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Pediatric Balance Lab

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The Pediatric Balance Lab at the University of Hartford aims to improve the postural stability, functional capacity and community participation of children with motor impairments.

We pioneer multidisciplinary research, offer clinical training in the Segmental Assessment of Trunk Control (SATCo), promote a segmental approach to postural dysfunction, and strive to make our methods and resources accessible so they can be widely shared and applied. Our approach is designed to be collaboratively delivered by practitioners and families—maximizing autonomy and meaningful progress of each child our work reaches.

About the Lab

Researcher holding a baby

For children with severe motor impairments, it can be very difficult to reach for a toy, sit upright, or even turn their head. The focus of our research is to develop a better understanding of the underlying mechanisms contributing to postural dysfunction and thus opening pathways for improved therapies for these children.
 
The Pediatric Balance Lab at the University of Hartford is known internationally for its work in the Segmental Assessment of Trunk Control (SATCo). We have collaboratively designed trainings, tools and resources to help clinicians and families assess and support upright control for children with postural dysfunction. 

The Lab seeks to raise awareness and expand the application of our work, which can benefit children with a range of conditions—such as cerebral palsy, Down syndrome, muscular dystrophy and spinal cord injury. We invite multidisciplinary research collaborations, present regularly, offer clinical training in SATCo and the segmental approach to postural dysfunction. Recent projects have included design of custom devices to promote participation in home and community settings for children with the most severe disabilities.

Research

child sitting in harness

Our research has three primary legs.  First, we conduct studies aimed at understanding the sensory and motor mechanisms underlying the emergence of upright postural control. These studies rely on collaborations with engineers to assess and model changes in system dynamics as children gain trunk control. This research that has been funded by the National Science Foundation and the National Institutes of Health.

Second, translational studies regarding the Segmental Assessment of Trunk Control (SATCo) and a segmental approach are in collaboration with a knowledge translation researcher and clinical partners who are exploring the challenges and paradigm shifts necessary to implement a segmental approach in clinical settings and across school districts. 

Finally, we are dedicated to translating laboratory research for clinical application to enhance function and participation of children with the most severe postural dysfunction. These studies include collaborations with researchers in special education and neuromotor recovery and engineering.  These are primarily proof of concept studies which we hope to develop in the future for intervention studies.

Publications

Book Chapters

Saavedra S, Goodworth AD (2018), “Posture control therapy in children and youth with cerebral palsy” in Cerebral Palsy, edited by Dr. Freeman Miller, Stephan Bachrach, Nancy Lennon and Margaret O’Neil. 

 

Peer Reviewed Publications

Goodworth AD, Kratzer A, Saavedra S. (2020) Influence of visual biofeedback and inherent stability on trunk postural control. Gait & Posture (80):308-314

Goodworth AD, Tetreault K, Lanman J, Klidonas T, Kim S, Saavedra S. (2018) Sensorimotor control of the trunk in sitting sway referencing. J Neurophys 120(1):37-52.

Duncan K, Goodworth A, Da Costa C, Wininger M, Saavedra S. (2018) Parent handling of typical infants varies segmentally across development of postural control. Exp Brain Res,236(3), 645-654.

Santamaria V, Rachwani J, Saavedra S, Mansell W, Woollacott MH. (2017). The impact of segmental trunk support on posture and reaching while sitting in healthy adults. J Motor Behav pp 1-14.

daCosta CSN, Saavedra SL, Rocha ACF, Woollacott M. (2016) The effect of biomechanical constraints on neural control of head stability in children with moderate-to-severe cerebral palsy. Physical Therapy Journal 97(3):374-385. 

Curtis DJ, Woollacott M2, Bencke J, Lauridsen LB, Saavedra S, Bandholm T, Sonne-Holm S. (2016). The functional effect of segmental trunk and head control training in moderate to severe cerebral palsy: a randomized controlled trial. Dev Neurorehabil Dec 26, pp 1-10.

Wu Y, Duncan K, Saavedra S, Goodworth AD (2016). Segmental trunk and head dynamics during frontal plane tilt stimuli in healthy sitting adults. J Biomech 49(13):2831-2837.

Goodworth AD, Wu Y-H, Felmlee D, Dunklebarger E, Saavedra S. (2016). A trunk support system to identify posture control mechanisms in populations lacking independent sitting. IEEE 25(1):19-27.

Santamaria V, Rachwani J, Saavedra S, Woollacott M. (2016) Effect of segmental trunk support on posture and reaching in children with cerebral palsy. Pediatr Phys Ther 28(3):285-293.

Saavedra S, Woolacott MH. (2015) Segmental contributions to trunk control in children with moderate-to-severe cerebral palsy. Arch Phys Med Rehab 96(6):1088-1097.

Rachwani J, Santamaria V, Saavedra SL, Woollacott MH, (2015) The development of trunk control and its relations to reaching in infancy: a longitudinal studyFrontiers in human neuroscience, 9.

Curtis D,  Hansen L, Bencke J, Saavedra S, Woollacott M, Luun M, Steenberg G, Sonne-Holm S. (2015) “Measuring postural sway in sitting- a new segmental approach.” J Motor Behav 47(5):427-435.

Curtis DJ. Butler P. Saavedra S. Bencke J, Kallemose,T, Sonne-Holm S, Woollacott, M. (2015), The central role of trunk control in the gross motor function of children with cerebral palsy: a retrospective cross-sectional study. Dev Med Child Neurol. 57(4), 351-357

Rachawani J, Santamaria V, Saavedra S, Wood S, Porter F, Woollacott MH, (2013) Segmental Trunk Control Acquisition and Reaching in typically Developing InfantsExp Brain Res 228(1):131-139

Saavedra S, van Donkelaar P., Woollacott M H, (2012) Learning about gravity: segmental assessment of upright control as infants develop independent sitting. J Neurophysiol 108: 2215-2229. PMC 3545022

Saavedra S, Teulier, C, Butler B, Kim BJ, Smith BA, Martin B, Ulrich BD. (2012) Behavioral and Step Changes in Infants with MMC due to Intermittent VibrationPhys Ther, 92:537-550. PMC3317481

Butler PB, Saavedra S, Sofranc M, Jarvis S,Woollacott M. (2010) Reliability and validity of the Segmental Assessment of Trunk Control. Pediatr Phys Ther 22(3):246-57, PMC2927393

Saavedra S, Woollacott M, van Donkelaar P. (2010) Head stability during quiet sitting in children with cerebral palsy: effect of vision and trunk support. Exp Brain Res 201(1): 13-23. PMC2821460

Saavedra S, Woollacott M, van Donkelaar P. (2009) Eye-Hand Coordination in Children with Cerebral Palsy. Exp Brain Res. 192(2): 155-165, PMC2800126

Reilly D, van Donkelaar P, Saavedra S, Woollacott MH (2008) Interaction between the development of postural control and executive function of attention. J Motor Behav 40(2):90-102

Reilly D, Woollacott MH, van Donkelaar P, Saavedra S. (2008) Dual task effects on postural control in children with cerebral palsy: static stance. Arch Phys Med Rehabil. 89:834-842

Van Donkelaar P, Saavedra S, Woollacott MH (2007) Multiple Saccades are more automatic than single saccadesJ Neurophysiol97:3148-3151.

Saavedra S, Woollacott MH, van Donkelaar P (2007) Effects of Postural Support on Eye Hand Interactions Across Development, Exp Brain Res. 180(3): 557-567, PMC2744857 

 

Invited Commentaries:

Saavedra S, (2015) Trunk control in reaching: growing into or out of dysfunction? Invited commentary on “Development of postural adjustments during reaching in infants at risk for cerebral palsy from 4 to 18 months”Dev Med Child Neurol 57(7):598-599.

