Journal of Rehabilitation Sciences & Research

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Editorial Board

Publication Ethics

Indexing and Abstracting

Related Links

FAQ

Peer Review Process

News

The Relationship between Attention and Balance in Children with Cerebral Palsy: A Comparative Preliminary Study in Diplegia and Hemiplegia

Document Type : Original Articles

Authors

1 Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran,

2 Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Attention and concentration disorders, alongside tone disorders and imbalance, are among the significant challenges faced by children with cerebral palsy (CP). This study investigated the relationship between attention and balance in children with CP.
Methods: This cross-sectional study included 15 children with hemiplegia (mean age: 8.8 ± 2 years) and 10 children with diplegia (mean age: 8.5 ± 1.43 years) recruited from occupational therapy clinics in Tehran, Iran. All participants were classified as level II on both the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). Attention and balance were assessed using the Continuous Performance Test (CPT) and the Pediatric Balance Scale (PBS). Spearman's correlation coefficient was calculated to determine the relationship between attention and balance, with a significance threshold of α=0.05.
Results: The results showed no significant correlation between dynamic and static balance with attention (P > 0.05) in children with hemiplegia. However, in children with diplegia, there were significant correlations between dynamic balance and attention (P = 0.04), static balance and attention (P = 0.01), and total balance and attention (P = 0.02).
Conclusion: This study found a significant correlation between attention and balance in children with diplegic CP but not those with hemiplegic CP. Given that children with diplegia exhibited weaker dynamic and static balance compared to those with hemiplegia, their balance deficits appear to demand more significant attentional resources. Due to the small sample size, further research is necessary to validate these findings.
 

