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AIMS: Systematically review literature addressing the effects of changes in base of support (BoS) configuration and characteristics of support surface (SS) on postural control of children with cerebral palsy (CP). METHODS: We conducted a tailored electronic database search in PubMed/Web of Science/SCOPUS/Embase. RESULTS: We identified 15 studies meeting inclusion criteria. CONCLUSION: The extant literature suggests that when children with CP experience changes in BoS and SS, they engage in fewer adaptive postural control responses than typically developing children. Documented response patterns of children with CP in the literature might guide the selection and development of rehabilitation strategies to appropriately facilitate or challenge postural control in children with CP.

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AIM: To describe current home participation (frequency, involvement) and caregiver's desire for change in home participation of children and adolescents with Down syndrome, as well as home environmental factors, and to explore the associations of personal and environmental factors with current participation and caregiver's desire for change. METHOD: Eighty-two caregivers (mean age = 45 years 10 months) of children and adolescents with Down syndrome (mean age = 10 years 7 months) were surveyed about the child's home participation and environmental factors using the Participation and Environment Measure-Children and Youth. Furthermore, children's personal and environmental factors were collected. Results are reported using descriptive analysis and correlations (Spearman's rank correlation coefficients and Mann-Whitney U test) to describe the relationship between current participation and caregiver's desire for change, with personal and environmental factors as ordinal and nominal variables respectively (p < 0.05). RESULTS: Children's participation was highest with regard to personal care management and lowest with regard to school-related activities. Most caregivers desired change in homework and household chores. Greater frequency was associated with male sex, caregiver less rigorous social distancing due to the COVID-19 pandemic, and children receiving therapies. Greater involvement was associated with younger age in children and higher environmental support. Older age in children was associated with caregiver's greater desire for change. INTERPRETATION: Personal and environmental factors correlated with participation in specific ways. Creative strategies to promote participation that consider caregiver's wishes should be undertaken.

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BACKGROUND: According to a biopsychosocial approach to health and disability, participation at home and functional skills are important components of the functioning. Therefore, knowledge about interactions between these components allows for targeting specific interventions. OBJECTIVE: This study investigated whether participation opportunities (frequency and involvement) for children/adolescents with Down syndrome (DS) in a realistic environment at their own home are associated with the functional skills related to the domains of Daily Activities, Mobility, Social/Cognitive and Responsibility. METHODS: This was an observational study. Forty-eight children/adolescents with DS participated (mean age: 10.73 ± 3.43; n = 27 females). Participants were evaluated using the Participation and Environment Measure for Children and Youth (PEM-CY) home environment setting (raw frequency and engagement scores) and Pediatric Evaluation of Disability Inventory speedy version (PEDI-CAT-SV) (continuous score). RESULTS: Significant and positive correlations were found between the frequency of participation at home with Daily Activities (ro = 0.320), Social/Cognitive (ro = 0.423) and Responsibility (ro = 0.455). For involvement, significant and positive correlations were found with Daily Activities (ro = 0.297), Social/Cognitive (ro = 0.380) and Responsibility (ro = 0.380). For the PEDI-CAT-SV Mobility, no significant correlation was found. CONCLUSIONS: Higher frequency and involvement of participation at home are associated with greater functional skills assessed, except for Mobility. This study provided pioneering insights about the relationships between the level of home participation and functional skills in DS, generating evidence that could guide approaches to participation-focused intervention.

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The COVID-19 pandemic and its demands of social distancing have created challenges in the lives of children/adolescents with developmental disabilities and their families, which would change aspects of children's functioning. The objetive of this study was to evaluate changes in some components of functioning of children/adolescents with disabilities following 4 months of social distancing during a period of high contamination rate in the year 2020 in Brazil. Participated 81 mothers of children/adolescents with disabilities, 3-17 years, most of them (80%) diagnosed with Down syndrome, cerebral palsy and autism spectrum disorder. Remote assessments of functioning' aspects including IPAQ, YC-PEM/ PEM-C, Social Support Scale and PedsQL V.4.0. Wilcoxon tests compared the measures, with significance level <0.05. No significant changes in participant's functioning were identified. Social adjustments required to facing the pandemic during two points in time in the midst of the pandemic did not change the evaluated aspects of functioning in our sample of Brazilian.

