Upper-Limb Position Sense Deficits in Adults with Cerebral Palsy

Langan, Jeanne; Kern, Kathy L.; Hurvitz, Edward A.; Brown, Susan H.

doi:10.1097/phm.0000000000000100

Cited by 10 publications

(9 citation statements)

References 33 publications

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“…This may be due to the strength of the WPST to distinguish deficits in position sense in clinical populations ( 42 , 68 , 69 ), but also may reflect an inadequate clinical picture of those with a diplegic presentation. The current findings indicate that hand proprioceptive acuity is diminished in adults with CP, building on past studies that have revealed similar deficits across the lifespan ( 13 – 15 , 55 , 56 ). However, the number of studies related to proprioception in this population remains very low ( 11 ).…”

Section: Discussionsupporting

confidence: 80%

“…The results from this study further confirmed the notion that adults with CP likely have proprioceptive errors. Past studies of children and adults with CP have identified decreased limb position sense in both the dominant and non-dominant limbs ( 13 , 15 , 55 , 56 ). Intact proprioception is an important part of optimal motor control, allowing for the updating of internal models throughout the lifespan ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…Proprioception is thought to play a significant role in motor skill development and the production of movement (12). In adults with CP, proprioceptive deficits have been noted in several studies (13)(14)(15). Nevertheless, the sensory contribution to both motor and overall function in people with CP remains vastly underappreciated (16) as the association between motor and sensory functions remains unclear across the literature (17).…”

Section: Introductionmentioning

confidence: 99%

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Reduced wrist flexor H-reflex excitability is linked with increased wrist proprioceptive error in adults with cerebral palsy

et al. 2022

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Although most neurophysiological studies of persons with cerebral palsy (CP) have been focused on supraspinal networks, recent evidence points toward the spinal cord as a central contributor to their motor impairments. However, it is unclear if alterations in the spinal pathways are also linked to deficits in the sensory processing observed clinically. This investigation aimed to begin to address this knowledge gap by evaluating the flexor carpi radialis (FCR) H-reflex in adults with CP and neurotypical (NT) controls while at rest and during an isometric wrist flexion task. The maximal H-wave (Hmax) and M-wave (Mmax) at rest were calculated and utilized to compute Hmax/Mmax ratios (H:M ratios). Secondarily, the facilitation of the H-wave was measured while producing an isometric, voluntary wrist flexion contraction (i.e., active condition). Finally, a wrist position sense test was used to quantify the level of joint position sense. These results revealed that the adults with CP had a lower H:M ratio compared with the NT controls while at rest. The adults with CP were also unable to facilitate their H-reflexes with voluntary contraction and had greater position sense errors compared with the controls. Further, these results showed that the adults with CP that had greater wrist position sense errors tended to have a lower H:M ratio at rest. Overall, these findings highlight that aberration in the spinal cord pathways of adults with CP might play a role in the sensory processing deficiencies observed in adults with CP.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reduced wrist flexor H-reflex excitability is linked with increased wrist proprioceptive error in adults with cerebral palsy

et al. 2022

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“…The majority of studies were conducted in the United States ( n = 12, 41%) [ 3 , 13 – 16 , 18 , 21 , 22 , 26 , 29 , 37 , 40 ]. Also, 6.88% of studies were carried out in Australia ( n = 2) [ 23 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

Telerehabilitation for upper limb disabilities: a scoping review on functions, outcomes, and evaluation methods

