ArticleEuropean journal of physical and rehabilitation medicine2026
The relationship between lower limb proprioception and balance performance in children with cerebral palsy: a multisystem and multi-joint approach.
Article in European journal of physical and rehabilitation medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBalance problems are a frequent focus of rehabilitation approaches in children with cerebral palsy (CP). Although proprioceptive impairments, affecting 46-90% of children with CP, are commonly observed, their role in postural control remains insufficiently understood.
aimGiven the multisystemic nature of postural control, this study aimed to investigate the association between lower-limb proprioception (hip, knee, ankle) and distinct postural control systems in children with CP compared to typically development (TD).
designCross-sectional case-control study.
settingDifferent outpatient settings and the community. POPULATION: Children aged 5-12 years with TD (N.=30, 8.6±2.2y; boys: 15) and spastic CP (N.=32, 8.4±2.1y; boys: 16; GMFCS-I/II/III: 24/7/1; uni-/bilateral: 17/15).
methodsPostural control was assessed using the age-specific Kids-Balance Evaluation Systems Test - extended version (Kids-BESTest-2). Hip, knee, and ankle proprioception were assessed using passive-ipsilateral Joint-Position-Reproduction (JPR). Joint Reproduction Error (JRE,°) was calculated from 3D kinematics for the joints of the dominant (JREd) and nondominant (JREnd) leg. Associations between Kids-BESTest-2 (total and domain scores, %), JRE<inf>total</inf> (all joints) and summed joint JRE<inf>ankle</inf>, JRE<inf>knee</inf> and JRE<inf>hip</inf> (JREd+JREnd) were analyzed using general linear models with correction for multiple testing.
resultsJRE<inf>total</inf> was not significantly associated with Kids-BESTest-2 scores in either group (P>0.01). In CP, higher JRE<inf>hip</inf> (reflecting poorer proprioception) was significantly associated with lower total (η<inf>p</inf>
conclusionsPostural control deficits in children with CP affect multiple systems, and each system is associated with joint-specific proprioceptive impairments (particularly at the hip), rather than overall proprioceptive accuracy. These findings suggest task-dependent and pathology-dependent associations, the latter likely reflecting limitations in compensatory proprioceptive reweighting across lower-limb joints. CLINICAL REHABILITATION IMPACT: These findings underscore the need for a system- and joint-specific approach to better understand postural control deficits in children with CP and tailor interventions that enhance proprioceptive input during task-specific balance training.
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