Purpose: Assessment of orthopaedic or surgical treatment in children with cerebral palsy is essential. For the lower limb, the main objective is to improve walking. Gait and control of static and dynamic posture are closely related. In this preliminary study, we attempted to determine whether treatment of pes equin which perturbs gait and equilibrium improves control of static and dynamic posture.
Material: Four children with spastic diplegia, one boy and three girls, aged five to fourteen years participated in this preliminary study. These children had unilateral or bilateral fixed or dynamic pes equin requiring medical (injection of botulinic toxin and/or lengthening casts) or surgical (aponeurotomy of the gastrocnemius) management.
Methods: Balance Master® was used for the posturographic evaluation. This system uses a force platform for calculating the vertical component at the centre of downward force on the feet. Five tests were used: distribution of body weight, stability in different sensorial conditions, single stance stability, limits of stability, rhythmic balancing movements. These tests were performed during the month preceding treatment and two and four months after treatment.
Results: For distribution of body weight, two children clearly improved after treatment. For the stability test in different sensorial conditions, all children showed improvement. There was no real improvement in the single stance test but two children who had had a unilateral treatment exhibited degradation on the untreated side. The rhythmic balancing movements test revealed an improvement in directional control in three of the four children.
Discussion and conclusion: This preliminary study demonstrated the feasibility of obtaining an easily implemented patient-friendly assessment of static and dynamic posture control in very young children with cerebral palsy. The Balance Master® system appears to be an interesting research tool for assessing posture control before and after treatment and might also be a useful rehabilitation tool.
