Jonathan Pierret

Sébastien Caudron

Jean Paysant

Christian Beyaert

Improving effect of enhanced axial rehabilitation on trunk control deficit in children with cerebral palsy

Improving effect of enhanced axial rehabilitation on trunk control deficit in children with cerebral palsy

Introduction

Recently, several studies have shown that children with cerebral palsy (PC) have trunk control disorders both while sitting [START_REF] Liao | Differences in seated postural control in children with spastic cerebral palsy and children who are typically developing[END_REF] and walking [START_REF] Attias | Trunk movements during gait in cerebral palsy[END_REF]. If most therapeutics focus on lower limb and gait disorders, trunk control deficit can roughly affect daily life. Lately, new tools to evaluate trunk control have appeared. The Trunk Control Measurement scale [START_REF] Heyrman | A clinical tool to measure trunk control in children with cerebral palsy: the Trunk Control Measurement Scale[END_REF] is a clinical scale developed to assess trunk control in children with CP in several ways such as static sitting balance, selective movement control and equilibrium reaction. Another tool is the unstable sitting device (Fig 1) that allows static and dynamic posturography of the trunk. Moreover, it can be calibrated in order to homogenize the difficulty between the subjects according to their anthropometric characteristics, during unstable posturography [START_REF] Larivière | Criterion validity and between-day reliability of an inertial-sensor-based trunk postural stability test during unstable sitting[END_REF].

The aim of our study was to test the effects of enhanced axial rehabilitation (EAR) on trunk control during seated posture in CP children.

CP and TD childrens were first compared on the TCMS and unstable sitting posturography. Then, the performances of CP childrens were compared before and after an enhanced axial rehabilitation (EAR) of 3 months. The EAR leaded by a physiotherapist was based on exercises in different postures performed by the child each day that strongly involve the trunk to cope with balance. Exercices included unsual movements such as lumbar delordosis and scapular and pelvis belt dissociation.

Fig 1 :

 1 Fig 1 : unstable sitting device on a 3D forceplate for sitting posturography