Assessing Proprioception in Children: A Review

Comparison of balance and proprioception of the shoulder joint in girls with and without upper cross syndrome

INTRODUCTION

Upper cross syndrome is one of the most common disorders of the upper part of body, often associated with abnormalities of forward head, forward shoulders, elevated and protracted of scapula, and increased thoracic kyphosis. Conducting research on upper cross syndrome, especially in girls, is of highly significant, considering this issue and lack of examination of complications and consequences of this syndrome; therefore, this study aims to compare the balance and proprioception of the shoulder joint in girls with and without upper cross syndrome.Method The statistical population included two groups of 10-12-year-old female students, i.e., healthy and those with upper cross syndrome in the city of Khalkhal in Iran in 2022-2023. A total of 60 girl children were included in this study. The subjects were screened using a checker board and after quantitative evaluations of posture, they were assigned into two groups: healthy group (No. 30) and the one suffering from upper cross syndrome (No. 30). Forward head and forward shoulder angle were assessed using photography and kinovea software, kyphosis angle using Goniometer-pro app, static and dynamic balance using BESS and Y tests, also proprioception at angles of 45- and 80-degrees external rotation of the shoulder joint through photography and kinovea software. Data were analyzed through independent t-test in SPSS software version 26 at the significance level of 0.05.Results Healthy girls were in a better position in all variables of static balance (1.14 95% CI: [0.96, 1.70], p = 0.001), dynamic balance (0.81, 95% CI: [0.73,1.24], p = 0.001), proprioception of external rotation of shoulder joint at 45- (0.78, 95% CI: [0.64, 1.14], p = 0.001) and 80-degrees (0.89, 95% CI: [0.59, 1.34], p = 0.001) angles than those with upper cross syndrome.Conclusion It can be concluded that upper cross syndrome causes a decrease in balance and proprioception of the shoulder joint in female students; therefore, along with correcting the abnormalities, special attention should be paid to strengthening and improving these components. It is recommended for rehabilitation professionals to apply exercise training programs to improve the balance and proprioception and correct of the upper cross syndrome: that the strengthening of these components prevents musculoskeletal disorders.Implications for clinical practice• It is recommended for rehabilitation professionals to apply exercise training programs to improve the balance and proprioception of individual with upper cross syndrome.• It is recommended for rehabilitation professionals to apply exercise training programs to correct of the upper cross syndrome in order to prevents musculoskeletal disorders.

Impaired motor skills and proprioceptive function in Mandarin-speaking children with developmental language disorder

This study examined proprioceptive acuity and its relationship with motor function in Mandarin-speaking children with and without developmental language disorder (DLD). Fifteen children aged 9-12 years with DLD and 15 age- and sex-matched typically developing (TD) children participated in this study. Children's motor function was assessed using the second edition of the Movement Assessment Battery for Children (MABC-2). Their proprioceptive acuity was measured based on the absolute error (i.e., proprioceptive bias) and variable error (i.e., proprioceptive precision) when performing joint position matching tasks. Compared with the TD group, the DLD group exhibited impaired motor function and poorer proprioceptive acuity, as evidenced by the lower scores on the MABC-2 and the higher rates of absolute and variable errors in the joint position matching tasks. A significant association between the proprioceptive bias (absolute error) and the MABC-2 total score was also observed in the combined cohort of children with and without DLD. We conclude that DLD is associated with proprioceptive dysfunction.

How does a motor or cognitive dual-task affect our sense of upper limb proprioception?

BACKGROUND

Daily upper limb activities require multitasking and our division of attention. How we allocate our attention can be studied using dual-task interference (DTi). Given the vital role proprioception plays in movement planning and motor control, it is important to investigate how conscious upper limb proprioception is impacted by DTi through cognitive and motor interference.

PURPOSE

To examine how dual-task interference impacts conscious upper limb proprioception during active joint repositioning tasks (AJRT).

METHODS

Forty-two healthy participants, aged between 18 and 35, took part in this cross-sectional study. Participants completed two AJRT during three conditions: baseline (single task), dual-cognitive task (serial subtractions), and dual-motor task (non-dominant hand movements). The proprioceptive error (PE; difference between their estimation and targeted position) was measured using an AJRT of 75% and 90% of maximum internal rotation using the Biodex System IIITM and the Upper Limb Proprioception Reaching Test (PRO-Reach). To determine if PEs differed during dual-task interference, interference change scores from baseline were used with one sample t-tests and analyses of variance.

