The relationship between lower limb proprioception and balance performance in children with cerebral palsy: a multisystem and multi-joint approach

BACKGROUND: Balance problems are a frequent focus of rehabilitation approaches in children with cerebral palsy (CP). Although proprioceptive impairments, affecting 46-90% of children with CP, are commonly observed, their role in postural control remains insufficiently understood.AIM: Given the multisystemic nature of postural control, this study aimed to investigate the association between lower-limb proprioception (hip, knee, ankle) and distinct postural control systems in children with CP compared to typically development (TD).DESIGN: Cross-sectional case-control study.SETTING: Different outpatient settings and the community.POPULATION: Children aged 5-12 years with TD (N.=30, 8.6±2.2y; boys: 15) and spastic CP (N.=32, 8.4±2.1y; boys: 16; GMFCS-I/II/III: 24/7/1; uni-/bilateral: 17/15).METHODS: Postural control was assessed using the age-specific Kids-Balance Evaluation Systems Test - extended version (Kids-BESTest-2). Hip, knee, and ankle proprioception were assessed using passive-ipsilateral Joint-Position-Reproduction (JPR). Joint Reproduction Error (JRE,°) was calculated from 3D kinematics for the joints of the dominant (JREd) and nondominant (JREnd) leg. Associations between Kids-BESTest-2 (total and domain scores, %), JREtotal (all joints) and summed joint JREankle, JREknee and JREhip (JREd+JREnd) were analyzed using general linear models with correction for multiple testing.RESULTS: JREtotal was not significantly associated with Kids-BESTest-2 scores in either group (P>0.01). In CP, higher JREhip (reflecting poorer proprioception) was significantly associated with lower total (ηp2=0.24, P