Assessing lower extremity proprioception and studying effects of proprioception on activity and participation in children with spastic hemiplegic cerebral palsy

This study was planned to assess lower extremity proprioception and to investigate the effect of proprioception on motor function and activity and participation levels in children with spastic hemiplegic cerebral palsy (CP). Twenty-two children with spastic hemiparetic CP between the ages of 4-18 were participated in this study. Lower extremity proprioception was evaluated with a protocol including verbal identification, unilateral and contralateral extremity matching, location identification, isometric contraction, static and dynamic balance, and deep tendon reflex tests. Tests were performed with the impaired and less-impaired lower extremity in open and closed conditions. Furthermore, level of spasticity, gross motor functions, balance skills, independence level in daily living activities, and activity-participation levels were evaluated by Modified Ashworth Scale (MAS), Gross Motor Function Measurement (GMFM), Pediatric Berg Balance Scale (PBS), Gilette Functional Assessment Questionnaire-22 (FAQ), The Functional Independence Measure (WeeFIM), and Pediatrics Outcomes Data Collection Instrument (PODCI), respectively. The results of study show that there was a significant difference in eyes-open and eyes-closed conditions (p<0,05) and also there was more loss of proprioception in the impaired-extremity compared to the less impaired-lower extremity (p<0,05). It was found that the proprioception loss of lower extremity in children was related to spasticity, gross motor function, balance skills, functional gait, independence level in daily life activities and activity-participation level at various levels (p <0,05). Considering the relationship between the loss of lower extremity proprioception, motor function and activity-participation level, we think that the treatment programs based on comprehensive physiotherapy evaluation including proprioception evaluation may become more effective in these children.