Saavedra S, (2015) Trunk control in cerebral palsy: are we ready to address the elephant in the room? Invited commentary on “The relationship between trunk control in sitting and during gait in children and adolescents with cerebral palsy”Dev Med Child Neurol  57(4): 309-310

Saavedra S, Bellows D, (2014) Commentary on “Sitting Postural Control Affects the Development of Focused Attention in Children with Cerebral Palsy”Pediatr Phys Ther  27(1):23

Saavedra S, Bellows D, DaCosta C, (2014) Commentary on “Analysis of postural stability in children with cerebral palsy and children with typical development: an observational study”Pediatr Phys Ther 26(3):331

Current Active Studies

Unraveling posture control in severe cerebral palsy

Funded by: National Science Foundation Disability and Rehabilitation Engineering (DARE) #1803714

Researchers: Adam Goodworth and Sandra Saavedra

For this study children come to the Pediatric Balance Laboratory. We provide segmental postural support for children and entertain them with videos while administering a series of postural perturbations.  For the children it feels like they are riding in a car on a bumpy road. From an engineering perspective we are able to extract specific information about the child’s postural control system and distinguish between sensory motor noise and the child’s underlying mechanisms and strategies for maintaining upright control.

enhp-research-pbl-current-studies-1.png

Data collections are currently on hold for this study due to concerns about covid 19.  While waiting for the next round of data collections we have been analyzing data and preparing the first manuscript to examine underlying postural mechanisms in children with severe cerebral palsy.

enhp-research-pbl-current-studies-2.png

Completed Studies

Information will be posted soon.

Training, Tools and Resources

Researcher performing Satco analysis

Dr. Saavedra co-authored the refinement and publication of the Segmental Assessment of Trunk Control (SATCo) and presents nationally and internationally on the SATCo and the segmental approach to postural dysfunction. The SATCo is now included in the NINDS core data elements for cerebral palsy and spinal cord injury and it has been shown to be valid and reliable for a number of additional pediatric diagnoses including premature infants, children with Down syndrome and muscular dystrophy.  Students, clinicians and researchers wanting more information about upcoming workshops, online training opportunities and opportunities for collaboration on research can find current resources here. 

Online Training

Webinars with ApplyEBP
  1. 90-minute: Introduction to SATCo (Segmental Assessment of Trunk Control)
  2. 90-minute: Using SATCo for adaptive positioning decisions
  3. 90-minute: Applying optimal theory of motor learning (OPTIMAL) for children with postural dysfunction (watch for link in October 2020)
  4. 90-minute: Focus on Function: effects of using SATCo for positioning.
    (watch for link in November 2020)

Online SATCo training for researchers or clinicians who require more extensive training.
(link to course will become available October 2020)
https://www.neurorecoverylearning.org/

Live, In-Person Courses

Live, in person course:

June 4-5, 2021
EasterSeals Dupage and Fox Valley
Villa Park, Illinois
https://www.easterseals.com/dfv/our-programs/employment-training/continuing-education.html

SATCo administration, scoring and application of segmental principles for training posture control.

Upcoming Presentations

Academy of Pediatric Physical Therapy, 2020 Annual Conference
November 12-14, 2020, preconference courses November 11.
https://www.eventscribe.com/2020/APTA/

Preconference course:
“Segmental Assessment of Trunk Control: administration, scoring and common errors”
1. Includes the Neurorecovery learning online course
2. Interactive remote session date and link will be added when it is available. 

2020 Annual Conference for the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM):
This year’s conference will be virtual.
https://www.aacpdm.org/meetings/2020/program

  1. Lunch and Learn session #21:
    “Postural contexts for participation: Increasing autonomy and self-efficacy of children with GMFCS IV and V.”
    Friday, September 25, 2020
    11:00 am-12:00 pm Central Daylight Time

  2. Demonstration poster: “Build Your Own Sit to Stand Box: Promoting Movement Transitions for Children with GMFCS levels III-V.”

