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About me

I am a pediatric physiotherapist, PhD, at the Motion Analysis Laboratory, and the department of physiotherapy at Karolinska University Hospital affiliated to Karolinska Institutet. I have a unique competence in both clinical and laboratory methods for measuring movement in children with movement disorders with special interest in how disturbances in perception influence motor function in cerebral palsy. 

Research description

My thesis - Abstract 

The movement and posture disorder of cerebral palsy (CP) is presumed to mainly be a consequence of the motor disorder, but accompanying disturbances with sensations and perception have also been suggested to influence motor function. The aim was to investigate factors influencing standing posture in children with bilateral spastic CP (BSCP) with varying standing abilities.

Three-dimensional motion analysis with surface electromyography was recorded to describe posture during three standing tasks: in a habitual standing position, while blindfolded, and during an attention-demanding task. Muscle strength in the lower limbs was measured with a hand-held dynamometer. Motor function was measured with the Gross Motor Function Measure. The children also underwent a neuro-ophthalmological examination.

Almost half of the participants required hand-held support to stand. Investigation of standing posture verified a crouched body position during standing which was more obvious in the children who required hand-held support. Muscle strength measurements indicated that the children in both groups were equally strong in the lower limb muscles despite their variation in standing abilities. The children who stood with support were as capable to perform motor activities in lying, sitting and kneeling positions as the children who stood unsupported.

Vision influenced posture differently depending on the children’s standing ability. During the attention demanding task, the children who stood unsupported stood more still and with less lower limb muscle activity. While blindfolded, they adapted their posture to the environmental change by activating muscles around the ankle with no changes in overall body position. In contrast, the children who required hand-held support to stand used another strategy; the already flexed body position became even more flexed, and muscle activity increased in the knee extensors while blindfolded, despite the use of external support.

Motor disorders could not explain the support for standing or the crouched body position during standing. The children were equally strong in the lower limb muscles and had reasonably similar abilities to perform motor activities in positions with no requirement of standing on the feet opposing gravity. The crouched body position and the reduced ability to maintain posture while blindfolded indicate proprioception deficits in the children who required support. The increased quadriceps muscle activity could be an indication of compensatory co-contraction caused by perceptual impairments. That motor function difficulty arises in a standing position opposing gravity indicates that standing difficulties may be attributable to sensory and/or perceptual disturbances. 

Doctoral thesis - Standing in children with bilateral spastic cerebral palsy: Aspects of muscle strength, vision and motor function

Publications

Head and Trunk Movements During Turning Gait in Children with Cerebral Palsy
Bartonek A, Lidbeck C, Hellgren K, Gutierrez-farewik E
Journal of motor behavior 2018;():1-9

European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch
Van Den Noort Jc, Bar-on L, Aertbeliën E, Bonikowski M, Braendvik Sm, Broström Ew, et al
European journal of neurology 2017;24(7):981-e38

Influence of External Visual Focus on Gait in Children With Bilateral Cerebral Palsy
Bartonek A, Lidbeck Cm, Gutierrez-farewik Em
PEDIATRIC PHYSICAL THERAPY 2016;28(4):393-399

The role of visual stimuli on standing posture in children with bilateral cerebral palsy
Lidbeck C, Bartonek Å, Yadav P, Tedroff K, Åstrand P, Hellgren K, et al
BMC neurology 2016;16(1):151-

Muscle strength does not explain standing ability in children with bilateral spastic cerebral palsy: a cross sectional descriptive study
Lidbeck C, Tedroff K, Bartonek Å
BMC neurology 2015;15():188-

Postural orientation during standing in children with bilateral cerebral palsy
Lidbeck Cm, Gutierrez-farewik Em, Broström E, Bartonek Å
Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association 2014;26(2):223-9

Influence of heel lifts during standing in children with motor disorders
Bartonek A, Lidbeck Cm, Pettersson R, Weidenhielm Eb, Eriksson M, Gutierrez-farewik E
Gait & posture 2011;34(3):426-31

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Institutionen för kvinnors och barns hälsa (KBH), K6, Enheten för Neurologi
Stockholm