Deliberately Light Interpersonal Contact Affects the Control of Head Stability During Walking in Children and Adolescents With Cerebral Palsy

Published:February 28, 2017DOI:


      • Apex interpersonal touch (IPT) alters locomotor control of head sway in cerebral palsy (CP).
      • Trunk IPT acts in opposition to head IPT in CP.
      • IPT affects typically developed individuals differently than individuals with CP.



      To evaluate the potential of deliberately light interpersonal touch (IPT) for reducing excessive head and trunk sway during self-paced walking in children and adolescents with cerebral palsy (CP).


      Quasi-experimental, proof-of-concept study with between-groups comparison.


      Ambulant care facility, community center.


      Children and adolescents (N=65), consisting of those with CP (spastic and ataxic, n=26; Gross Motor Function Classification System I–III; mean age, 9.8y; 11 girls, 15 boys) and those who were typically developed (TD, n=39; mean age, 10.0y; 23 girls, 16 boys).


      IPT applied by a therapist to locations at the back and the head.

      Main Outcome Measures

      As primary outcomes, head and trunk sway during self-paced walking were assessed by inertial measurement units. Secondary outcomes were average step length and gait speed.


      CP group: apex and occiput IPT reduced head velocity sway compared with thoracic IPT (both P=.04) irrespective of individuals' specific clinical symptoms. TD group: all testing conditions reduced head velocity sway compared with walking alone (all P≤.03), as well as in apex and occiput IPT compared with paired walking (both P≤.02).


      Deliberately light IPT at the apex of the head alters control of head sway in children and adolescents with CP. The effect of IPT varies as a function of contact location and acts differently in TD individuals.


      List of abbreviations:

      CP (cerebral palsy), GMFCS (Gross Motor Function Classification System), HVS (head velocity sway), IPT (interpersonal touch), TD (typically developed), TVS (trunk velocity sway)
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        • dos Santos A.N.
        • Pavao S.L.
        • de Campos A.C.
        • Rocha N.A.
        International Classification of Functioning, Disability and Health in children with cerebral palsy.
        Disabil Rehabil. 2012; 34: 1053-1058
        • Kavanagh J.J.
        • Barrett R.S.
        • Morrison S.
        Upper body accelerations during walking in healthy young and elderly men.
        Gait Posture. 2004; 20: 291-298
        • Schweizer K.
        • Brunner R.
        • Romkes J.
        Upper body movements in children with hemiplegic cerebral palsy walking with and without an ankle-foot orthosis.
        Clinical Biomech (Bristol, Avon). 2014; 29: 387-394
        • Heyrman L.
        • Feys H.
        • Molenaers G.
        • et al.
        Altered trunk movements during gait in children with spastic diplegia: compensatory or underlying trunk control deficit?.
        Res Dev Disabil. 2014; 35: 2044-2052
        • Attias M.
        • Bonnefoy-Mazure A.
        • Lempereur M.
        • Lascombes P.
        • De Coulon G.
        • Armand S.
        Trunk movements during gait in cerebral palsy.
        Clinical Biomech (Bristol, Avon). 2015; 30: 28-32
        • Heyrman L.
        • Desloovere K.
        • Molenaers G.
        • et al.
        Clinical characteristics of impaired trunk control in children with spastic cerebral palsy.
        Res Dev Disabil. 2013; 34: 327-334
        • Cromwell R.
        • Schurter J.
        • Shelton S.
        • Vora S.
        Head stabilization strategies in the sagittal plane during locomotor tasks.
        Physiother Res Int. 2004; 9: 33-42
        • Pozzo T.
        • Berthoz A.
        • Lefort L.
        • Vitte E.
        Head stabilization during various locomotor tasks in humans. II. Patients with bilateral peripheral vestibular deficits.
        Exp Brain Res. 1991; 85: 208-217
        • Horak F.B.
        • Macpherson J.M.
        Postural orientation and equilibrium.
        in: Rowell L.B. Shepherd J.T. Handbook of physiology. Section 12. Exercise: regulation and integration of multiple systems. Oxford University Pr, New York1996: 255-292
        • Pavão S.L.
        • Silva F.P.
        • Savelsbergh G.J.
        • Rocha N.A.
        Use of sensory information during postural control in children with cerebral palsy: systematic review.
        J Mot Behav. 2015; 47: 291-301
        • Baldan A.M.
        • Alouche S.R.
        • Araujo I.M.
        • Freitas S.M.
        Effect of light touch on postural sway in individuals with balance problems: a systematic review.
        Gait Posture. 2014; 40: 1-10
        • Johannsen L.
        • Wing A.M.
        • Hatzitaki V.
        Contrasting effects of finger and shoulder interpersonal light touch on standing balance.
        J Neurophysiol. 2012; 107: 216-225
        • Sofianidis G.
        • Hatzitaki V.
        • Grouios G.
        • Johannsen L.
        • Wing A.
        Somatosensory driven interpersonal synchrony during rhythmic sway.
        Hum Mov Sci. 2012; 31: 553-566
      1. Johannsen L, McKenzie E, Brown M, Redfern MS, Wing AM. Deliberately light interpersonal touch as an aid to balance control in neurologic conditions. Rehabil Nurs. 2014 Dec 7. [Epub ahead of print].

        • Krishnamoorthy V.
        • Slijper H.
        • Latash M.L.
        Effects of different types of light touch on postural sway.
        Exp Brain Res. 2002; 147: 71-79
        • Rogers M.W.
        • Wardman D.L.
        • Lord S.R.
        • Fitzpatrick R.C.
        Passive tactile sensory input improves stability during standing.
        Exp Brain Res. 2001; 136: 514-522
        • Mergner T.
        • Maurer C.
        • Peterka R.J.
        A multisensory posture control model of human upright stance.
        Prog Brain Res. 2003; 142: 189-201
        • Palisano R.J.
        • Hanna S.E.
        • Rosenbaum P.L.
        • et al.
        Validation of a model of gross motor function for children with cerebral palsy.
        Phys Ther. 2000; 80: 974-985
        • Ledebt A.
        • Bril B.
        • Wiener-Vacher S.
        Trunk and head stabilization during the first months of independent walking.
        Neuroreport. 1995; 6: 1737-1740
        • Wallard L.
        • Bril B.
        • Dietrich G.
        • Kerlirzin Y.
        • Bredin J.
        The role of head stabilization in locomotion in children with cerebral palsy.
        Ann Phys Rehabil Med. 2012; 55: 590-600
        • Dirks T.
        • Blauw-Hospers C.H.
        • Hulshof L.J.
        • Hadders-Algra M.
        Differences between the family-centered “COPCA” program and traditional infant physical therapy based on neurodevelopmental treatment principles.
        Phys Ther. 2011; 91: 1303-1322
        • Allum J.H.
        • Carpenter M.G.
        A speedy solution for balance and gait analysis: angular velocity measured at the centre of body mass.
        Curr Opin Neurol. 2005; 18: 15-21