et al. 2022

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Background Upper limb (UL) disabilities have attracted worldwide attention due to the high economic costs of health care and the negative effects on the quality of life of patients with these disabilities. Telerehabilitation technologies are one of the most important ways to reduce rehabilitation costs and increase the quality of life of patients. Therefore, the aim of this study was to investigate the role of telerehabilitation in improving the health status of patients with upper limb disabilities. Methods This scoping review was conducted by searching the Web of Science, PubMed, and Scopus until July 30, 2021. We used a data extraction form with 18 fields to extract data from primary studies. The selection of articles and data extraction was made by four researchers using a data collection form based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth and sixth researchers.Inclusion criteria were studies published in English, studies on upper limb disability, and telerehabilitation based on any technology (synchronous telerehabilitation, asynchronous, or both). Exclusion criteria were articles that did not focus on telerehabilitation and upper limb disabilities. Also, books, book chapters, letters to the editor, and conference abstracts were also removed. Results A total of 458 articles were retrieved, and after removing irrelevant and duplicate articles, 29 articles were finally included in this review. Most telerehabilitation was performed for patients with stroke (65%). Among the 15 different services provided with telerehabilitation technologies, "Evaluation of exercises and also a musculoskeletal function of patients by the therapist","Recording of patients' rehabilitation exercises and sending them to the therapist” and "Prescribing new rehabilitation exercises by the therapist" were the most widely used services, respectively. Virtual reality technologies, smart wearables, and robots were used to provide telerehabilitation services. Among the 13 types of evaluation used for telerehabilitation systems, “Evaluation and measurement of upper limb function” was the most used evaluation in the studies. "Improvement in musculoskeletal functions”, "Increasing patients' interest and motivation to perform rehabilitation exercises", and "Increasing adherence to rehabilitation exercises and greater participation in treatment processes" were the most important outcomes, respectively. Conclusion Our findings indicate that telerehabilitation provides individuals with equitable access to rehabilitation services, improves musculoskeletal function, and empowers individuals by providing a variety of rehabilitation capabilities.

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“…To address these concerns, based on recent literature [18,19] we introduce a motion capture-based framework to assess multi-joint PPS of the upper limbs precisely while not providing any external arm support during contralateral pose matching tasks. We rely on the assumption that the symmetry of pose matching tasks is primarily dependent on the degree of PPS present, as previous studies have done [20,21,22].…”

Section: Introductionmentioning

confidence: 99%

Estimating Proprioceptive Position Sense of Upper Limbs Using Joint Distance and Joint Angle Symmetries

Ratnadurai-Giridharan

Delfing

Robert

et al. 2021

Preprint

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Background Proprioceptive position sense (PPS) plays a critical role in movement and coordination of the upper limbs. It is commonly affected in neurological disorders such as unilateral spastic cerebral palsy (USCP) and stroke. However, UL PPS is often not considered during assessment or treatment in motor rehabilitation programs, in part due to limitations of current methods to quantify PPS. Traditional methods assess the similarity or symmetry of angles of a single joint and may not be sufficiently sensitive nor accurate. Emerging methods such as the use of robotic technology typically are limited to 2D and are also not standardizable as they are not easily available to clinics and research labs. This study aims to introduce a standardized and accessible way to quantify multi-joint PPS using 3D kinematic measures. Methods We developed novel multi-joint angle and distance-based measures of symmetry to assess upper limb PPS. Healthy adults (N = 17) and children with USCP (N=9) participated in this study. Kinematics were extracted during upper limb 3D pose matching tasks using a VICON Nexus system. Brunner-Munzel permutation tests were used for statistical comparisons between groups. Pearson’s correlation coefficient was used to investigate the relationship between the different symmetry measures and pose matching tasks. Results We introduced novel angle and distance-based measures of symmetry to estimate PPS. Healthy adults scored higher on both these symmetry measures compared to children with USCP. Angle and distance-based symmetries did correlate with each other. Exploratory factor analysis indicated that both angle symmetry and joint distance symmetry were highly loaded by the latent factor that best explained variance in the data. These results suggest that the two measures of pose symmetry are not redundant. It was also observed that distance symmetry was less sensitive to the different poses while angle symmetry varied across poses. Conclusions Symmetry measures derived from kinematics during upper limb pose matching tasks can estimate multi-joint PPS. Angle and distance-based symmetries together provide information about an individual’s ability to sense joint position. This framework will allow clinicians and researchers to measure PPS of upper limbs only using kinematic acquisition devices.

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Upper-Limb Position Sense Deficits in Adults with Cerebral Palsy

Abstract: The results suggest an important role for the reference arm in bilateral position matching tasks and the potential for improved proprioceptive performance after training in movement and unrelated sensory tasks.

Cited by 10 publications

References 33 publications

Reduced wrist flexor H-reflex excitability is linked with increased wrist proprioceptive error in adults with cerebral palsy

Reduced wrist flexor H-reflex excitability is linked with increased wrist proprioceptive error in adults with cerebral palsy

Telerehabilitation for upper limb disabilities: a scoping review on functions, outcomes, and evaluation methods

Estimating Proprioceptive Position Sense of Upper Limbs Using Joint Distance and Joint Angle Symmetries

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