Understanding Postural and Segmental Trunk Control and Their Effect on Sitting in Children with Cerebral Palsy: A Systematic Scoping Review

Cerebral palsy (CP) is a heterogeneous group of neuromuscular disorders with disorganized postural and segmental trunk control that limits functional abilities. Sitting is essential for development but is commonly affected in CP due to poor head and trunk control. This scoping review aims to understand and describe literatures addressing the effect of altered postural and segmental trunk control on sitting in children with CP. A comprehensive systematic search of online databases, research hosting directories identified 1539 studies published from 2010 to 2020 on postural and segmental trunk control and sitting in CP, of which 11 qualitative studies were retrieved. Interventional studies were excluded as the review aimed to understand the dysfunctional mechanisms of control and its effects on sitting abilities, rather than strategies to improve it. The potential risk for bias in selected studies were controlled through clearly described eligibility criteria in study selection, study quality appraisal and randomization during data extraction and synthesis process. The outcomes were categorized into postural control, segmental trunk control, and sitting abilities in children with CP and were analyzed for 481 children across the 11 studies included in this review. It is noted that children with CP present with delay and dysfunction of postural and segmental trunk control, thus leading to reduced variability in acquiring independent sitting to perform various activities. Postural and segmental trunk control are essential to achieve independent sitting and improve functional abilities. However, owing to the neuromuscular deficits, these components are impaired in children with CP and thus hamper functional ability. Therefore, a thorough evaluation of these components is vital and can help estimate the child’s functional ability and plan interventional goals accordingly.