Joint-Position Sense and Kinesthesia in Cerebral Palsy
Presented to the Annual American Academy of Cerebral Palsy and Developmental Medicine, September 13–16, 2006, Boston, MA.
Abstract
Wingert JR, Burton H, Sinclair RJ, Brunstrom JE, Damiano DL. Joint-position sense and kinesthesia in cerebral palsy.
Objectives
To examine joint-position sense and kinesthesia in all extremities in participants with diplegic or hemiplegic cerebral palsy (CP).
Design
Survey of joint-position sense and kinesthesia differences between aged-matched controls and 2 groups with CP.
Setting
University movement assessment laboratory.
Participants
Population-based sample of participants with CP, diplegia (n=21), hemiplegia (n=17), and age-matched volunteers (n=21) without neurologic disease.
Interventions
Not applicable.
Main Outcome Measures
Joint-position sense and kinesthesia were measured in the transverse plane (forearm pronation/supination and hip internal/external rotation) using a custom-built device. For joint-position sense, participants actively rotated the tested limb to align the distal end with 10 target positions first with the limb and targets visible to assess their ability to perform the task motorically. The task was then repeated with vision of the limb occluded, with targets remaining visible. Joint-position sense error was determined by the magnitude and direction of the rotation errors for each limb in the vision and no vision conditions. Kinesthesia was evaluated by the ability to detect passive limb rotation without vision.
Results
No group differences were detected in the vision condition. Indicative of joint-position sense deficits, a significant increase in errors was found in the no vision condition in all limbs except the dominant upper limb for both groups with CP. Joint-position sense errors were systematically biased toward the direction of internal rotation. Kinesthesia deficits were evident on the nondominant upper limb in diplegia and hemiplegia, and bilaterally in the lower limbs in hemiplegia. In hemiplegia, joint-position sense and kinesthesia deficits were noted on the dominant limbs, but were significantly worse on the nondominant limbs.
Conclusions
These results indicate that people with CP have proprioception deficits in all limbs.
aDepartment of Health and Wellness, University of North Carolina at Asheville, Asheville, NC
bDepartments of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO
cDepartment of Neurology, Washington University School of Medicine, St. Louis, MO
dRehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
Reprint requests to Jason R. Wingert, PhD, MPT, Dept of Health and Wellness, WHC CPO #2730, UNC Asheville, One University Heights, Asheville, NC 28804
Supported by the United Cerebral Palsy Research and Education Foundation, the Foundation for Physical Therapy Promotion of Doctoral Studies Scholarship, the Ogle family, and the National Institutes of Health (grant nos. NS054413 and NS31005).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT