Beyond motor ımpairment somatosensory function and body awareness as contributors to activity, participation and quality of life in children with cerebral palsy

Hemiplegic Cerebral Palsy (CP) in childhood is characterized not only by motor deficits but also by accompanying sensory and perceptual impairments. Despite the recognized importance of somatosensory functions and body awareness, their associations with activity, participation, and quality of life remain relatively unexplored within an ICF-oriented framework. This study aimed to investigate the associations between somatosensory functions, body awareness, and functional outcomes, including activity performance, participation, and quality of life, in school-aged children with hemiplegic CP. This cross-sectional study included 43 children with hemiplegic CP aged between 6 and 17 (12.65 ± 3.74) years. Somatosensory functions were assessed using the Semmes-Weinstein Monofilament Test for tactile perception, two-point discrimination with a calibrated esthesiometer, vibration perception with a tuning fork, proprioception with a goniometer, and stereognosis using standardized everyday objects. Body awareness was evaluated using a multisensory afferent model-based assessment including body schema, structural body representation, and body image tasks. Activity was assessed using the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT), participation using the Child Adolescent Scale of Participation (CASP), and quality of life using the KIDSCREEN-27. Following Holm correction, vibration perception, foot stereognosis, and body awareness were significantly associated with multiple PEDI-CAT domains (ρ = 0.372-0.514, p < 0.05). Body awareness demonstrated the strongest and most consistent associations with CASP participation domains (ρ = 0.362-0.697, p < 0.05), while vibration perception was also significantly associated with school participation (ρ = 0.400-0.404, p < 0.05). For KIDSCREEN-27, two-point discrimination, proprioception, and stereognosis were significantly associated with physical activities and health domain (ρ = - 0.453-0.443, p < 0.05). Body awareness and stereognosis were the somatosensory variables most consistently associated with activity, participation, and quality of life in school-aged children with hemiplegic CP. These findings suggest that higher-order sensory-perceptual functions may play a meaningful role in daily life functioning and may represent important targets for comprehensive rehabilitation strategies.