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Lee DY. Differences of the ankle plantar flexor length in typically developing children and children with spastic hemiplegic cerebral palsy. J Exerc Rehabil 2019; 15:445-448. [PMID: 31316939 PMCID: PMC6614768 DOI: 10.12965/jer.1938216.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/29/2019] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study is to analyze the lengths of the medial and lateral gastrocnemius and soleus muscles in children with spastic hemiplegic cerebral palsy to quantitatively assess the structural differences in skeletal muscles. This study included 10 children with spastic cerebral palsy and 10 children with typically development. To assess the changes in the length of the ankle plantar flexor due to cerebral palsy, we utilized both gait analysis and software for interactive musculoskeletal modeling to model skeletal muscle length. With this model, the differences in the lengths of the medial and lateral gastrocnemius and soleus muscles were assessed at different knee (0°, 45°, and 90°) and ankle (-10°, 0°, 15°, and 30°) angles. Muscle length on the paretic group was shorter than the typically developing and nonparetic group for all three muscles (medial and lateral gastrocnemius and soleus muscles) for knee and ankle angles. These results were not statistically significant. Normalized muscle lengths in the dynamic/static status revealed a significant difference in the length of the lateral gastrocnemius muscle between the cerebral palsy and typically developing group. I observed muscle shortening on the paretic side of the children with cerebral palsy. This finding suggests that the recovery of plantar flexor length is the most important issue that must be resolved for normal gait and motor function.
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Affiliation(s)
- Dae-Yeon Lee
- Faculty of Liberal Arts, Kangnam University, Yongin, Korea
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52
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Ultrasound imaging for sarcopenia, spasticity and painful muscle syndromes. Curr Opin Support Palliat Care 2019; 12:373-381. [PMID: 29912727 DOI: 10.1097/spc.0000000000000354] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW On the basis of its various advantages and the relevant awareness of physicians, ultrasound imaging has overwhelmingly taken its place in the scientific arena. This is true both from the side of daily clinical applications and also from the side of research. Yet, ultrasound provides real-time (diagnostic) imaging and (interventional) guidance for a wide spectrum of muscle disorders. In this regard, this review aims to discuss the potential/actual utility of ultrasound imaging in particular muscle disorders, that is, sarcopenia, spasticity and fibromyalgia/myofascial pain syndrome. RECENT FINDINGS Due to the aging population worldwide and the importance of functionality in the older population, mounting interest has been given to the diagnosis and management of sarcopenia in the recent literature. Likewise, several articles started to report that ultrasound imaging can be used conveniently and effectively in the early diagnosis and quantification of sarcopenia.For spasticity, aside from ultrasound-guided botulinum toxin injections, intriguing attention has been paid to sonographic evaluation of muscle architecture, echogenicity and elasticity in the follow-up of these chronic conditions.As regards painful muscle syndromes, quantitative ultrasound techniques have been shown to detect statistically significant differences between healthy controls and patients with myofascial pain syndrome. SUMMARY Ultrasound imaging seems to be a promising tool that indisputably deserves further research in the management of a wide range of muscle disorders. VIDEO ABSTRACT: http://links.lww.com/COSPC/A17.
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53
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Sahrmann AS, Stott NS, Besier TF, Fernandez JW, Handsfield GG. Soleus muscle weakness in cerebral palsy: Muscle architecture revealed with Diffusion Tensor Imaging. PLoS One 2019; 14:e0205944. [PMID: 30802250 PMCID: PMC6388915 DOI: 10.1371/journal.pone.0205944] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/24/2019] [Indexed: 11/28/2022] Open
Abstract
Cerebral palsy (CP) is associated with movement disorders and reduced muscle size. This latter phenomenon has been observed by computing muscle volumes from conventional MRI, with most studies reporting significantly reduced volumes in leg muscles. This indicates impaired muscle growth, but without knowing muscle fiber orientation, it is not clear whether muscle growth in CP is impaired in the along-fiber direction (indicating shortened muscles and limited range of motion) or the cross-fiber direction (indicating weak muscles and impaired strength). Using Diffusion Tensor Imaging (DTI) we can determine muscle fiber orientation and construct 3D muscle architectures which can be used to examine both along-fiber length and cross-sectional area. Such an approach has not been undertaken in CP. Here, we use advanced DTI sequences with fast imaging times to capture fiber orientations in the soleus muscle of children with CP and age-matched, able-bodied controls. Cross sectional areas perpendicular to the muscle fiber direction were reduced (37 ± 11%) in children with CP compared to controls, indicating impaired muscle strength. Along-fiber muscle lengths were not different between groups. This study is the first to demonstrate along-fiber and cross-fiber muscle architecture in CP using DTI and implicates impaired cross-sectional muscle growth in children with cerebral palsy.