RESULTS

The overall mean PE with the Biodex was 4.1° ± 1.9 at baseline. Mean change scores from baseline reflect a mean improvement of 1.5° ± 1.0 (p < .001) during dual-cognitive task and of 1.5° ± 1.2 (p < .001) during dual-motor task. The overall mean PE with the PRO-Reach was 4.4cm ± 1.1 at baseline. Mean change scores from baseline reflect a mean worsening of 1.0cm ± 1.1 (p < .001) during dual-cognitive task and improvement of 0.8cm ± 0.6 (p < .001) during dual-motor task. Analysis of variance with the Biodex PEs revealed an interference effect (p < .001), with the cognitive condition causing greater PEs compared to the motor condition and a criterion position effect (p = .006), where 75% of maximum IR produced larger PEs during both interference conditions. An interference effect (p = .022) with the PRO-Reach PEs was found highlighting a difference between the cognitive and motor conditions, with decreased PEs during the contralateral motor task.

CONCLUSION

Interference tasks did impact proprioception. Cognitive interference produced mixed results, whereas improved proprioception was seen during motor interference. Individual task prioritization strategies are possible, where each person may choose their own attention strategy when faced with dual-task interference.

Relationship between play skills and sensory processing in children with autism

Play skills in children with autism are limited due to autism symptoms. It is important to determine the effect of sensory processing skill, which is one of these symptoms, on play skills. Therefore, we aimed to investigate of the relationship between play skills and sensory processing of children with autism. A total of 58 children with autism (n = 29) and typically developing children (n = 29) participated. We used the Sensory Profile and the Revised Knox Preschool Play Scale. Spearman's correlation coefficient was used. Children with autism demonstrated a significantly lower developmental play age and were rated lower on all dimensions of the RKPPS than typically developing children. Moreover, the results of this study showed that there are complex correlations between play skills and sensory processing in children with autism. Sensory processing and play skills have complex relationships in children with autism.

The relationship between the backward walking and proprioception, trunk control, and muscle strength in children with cerebral palsy

OBJECTIVE

This study was planned to determine the factors affecting backward walking in children with cerebral palsy (CP).

METHODS

The study included 30 children with CP, with a mean age of 10.43 ± 2.76 years. Backward walking abilities were evaluated with the 3-Meter Back Walk Test (3MBWT). A digital goniometer was used to evaluate proprioception, the Trunk Control Measurement Scale (TCMS) was used for trunk control, a digital muscle dynamometer was used for muscle strength, and the Gillette Functional Assessment Questionnaire (FAQ) was used for gait evaluation.

RESULTS

When the spasticity of children at levels I and II according to the Gross Motor Function Classification System (GMFCS) was compared, a significant difference was found in favor of level I in hamstring, gastro-soleus, and gastrocnemius spasticity (p < 0.05). When the results of the 3MBWT, TCMS, and FAQ were compared, a significant difference was found in favor of level I (p < 0.05). No significant relationship was revealed between the 3MBWT and lower extremity proprioception and TCMS (p > 0.05). A significant negative correlation was observed between the 3MBWT and FAQ (p < 0.05). No significant correlation was found between the 3MBWT and lower extremity muscle strengths (p > 0.05). A significant positive correlation was found only between hip extension proprioception and iliopsoas muscle strength (p = 0.023). There was no significant correlation between the FAQ and lower extremity muscle strength (p > 0.05).

CONCLUSION

It was revealed that the backward walking ability increased as the forward walking function improved in children with CP, but it was not affected by proprioception, trunk control, and muscle strength.

CLINICAL TRIALS

NCT05088629 (10/11/2021).

Evaluation of Knee Position Sense in Children with Motor Disabilities and Children with Typical Development: A Cross-Sectional Study

BACKGROUND

In children with motor disabilities, knee position during walking is often of concern in rehabilitation. This study aimed to investigate knee joint position sense. Thirty-seven children with Cerebral Palsy (CP), 21 with Myelomeningocele (MMC), 19 with Arthrogryposis (AMC), and 42 TD children participated in the study. Knee joint position sense, i.e., the difference between the criterion angle and the reproduced angle (JPS-error), was assessed in sitting while 3D motion capture was recorded at flexed knee 70 (Knee70), 45 (Knee45), and 20 (Knee20) degrees, and after three seconds at maintained criterion angle (CAM) and maintained reproduced angle (RAM). No differences were found between the groups in JPS-error, CAM, and RAM. At Knee70, CAM differed between the right and left legs in the TD group (p = 0.014) and RAM in the MMC group (p = 0.021). In the CP group, CAM was greater than RAM at Knee70 in the left leg (p = 0.002), at Knee45 in both legs (p = 0.004, p = 0.025), and at Knee20 in the right leg (p = 0.038). Difficulties in maintaining the knee position at CAM in the CP group sheds light on the need for complementary judgments of limb proprioception in space to explore the potential influence on knee position during walking.

Lower extremity proprioception and its association with activity and participation in children with unilateral spastic cerebral palsy

OBJECTIVE

This cross-sectional study aimed to assess lower extremity proprioception and investigate its relationship to activity and participation levels in children with unilateral spastic cerebral palsy (USCP).

METHODS

A total of 22 children with USCP between the ages of 5 and 16 years participated in this study. Lower extremity proprioception was evaluated with a protocol that consisted of verbal and location identification, unilateral and contralateral limb matching, and static and dynamic balance tests performed with the impaired and less impaired lower extremities under eyes-open and eyes-closed conditions. Furthermore, the Functional Independence Measure (WeeFIM) and Pediatric Outcomes Data Collection Instrument (PODCI) were used to evaluate the independence levels in daily living activities and participation levels.

RESULTS

Children demonstrated proprioceptive loss, as evidenced by an increase in matching errors under the eyes-closed condition compared to the eyes-open condition (p<0.05). Also, the impaired extremity had greater proprioceptive loss than the less impaired extremity (p<0.05). The 5-6-year age group experienced greater proprioceptive deficits than did the 7-11 and 12-16 age groups (p<0.05). Children's lower extremity proprioceptive deficit was moderately associated with their activity and participation levels (p<0.05).

CONCLUSIONS

Our findings suggest that treatment programs based on comprehensive assessments, including proprioception, may be more effective in these children.

Comparison of proprioception recovery following anterior cruciate ligament reconstruction using an artificial graft versus an autograft

BACKGROUND

To compare proprioception recovery after anterior cruciate ligament reconstruction (ACLR) with a hamstring tendon autograft versus the artificial Ligament Advanced Reinforcement System (LARS).

MATERIAL AND METHODS

Forty patients (9 females, 31 males) with anterior cruciate ligament (ACL) rupture were enrolled in this prospective study. Patients were randomized to two groups, 1) ACLR using a hamstring tendon autograft (n = 20) or 2) ACLR using artificial LARS (n = 20). Proprioception was assessed with knee joint position sense (JPS) passive-passive test at 45° and 75° flexions, with the contralateral healthy knee as a control baseline to calculate the JPS error. Knee JPS absolute error was used as the main outcome variable and defined as the absolute difference between the reproduction and target angles.

RESULTS

JPS error in both groups at 3 months after ACLR was significantly higher than that at 12 months. However, no significant difference in JPS error was detected between the LARS and autograft groups at either 3 or 12 months after ACLR. Analyzing JPS data by grouping patients according to whether ACLR was performed more or less than 1 year following injury regardless of graft type showed a statistically significant difference between the groups at 3 months, but not at 12 months, after ACLR. Patients receiving the graft within 1 year of injury had a lower JPS error than those receiving the graft more than 1 year after injury at 3 months. No complications were associated with either ACLR method.

CONCLUSION

ACLR with a hamstring tendon autograft or LARS artificial graft is similarly safe and effective for recovering knee proprioception.

Development and pilot testing of an early childhood somatosensory assessment: Somatosensory test of reaching

Thirty-two children (50% female, 59.3% White, 7-60 months), from middle to high socioeconomic status families, participated in pilot feasibility and validity testing of the somatosensory test of reaching (STOR). STOR tested the child's accuracy of reach to visual and somatosensory targets. All children were able to complete the assessment. Statistically significant differences were found between age groups (p = .0001), showing developmental trends, and between test conditions (p < .001), showing that the ability to reach to visible targets develops before somatosensory targets. STOR also showed a moderate correlation with the Developmental Assessment of Young Children 2nd edition. STOR appears to be a promising tool for assessing somatosensory processing in very young children, and it warrants additional testing in larger participant samples.

Sensory Processing Impairments in Children with Developmental Coordination Disorder

The two objectives of this systematic review were to examine the following: (1) the difference in sensory processing areas (auditory, visual, vestibular, touch, proprioceptive, and multi-sensory) between children with and without developmental coordination disorder (DCD), and (2) the relationship between sensory processing and motor coordination in DCD. The following databases were comprehensively searched for relevant articles: PubMed, Science Direct, Web of Science, and Cochrane library. There were 1107 articles (published year = 2010 to 2021) found in the initial search. Full-text articles of all possibly relevant citations were obtained and inspected for suitability by two authors. The outcome measures were sensory processing impairments and their relationship with motor coordination. A total of 10 articles met the inclusion criteria. Children with DCD showed significant impairments in visual integration, tactile integration, proprioceptive integration, auditory integration, vestibular integration, and oral integration processes when compared with typically developing children. Evidence also supported that sensory processing impairments were associated with poor motor coordination in DCD. Preliminary support indicated that DCD have sensory processing impairments in visual, tactile, proprioceptive, auditory, and vestibular areas, which might contribute to participation restriction in motor activities. It is important to apply sensory integration therapy in rehabilitation programs for DCD in order to facilitate participation in daily activities.

Extracurricular sports activities modify the proprioceptive map in children aged 5-8 years

The Chinese government has recently issued the strictest ever guideline to improve the compulsory education system. The new policy aims at reducing the burden of excessive homework and supplementary tutoring, whilst promoting extracurricular activities, including sports and arts, for primary and junior middle school students. To examine the impact that this reform might have on sensory development—which is critical for higher-order cognitive functions—we assessed proprioceptive abilities in children from 5 to 8 years of age. Proprioception refers to sensations of position and motion of the body in space and is mediated by activity in somatosensory and prefrontal cortical areas. By asking participants to perform position matching tasks in the forward–backward directions, we were able to compare the proprioceptive maps of children with and without regular sports training. We demonstrate that extracurricular sports activities can modify the proprioceptive map and improve proprioceptive acuity and stability in school-aged children.

RESNA position on the application of dynamic seating

Dynamic Seating is an intervention used as a part of a manual or power wheelchair to provide movement against resistance in response to client force. This technology can be used for various clinical applications including preventing client injury and equipment breakage; dissipating extensor forces; providing movement for sensory input, calming, and increased alertness; increasing muscle strength, trunk and head control; and other medical benefits. The purpose of this RESNA Position Paper is to provide a definition for this technology in relation to other seating and wheeled mobility technologies as well as present clinical indicators for this seating intervention including literature to substantiate these claims. Although more recent and stronger evidence is needed, existing research does support the application of dynamic seating in numerous clinical scenarios.

Pilot Study to Measure Deficits in Proprioception in Children With Somatodyspraxia

IMPORTANCE

Given the importance of proprioception in motor coordination, the identification of sensory deficits contributing to motor challenges is crucial for appropriate intervention; however, objective proprioceptive tests are not currently available in pediatric clinical practice.

OBJECTIVE

To pilot test methods for assessing proprioception in children. Children with somatodyspraxia were predicted to have reduced proprioceptive awareness compared with age-matched control children.

DESIGN

Observational study.

SETTING

Individual clinic.

PARTICIPANTS

Ten children identified as having somatodyspraxia and 10 typically developing children, ages 6-8 yr.

OUTCOMES AND MEASURES

Spatial awareness and force perception were assessed by having the children match arm positions and grip and pinch forces using electronic dynamometers.

RESULTS

All children were able to complete the proprioceptive assessments. Of those identified as having somatodyspraxia, 90% showed deficits in at least one area of proprioception. Children with somatodyspraxia performed more poorly on spatial awareness and force perception tests than typically developing children (p < .05).

CONCLUSIONS AND RELEVANCE

Children with dyspraxia have difficulties with spatial awareness and force perception, confirming a somatosensory contribution to dyspraxia.

WHAT THIS ARTICLE ADDS

This article presents a framework and methods to measure proprioception in children. These methods will allow occupational therapy practitioners to quantify the proprioceptive deficits common in children with dyspraxia.

