Effect of Lumbar Position Sense on Lumbar Muscle Strength, Static versus Dynamic Balance and Functional Status in Children with Spastic Diplegic Cerebral Palsy: A Cross-Sectional Study

Abstract

BACKGROUND: Cerebral palsy (C.P.) is the most common motor disability of childhood in which spastic diplegia have primarily lower extremity involvement with weak trunk musculature. While deficits of trunk muscle strength have been identified, it is unclear whether they have adequate proprioception to ensure stable balance for functional tasks. OBJECTIVE: To assess lumbar position sense and its effect on lumbar muscle strength, static versus dynamic balance and functional status in children with spastic diplegic cerebral palsy. METHODOLOGY: 44 children aged 5 to 15 years with spastic diplegic C.P meeting inclusion criteria were recruited from tertiary care centres in Surat city. Lumbar repositioning error was assessed by bubble inclinometer in degrees. Outcome measures included lumbar muscle strength (assessed by manual muscle test), static balance (using static components of pediatric balance scale), dynamic balance (using dynamic components of pediatric balance scale & dynamic gait index) and functional status (measured by WeeFIM). RESULT: The correlation between these variables was tested using Spearman’s correlation coefficient. A p value of <0.05 was considered statistically significant. Significant negative correlation was found between lumbar repositioning error and lumbar muscle strength, static, dynamic balance and functional status. Also, significant positive correlation was found between lumbar repositioning error and GMFCS. CONCLUSION: Children with spastic diplegic C.P. with better lumbar position sense showed greater muscle strength and balance. Although both static and dynamic balance were affected with increased repositioning errors, static was more affected so interventions focusing more on static balance and proprioceptive training should be kept in mind. Key words: Position Sense, Repositioning error, muscle strength, static balance, dynamic balance, functional status