Upper-limb position sense deficits in adults with cerebral palsy

OBJECTIVE: The aim of this study was to examine proprioceptive performance in adults with hemiplegic cerebral palsy and the possibility that a home-based sensorimotor training program could improve proprioceptive performance.

DESIGN: This study is a preintervention/postintervention assessment of 12 adults participating in a home-based program consisting of targeted unilateral and bilateral reaching movements, hand manipulation tasks, tactile discrimination, and stereognosis. It did not specifically include proprioceptive tasks. Training sessions were 45 mins, 5 days per week, for 8 wks. Limb position sense was assessed using three conditions: ipsilateral remembered (same arm used for reference and matching targets), contralateral concurrent (reference arm moved and held at target position while opposite arm matched reference position), and contralateral remembered (reference arm moved to target position and then returned to start position before opposite arm matching position).

RESULTS: The participants demonstrated greater absolute and constant error when the more affected arm served as the reference arm, and matching was performed by the less affected arm, particularly in the contralateral remembered condition. After training, the participants demonstrated less absolute error across matching tasks and no change in constant error.

CONCLUSIONS: The results suggest an important role for the reference arm in bilateral position matching tasks and the potential for improved proprioceptive performance after training in movement and unrelated sensory tasks.