An Instrumented Assessment of a Rhythmic Finger Task among Children with Motor Coordination Difficulties

BACKGROUND

Coordination is crucial for motor function, yet objective clinical evaluations are limited. We therefore developed and tested the reliability and validity of a low-cost sensorized evaluation of a rhythmic finger task.

METHODS

Children with coordination difficulties (n = 24) and typically developing children (n = 24) aged from 5 to 7 years performed the Sensorized Finger Sequencing Test (SFST), a finger sequencing test that records the correct sequence, total time, and the standard deviation (SD) of touch time. Additionally, motor performance tests and parents' reports were applied in order to test the reliability and validity of the SFST.

RESULTS

The study group had significantly greater thumb-finger test scores-total time in the dominant hand (p = 0.035) and the SD of the touch time in both dominant (p = 0.036) and non-dominant (p = 0.032) hands. Motor performance tests were not correlated with the SFST. Test-retest reliability in 10 healthy children was found for the SD of touch time in the dominant hand (r = 0.87, p = 0.003).

CONCLUSIONS

The SFST was successful in assessing the movement pattern variability reported in children with motor difficulties. This exploratory study indicates that the low-cost SFST could be utilized as an objective measure for the assessment of proprioception components, which currently are overlooked by standardized motor performance assessments.

Sensory processing patterns in developmental coordination disorder, attention deficit hyperactivity disorder and typical development

BACKGROUND

Sensory processing difficulties (SPD) are present in children with Developmental Coordination Disorder (DCD) and Attention Deficit and Hyperactivity Disorder (ADHD). However, little is known about sensory processing variability in these disorders.

OBJECTIVE

The purpose of this study was to explore SPD among children with DCD, ADHD and co-occurring symptoms in comparison to children with typical development (TD) and to determine how potential social confounders may influence these associations.

METHODS

The study involved 452 children aged 6-12 years. The Short Sensory Profile-2 was used to assess sensory processing patterns. Multiple linear regressions were utilized to investigate the relationship between DCD, ADHD and co-occurring symptoms and sensory processing patterns, adjusting for social covariates.

RESULTS

Children with DCD and ADHD symptoms showed greater variability of atypical sensory processing patterns compared with TD children. Low registration and sensory sensibility issues were more prevalent in the DCD group. ADHD children showed higher rates of low registration, sensory sensibility and sensory seeking, and all children in the co-occurring symptoms group presented sensory sensibility.

CONCLUSION

This study reports significant variability in sensory processing among children with DCD, ADHD and co-occurring symptoms using a population-based sample. These differences can contribute to understand how neurological and social factors correlates across diagnoses.

Psychometric properties of knee proprioception tests targeting healthy individuals and those with anterior cruciate ligament injury managed with or without reconstruction: a systematic review protocol

INTRODUCTION

An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore, there is a growing need for valid, reliable and responsive knee proprioception tests. No previous study has comprehensively reviewed all the relevant psychometric properties (PMPs) of these tests together. The aim of this review protocol is to narrate the steps involved in synthesising the evidence for the PMPs of specific knee proprioception tests among individuals with an ACL injury and knee-healthy controls.

METHODS AND ANALYSIS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses will be followed to report the review. A combination of four conceptual groups of terms-(1) construct (knee proprioception), (2) target population (healthy individuals and those with an ACL injury managed conservatively or with a surgical reconstruction), (3) measurement instrument (specific knee proprioception tests) and (4) PMPs (reliability, validity and responsiveness)-will be used for electronic databases search. PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials and ProQuest will be searched from their inception to November 2018. Two reviewers will independently screen titles, abstracts and full text articles, extract data and perform risk of bias assessment using the updated COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist for the eligible studies. A narrative synthesis of the findings and a meta-analysis will be attempted as appropriate. Each PMP of knee proprioception tests will be classified as 'sufficient', 'indeterminate' or 'insufficient'. The overall level of evidence will be ascertained using an established set of criteria.

ETHICS AND DISSEMINATION

Ethical approval or patient consent is not required for a systematic review. The review findings will be submitted as a series of manuscripts for peer-review and publication in scientific journals.

PROSPERO REGISTRATION NUMBER

CRD42018108014.