Unraveling tactile and proprioceptive upper limb function in children with unilateral cerebral palsy: a combination of robotic and clinical assessments.

Abstract

To map somatosensory impairments in the more-impaired and less-impaired upper limb of children with unilateral cerebral palsy (uCP) compared to typically developing children (TDC), using clinical and robotic assessments. Additionally, we explored which subgroups of children with uCP are more likely to experience somatosensory impairments. This cross-sectional study included 49 children with uCP (11y11m ± 2y10m, 26 males) and 49 age- and sex-matched TDC (11y10m ± 2y10m). Tactile registration (Semmes-Weinstein monofilaments), tactile perception (stereognosis, two-point discrimination), and proprioception (clinical movement sense, ETH MIKE robot, and Kinarm exoskeleton) were assessed. Differences between groups and across manual ability levels and brain lesion types were analyzed using generalized estimating equation models. Children with uCP exhibited tactile impairments in both hands (more-impaired: 27-43%; less-impaired: 12-16%) and worse proprioception bilaterally compared to TDC (<i>p</i> ≤ 0.003). Lower manual ability was related to worse tactile perception (<i>p</i> ≤ 0.001) and proximal proprioception (<i>p</i> ≤ 0.045). Predominant grey matter lesions were correlated with worse tactile registration (<i>p</i> = 0.016), perception (<i>p</i> ≤ 0.009), and distal proprioception (<i>p</i> = 0.009). Our results underline the importance of including clinical and robotic assessments in the follow-up of children with uCP to identify bilateral somatosensory impairments. An international consensus on clinically relevant and well-defined assessment protocols is needed to enhance clinical translation.