Postural problems play a central role in the dysfunction of children with disabilities and affect how they perform activities of daily living. Understanding the specific nature of postural problems is vital, as it can be an important element for the physiotherapist to consider when tailoring therapy to a specific patient.

Postural control is an active process in which the central nervous system continuously explores its limits of stability, tries to predict the effects of changes in the environment on posture and tries to counteract effectively the consequences of sudden mechanical disturbances. It is a complicated task that involves practically every part of the central nervous system.

This means that it is vulnerable to compromised development in the first years of life. Almost all children with disorders that affect the developing brain, such as cerebral palsy, developmental coordination disorder (DCD) and autism, have some level of dysfunction in postural control. Children with neuromuscular problems such as spina bifida and neuromuscular disorders also suffer from postural problems and have to find specific age-appropriate solutions in order to perform daily activities.

According to Brogren, this means that performing activities of daily living requires flexible posture control. Even relatively simple tasks, such as putting on a jumper, require complex interactions among the different systems that work together in the control of movement and posture. The general objective of the management and treatment of children with developmental disabilities is to improve their ability to perform activities in the context of daily life. Treatment and management can be divided into three categories: procedures directed specifically at impediments, procedures taking place in the context of daily life that require the child's active participation and procedures to adjust the environment.

Eva Brogren is an associate professor in the Department of Women’s and Children’s Health at the Karolinska Institute in Sweden. Throughout her career as a physiotherapist, she has specialized in therapies for children with cerebral palsy.