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OBJECTIVE: The purpose of this study was to investigate the cognitive-motor dual-task costs (DTCs) on postural sway of children with typical development (TD) and children with cerebral palsy (CP) during the sit-to-stand movement. METHODS: Twenty children with TD (mean age = 9.35 years) and 17 children with CP (mean age = 8.29 years) randomly performed 3 test conditions: simple motor task, low-complexity cognitive-motor dual-task, and high-complexity cognitive-motor dual-task. The sit-to-stand movement was divided into 3 phases for data analysis: preparation (P1), rising (P2), and stabilization (P3). For each of these phases, the DTCs were calculated by the percentage change in the center of pressure area of sway, velocity of sway, and duration variables between the simple and dual-task conditions. Analysis of variance was applied to test the group, task conditions, and interaction effects. RESULTS: Children with CP had lower DTC than children with TD in area of sway in P1 and P2 variables; anteroposterior velocity of sway in P1, P2, and P3; and duration in P3. Children with TD had higher DTC in the high-complexity cognitive-motor dual-task than in the low complexity one. Children with CP did not show adaptations between the dual-task conditions, showing no differences in DTCs. CONCLUSION: The simultaneous performance of a motor task and a cognitive task seems to affect children with CP and children with TD differently, but the effects depend on the specific demands of each task. These results demonstrate the importance of rehabilitation actions to place demands involving a variety of postural sway strategies. IMPACT: DTCs are different for children with TD and children with CP. Assessment and rehabilitation strategies must take into account the postural sway behavior of these children.

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BACKGROUND: Social support and Quality of life (QoL) are important aspects of life and should be explored during the specific scenario of the pandemic. AIMS: (i) to compare the perceived social support (PSS) in caregivers and the domains of QoL of the caregiver and the child with developmental disabilities (DD) and typical development (TD); (ii) to verify the existence of the association, in each group, between the PSS, and the domain of QoL of the caregiver and the child. METHODS AND PROCEDURES: 52 caregivers of children with DD and 34 with TD participated remotely. We assessed PSS (Social Support Scale), children's QoL (PedsQL-4.0-parent proxy) and caregivers' QoL (PedsQL-Family Impact Module). The groups were compared for the outcomes using the Mann-Whitney test, and Spearman's test evaluated the correlation between the PSS and the QoL (child and caregiver) in each of the groups. OUTCOMES AND RESULTS: There was no difference between groups for PSS. Children with DD presented lower values in PedsQL total, psychosocial health, physical health, social activities, and school activity. Caregivers of children with TD presented lower values in PedsQL family total, physical capacity, emotional aspect, social aspect, daily activities, and higher value in communication. In the DD group, we found a positive relationship between PSS with child: Psychosocial Health (r = 0.350) and Emotional Aspect (r = 0.380), and with family: Total (r = 0.562), Physical Capacity (r = 0.402), Emotional Aspect (r = 0.492), Social Aspect (r = 0.606), Communication (r = 0.535), Concern (r = 0.303), Daily Activities (r = 0.394) and Family Relationships (r = 0.369). In the TD group, we found that PSS was positively associated with Family: Social Aspect (r = 0.472) and Communication (r = 0.431). CONCLUSIONS AND IMPLICATIONS: During the COVID-19 pandemic, despite both groups presenting similar PSS, there are important differences in QoL between them. For both groups, greater levels of perceived social support are associated with greater caregiver-reported in some domains of the child's and caregiver's QoL. These associations are more numerous, especially for the families of children with DD. This study provides a unique view into the relationships between perceived social support and QoL during the "natural experiment" of living through a pandemic.

