Effect of Adaptive Seating in Postural Control among Children with Cerebral Palsy: A Systematic Review

Abstract

Background: Children with cerebral palsy (CP) with Gross Motor Functional Classification System (GMFCS) level III to V have weak anti-gravity muscles. So, they required the adaptive seating system (AdSS) for postural control. Many studies reported positive results of AdSS on postural control. However, the quality of studies is crucial to ensure the benefits of AdSS. Therefore, the effectiveness of AdSS on postural control should be reviewed with strong evidence. Objective of this study was to systematically review the effect of AdSS for postural control in CP children with GMFCS III to V. Method: This systematic review followed the Preferred Reporting Guideline for Systematic Review and Meta-analysis (PRISMA) guideline. PubMed, Web of Science, Embase, CINAHL, and Cochrane databases from the years 1991 to March 2022 were used to search. 293 articles were found, among which 14 articles met the inclusion criteria. Keywords used in the search were CP, children, postural control, or postural balance. Inclusion criteria were cerebral palsy participants with GMFCS III to V; aged <18 years; adaptive seating intervention; postural control outcome and papers in English. Exclusion criteria include ambulatory CP, case series, and case reports. Articles were independently reviewed, and quality assessment was done by 2 reviewers and verified by experts. Results: 14 articles were included, 3 were good quality, 8 were fair and 3 poor. There were 5 cohorts, 4 experimental, and 5 cross-sectional studies, and no RCT was found. Participants were GMFCS Level III to V with 51.9% male. These studies reported the benefits of AdSS on body function activities, participation, and environmental aspects. Conclusion: This systematic review shows that postural control enhances the sitting ability, and hands performance, and promotes the functional level of children with cerebral palsy. Fair to good quality studies demonstrated adaptive seating systems are effective on postural control however there was a need for prospective RCTs. Although this study has strong clinical significance but couldn’t perform activity performance, sitting posture, and sub-group to make the study more heterogeneous. Fair to good quality studies demonstrated AdSS are effective on postural control however prospective RCTs are needed.