Sense of movement in children and youths with cerebral palsy : aspects of vision, proprioception and motor functioning

The sense of movement (i.e. the brain's synthesis of information from vision, proprioception, and the vestibular system into an internal model for action and perception) can be affected in individuals with cerebral palsy (CP). Cerebral palsy is a group of disorders of movement and posture attributed to disturbances in the developing brain. Sensory and perceptual disturbances such as cerebral visual impairments (CVI) and proprioceptive deficits are common in individuals with CP. There is a lack of knowledge and instruments for assessing the sensory aspects of motor functioning in individuals with CP. This thesis aimed to examine how aspects of visual perception, proprioception, and sensory behaviours in children and youths (C&Y) with spastic CP relate to motor functioning. The hypotheses were that: C&Y with CP with difficulties walking (at Gross Motor Functioning Classification System (GMFCS) II-IV) are more influenced by sensory disturbances than those walking without limitations (at GMFCS I). C&Y with bilateral spastic CP (BSCP) are more affected by sensory disturbances than those with unilateral CP (USCP). Methods The participants were 73 C&Y with spastic CP aged 6-20 years, at GMFCS levels I-IV, recruited through the Karolinska University Hospital in Solna, and a reference group with 42 typically developing (TD) C&Y in the same age range. Two groups of children with primarily motor disorders, myelomeningocele (MMC), n=21, and arthrogryposis (AMC), n=19, participated in one of the studies. Instruments: The Swedish CVI Questionnaire (CVIQ), the Child Sensory Profile-20 (CSP-20), and two questions formulated by the researchers regarding posture and sound sensitivity, were used to examine how parents of C&Y with CP rated how vision affected their child in everyday activities/features of CVI, and their child's responses to sensory events in daily life. A computerized visual motion coherence test (VMCT) evaluated global motion perception. Raven's Coloured Progressive Matrices@ measured non-verbal reasoning and general cognitive ability. Three-dimensional motion analysis and a knee joint position sense (JPS) test evaluated the ability to reproduce and maintain a knee flexion angle in a sitting position without seeing the legs. Results The parental reports showed: A higher median CVIQ score, indicating more features of CVI in the group with CP than in the TD group, 28 vs. 4.5, p