The influence of visual restriction and lower-limb proprioception on walking capacity in children with and without upper motor neuron lesions.

BACKGROUND

Gait stability depends on the integration of visual and proprioceptive feedback. Children with upper motor neuron (UMN) lesions often exhibit proprioceptive deficits; however, the interaction between these deficits and visual input during walking remains unclear. This study investigated the influence of visual restriction and lower-limb proprioceptive function on walking capacity in children with UMN lesions compared to typically developing (TD) peers.

METHODS

In this cross-sectional study, 42 children with UMN lesions and 49 TD peers completed the 10-Meter Walk Test under normal and reduced visual conditions. We calculated absolute and relative (reduced vision/normal vision) gait capacity metrics. Proprioception was assessed at the hip, knee, and ankle using joint movement sense (JMS), joint position sense (JPS), and dynamic position sense (DPS). Spearman correlations examined relationships between proprioception and gait capacity.

RESULTS

Both groups walked slower and took shorter steps under reduced vision; however, children with UMN lesions exhibited larger changes (p < 0.001). In these children, proprioceptive modalities showed weak-to-moderate correlations with gait parameters that strengthened under visual restriction, a pattern observed in pooled analyses. JMS showed the strongest, though weak, correlation with relative walking speed. Joint-specific analyses showed the strongest correlations at the more affected ankle and the less affected hip in children with UMN lesions.

CONCLUSION

Children with UMN lesions rely more on proprioceptive input for gait under reduced vision, with the less affected hip and more affected ankle possibly compensating for deficits. Interventions targeting proprioception may enhance walking performance under varying sensory conditions.