Effects of Forward Tilting of Seat Surface on Arm-hand Mobility of Young Children with Bilateral Spastic Cerebral Palsy: a Preliminary Study

Abstract

This preliminary study is on the effect of forward-tilting of the seat-surface on arm-hand function of young children with cerebral palsy (CP). Five children were recruited (two females, three males; median age 2 years 7 months). Inclusion criteria: preschool age, bilateral spastic CP with truncal hypotonia, Gross Motor Function Classification System levels II-IV. Participants served as their own controls. Adaptive seating with three wedge-inserts inducing 10, 20 or 30 degrees forward-tilt of the seat-surface was used. The tilt which induced best postural stability and alignment was applied. Arm mobility was assessed three times with one week intervals. Arm-hand function was assessed using the upper limb physicians rating scale (ULPRS) in the horizontal condition (H), and forward tilt condition (FW), 10 minutes per condition in random order. Two children were tested with 10-degree FW tilted seating, three children with 20 degrees. Mean ULPRS scores were higher in FW [dominant arm: 19.73 (1.94), non-dominant arm: 16.53 (2.21)] than in H condition [dominant arm: 17.93 (1.92), non-dominant arm: 13.73 (2.52)]. ANOVA demonstrated an effect of condition (dominant arm: p=0.001, non-dominant arm: p=0.009), but not of the testing session (dominant arm: p=0.970, non-dominant arm: p=0.724). Therefore, forward-tilting of the seat-surface may enhance arm-hand function in preschool children with Bi-CP.