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Affiliation(s)
- Annika S. Sahrmann
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Ngaire Susan Stott
- Department of Orthopaedic Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Thor F. Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
| | - Justin W. Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
| | - Geoffrey G. Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- * E-mail:
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54
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The Effect of Functional Home-Based Strength Training Programs on the Mechano-Morphological Properties of the Plantar Flexor Muscle-Tendon Unit in Children With Spastic Cerebral Palsy. Pediatr Exerc Sci 2019; 31:67-76. [PMID: 30424684 DOI: 10.1123/pes.2018-0106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of functional progressive resistance training (PRT) and high-intensity circuit training (HICT) on the mechano-morphological properties of the plantar flexor muscle-tendon unit in children with spastic cerebral palsy. METHODS Twenty-two children (12.8 [2.6] y old, Gross Motor Function Classification System levels I/II = 19/3) were randomly assigned to either a PRT group or an HICT group. The interventions consisted of functional lower limb exercises, which were performed at home 3 times per week for 8 weeks. Measurements at baseline, preintervention, postintervention, and follow-up were taken to assess ankle joint range of motion and the properties of the gastrocnemius medialis, vastus lateralis, rectus femoris, and Achilles tendon (eg, thickness, strength, stiffness). RESULTS Despite a nonsignificant increase in active torque in the HICT group, neither gastrocnemius medialis morphology nor Achilles tendon properties were significantly altered after the interventions. Vastus lateralis thickness increased following PRT only. CONCLUSIONS Functional home-based strength training did not lead to significant changes at the muscular level in children with cerebral palsy. We therefore assume that a more specific stimulus of higher intensity combined with a longer training duration might be necessary to evoke changes in muscles and tendons in individuals with cerebral palsy.
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55
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Pingel J, Andersen JD, Christiansen SL, Børsting C, Morling N, Lorentzen J, Kirk H, Doessing S, Wong C, Nielsen JB. Sequence variants in muscle tissue-related genes may determine the severity of muscle contractures in cerebral palsy. Am J Med Genet B Neuropsychiatr Genet 2019; 180:12-24. [PMID: 30467950 DOI: 10.1002/ajmg.b.32693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/20/2018] [Accepted: 09/20/2018] [Indexed: 12/30/2022]
Abstract
Muscle contractures are a common complication to cerebral palsy (CP). The purpose of this study was to evaluate whether individuals with CP carry specific gene variants of important structural genes that might explain the severity of muscle contractures. Next-generation-sequencing (NGS) of 96 candidate genes associated with muscle structure and metabolism were analyzed in 43 individuals with CP (Gross Motor Function classification system [GMFCS] I, n=10; GMFCS II, n=14; GMFCS III, n=19) and four control participants. In silico analysis of the identified variants was performed. The variants were classified into four categories ranging from likely benign (VUS0) to highly likely functional effect (VUS3). All individuals with CP were classified and grouped according to their GMFCS level: Statistical comparisons were made between GMFCS groups. Kruskal-Wallis tests showed significantly more VUS2 variants in the genes COL4 (GMFCS I-III; 1, 1, 5, respectively [p < .04]), COL5 (GMFCS I-III; 1, 1, 5 [p < .04]), COL6 (GMFCS I-III; 0, 4, 7 [p < .003]), and COL9 (GMFCS I-III; 1, 1, 5 [p < .04]), in individuals with CP within GMFCS Level III when compared to the other GMFCS levels. Furthermore, significantly more VUS3 variants in COL6 (GMFCS I-III; 0, 5, 2 [p < .01]) and COL7 (GMFCS I-III; 0, 3, 0 [p < .04]) were identified in the GMFCS II level when compared to the other GMFCS levels. The present results highlight several candidate gene variants in different collagen types with likely functional effects in individuals with CP.
