Developmental Medicine & Child Neurology

Developmental Medicine & Child Neurology (2003), 45:9:591-602 Mac Keith Press
Copyright © 2003 Mac Keith Press

Original Articles

Effect of balance training on recovery of stability in children with cerebral palsy

Anne Shumway-Cook  a1 c1, Susan Hutchinson  a1, Deborah Kartin  a1, Robert Price  a2 and Marjorie Woollacott  a3
a1 Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
a2 Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
a3 Department of Exercise and Movement Science and Institute of Neuroscience, University of Oregon, Eugene, OR, USA.


This study examined the effect of massed practice in balance recovery of stability in six children (four males, two females; mean age 9 years 2 months, SD 2 years, range 7 years 5 months to 12 years 11 months) with cerebral palsy (CP). Four children were diagnosed with spastic diplegia (Gross Motor Function Classification System [GMFCS] level II) and two with spastic hemiplegia (GMFCS level I). A single-subject, multiple-baseline experimental design involving three pairs of children matched for diagnosis was used. A moveable forceplate system was used to test and train reactive balance control. Area per second (i.e. area covered by the center of pressure over a one second period) and time to stabilization from center of pressure measures were calculated following perturbations. The intervention phase consisted of massed practice on the moving platform (100 perturbations/day for 5 days). Analysis included hierarchical linear modeling and a repeated measures ANOVA. All children demonstrated a significant improvement in their ability to recover stability as demonstrated by reduced center of pressure area and time to stabilization following training. These improvements were still present 30 days following completion of training. Results suggest that postural control mechanisms in school-age children (7 to 13 years) with CP are modifiable.

(Accepted April 29 2003)

c1 Department of Rehabilitation Medicine, University of Washington, Box 356490, 1956 NE Pacific Street, Seattle, WA 98195-6490, USA. E-mail: