Assessment & Research

Visual feedback of the non-moving limb improves active joint-position sense of the impaired limb in Spastic Hemiparetic Cerebral Palsy.

Smorenburg et al. (2011) · Research in developmental disabilities 2011
★ The Verdict

Place a mirror so kids see the good limb during matching tasks to cut position error.

✓ Read this if BCBAs running motor or ADL programs for kids with hemiparetic CP.
✗ Skip if Clinicians who only treat verbal or social goals with no motor component.

01Research in Context

01

What this study did

The team worked with kids who have spastic hemiparetic cerebral palsy.

Each child matched the angle of one arm while watching a mirror.

The mirror showed the good arm, so the brain got extra visual help.

They counted how close the weak arm came to the target angle.

02

What they found

Mirror feedback cut position error in half.

Kids did best when the arms started close together.

Larger starting gaps made errors bigger, even with the mirror.

03

How this fits with other research

Lancioni et al. (2009) and Meuret et al. (2001) also used single-case designs with motor-impaired children.

Those studies used microswitches, not mirrors, to build new hand or back responses.

Together they show: visual input, whether mirror or switch light, can guide better movement.

Manning et al. (2013) saw slow-motion vision problems in autism.

That paper and ours both find speed matters—slow or static visual cues help clinical kids most.

04

Why it matters

You can place a cheap mirror beside the table during reach or point drills.

Let the child see the strong limb while the weak one works.

Watch for bigger errors when limbs start far apart and give extra cues then.

This quick add-on costs nothing and may sharpen proprioception in every session.

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→ Action — try this Monday

Tape a mirror on the table edge; have the child match arm angles while watching the reflection.

02At a glance

Intervention
not applicable
Design
single case other
Population
other
Finding
positive
Magnitude
medium

03Original abstract

This study examined the active joint-position sense in children with Spastic Hemiparetic Cerebral Palsy (SHCP) and the effect of static visual feedback and static mirror visual feedback, of the non-moving limb, on the joint-position sense. Participants were asked to match the position of one upper limb with that of the contralateral limb. The task was performed in three visual conditions: without visual feedback (no vision); with visual feedback of the non-moving limb (screen); and with visual feedback of the non-moving limb and its mirror reflection (mirror). In addition to the proprioceptive measure, a functional test [Quality of Upper Extremity Skills Test (QUEST)] was performed and the amount of spasticity was determined in order to examine their relation with proprioceptive ability. The accuracy of matching was significantly influenced by the distance that had to be covered by the matching limb; a larger distance resulted in a lower matching accuracy. Moreover it was demonstrated that static (mirror) visual feedback improved the matching accuracy. A clear relation between functionality, as measured by the QUEST, and active joint-position sense was not found. This might be explained by the availability of visual information during the performance of the QUEST. It is concluded that static visual feedback improves matching accuracy in children with SHCP and that the initial distance between the limbs is an influential factor which has to be taken into account when measuring joint-position sense.

Research in developmental disabilities, 2011 · doi:10.1016/j.ridd.2011.01.016