability Scale (PPAS). This project specifically examines the reliability of using this technique, in order for it to inform clinical and research processes in the future. If reliable it would allow for scoring postures that children with HCP adopt naturally while completing everyday tasks and fill a measurement gaps in the field of postural research for children with HCP.

The second study was a prospective study funded by the National Institute of Child Health & Human Development investigating how children with HCP distribute their center of pressure (COP) when standing and how it might change when expecting to walk. Children with HCP were matched by age and gender to typically developing children in a case series, and compared to a larger cohort of typically developing children. Biomechanic data and clinical motion analyses provide a descriptive data set that will inform pediatric rehabilitationists. Farah’s projects illustrate a translational research process that bridges science and health concepts, techniques, and campuses.

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