A New Method for Postural Misalignment of a 6-Year-Old Girl With Cerebral Palsy: A Case Report

OBJECTIVE: To demonstrate the effects of a newly designed postural alignment relearning system on postural control dysfunction in a typical patient with cerebral palsy (CP). DESIGN: Evaluation before and after 8 weeks of Constraint Standing Training 3-dimensional postural alignment relearning system. SETTING: Department of Rehabilitation Medicine. PARTICIPANT: A 6-year-old girl with CP and postural misalignment on Gross Motor Function Classification System level I. INTERVENTIONS: Constraint Standing Training for 8 weeks to correct postural misalignment. MAIN OUTCOME MEASURES: Parameters of lateral plain radiographs in static standing, posturography measurements in standing and walking, motor ability (Gross Motor Function Measure-88 [GMFM-88] scores, manual muscle testing [MMT] scores, muscle architecture), and gait kinematic parameters (40 3-dimensional parameters of arms, trunk, waist, and lower limbs). RESULTS: Knee hyperextension angle in static standing; peaks of knee flexion angle (KFA) when walking, hip flexion angle and ankle flexion angle in dynamic standing; and the KFA at initial contact in gait cycle all decreased significantly (P<.01). Scores of GMFM-88 sections D and E and MMT of 5 core stability muscles improved (P<.01). The velocities and range of motion of the arms, the 3-dimensinoal range of motion of the trunk and waist, and most of the parameters of the lower limbs showed statistically significant change (P<.01). Bilateral muscle thickness did not change significantly after the treatment (P=.738 left, P=.978 right), but the gluteus maximus morphology was changed: the muscle fibers became rounder, the interfiber space decreased, and the border lines of the muscle fibers got clearer. CONCLUSIONS: Postural alignment, motor ability, and gait may be homologous external manifestations of more fundamental core abilities, referring to correct standing posture cognition, muscle activation, and postural unconsciousness. Constraint Standing Training 3-dimensional postural alignment relearning system aimed to improve the static and dynamic standing control ability, may fix postural misalignment and improve motor ability and flexed-knee gait. Future work should use Constraint Standing Training with patients with different kinds of misalignment, choose sensitive indicators, observe the duration of each step, and reveal the mechanism causes postural misalignment.