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Affiliation(s)
- Jessica Pingel
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeppe Dyrberg Andersen
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Lindgren Christiansen
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Børsting
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Morling
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Helene Elsass Center, Charlottenlund, Denmark
| | - Henrik Kirk
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Helene Elsass Center, Charlottenlund, Denmark
| | - Simon Doessing
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christian Wong
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Helene Elsass Center, Charlottenlund, Denmark
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56
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Dimakopoulos R, Syrogiannopoulos G, Youroukos S, Dailiana Z, Spinou A. Passive range of motion changes in young children with spastic diplegia. A study during the initial stages of independent walking. J Pediatr Rehabil Med 2019; 12:151-159. [PMID: 31227665 DOI: 10.3233/prm-180539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To investigate how the onset of independent walking in children with Cerebral Palsy (CP) influences the Passive Range of Motion (PROM) of lower limb joints. METHOD Sixteen children with CP, GMFCS levels I and II, and 16 Typical Development (TD) children who had just begun independent walking participated in the study. The PROM of the hip abduction and external rotation, knee extension, popliteal angle, and ankle dorsiflexion was recorded with a goniometer at the onset of independent walking and 8 months later. A repeated-measures two-way ANOVA was conducted to compare the main effects of "walking experience" and "group of children" and the interaction effect between them on PROM of lower extremities' joints. RESULTS The effect of "group of children" in the PROM was significant; differences were observed between children with CP and TD children for all joints (p< 0.05). The effect of "walking experience" did not have a significant impact on PROM changes and the interaction effect of "group of children" and "walking experience" was also not significant for all the variables. CONCLUSIONS The alternative gait pattern spontaneously adopted by children with CP does not significantly impact their PROM during the initial stages of walking development. The lower PROM in highly functional children with CP compared to TD children cannot be attributed to gait initiation with an "atypical" pattern, but possibly to other factors such as reduced voluntary movement and age.
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Affiliation(s)
- Rigas Dimakopoulos
- Department of Pediatrics, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Sotirios Youroukos
- First Pediatric Clinic, University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Zoe Dailiana
- Departments of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Arietta Spinou
- School of Health Sport and Bioscience, University of East London, London, UK
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Barber L, Alexander C, Shipman P, Boyd R, Reid S, Elliott C. Validity and reliability of a freehand 3D ultrasound system for the determination of triceps surae muscle volume in children with cerebral palsy. J Anat 2018; 234:384-391. [PMID: 30525186 DOI: 10.1111/joa.12927] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 11/30/2022] Open
Abstract
This study assessed the validity, intra-rater and inter-rater reliability of segmentation of in vivo medial gastrocnemius (MG), lateral gastrocnemius (LG) and soleus (SOL) muscle volume measurement using a single sweep freehand 3D ultrasound (3DUS) in children with cerebral palsy (CP). The MG, LG and SOL of both limbs of 18 children with CP (age 8 years 4 months ± 1 year 10 months, 11 males, unilateral CP = 9, bilateral CP = 9, Gross Motor Functional Classification System I = 11, II = 7) were scanned using freehand 3DUS and magnetic resonance imaging (MRI). All freehand 3DUS and MRI images were segmented and volumes rendered by two raters. Validity was assessed using limits of agreement method. Intra-rater and inter-rater reliability was assessed using intra-class correlation (ICC), coefficient of variance (CV) and minimal detectable change (MDC). Freehand 3DUS overestimated muscle volume of the MG and LG by < 0.3 mL (1%) and underestimated SOL by < 1.3 mL (1.5%) compared with MRI. ICCs for intra-rater reliability of the segmentation process for the freehand 3DUS system and MRI for muscle volume were > 0.98 and 0.99, respectively, for all muscles. ICCs for inter-rater reliability of the segmentation process for freehand 3DUS and MRI volumes were > 0.96 and 0.98, respectively, for all muscles. MDCs for single rater freehand 3DUS and MRI were < 4.0 mL (14%) and 3.2 mL (11%), respectively, in all muscles. Freehand 3DUS is a valid and reliable method for the measurement of lower leg muscle volume that can be measured with a single sweep in children with CP in vivo. It can be used as an alternative to MRI for the detection of clinically relevant changes in calf muscle volume as the result of growth and interventions.
