Postural control in children with spastic diplegia: muscle activity during perturbations in sitting.

To clarify the neural mechanisms controlling equilibrium during sitting, and the implications for the optimal sitting position for children with CP, automatic postural adjustments after perturbations of the support surface during sitting were investigated in seven children with spastic diplegia and in seven age-matched controls. A sudden backward sway of the body evoked brisk responses in ¿ventral' muscles in both groups. However, the order of muscle recruitment, which in most non-disabled children was caudal, was reversed in the children with diplegia, whose first response was in the neck flexors. The children with diplegia also co-activated antagonistic neck and hip muscles. The authors concluded that although children with spastic diplegia may produce a basic muscle activation pattern (first level of the central pattern generator, CPG), they cannot adjust the pattern in response to external changes (second level of the CPG).