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We investigated factors related to postural sway during sit-to-stand movement in children and adolescents with Down syndrome (DS). Our assessment of participants followed the biopsychosocial model. Body function and structure were represented by muscle strength and postural sway during sit-to-stand movement, which were assessed by manual muscle testing and kinetics analysis, respectively. The Gross Motor Function Measure and Pediatric Balance Scale depicted the activity component. In addition, we included these relevant contextual factors: age, Home Observation for Measurement of the Environment, family income, and maternal schooling. A correlation analysis verified a suspected association between biopsychosocial and postural sway variables. There were significant separated correlations between postural sway in the three phases of the sit-to-stand movement, and age, GMFM-88 dimension D, and muscle strength. Thus, postural control in sit-to-stand movement was related to biopsychosocial factors involving different life aspects of children and adolescents with DS, and these factors should be addressed in rehabilitation therapy intended to improve postural control among these individuals.

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The COVID-19 pandemic interrupted face-to-face health services, leveraging telehealth strategies. The aim of this cross-sectional study was to investigate, from a parent's perspective, the feasibility of a remote assessment of functioning in children with developmental disabilities during the pandemic and related contextual factors, based on how parents carry out the assessment. Parents of children with developmental disabilities (mean age = 7.56 ± 3.68) responded to a remote assessment via electronic forms and telephone interview. We analyzed parents' perspectives about the feasibility of the assessment. We also tested the association between feasibility score and sociodemographics/pandemic experience. Regression analysis tested if children's functioning characteristics predicted feasibility. A total of 57 mothers completed the remote assessment, and more than 95% did not report difficulties in accessing/responding to electronic forms. They scored remote assessment as easy and feasible, and reported no difficulties with telephone interview. Greater feasibility rates were related to lower maternal age (rho Spearman = -0.290; p = 0.029). The model shows that children's characteristics predicted 20.4% of feasibility (p < 0.005). Remote assessment showed to be feasible. Younger mothers might consider easier-to-use technologies, beyond considering remote assessment more viable. These results can guide the next steps in research and remote clinical practice.

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PURPOSE: Postural control assessment in children with Down syndrome (DS) may contribute to understanding the impact of impairments in Body Structures and Functions on Activities and Participation, providing a biopsychosocial approach to support clinical practice. The present study aimed to systematically review the literature addressing postural control in children and adolescents with Down syndrome, with a focus in the interactions among the components of the International Classification of Functioning (ICF). METHODS: We conducted a tailored search in PubMed; Web of Science, SCOPUS and Science Direct databases. RESULTS: We identified 20 full-texts that fulfilled the inclusion and exclusion criteria. Children and adolescents with DS showed lower postural stability across studies. The ICF components most commonly addressed were Body Structure and Function and Activity. Although the studies measured these components, they did not analyze the interrelationships of components when describing the determinants of postural control in this population. CONCLUSIONS: Overall, the studies indicate that children and adolescents with DS show decreased postural stability and greater vulnerability to sensory changes than their typical peers. There is a lack of studies using the biopsychosocial approach. Only few studies have related the activity level of the participants with the variables of postural control. None of them addressed components of Participation and Environmental Factors. The poor methodological quality of the included studies limits the translation of results to clinical practice. Further studies addressing children with disabilities, such as DS, should utilize the ICF framework, thus providing a biopsychosocial approach of health in these individuals.IMPLICATIONS FOR REHABILITATIONChildren with Down syndrome show decreased postural stability and greater vulnerability to sensory changes than their typical peers.In clinical practice, when assessing postural control of individuals with DS, rehabilitation professionals should not only address components of Body Structures and Functions, but also investigate their impact on Activity and Participation.Training of postural control should address strategies that include natural environments and participation situations.The biopsychosocial approach provided by the ICF framework should be implemented in clinical practice.

