Best evidence summary for posture management in children and adolescents with neurodevelopmental disorders_Journal of Epilepsy

Authors：

WAN Yan ,  WANG Shuangyu

Department of Neurology, Children's Hospital of Fudan University, Shanghai 201102, China;

Corresponding?author：

WANG Shuangyu, Email: huangtaihou@163.com

Keywords：

Posture management; Neurodevelopmental disorders; Children; Adolescents; Postural support; Evidence summary

DOI：

10.7507/2096-0247.202604012

Video：

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Objective To summarize the best evidence for posture management in children and adolescents with neurodevelopmental disorders, and to provide an evidence-based reference for clinical posture management, musculoskeletal deformity prevention and functional outcome improvement. Methods The evidence-based question was formulated using the PIPOST framework. A systematic search was performed following the 6S evidence model in UpToDate, BMJ Best Practice, Web of Science, Cochrane Library, PubMed, CNKI, CBM, VIP and Wanfang Data, from January 2021 to May 2026. Results A total of 35 articles were included, consisting of 5 guidelines, 20 systematic reviews/Meta-analyses, 8 randomized controlled trials and 2 expert consensuses. Twelve pieces of best evidence were extracted across 6 domains: 24-hour posture management, disease-specific interventions, assessment tools, stratified functional intervention, nighttime postural support and emerging technologies. Conclusion The summarized best evidence for posture management in children and adolescents with neurodevelopmental disorders helps standardize clinical postural interventions, reduce the risk of musculoskeletal deformities, and support stratified, individualized rehabilitation management.

Citation： WAN Yan, WANG Shuangyu. Best evidence summary for posture management in children and adolescents with neurodevelopmental disorders. Journal of Epilepsy, 2026, 12(4): 343-349. doi: 10.7507/2096-0247.202604012 Copy