Keywords

References
  1. Piitulainen H, Kulmala J-P, Mäenpää H, Rantalainen T. The gait is less stable in children with cerebral palsy in normal and dual-task gait compared to typically developed peers. Journal of biomechanics. 2021;117:110244.
  2. Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral palsy: current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatric disease and treatment. 2020:1505-18.
  3. Amiri A, Akbarfahimi N, Hosseini SA. The Correlation Between Leisure Participation and Parental Life Balance in Children and Adolescents With Cerebral Palsy and Their Typically Developing Peers. Iranian Rehabilitation Journal. 2022;20(2):139-48.
  4. Jahan I, Muhit M, Hardianto D, Laryea F, Chhetri AB, Smithers‐Sheedy H, et al. Epidemiology of cerebral palsy in low‐and middle‐income countries: preliminary findings from an international multi‐centre cerebral palsy register. Developmental Medicine & Child Neurology. 2021;63(11):1327-36.
  5. Khandaker G, Muhit M, Karim T, Smithers‐Sheedy H, Novak I, Jones C, et al. Epidemiology of cerebral palsy in Bangladesh: a population‐based surveillance study. Developmental Medicine & Child Neurology. 2019;61(5):601-9.
  6. Rojas VG, Rebolledo GM, Muñoz EG, Cortés NI, Gaete CB, Delgado CM. Differences in standing balance between patients with diplegic and hemiplegic cerebral palsy. Neural regeneration research. 2013;8(26):2478.
  7. Soleimani F, Vameghi R, Rassafiani M, AKBAR FN, Nobakht Z. Cerebral palsy: motor types, gross motor function and associated disorders. 2011.
  8. Mak C, Whittingham K, Cunnington R, Boyd RN. Effect of mindfulness yoga programme MiYoga on attention, behaviour, and physical outcomes in cerebral palsy: a randomized controlled trial. Developmental Medicine & Child Neurology. 2018;60(9):922-32.
  9. Pashmdarfard M, Amini M, NAMAZI NG, RASSAFIANI M. Does parent report gross motor function level of cerebral palsy children impact on the quality of life in these children? Iranian journal of child neurology. 2017;11(4):52.
  10. Schmit J, Riley M, Cummins-Sebree S, Schmitt L, Shockley K. Children with cerebral palsy effectively modulate postural control to perform a supra-postural task. Gait & posture. 2015;42(1):49-53.
  11. Gabis LV, Tsubary NM, Leon O, Ashkenasi A, Shefer S. Assessment of abilities and comorbidities in children with cerebral palsy. Journal of child neurology. 2015;30(12):1640-5.
  12. Bonnechère B, Omelina L, Jansen B, Van Sint Jan S. Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: preliminary results. Disability and rehabilitation. 2017;39(4):403-6.
  13. de AC Duarte N, Grecco LAC, Franco RC, Zanon N, Oliveira CS. Correlation between Pediatric Balance Scale and functional test in children with cerebral palsy. Journal of physical therapy science. 2014;26(6):849-53.
  14. Lazzari RD, Politti F, Belina SF, Collange Grecco LA, Santos CA, Dumont AJL, et al. Effect of transcranial direct current stimulation combined with virtual reality training on balance in children with cerebral palsy: a randomized, controlled, double-blind, clinical trial. Journal of motor behavior. 2017;49(3):329-36.
  15. Pashmdarfard M, Badv RS. The impact of manual ability level on participation of children with cerebral palsy in life areas: a cross-sectional study. Iranian Journal of Child Neurology. 2019;13(3):83.
  16. Surkar SM, Edelbrock C, Stergiou N, Berger S, Harbourne R. Sitting postural control affects the development of focused attention in children with cerebral palsy. Pediatric Physical Therapy. 2015;27(1):16-22.
  17. Reilly DS, Woollacott MH, van Donkelaar P, Saavedra S. The interaction between executive attention and postural control in dual-task conditions: children with cerebral palsy. Archives of physical medicine and rehabilitation. 2008;89(5):834-42.
  18. Reilly DS, van Donkelaar P, Saavedra S, Woollacott MH. Interaction between the development of postural control and the executive function of attention. Journal of motor behavior. 2008;40(2):90-102.
  19. Brauer S, Broome A, Stone C, Clewett S, Herzig P. Simplest tasks have greatest dual task interference with balance in brain injured adults. Human movement science. 2004;23(3-4):489-502.
  20. Cherriere C, Martel M, Sarrasin A, Ballaz L, Tallet J, Lemay M. Benefits of a dance intervention on balance in adolescents with cerebral palsy. Physical & occupational therapy in pediatrics. 2020;40(5):518-33.
  21. Bøttcher L, Stadskleiv K, Berntsen T, Christensen K, Korsfelt Å, Kihlgren M, et al. Systematic cognitive monitoring of children with cerebral palsy–the development of an assessment and follow-up protocol. Scandinavian Journal of Disability Research. 2016;18(4):304-15.
  22. Pashmdarfard M, Richards LG, Amini M. Factors affecting participation of children with cerebral palsy in meaningful activities: systematic review. Occupational Therapy in Health Care. 2021;35(4):442-79.