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PURPOSE: To compare functioning and environmental aspects before and during physical distancing (DPD) and to determine which social, physical, behavioral and functioning aspects of DPD are correlated. METHODS: Sixteen parents of children/adolescents with Down syndrome (11.38 ± 3.00 years) were surveyed before and DPD. Paired t-tests were used to compare functioning and environmental aspects before and DPD and chi-square tests were used to test associations. RESULTS: There were increases in the frequency (p < 0.001) and involvement (p = 0.01) in home participation and on the impact, noticed by the parents, of the possibility of child to participate in daily activities (p = 0.036), as well as a reduction in social supports perceived by caregivers (p = 0.049). An association was found between the child's socio-emotional difficulties symptoms and practice of physical activity (p = 0.043) and with parents' satisfaction with the level of child's home participation (p = 0.042). CONCLUSION: Functioning can be affected in either positive or negative ways.

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We investigated the influence of sex and age in postural sway during sit-to-stand (STS) in children and adolescents of 5-15 years. We evaluated sway during STS in 86 typical participants. STS was divided into three phases: preparation, rising, and stabilization. We calculated for each phase: area, anterior-posterior, and medial-lateral velocity of center-of-pressure sway. We applied a stepwise multiple linear regression model to determine if age and sex might be predictors of postural sway during STS. Only age was associated with sway, accounting for between 6.5% and 14.6% of the variability in sway during STS. The age of the subject influences postural sway during STS, but in a small amount. This variable should be taken into account as a variable of control in the assessment of dynamic postural control. Moreover, postural stability during STS was not associated with the sex of the participants.

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BACKGROUND: Postural stability requires attentional resources. Dual-task paradigms are used to investigate the attentional demand of the studied tasks. However, no studies have been conducted on the subjects' level of attention, analyzing its association with dual-task costs (DTC). RESEARCH QUESTION: To evaluate the attentional level and DTC on postural sway and cognitive yield in children, adolescents, and young adults, investigating age-related differences, and to analyze if the participants' attention level is associated with DTC. METHODS: Postural sway and cognitive-yield of 30 children, 24 adolescents, and 32 young adults were assessed in a dual-task paradigm. We calculated DTC on postural sway and cognitive yield. Attention level was tested using Psychological Battery for Attention Assessment. We tested the association between DTC and attention level. RESULTS: Young adults showed higher DTC on area and velocity of postural sway than children and adolescents. No differences in DTC on cognitive yield were found between the groups. Children showed lower attention levels than adolescents and young adults. Attention level was negatively associated with DTC on cognitive yield in young adults. Focused Attention is responsible for 24.4% of the variance in DTC on cognitive yield. CONCLUSION: Age impacts DTC on postural stability, but not on cognitive performance. The smaller changes in sway found in children/adolescents when dual-tasking, potentially reflect less developed attentional levels and postural control, which make them performing postural tasks closed to their stability boundaries, and, therefore, make them prioritize stability protection more than adults. Similar DTC on cognition between groups may reflect an equalization of the chosen cognitive task at everyone's difficulty level. The lower attention levels of children may reflect an attentional system in development, with prioritization o postural tasks when dual-tasking to maintain stability. Although attention level increases throughout age, attention only predicted DTC on cognition. Better Focused Attention's levels predicted lower DTC on cognitive yield for young adults.

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BACKGROUND: Investigating the influence of sensory processing disorders on the level of function of children with cerebral palsy (CP) may help therapists identify specific impairments that impact activity and participation in these children. This may provide direction on selection of interventions to improve function and quality of life. OBJECTIVES: To investigate if sensory processing disorders in children with CP levels I and II on the Gross Motor Function Classification System (GMFCS) are associated with activity performance. METHODS: Sensory processing and activity performance of 28 children with CP between 5 and 15 years (mean ±â€¯standard deviation; 9.9 ±â€¯3.2 years) were evaluated using the Sensory Profile (SP) and Pediatric Evaluation of Disability Inventory (PEDI), respectively. Associations between the components of the SP and PEDI were assessed with Spearman correlation coefficients. Multiple linear regression analysis using backward stepwise method was used to determine the variables of sensory processing that are associated with activity performance on the PEDI. RESULTS: The category of Behavioral Outcomes of Sensory Processing was the only variable associated with Functional Abilities in self-care and social function (r2 = 0.30 and r2 = 0.39, respectively) and Caregiver Assistance (r2 = 0.36 and r2 = 0.37, respectively), (p < 0.05). CONCLUSION: Sensory processing in children with CP levels I-II on the GMFCS is associated with their ability to perform daily living activities and in their social interaction with the environment.

