Management of postural abnormalities in children with cerebral palsy

Postural problems play a central role in the motor dysfunction of children with cerebral palsy. The performance of everyday activities is noticeably influenced by such postural deficits. In this chapter, we will review the epidemiology of postural deformities such as scoliosis, pelvic obliquity and hip subluxation/dislocation in these children. We then relate these deformities with secondary problems like pain, loss of ability, increased care burden, pressure problems, cardio-pulmonary dysfunctions, swallowing difficulties and sleep disturbance, which can all adversely affect the quality of life of the children as well as that of their caregivers. Many factors are involved in the development and aggravation of postural deformities, such as tone abnormalities, persistent primary reflexes, handedness, habitual posture, pain and inappropriate postural management. Among these factors, recent studies suggest that asymmetrical skull deformity (ASD) is frequently observed in cerebral palsy and closely related with asymmetric postural deformities. ASD is thought to be brought about by a predominantly one-sided facial direction during early childhood when the skull is softer, and once ASD becomes established, it aggravates the asymmetrical posture further. An asymmetrical tonic neck reflex caused by a one-sided face direction could contribute to the development and aggravation of postural abnormalities and limb and spinal deformities. A recent consensus statement by an expert multidisciplinary group defined a postural management program for children with cerebral palsy as "a planned approach encompassing all activities and interventions which impact on an individual's posture and function". In this comprehensive approach, postural management focused on ASD and facial direction appears to be necessary to prevent deformities in children with cerebral palsy.