Laura Peeters

26 | Chapter 2 the stage or severity of the disease. In children with CP, the UEs are often spastic, ataxic or dyskinetic, whereas in DMD and SMA muscle weakness is most prominent, which may result in differently disturbed interactions with a flaccid trunk. SCI most often occurs in adults, but it may also be present in childhood due to e.g. trauma, neoplasma or infection. Depending on the lesion level, a flaccid trunk may coincide with normal UE function (high thoracic lesions) or impaired UE function (cervical lesions). Therefore, the interaction between trunk, UE and head movements may differ between diagnoses. The impact of a flaccid trunk is probably also dependent on age. First, the interaction between trunk, UEs and head changes with age due to maturation [12, 13]. Second, children are more prone than adults to develop spine deformities due to muscle weakness, which also affects their trunk movement and stability [14]. The goal of this review was to provide an overview of the changes in trunk movement and stability when performing UE activities in a seated position, and their relation with UE and head movements in neurological patients with a flaccid trunk compared to healthy subjects. A special focus will be given on childhood and development with age. METHODS PubMed was used as an electronic database to search for studies up to September 2016. Four search term categories were used in the search strategy: (1) population,(2) tasks, (3) body segments, and (4) outcomes (i.e. kinematics or stability). The key terms for each category were: 1. “muscular dystrophies”, “spinal muscular atrophy”, “Duchenne”, “cerebral palsy”, “spinal cord injuries”, “ spinal dysraphism”, “spina bifida” or “healthy” 2. “reach”, “reaching”, “drinking”, “activities of daily living”, “ADL”, “daily activity” or “pointing” 3. “upper body” or “arm” combined with either “trunk”, “torso” or “head”, “upper extremity” combined with either “trunk”, “torso” or “head” or “trunk” combined with “head” 4. A. Kinematics: “movement”, “motion”, “kinematics”, “motor skills” or “coordination” B. Stability: “postural balance”, “balance”, “stability”, “postural control”, “sway” or “postural adjustments” The literature search was performed according to the PRISMA guidelines [15]. Studies were included when written in English. The articles were sorted in two phases. First, articles were screened by title and were included if the topic was potentially relevant.