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Cerebral Palsy and Posture: Early Signs, Risks, and Management

cerebral palsy posture abnormalities

If your loved one has cerebral palsy, it’s essential to understand how the condition can affect one’s posture.

Postural control is the ability to control the body’s position in space to obtain stability and orientation. This skill is fundamental to almost every movement we make. As a result, when individuals have poor postural control, a variety of other motor functions may be affected.

To help you understand the link between cerebral palsy and posture, this article will discuss:

How Cerebral Palsy Affects Posture

The primary causes of compromised posture in individuals with CP are abnormal muscle tone and muscle imbalances.

Individuals with cerebral palsy may experience high or low muscle tone, or a combination of both. Low muscle tone in the core makes it difficult for children to sit upright and stay balanced. As a result, many individuals with poor trunk stability may start to lean to the side.

Similarly, high muscle tone may pull the body into abnormal postures. The longer an individual remains in a specific posture, the greater their risk of developing contractures. The body can get accustomed to consistently compromised posture, which can contribute to the development of long-term postural abnormalities.

While postural abnormalities are generally not present at birth, they typically become more prominent with age. Generally, trunk deformity becomes noticeable around 7 years of age. Likewise, those with more severe motor impairments are more likely to experience postural abnormalities.

Cerebral palsy is a developmental motor disabilty and compromised posture can significantly affect growth and development. Therefore, it’s essential to seek early intervention for postural abnormalities. Up next, we’ll discuss early signs of compromised posture due to CP.

Early Signs of Compromised Posture in Individuals with CP

child with cerebral palsy getting checked for abnormal posture

Because individuals with cerebral palsy have an increased risk of developing abnormal posture, early identification and intervention are essential.

Early signs of posture problems may include:

  • High or low muscle tone in the trunk
  • Difficulty keeping the head raised
  • Leaning
  • Tilted pelvis
  • Rounded shoulders
  • Bending of the knees while standing

If your child demonstrates any of these signs, consult with their pediatrician. In the following section, we’ll discuss the risks associated with compromised posture in individuals with CP.

Risks Associated with Poor Posture in Individuals with Cerebral Palsy

Compromised posture due to cerebral palsy may lead to a wide range of other motor impairments.

Individuals with poorly managed posture due to CP generally have an increased risk of:

  • Pain
  • Scoliosis (the development of a sideways curvature of the spine)
  • Breathing difficulties (due to the rib cage pressing against the lungs)
  • Cardiac problems (due to the rib cage pressing against the heart)
  • Poor balance 
  • Further mobility restrictions
  • Uneven growth 
  • Hip subluxation/ dislocation

Musculoskeletal imbalances place excess strain on the bone and joints. As a result, poorly managed posture and form can ultimately compromise function.

In the following section, we’ll discuss management interventions that can help reduce the progression of posture abnormalities in individuals with cerebral palsy.

How to Manage Compromised Posture

child with cerebral palsy practicing core-engaging exercises to promote better posture and balance

The overall goal for managing postural abnormalities in individuals with cerebral palsy is to improve one’s functional abilities and prevent posture from worsening.

If not properly managed, posture can be compromised at any age. Cerebral palsy is a lifelong condition, and while the brain damage that caused it will not progress, symptoms like abnormal muscle tone can.

Some interventions to manage and improve posture include:

  • Spasticity management. Because abnormal muscle tone is the primary cause of poor posture, targeting spasticity can help relax the muscles and reduce muscle imbalances. Spasticity management typically consists of medications that temporarily reduce muscle tone (Botox, baclofen, etc.) and intensive physical training.
  • Physical therapy. Physical therapy involves practicing exercises that target underused muscles, stretch tight muscles, and expand range of motion. This may help reduce musculoskeletal strain and improve postural control.
  • Orthotics. Wearing a trunk brace can help stabilize the spine in an upright position and delay surgery. Typically, bracing is most effective for managing the early stages of scoliosis because that is when the spine is most flexible.
  • Wheelchair modifications. A seat mold for wheelchairs can help promote correct posture and discourage leaning to the side.
  • Compression suits. Compression suits are a great alternative to braces. The strategically placed paneling helps support better postural alignment without restricting movement.
  • Osteopathy. Osteopathy is an alternative medicine that uses manipulation and massage of the bones, joints, and muscles to improve the structural alignment of the body.
  • Hippotherapy. Consistently engaging the core is essential to improving posture and stability. Hippotherapy is a fun form of physical therapy that involves horseback riding. It is a multi-sensory experience that is proven to improve sitting balance, standing balance, and postural control.
  • Functional electrical stimulation. Functional electrical stimulation involves placing electrode arrays on the skin to stimulate neuronal activity. Studies [1],[2] on individuals with cerebral palsy demonstrate that FES along with rehabilitation improved postural alignment to a greater extent than rehabilitation alone.
  • Surgery. More severe posture problems (such as a 45° or greater curve of the spine) usually require surgery. The most commonly performed surgery for scoliosis is spinal fusion. It involves using metal rods, screws, and hooks to hold the spine together until the curved vertebrae fuse into a single bone.

Depending on the severity of your child’s postural abnormalities, some management interventions may be more ideal than others. Generally, the earlier posture problems are identified, the more effective non-invasive interventions will be.

Cerebral Palsy and Posture: Key Points

Cerebral palsy is a motor disability that can significantly affect one’s posture. Fortunately, there are many effective ways to prevent a decline in posture and optimize motor functions to improve your quality of life.

We hope this article helped you understand how cerebral palsy may affect posture and how to promote better postural control and stability. Good luck!

Photos from top to bottom: iStock/LeManna/Albina Gavrilovic/KatarzynaBialasiewicz

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