Somatosensory Deficits Affect Balance and Motor Function in Children with Cerebral Palsy: Stochastic Resonance Stimulation can Modulate Somatosensation to Enhance Balance

摘要

Traditional rehabilitation and motor learning approaches in Cerebral Palsy (CP) are generally motor-centric focusing on how to improve musculoskeletal and motor impairments, and are marginally effective. Less attention has been paid to deficits in sensory processing that could potentially shape motor behavior, especially in relation to dynamic control of upright stance. Recent neuroimaging evidence on disrupted thalamocortical connections and aberrant somatosensory cortical activation supports the presence of sensory dysfunction in children with CP. Yet, limited research has thus far explored somatosensory deficits in lower extremities (LE) and how they influence motor ability in CP. Additionally, there is not a universally accepted framework for the diagnosis and treatment of sensory information and processing impairments in this population. Hence, the purpose of this dissertation was to identify distal LE somatosensation deficits, delineate their relationship with balance and motor function, and investigate if they can be modulated by utilizing Stochastic Resonance (SR) stimulation to enhance balance control in CP. Our results indicated that children with spastic diplegia exhibited diminished plantar cutaneous and ankle proprioceptive ability that may influence their balance and motor control; therefore, contributing to their poor functional performance. Applying SR stimulation in the LE during quiet stance resulted in decreased postural sway suggesting enhanced stability and, thus, SR may be used as a therapeutic tool to improve balance performance by up-regulating somatosensory information in CP. From a clinical standpoint, these findings could lead to an improved therapeutic management in CP by: 1) recommending the use of an easy to administer and cost effective battery of sensory tests in daily practice to identify individuals with somatosensory impairments, 2) assisting clinicians to design more effective subject-specific plans by targeting not only motor but also sensory deficits, and 3) introducing SR stimulation as a novel sensory-oriented method for somatosensory facilitation and training balance control in CP. Specifically, combining afferent SR stimulation while performing daily activities may promote neuroplasticity and, as a result enhance motor and sensory function compared to traditional motor-centric protocols.