Contribution of hip joint proprioception to static and dynamic balance in cerebral palsy: a case control study

Abstract

BackgroundBalance problems are common in cerebral palsy (CP) but etiology is often uncertain. The classic Romberg test compares ability to maintain standing with eyes open versus closed. Marked instability without vision is a positive test and generally indicates proprioceptive loss. From previous work showing diminished hip joint proprioception in CP, we hypothesized that static and dynamic balance without vision (positive Romberg) would be compromised in CP.MethodsForce plate sway and gait velocity data were collected using 3D motion capture on 52 participants, 19 with diplegic CP, 13 with hemiplegic CP, and 20 without disability. Center of mass (COM) and center or pressure (COP) velocity, excursion, and differences between COM and COP in AP and ML directions were computed from static standing trials with eyes open and closed. Mean gait velocity with and without dribble glasses was compared. Hip joint proprioception was quantified as the root mean square of magnitude of limb positioning errors during a hip rotation task with and without view of the limb. Mixed model repeated measures analysis of variance (ANOVA) was performed with condition as within-subject (EO, EC) and group as between-subject factors (hemiplegia, diplegia, controls). Sway characteristics and gait speed were correlated with proprioception values.ResultsGroups with CP had greater sway in standing with eyes open indicating that they had poorer balance than controls, with the deficit relatively greater in the ML compared to AP direction. Contrary to our hypothesis, the decrement with eyes closed did not differ from controls (negative Romberg); however, proprioception error was related to sway parameters particularly for the non-dominant leg. Gait speed was related to proprioception values such that those with worse proprioception tended to walk more slowly.ConclusionsPostural instability is present even in those with mild CP and is yet another manifestation of their motor control disorder, the specific etiology of which may vary across individuals in this heterogeneous diagnostic category.

Effects of Three Weeks of Whole-Body Vibration Training on Joint-Position Sense, Balance, and Gait in Children with Cerebral Palsy: A Randomized Controlled Study

“…22 In general, proprioceptive sense (JPS) is used to perceive the movement of the joints and plays an important role in gait and postural control. 23 …”

“…2 Ankle JPS should be taken into account in clinical decision making about the necessity of changing gait patterns in children with CP. Clinically, patients who report not knowing where their foot is tend to walk more slowly and take smaller steps.…”

“…1 Proprioception, the receipt of information about changes in joint position, is closely associated with control of gait and posture; 2 according to Wingert and colleagues, 3 children who have CP with gait disturbance show a reduced proprioceptive sense compared with typically developing children. There may be important differences between therapeutic approaches aimed at enhancing proprioception in children who have decreased ability to self-correct posture.…”

Effect of Backward Walking Training on Dynamic Balance in Children with Spastic Hemiplegic Cerebral Palsy

“…Third, the biomechanical/musculoskeletal system includes the muscles that create the movement torques and the bones and joint frame on which movements are made. 4) All three systems may be associated with an improvement in balance by backward walking training. Furthermore, oxygenated hemoglobin was found to be increased in the supplementary motor area, precentral gyrus, and superior parietal lobule when participants walked backwards rather than forwards.…”

“…3) Furthermore, problems with dynamic balance are common in children with cerebral palsy 4) and include inappropriate muscle organization, abnormal intersensory integrative ability and late onset of muscle activation. 5) During walking, children with spastic hemiplegic cerebral palsy have poor motor coordination, which results in a short stride, increased stride frequency to maintain speed, increased swing, and poor stability due to center-of-gravity fluctuations.…”