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Aims: To compare the performance of children with mild and moderate-to-severe cerebral palsy (CP) on the Trunk Impairment Scale (TIS), Gross Motor Function Measure (GMFM), and on center-of-pressure variables; to establish the discriminant ability of these tools to predict severity of motor impairment in CP; and to investigate the criterion validity of the TIS. Methods: Children with mild (n = 18, 11 males, 7 females, mean age = 9.5 ± 2.9 years, Gross Motor Function Classification System I-II) and moderate-to-severe (n = 18, 11 males, 7 females, mean age = 9.2 ± 229, Gross Motor Function Classification System III-IV) CP were tested using the TIS and the GMFM, and during static sitting on force-plate. Results: Children with mild CP showed better trunk (median; 95% confidence interval = 22.5; 21.29-22.59 vs. 13; 11.97-14.8; p < 0.001) and gross motor (60; 57.73-59.3 vs. 40; 38.96-46.25; p < 0.001) scores, and better postural control (lower center of pressure (CoP) displacement [anterior-posterior: (0.42; 0.32-1.11 vs. 0.89; 0.70-1.65; p = 0.022); medial-lateral: (0.42; 0.31-1.08 vs. 0.91; 0.65-1.17; p = 0.044)], and lower area of sway, (0.05; -0.15-0.97 vs. 0.44; 0.23-0.90; p = 0.008) than the moderate-to-severe group. Trunk control and gross motor function explained 81.5% of the variance in the severity of motor condition. Correlations between the TIS and the GMFM were excellent (ρ = 0.944, p < 0.001); correlations between the TIS and CoP variables were low (anterior-posterior displacement: ρ = -0.411, p < 0.05; medial-lateral displacement: ρ = -0.327, p < 0.05); area of sway: ρ = -0.430, p < 0.05; velocity of sway: ρ = -0.308, p < 0.05). Conclusions: The TIS is able to differentiate levels of trunk control across various levels of motor impairments in CP. It is a valid tool to assess trunk control, showing very high concurrent validity with the GMFM sitting dimension. Implications for Rehabilitation Trunk Impairment Scale (TIS) can be used by rehabilitation professionals to differentiate levels of trunk control across levels of motor impairment. TIS showed concurrent validity with Gross Motor Function Measure and should be used to assess trunk control in children with cerebral palsy (CP) in clinical settings. The use of TIS allows a reliable assessment of postural control in children with CP in clinical settings.

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AIM: To investigate the effects of manipulating visual information and the compliance of the support surface on the area of sway and dynamical trajectories of center-of-pressure (CoP) in children with CP and children with typical development during static sitting. METHODS: 32 typical children, 14 children with mild CP and 12 with moderate-to-severe CP were tested for CoP sway during static sitting under four sensory conditions: (1) eyes open on a rigid surface; (2) eyes closed on a rigid surface; (3) eyes open on foam; (4) eyes closed on foam. RESULTS: Children with moderate-to-severe CP showed greater regularity and local stability of dynamical CoP trajectories and lower complexity in their motor patterns than typical children and children with mild CP. Moreover, removing vision and sitting on a compliant surface reduced the regularity of CoP trajectories. CONCLUSION: Children with CP were able to adjust the structure and complexity of their postural control responses to sensory challenges, although the structure of their postural responses was poorer than in typical children.