1.	Higgins C, Turner E, Gates K, et al. A scoping review of research on postural care interventions and outcome measures for non-ambulant children and young people with complex neurodisability. APCP Journal, 2026, 17: 1-15.
2.	Effectiveness of postural interventions in cerebral palsy: umbrella systematic review. Paediatrics & Child Health, 2024, 1: e156211.
3.	Noble E. Evidence update: postural interventions for cerebral palsy-a systematic review. Rifton Education Center, 2024, 56: e11254.
4.	Morgan C, Fetters L, Adde L, et al. Early intervention for cerebral palsy: a systematic review and meta-analysis. Pediatrics, 2021, 148(3): e2021050518.
5.	Riquelme I, Hatem SM, Montoya P, et al. Postural control in autism: a systematic review and meta-analysis. J Autism Dev Disord, 2022, 52(9): 3855-3873.
6.	Healy S, Marchand G, Haegele JA, et al. Aquatic interventions for children with autism spectrum disorder: a meta-analysis. J Autism Dev Disord, 2024, 54(2): 567-582.
7.	Rosenbaum P, Gorter JW, Palisano RJ, et al. The 24-hour postural care concept for children with severe CP. Dev Med Child Neurol, 2022, 64(10): 1205-1211.
8.	Khanna A, Khanna S. Impact of 24-hour postural care in management of scoliosis, windswept deformity, hip dislocation, and subluxation in children with cerebral palsy: a literature review. Asian Pacific Journal of Health Sciences, 2025, 12(4): 51-55.
9.	Van Grinderbeek M, Nijhuis B, Geurts A, et al. Assessing postural control deficits with the balance evaluation systems test for children, second edition in children with developmental coordination disorder. Brazilian Journal of Physical Therapy, 2026, 30(1): 101558.
10.	Toohey M, Bladen A, Gough K, et al. New paper helps clinicians improve the lives of people with CP. Cerebral Palsy Alliance, 2024, 23: e02457.
11.	Brochard S, Sellers D, Crombie S, et al. Core outcome set for postural care in neurodisability. Arch Phys Med Rehabil, 2026, 107(1): 55-63.
12.	Kim C, Park H. Evidence-based clinical guidelines for optimizing the use of standing frame: a systematic review of dosing recommendations among cerebral palsy. Korean Journal of Physical Therapy, 2024, 31(2): 131-141.
13.	Paleg G, Livingstone R, Rodby-Bousquet E. Standing frame use in children with cerebral palsy: a systematic review of dose and frequency. Phys Ther, 2022, 102(5): pzac028.
14.	Ryan JM, Smith E, Lavelle G, et al. Standing frame use in Duchenne muscular dystrophy: a systematic review. Neuromuscul Disord, 2023, 33(5): 401-409.
15.	Craig F, Lorenzo A, Lucarelli E, et al. Postural control in Rett syndrome: a systematic review. Eur J Paediatr Neurol, 2023, 42: 12-20.
16.	Acharya BD, Bhatia D, Goyal M, et al. Effect of adaptive seating in postural control among children with cerebral palsy: a systematic review. Journal of Health Research, 2023, 37: S24-S32.
17.	Novak I, Morgan C, Fahey M, et al. State of the evidence traffic lights 2023: systematic review of interventions for cerebral palsy. Dev Med Child Neurol, 2023, 65(8): 1022-1035.
18.	Pav?o SL, Rocha NACF, Tudella E, et al. Postural control interventions in cerebral palsy: a network meta-analysis. Dev Med Child Neurol, 2024, 66(5): 589-601.
19.	Chen Y, Fanchiang HD, Howard A, et al. Robot-assisted gait training for children with cerebral palsy: a meta-analysis. J Neuroeng Rehabil, 2023, 20(1): 34.
20.	Dusing SC, Harbourne RT, Lobo MA, et al. Early postural control assessment in infants at risk for CP. Phys Ther, 2022, 102(9): pzac089.
21.	Birnkrant DJ, Bushby K, Bann CM, et al. DMD care guidelines update 2022. Lancet Neurol, 2022, 21(3): 234-245.
22.	中華醫學會兒科學分會. 腦性癱瘓姿勢管理臨床實踐指南(2024). 中華兒科雜志, 2024, 62(7): 620-630.
23.	World Health Organization. Wheelchair service training package for spina bifida. Geneva: WHO, 2021.
24.	中國康復醫學會. 兒童發育性協調障礙早期干預與康復指南(2025). 中國循證兒科雜志, 2025, 20(2): 98-106.
25.	Lobo MA, Harbourne RT, Dusing SC, et al. NIH Infant Toolbox: motor domain standardization. J Pediatr, 2022, 245: 45-53.
26.	Wilson RB, Smith A, Jones C, et al. Sleep positioning systems for children with CP: a pilot RCT. Dev Neurorehabil, 2025, 28(1): 22-30.
27.	Bezgin S, Aksu M, Yildirim A, et al. The validity and reliability of the seated postural control measure in cerebral palsy. Pediatric Physical Therapy, 2025, 37(2): 248-255.
28.	Park EY, Kim WH, Park JH, et al. Seated postural control measure across GMFCS levels. Disabil Rehabil, 2023, 45(8): 1355-1362.
29.	Gyllensten AL, Strandberg E, Haglund E, et al. Sway app validity in DCD. Gait Posture, 2024, 109: 112-118.
30.	Palisano RJ, Di Rezze B, Avery L, et al. Relationship between postural management and participation in children with CP. Phys Occup Ther Pediatr, 2025, 45(2): 210-225.
31.	SSAP3D trial protocol: 3D printed seating for children with neuromotor dysfunction. Trials, 2025, 26(1): 89.
32.	Smits-Engelsman B, Bonney E, Ferguson G, et al. Task-oriented training for children with developmental coordination disorder: an updated systematic review. Phys Ther, 2023, 103(6): pzad045.
33.	李靜, 王偉, 張華, 等. 水中運動對自閉癥兒童姿勢控制效果的系統評價. 中國康復理論與實踐, 2024, 30(4): 421-428.
34.	Therapeutic benefits of robotics and exoskeletons for gait and postural balance among children and adolescents with cerebral palsy: an overview of systematic reviews. Healthcare, 2025, 13(23): 3120.
35.	Hadders-Algra M. Early human motor development and postural control. Early Hum Dev, 2021, 156: 105346.

