Examining links between somatosensation and cognition in children with hemiplegic cerebral palsy

Children with cerebral palsy (CP) are at increased risk of impaired somatosensation and cognition. Among children with hemiplegia, approximately three-quarters have impaired somatosensation and one-third have intellectual impairment. While somatosensation may relate to cognitive functioning in CP, this relationship has not previously been investigated. This cross-sectional study examined the relationship between somatosensation and cognition in children with hemiplegic CP, and whether the pattern of brain injury, classified using an established MRI classification system, moderates this relationship. Forty-seven children (26 females) with hemiplegic CP participated (mean age = 11.0 years; SD = 3.6; range: 6-16 years). Parent questionnaires provided demographic, educational, and medical history. Cognition was assessed using Index scores from the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V). Somatosensation in the affected and less-affected hands was measured using subtests from Sense©_Assess Kids. Wrist position sense and haptic ability of the affected hand significantly correlated with most WISC-V Index scores. Somatosensory functioning of the less-affected hand showed inconsistent associations with cognition. Multiple regressions indicated that wrist position sense of the affected hand predicted visuospatial ability, fluid reasoning, and overall intelligence. Haptic ability of the affected hand predicted verbal comprehension and overall intelligence. For the less-affected hand, wrist position sense predicted visuospatial ability, but haptic ability did not predict any cognitive outcomes. Multicategorical moderation showed that the pattern of brain injury did not consistently moderate somatosensation-cognition relationships. Identifying somatosensory difficulties may provide early insight into cognitive performance in children with hemiplegic CP. Further research is needed to understand the direction and mechanisms of this relationship.