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

This was an observational case-control study, so it can show associations between proprioception and balance, not that proprioceptive deficits caused balance problems. The final analysis included 58 children, and 21 hip and knee joint position trials were missing out of 1110 completed trials, so hip and knee estimates were based on fewer children. The cerebral palsy group was mostly GMFCS level I to II and ambulatory, so the results may not apply to children with more severe gross motor impairment. The study did not analyse unilateral and bilateral cerebral palsy separately because each subgroup was small. Joint position sense was tested in one movement direction per joint and mainly measures conscious position sense, not the subconscious proprioception used for posture. Balance was scored from clinical observation rather than quantitative centre-of-mass dynamics, and other factors such as spasticity, contractures, vestibular function and muscle weakness may have contributed.

The authors declared no financial conflicts of interest. Funding came from the Research Foundation-Flanders and the Hasselt University Special Research Fund.

Do not conclude that treating hip proprioception will improve balance. The study compared children with cerebral palsy and typically developing children and found associations, not changes from an intervention; total lower-limb joint position error was not associated with overall balance scores.