Photographic Posture Analysis in Children with Cerebral Palsy and Its Relationship with Motor Performance and Trunk Control

Abstract

Objective: The primary purpose of this study was to investigate the relationship of photographic posture analysis (PPA) with motor performance and trunk, and the reliability of PPA in the sitting position control in children with cerebral palsy (CP). Methods: Sixty-five children with CP between 5 and 12 years of age were investigated by PPA in a sitting position. The angles calculated for the PPA were the craniovertebral angle, sagittal head tilt, sagittal shoulder-C7 angle, thoracic kyphosis angle, lumbal lordosis angle, coronal head tilt, coronal shoulder angle, and coronal pelvic angle. Trunk control was measured by the Trunk Control Measurement Scale (TCMS), and motor functions were evaluated by the Gross Motor Function Measure (GMFM). Results: We found that PPA had high intra- and inter-rater reliability in sitting posture in children with CP (ICC: 0.951-0.998). Additionally, “coronal head tilt” and “coronal pelvic angle” had moderate correlations with some TCMS and GMFM scores (P < .05). There was a negative moderate significant correlation between “coronal pelvic angle” and “standing” (r = 0.557, P = .001), “walking/running/jumping” (r = –0.549, P = .001), and “total” (r = –0.535, P = .001) GMFM scores. There was a negative moderate significant correlation between “coronal head tilt” and “static sitting” (r = –0.444, P = .001), “dynamic reach” (r = –0.437, P = .001), and “total” (r = 0.442, P = .001) scores of TCMS. There was a negative moderate significant correlation between “coronal pelvic angle” and “static sitting” (r = –0.479, P = .001) and “total” (r = –0.454, P = .001) scores of TCMS. Conclusion: PPA was a reliable method for children with CP in a sitting posture. The findings suggest that posture and function may affect each other; in particular, coronal angles and gross motor and trunk functions may be related. © 2025