Full length articleSensory processing disorders in children with cerebral palsy
Introduction
The motor disorders in children with cerebral palsy (CP) are often accompanied by disturbances of sensation, perception, cognition, communication and behavior (Bax et al., 2005). Some of the most important determinants of sensory deficits are the white matter lesions, present in 45% of the children with CP (Reid, Dagia, Ditchfield, Carlin & Reddihough, 2013). The destruction of white matter can have secondary effects on the development of cortical and thalamic regions, which are responsible for sensory processing (Tsao, Pannek, Fiori, Boyd & Rose, 2014). Other factors present in CP, such as the neuromuscular deficits, can contribute to these sensory impairments since they restrict the child’s level of activity (Dos Santos, Pavão & Rocha, 2011).
Sensory impairments may coexist with motor disabilities in children with CP and may contribute to the motor dysfunction observed in these children (Pavão, Silva, Savelsbergh & Rocha, 2015). The success in the performance of motor tasks depends on the quality of afferent inputs which act providing feedback and guiding motor function in order to correct potential motor mistakes (Dunn and Daniels, 2002, Mulligan, 1995, Papadelis et al., 2014).
Sensory impairments in CP are widely discussed in literature (Bleyenheuft and Gordon, 2013, Cascio, 2010; De Campos, Kukke, Hallet, Alter & Damiano, 2014). The main reported disturbances in this population are deficits in stereognosis (Kingles et al., 2010), tactile discrimination and proprioception (Bleyenheuft & Gordon, 2013). However, there seems to be a lack of studies addressing sensory processing disturbances in CP.
Sensory processing involves registration and modulation of sensory information, as well as an internal organization of afferent inputs in order to provide adaptive behaviors and success in the performance of tasks (Humphry, 2002). The registration process involves the perception of the sensory stimuli by the central nervous system (CNS). Modulation process is the brain’s regulation of neural messages providing the balance between excitation and inhibition based on the available stimuli (Dunn, 1999). An adequate sensory integration of afferent inputs ensures children present an adaptive behavior in tasks of daily routine and meet the demands imposed by the environment. Thus, suitable sensory integration promotes functional performance (Dunn, 1999; White, Mulligan, Merrill & Wright 2007).
Therefore, deficits in sensory processing are believed to affect the way a child behaves, including his or her ability to attend, learn, organize (Dunn & Daniels, 2002), as well as they can affect the children’s ability to perform motor and functional tasks achieving adaptive success (Mulligan, 1995, Pavão et al., 2015, White et al., 2007). Thus, the systematic evaluation of sensory processing allows therapists to adapt their intervention improving sensory integration of the inputs constantly received from the environment in order to improve motor performance and adaptive success of children with CP (Schhaf & Miller, 2005).
Some procedures of assessment can be used to identify sensory processing disorders, including child and caregiver interview, formal standardized assessments of sensory processing abilities and clinical observations. Identification of these disorders is generally through observation of behavioral difficulties such as responding to touch aggressively, withdrawing from or failing to respond to sensory input (Ayres, 1989, Dunn, 1994, Dunn, 1997, Dunn, 1999).
In fact, there is a lack of instruments assessing sensory processing in literature (Pavão et al., 2015). This lack is even greater considering children evaluation. Sensory Profile is one of the most complete available validated checklists that measures integrative sensory processing (Dunn and Daniels, 2002, White et al., 2007). It is a parent reporting measure that records children's responses to sensory events in daily life (Dunn & Brown, 1997).
We selected this instrument for our study because it is psychometrically sound; quick to administer, score, and interpret; and most important because it was designed specifically to measure “children’s sensory processing abilities that support or interfere with functional performance” (Dunn, 1999) and allows professionals to use in clinical environment. Although we have used an instrument that relies exclusively on a third-party retrospective report, rather than a direct measure of sensory processing capacity or even a direct observational measure of child behavior, this tool is a validated instrument (Dunn, 1999). In addition, sensory processing is a neurological process that cannot be measured directly, so, caregivers are asked to rate child behaviors believed to be associated with sensory processing (White et al., 2007).Although the Sensory Profile has been used in the literature with children presenting different types of developmental disorders (Mulligan, 1995, Schaaf and Miller, 2005, Tomchek and Dunn, 2007), we did not find studies that have used this instrument to evaluate and characterize sensory processing in children with CP.
Taking into account the reported sensory deficits in CP (Kulak, Sobaniec, Kuzia & Bockowski, 2006; Pavão et al., 2015) and their potential repercussions on activity level and social participation (Dunn and Daniels, 2002, Pavão et al., 2015, White et al., 2007), it seems to be important the implementation of a proper evaluation of sensory processing in these children.
Therefore, the objective of this study was to evaluate sensory processing in children with CP using the Sensory Profile and to compare the results with the ones of children with typical development in order to outline the sensory processing impairments observed in CP. We expect that children with CP exhibit a large amount sensory processing disorders compared with typical ones, which can constrain their daily life activities.
Section snippets
Participants
All the participants were recruited from kindergarten, regular schools or rehabilitation centers specialized in children care. Only participate in the study children who received parental consent to participate. This study was approved by the local Ethics Committee (CAAE 17495213.8.0000.5504).
Two groups of participants were evaluated. The control group was composed by 59 children, 31 male and 28 female, aged from 3 to 15 years-old (M = 8.9 ±3.4 years). Participants with orthopedic conditions
Results
The characterization of the sample, as well as the confidence interval for the score in each of the evaluated categories in Sensory Profile for both groups and the statistic differences between groups found in Sensory Profile categories can be observed in Table 1. The power of the statistical tests performed was 75%.
Children with CP presented worse sensory processing compared with typical children. The disorders children with CP exhibited were found in the following items of Sensory Profile’s
Discussion
The present study aimed to evaluate sensory processing in children with CP and children with typical development. We observed that children with CP present important disorders in sensory processing compared with children with typical development.
Although the deficits in sensory system have been widely reported in children with CP (De Campos et al., 2014; Bleyenheuft & Gordon, 2013; Cooper, Majnemer, Rosemblatt & Birnbaum, 1995; Klingels et al., 2010), we have found a few number of studies
Conclusion
According to our results, children with CP present important sensory processing deficits compared to typical ones. They exhibited important impairments in the processing of visual, vestibular and multisensory information, as well as important constraints in modulation of sensory information affecting their level of activity, muscle resistance, body position in space and emotional responses. Together, these impairments determine a sensory style of low resistance, distractibility, poor
Acknowledgement
The authors declare that the present manuscript was supported financially by a grant from xxxxxxxxxxx.
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