Perceived Body Distortion Rather Than Actual Body Distortion Is Associated With Chronic Low Back Pain in Adults With Cerebral Palsy: A Preliminary Investigation

Abstract

Objectives The aim of the present study was to investigate whether distorted body perception is a feature of the low back pain (LBP) experience in people with cerebral palsy (CP) and whether any distortions noted are confounded by the presence of motor and postural impairments commonly seen in CP. Methods Forty‐five individuals participated in this study: 15 adults with CP with LBP (CP_Pain group), 15 adults with CP without LBP (CP_noPain group), and 15 age‐matched adults with LBP but no CP (Pain group). Body perception was evaluated using the Fremantle Back Awareness Questionnaire (FreBAQ) and by assessing 2‐point discrimination thresholds over the low back. A comprehensive assessment of motor function was also undertaken in the CP population, and postural function was assessed in all 3 groups. Results Significant differences between the 3 groups were found for FreBAQ scores (P < 0.0001). The TPD threshold in the low back of the CP_Pain group was significantly larger than that of the CP_noPain group (P = 0.01), though we found no difference between the CP_noPain group and the Pain group (P = 0.21). We found no difference in motor or postural function between the 2 CP groups. Discussion The present results suggest that body image is disrupted in people with CP who experience LBP. The disruptions in perception were similar to those seen in people with LBP and no CP, suggesting that the distortions may be more related to the presence of pain than the presence of CP.

“But it feels swollen!”: the frequency and clinical characteristics of people with knee osteoarthritis who report subjective knee swelling in the absence of objective swelling

“…4,23,30 We know of no direct evidence of cortical changes in people with knee OA, but it is plausible that disruption of the brain grounded representation of the knee might be present in those who report disrupted conscious representation of the knee. Previous data support that increased TPD thresholds seem to be specific to the painful area, 11,42,62 and the failure to detect any differences on the lateral side of the knee might reflect the greater prevalence of medial knee pain in knee OA, 61 or be a reflection of the small sample size. Indeed, past work in knee OA has shown TPD impairments both medial and lateral to the patella.…”

Somatosensory deficits and neural correlates in cerebral palsy: a scoping review

“…A total of 9766 records were retrieved (including additional records identified through other sources). After discarding duplicates, the titles and abstracts of 4882 references were screened; 114 full‐text articles were assessed for eligibility and 66 were excluded because they were not original research 29–47 ( n =19), they did not assess somatosensory processing 48–65 ( n =18), they did not include a control group 66–81 ( n =16), they were not in English or French and they could not be translated using free online tools 82–88 ( n =7), they did not include individuals diagnosed with CP 89–91 ( n =3), or their full text was not available 92–94 ( n =3, all published before 1960). Therefore, 48 articles met the inclusion criteria and were included in this scoping review (Fig.…”

“…The posterior parietal cortex is involved in internal models of motor control and in multisensory integration, which allow individuals to have a unified representation of the body (body schema) 138 . Alterations in the internal models of motor control have been suggested 139,140 and disturbances in body schema have been observed in individuals with CP 79,141–144 . Body schema disorders are characterized by altered motor imagery, 141,143,144 a decreased perceived length of the hemiparetic arm, 142 and altered lower back perception 79 .…”

“…138 Alterations in the internal models of motor control have been suggested 139,140 and disturbances in body schema have been observed in individuals with CP. 79,[141][142][143][144] Body schema disorders are characterized by altered motor imagery, 141,143,144 a decreased perceived length of the hemiparetic arm, 142 and altered lower back perception. 79 Interestingly, in the latest study, alteration was more pronounced in individuals with CP with lower back pain than in individuals with CP without pain, 79 which is in line with studies showing that people with pain have strong alterations in somatosensory registration and perception.…”

“…79,[141][142][143][144] Body schema disorders are characterized by altered motor imagery, 141,143,144 a decreased perceived length of the hemiparetic arm, 142 and altered lower back perception. 79 Interestingly, in the latest study, alteration was more pronounced in individuals with CP with lower back pain than in individuals with CP without pain, 79 which is in line with studies showing that people with pain have strong alterations in somatosensory registration and perception. [145][146][147] However, this scoping review reveals that pain has received very little consideration in the literature on somatosensory functions in CP.…”