Sit to Stand Box

Join a Study

If you are interested in having your child participate in a study of the Sit to Stand box, please fill out the contact form here.

enhp-research-sit-to-stand-box-copy.pngChildren with disabilities that interfere with their ability to walk independently miss hundreds of opportunities every day for strengthening their muscles and bones through weight shifting and transitions from sit to stand. They depend on other people in their lives to assist them to stand, walk or change position. This places a burden on their caregivers and deprives the children from having choices about how much and how often they move. Caregiver support also reduces the range of control and exploratory movements the children can make.

The task of practicing sit to stand has been used for decades to help strengthen adults and children and has been shown to improve balance and functional skills in ambulatory children with cerebral palsy. However, this opportunity is denied to non-ambulatory children unless their caregivers take time out to help them practice every day.

Our goal in designing sit to stand boxes was to provide non-ambulatory children an opportunity for independent exploration of posture and lower extremity weight bearing, weight shifting and freedom of choice while also allowing their caregivers some level of respite.

We are sharing these instructions with parents, clinicians and researchers so that you can provide the same opportunity to children in your home, clinic or research studies.

Read more about the Sit to Stand box and view videos

Poster Presentation

Click here to view a poster presentation on the Sit to Stand box by DPT student Jason Hubeny.

As with all professional practice, clinicians must use caution and care to assure the safety of the child and take responsibility to train the caregivers and educational staff in proper use of the equipment.

Please check your professional organization and state practice acts with regards to modification or creation of adaptive equipment.

Additional information related to sit to stand:

Two studies that showed improved balance and function in ambulatory children with CP used sit to stand activities as part of their intervention. The Sit to stand boxes allow non-ambulatory children the opportunity to practice sit to stand movements with as many repetitions as they desire during a day.  More research is needed to demonstrate the effect of this practice on posture and function.

Citations:

1. Katz-Leurer M, Rotem H, Keren O, Meyer S. The effects of a 'home-based' task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury. Clin Rehabil. 2009;23(8):714-724.
2. Salem Y, Godwin EM. Effects of task-oriented training on mobility function in children with cerebral palsy. NeuroRehabilitation. 2009;24(4):307-313.

Videos

These videos show the changes in the sit to stand performance of one child who participated in the pilot study. The first video was taken during the first week of the study, while the second video was taken three weeks later and shows improvement in his ability to stand.

 

Adjustable height of bolster:
Some children find the traditional 90-degree angle of hips and knees as the starting point of sit to stand too overwhelming.  Studies of sit to stand in adults have shown the benefit of raising the seat height, and we have found this to be very effective for some children in helping this to be an enjoyable activity with hundreds of repetitions per day. 

In these videos, a child in the pilot study was more successful in the Sit to Stand box from an elevated height rather than a traditional 90-90 alignment. Consider using a slightly higher bolster to give the child more ease of movement.

Download Instructions (PDF)

Click here to read the voluntary consent and liability form and download a PDF of the Sit to Stand Box instructions.

Stories

josh and sandy with water strider

Student's Invention Gives Children With Cerebral Palsy Freedom in the Pool

Physical Therapy student Josh Breighner '20 has developed the Water Strider, a device that allows children with cerebral palsy to play independently in the pool. Tests of the Water Strider have been so successful that Josh and the University have filed a patent application and hope to locate a company to make it commercially available.  Read more

brayden with spinal support

Cutting-edge Research Improves the Lives of Children with Cerebral Palsy

When five-year-old Brayden Starr was diagnosed with cerebral palsy as a baby, his parents struggled to find ways to give him the best quality of life. There are few treatment options for children with moderate-to-severe cerebral palsy (CP), a brain injury that affects body movement and muscle coordination. When the Starrs met Assistant Professor Sandra Saavedra, they found a new option. Saavedra is currently the only physical therapist in the United States who offers a treatment that has dramatically improved Brayden’s capabilities. Read more

Contact Information

Sandra Saavedra
Associate Professor of Physical Therapy
Department of Rehabilitation Sciences
University of Hartford
200 Bloomfield Ave.
West Hartford, CT 06117
860.768.5567
saavedra@hartford.edu