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OBJECTIVE: To assess age-related changes in postural sway during sit-to-stand (STS) in typical children (TC) and children with mild cerebral palsy (CP). METHODS: Thirty-five TC and 23 children with mild CP were allocated in four different age groups: 5-6, 7-9, 10-12, and 13-15 years; they all performed STS movements over a force plate. Anterior-posterior and medial-lateral amplitude of center of pressure (CoP) displacement, area and velocity of CoP sway were analyzed and compared between the age groups for TC and children with CP. RESULTS: TC at 5 to 6 years of age showed higher values of anterior-posterior CoP displacement and Area of CoP sway than at 10-12 years, during the stabilization phase. There were no age-related changes for CP. CONCLUSION: TC change their postural sway during the last STS phase over the years, reducing their body sway. Children with CP did not show age-related changes in sway during STS, reflecting a distinct rhythm of postural control development in this population.

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AIM: To investigate suit-orthosis effects on postural sway during anticipatory and compensatory postural adjustments (APA and CPA, respectively) in a seated reaching task performed by children with cerebral palsy (CP). METHODS: Twenty-nine children were divided according to Manual Ability Classification System (MACS) I and II-III. Participants were instructed to reach forward toward an object both in a no-suit condition and in a suit-orthosis condition. RESULTS: Using the suit-orthosis, children at MACS II-III decreased velocity of center-of-pressure (CoP) sway during APA, whereas children at MACS I increased the anterior-posterior CoP displacement during CPA. CONCLUSION: Suit-orthosis improved postural stability in children at MACS II-III during APA. The suit may assist with arm function control during postural sway when preparing to reach for objects. CLINICAL IMPLICATIONS: Suit-orthoses in therapy should be individually prescribed considering the intended activity and person's motor impairment.

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The authors sought to verify the effects of vision on sit-to-stand (STS) movement performance by means of postural sway in children with cerebral palsy (CP) and typical children (TC). Participants were 42 TC and 21 children with CP. STS movement was assessed with eyes open and with eyes closed. Area and velocity of center of pressure sway were analyzed in each of the 3 STS phases. We observed greater postural sway during STS movement with eyes closed. Children with CP presented greater postural sway than TC did. Both groups exhibited greater postural instability with absence of vision expressing the role of vision to keep postural stability. Moreover, the greater postural instability was observed in children with CP.

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The authors aimed to compare the weight bearing on hands during sit-to-stand (STS) movement in children with cerebral palsy (CP) and typical children (TC), verify its effect on postural oscillation, and analyze the relationship between weight bearing on hands and postural oscillation. Twenty children with CP (Gross Motor Function Classification System levels I and II) and 35 TC performed STS with and without anterior hands support. Mann-Whitney test compared weight bearing between groups. Wilcoxon test investigated differences in postural oscillation between the conditions with and without anterior hand support for both groups. The Spearman correlation tested the relationship between weight-bearing and postural oscillation during the hand support condition. Children with CP bore more weight on hands than TC to perform STS. The hand support reduced postural oscillation during the second phase of STS in both groups. In the CP group, greater weight bearing was related with lower postural oscillation in the beginning of STS. Although children with CP were able to perform STS without support, they bore more weight on their hands to perform the task than TC. Moreover, children with CP and TC use mechanical and somatosensory information to modulate their postural control during STS in different ways.

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Impairments in sensory processing in children with cerebral palsy (CP) appear to be a cause of the postural control deficits they present and may affect function and participation in daily activities. Understanding the role of sensory processing in postural control can better inform their rehabilitation. Thus, the authors aimed to systematically review the literature concerning effects of sensory information manipulation on postural control in children with CP. A tailored search strategy in relevant databases identified 11 full-text reports that fulfilled the predefined inclusion and exclusion criteria. Sensory information affects postural control in children with CP. These children are less responsive to sensory input, and therefore are less able to perform adjustments during sensory perturbation. They exhibit less postural stability in the presence of sensory conflicts. The most commonly studied sources of sensory data are visual and somatosensory information, particularly when processed under static conditions. There are no studies addressing sensory information manipulation on postural control during the performance of functional activities. Further studies addressing manipulation of new sources of sensory cues on postural control are required.

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