1. Higgins C, Turner E, Gates K, et al. A scoping review of research on postural care interventions and outcome measures for non-ambulant children and young people with complex neurodisability. APCP Journal, 2026, 17: 1-15.
2. Effectiveness of postural interventions in cerebral palsy: umbrella systematic review. Paediatrics & Child Health, 2024, 1: e156211.
3. Noble E. Evidence update: postural interventions for cerebral palsy-a systematic review. Rifton Education Center, 2024, 56: e11254.
4. Morgan C, Fetters L, Adde L, et al. Early intervention for cerebral palsy: a systematic review and meta-analysis. Pediatrics, 2021, 148(3): e2021050518.
5. Riquelme I, Hatem SM, Montoya P, et al. Postural control in autism: a systematic review and meta-analysis. J Autism Dev Disord, 2022, 52(9): 3855-3873.
6. Healy S, Marchand G, Haegele JA, et al. Aquatic interventions for children with autism spectrum disorder: a meta-analysis. J Autism Dev Disord, 2024, 54(2): 567-582.
7. Rosenbaum P, Gorter JW, Palisano RJ, et al. The 24-hour postural care concept for children with severe CP. Dev Med Child Neurol, 2022, 64(10): 1205-1211.
8. Khanna A, Khanna S. Impact of 24-hour postural care in management of scoliosis, windswept deformity, hip dislocation, and subluxation in children with cerebral palsy: a literature review. Asian Pacific Journal of Health Sciences, 2025, 12(4): 51-55.
9. Van Grinderbeek M, Nijhuis B, Geurts A, et al. Assessing postural control deficits with the balance evaluation systems test for children, second edition in children with developmental coordination disorder. Brazilian Journal of Physical Therapy, 2026, 30(1): 101558.
10. Toohey M, Bladen A, Gough K, et al. New paper helps clinicians improve the lives of people with CP. Cerebral Palsy Alliance, 2024, 23: e02457.
11. Brochard S, Sellers D, Crombie S, et al. Core outcome set for postural care in neurodisability. Arch Phys Med Rehabil, 2026, 107(1): 55-63.
12. Kim C, Park H. Evidence-based clinical guidelines for optimizing the use of standing frame: a systematic review of dosing recommendations among cerebral palsy. Korean Journal of Physical Therapy, 2024, 31(2): 131-141.
13. Paleg G, Livingstone R, Rodby-Bousquet E. Standing frame use in children with cerebral palsy: a systematic review of dose and frequency. Phys Ther, 2022, 102(5): pzac028.
14. Ryan JM, Smith E, Lavelle G, et al. Standing frame use in Duchenne muscular dystrophy: a systematic review. Neuromuscul Disord, 2023, 33(5): 401-409.
15. Craig F, Lorenzo A, Lucarelli E, et al. Postural control in Rett syndrome: a systematic review. Eur J Paediatr Neurol, 2023, 42: 12-20.
16. Acharya BD, Bhatia D, Goyal M, et al. Effect of adaptive seating in postural control among children with cerebral palsy: a systematic review. Journal of Health Research, 2023, 37: S24-S32.
17. Novak I, Morgan C, Fahey M, et al. State of the evidence traffic lights 2023: systematic review of interventions for cerebral palsy. Dev Med Child Neurol, 2023, 65(8): 1022-1035.
18. Pav?o SL, Rocha NACF, Tudella E, et al. Postural control interventions in cerebral palsy: a network meta-analysis. Dev Med Child Neurol, 2024, 66(5): 589-601.
19. Chen Y, Fanchiang HD, Howard A, et al. Robot-assisted gait training for children with cerebral palsy: a meta-analysis. J Neuroeng Rehabil, 2023, 20(1): 34.
20. Dusing SC, Harbourne RT, Lobo MA, et al. Early postural control assessment in infants at risk for CP. Phys Ther, 2022, 102(9): pzac089.
21. Birnkrant DJ, Bushby K, Bann CM, et al. DMD care guidelines update 2022. Lancet Neurol, 2022, 21(3): 234-245.
22. 中華醫學會兒科學分會. 腦性癱瘓姿勢管理臨床實踐指南(2024). 中華兒科雜志, 2024, 62(7): 620-630.
23. World Health Organization. Wheelchair service training package for spina bifida. Geneva: WHO, 2021.
24. 中國康復醫學會. 兒童發育性協調障礙早期干預與康復指南(2025). 中國循證兒科雜志, 2025, 20(2): 98-106.
25. Lobo MA, Harbourne RT, Dusing SC, et al. NIH Infant Toolbox: motor domain standardization. J Pediatr, 2022, 245: 45-53.
26. Wilson RB, Smith A, Jones C, et al. Sleep positioning systems for children with CP: a pilot RCT. Dev Neurorehabil, 2025, 28(1): 22-30.
27. Bezgin S, Aksu M, Yildirim A, et al. The validity and reliability of the seated postural control measure in cerebral palsy. Pediatric Physical Therapy, 2025, 37(2): 248-255.
28. Park EY, Kim WH, Park JH, et al. Seated postural control measure across GMFCS levels. Disabil Rehabil, 2023, 45(8): 1355-1362.
29. Gyllensten AL, Strandberg E, Haglund E, et al. Sway app validity in DCD. Gait Posture, 2024, 109: 112-118.
30. Palisano RJ, Di Rezze B, Avery L, et al. Relationship between postural management and participation in children with CP. Phys Occup Ther Pediatr, 2025, 45(2): 210-225.
31. SSAP3D trial protocol: 3D printed seating for children with neuromotor dysfunction. Trials, 2025, 26(1): 89.
32. Smits-Engelsman B, Bonney E, Ferguson G, et al. Task-oriented training for children with developmental coordination disorder: an updated systematic review. Phys Ther, 2023, 103(6): pzad045.
33. 李靜, 王偉, 張華, 等. 水中運動對自閉癥兒童姿勢控制效果的系統評價. 中國康復理論與實踐, 2024, 30(4): 421-428.
34. Therapeutic benefits of robotics and exoskeletons for gait and postural balance among children and adolescents with cerebral palsy: an overview of systematic reviews. Healthcare, 2025, 13(23): 3120.
35. Hadders-Algra M. Early human motor development and postural control. Early Hum Dev, 2021, 156: 105346.

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