Developmental sequence of postural control in prone position in children with spastic diplegia

The aim of this study was to assess the development of postural control in the prone position in children with spastic diplegia and triplegia, and det ermine the influence of clinical characteristics, visual acuity and cogniti ve performance on that development. We also analysed the relation between t hese early motor achievements in the prone position and the subsequent acqu isition of motor competence in the sitting position. We followed 24 diplegi c and triplegic children from before age 2 years (mean age 12 months) to me an age 41 months, videorecording motor behaviour every six months and abstr acting acquisitions in alignment and balance using a standardised procedure . We confirm a developmental sequence of all the acquired movements in the prone position. 83.3% of the children completed the uprighting sequence in the sagittal plane, acquired good balance, and ability to rotate the head a nd trunk. 70.8% of the children (all but one of the diplegic children and n one among triplegic children) acquired symmetric posture in the frontal pla ne and 83.3% reduced leg hyperextension. Development was not uniform, and a t 12-18 months two groups began to emerge: diplegic children who rapidly ac hieved all or most of the steps in the sequence and had a favourable progno sis for subsequent motor development; and triplegic children who achieved t hese steps at a much slower rate or in some cases not at all and had a less favourable prognosis for future development. Diplegic children with normal visual acuity, and general quotient GQ > 70 did better than triplegic chil dren with compromised visual acuity and GQ < 70. Acquisition of the full up righting sequence in the prone position before the age of two related to th e later acquisition of autonomous sitting. (C) 2000 Elsevier Science B.V. A ll rights reserved.