  23. Huxhold O, Li S-C, Schmiedek F, Lindenberger U. Dual-tasking postural control: aging and the effects of cognitive demand in conjunction with focus of attention. Brain research bulletin. 2006;69(3):294-305.
  24. Teasdale N, Simoneau M. Attentional demands for postural control: the effects of aging and sensory reintegration. Gait & posture. 2001;14(3):203-10.
  25. Palluel E, Chauvel G, Bourg V, Commare M-C, Prado C, Farigoule V, et al. Effects of dual tasking on postural and gait performances in children with cerebral palsy and healthy children. International Journal of Developmental Neuroscience. 2019;79:54-64.
  26. Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Developmental Medicine & Child Neurology. 2008;50(10):744-50.
  27. Dehghan L, Abdolvahab M, Bagheri H, Dalvand H, Faghih Zade S. Inter rater reliability of Persian version of Gross Motor Function Classification System Expanded and Revised in patients with cerebral palsy. Daneshvar Medicine. 2020;18(6):37-44.
  28. Eliasson A-C, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Öhrvall A-M, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Developmental medicine and child neurology. 2006;48(7):549-54.
  29. Eliasson AC, Ullenhag A, Wahlström U, Krumlinde‐Sundholm L. Mini‐MACS: development of the Manual Ability Classification System for children younger than 4 years of age with signs of cerebral palsy. Developmental Medicine & Child Neurology. 2017;59(1):72-8.
  30. Riyahi A, Akbarfahimi N, Sarlak N, Abdolrazaghi H, Nobakht Z. Validating the Reliability and Validity of the Persian Version of the Mini-Manual Ability Classification System. Journal of Rehabilitation Sciences & Research. 2023;10(4):203-8.
  31. Miranda MC, Sinnes EG, Pompéia S, Francisco Amodeo Bueno O. A comparative study of performance in the Conners' Continuous Performance Test between Brazilian and North American children. Journal of Attention Disorders. 2008;11(5):588-98.
  32. Borgaro S, Pogge DL, DeLuca VA, Bilginer L, Stokes J, Harvey PD. Convergence of different versions of the continuous performance test: Clinical and scientific implications. Journal of clinical and experimental neuropsychology. 2003;25(2):283-92.
  33. Roebuck H, Freigang C, Barry JG. Continuous performance tasks: Not just about sustaining attention. Journal of speech, language, and hearing research. 2016;59(3):501-10.
  34. Conners CK, Epstein JN, Angold A, Klaric J. Continuous performance test performance in a normative epidemiological sample. Journal of abnormal child psychology. 2003;31:555-62.
  35. Franjoine MR, Darr N, Held SL, Kott K, Young BL. The performance of children developing typically on the pediatric balance scale. Pediatric physical therapy. 2010;22(4):350-9.
  36. Alimi E, Kalantari M, Nazeri A-R, Baghban AA. Test-retest & Inter-rater Reliability of Persian Version of Pediatric Balance Scale in Children with Spastic Cerebral Palsy. Iranian journal of child neurology. 2019;13(4):163.
  37. Kalantari M, Alimi E, Irani A, Nazeri A, Akbarzade Baghban A. Content and face validity of Pediatric Balance Scale in children with spastic cerebral palsy. The Scientific Journal of Rehabilitation Medicine. 2016;5(3):104-10.
  38. Franjoine MR, Darr N, Young B, McCoy SW, LaForme Fiss A. Examination of the effects of age, sex, and motor ability level on balance capabilities in children with cerebral palsy GMFCS levels I, II, III and typical development using the Pediatric Balance Scale. Developmental Neurorehabilitation. 2022;25(2):115-24.
  39. Abuin-Porras V, Villafañe JH, Jiménez-Antona C, Palacios A, Martínez-Pascual B, Rodríguez-Costa I. Relationship between attention and balance: a dual-task condition study in children. Journal of exercise rehabilitation. 2018;14(3):349.
  40. Brunt D, Greenberg B, Wankadia S, Trimble MA, Shechtman O. The effect of foot placement on sit to stand in healthy young subjects and patients with hemiplegia. Archives of physical medicine and rehabilitation. 2002;83(7):924-9.
  41. Galli M, Cimolin V, Crivellini M, Campanini I. Quantitative analysis of sit to stand movement: experimental set-up definition and application to healthy and hemiplegic adults. Gait & Posture. 2008;28(1):80-5.
  42. Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice: Lippincott Williams & Wilkins; 2007.
  43. Roostaei M, Raji P, Morone G, Razi B, Khademi-Kalantari K. The effect of dual-task conditions on gait and balance performance in children with cerebral palsy: A systematic review and meta-analysis of observational studies. Journal of bodywork and movement therapies. 2021;26:448-62.
  44. Akbar Fahimi N, Hosseini SA, Rassafiani M, Farzad M, Haghgoo HA. The reactive postural control in spastic cerebral palsy children. Iranian Rehabilitation Journal. 2012;10(2):66-74.
  45. Wist S, Carcreff L, Bruijn SM, Allali G, Newman CJ, Fluss J, et al. Gait stability in ambulant children with cerebral palsy during dual tasks. Plos one. 2022;17(6):e0270145.

 

Journal of Rehabilitation Sciences & Research
Volume 12, Issue 2
June 2025
Pages 66-72
Files
Share
How to cite
Statistics