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Affiliation(s)
- L Barber
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - C Alexander
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - P Shipman
- Diagnostic Imaging, Princess Margaret Hospital, Subiaco, WA, Australia
| | - R Boyd
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - S Reid
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - C Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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58
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Trinh A, Wong P, Fahey MC, Ebeling PR, Fuller PJ, Milat F. Trabecular bone score in adults with cerebral palsy. Bone 2018; 117:1-5. [PMID: 30193871 DOI: 10.1016/j.bone.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/06/2018] [Accepted: 09/03/2018] [Indexed: 01/14/2023]
Abstract
CONTEXT Bone fragility in cerebral palsy (CP) is secondary to a complex interplay of functional, hormonal, and nutritional factors that affect bone remodelling. A greater understanding of bone microarchitectural changes seen in CP should assist therapeutic decision making. OBJECTIVE To examine the relationship between trabecular bone score (TBS), BMD and fractures in adults with CP; the influence of clinical factors and body composition on bone microarchitecture were explored. DESIGN Retrospective cross-sectional study. SETTING AND PARTICIPANTS 43 adults (25 male) with CP of median age 25 years (interquartile range 21.4-33.9) who had evaluable dual-energy X-ray absorptiometry imaging of the lumbar spine from a single tertiary hospital between 2005-March 2018. RESULTS 24/43 (55.8%) of patients had TBS values indicating intermediate or high risk of fracture (<1.31). TBS correlated with areal BMD at the lumbar spine, femoral neck and total body. TBS was significantly associated with arm and leg lean mass, with adjustment for age, gender and height (adjusted R2 = 0.18, p = 0.042 for arm lean mass; adjusted R2 = 0.19, p = 0.036 for leg lean mass). There was no difference in TBS when patients were grouped by fracture status, anticonvulsant use, gonadal status or use of PEG feeding. TBS was lower in non-ambulatory patients compared with ambulatory patients (1.28 vs 1.37, p = 0.019). CONCLUSIONS Abnormal bone microarchitecture, as measured by TBS, was seen in >50% of young adults with CP. TBS correlated with both areal BMD and appendicular lean mass. Maintaining muscle function is likely to be important for bone health in young adults with CP and needs to be confirmed in further studies.
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Affiliation(s)
- A Trinh
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia.
| | - P Wong
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia
| | - M C Fahey
- Hudson Institute of Medical Research, Clayton, Australia; Departments of Paediatrics, Monash Health and Monash University, Clayton, Australia
| | - P R Ebeling
- Department of Endocrinology, Monash Health, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia
| | - P J Fuller
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia
| | - F Milat
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia
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59
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Battisti N, Milletti D, Miceli M, Zenesini C, Cersosimo A. Usefulness of a Qualitative Ultrasound Evaluation of the Gastrocnemius-Soleus Complex with the Heckmatt Scale for Clinical Practice in Cerebral Palsy. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2548-2555. [PMID: 30253885 DOI: 10.1016/j.ultrasmedbio.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound is increasingly used for the evaluation of spastic muscles in cerebral palsy. Increased echo intensity is considered indicative of a muscle fibrous involution. The aim of this study was to highlight any correlation between increased echo intensity of the gastrocnemius-soleus complex and clinical tests for stiffness evaluation, age and functional level measured with the Gross Motor Function Classification System. We used the qualitative echo intensity grading system of the Heckmatt scale (HS) and tested its inter-rater reliability. The study group comprised 60 patients with cerebral palsy. We found a weak significant correlation between HS scores and clinical stiffness measures and between HS and age for all muscles studied, and between the HS and Gross Motor Function Classification System only for the soleus muscle. The study indicated moderate inter-rater reliability, with κ values between 0.60 and 0.73, for almost all muscles studied. Ultrasound provides a useful complementary survey of stiffness tests in cerebral palsy.
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Affiliation(s)
- Nicoletta Battisti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa Infantile, Bologna, Italy.
| | - David Milletti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa, Bologna, Italy
| | - Marco Miceli
- Azienda Unità sanitaria Locale di Bologna,UOC Radiologia, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Epidemiologia e Statistica, Bologna, Italy
| | - Antonella Cersosimo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa Infantile, Bologna, Italy
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60
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Alexander C, Elliott C, Valentine J, Stannage K, Bear N, Donnelly CJ, Shipman P, Reid S. Muscle volume alterations after first botulinum neurotoxin A treatment in children with cerebral palsy: a 6-month prospective cohort study. Dev Med Child Neurol 2018; 60:1165-1171. [PMID: 30151852 DOI: 10.1111/dmcn.13988] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 12/21/2022]
Abstract
AIM This study aimed to track alterations in muscle volume for 6 months in children with cerebral palsy (CP) after the first exposure to botulinum neurotoxin A (BoNT-A), a commonly used focal spasticity treatment. METHOD Eleven ambulant children (eight males, three females) with spastic CP, mean age 8 years 10 months (SD 3y 1mo) participated. Participants received injections to the affected gastrocnemius. The muscle volume of the gastrocnemius, soleus, tibialis anterior, and hamstrings was measured using magnetic resonance imaging. Muscle volume was normalized to bone length, and changes analysed relative to baseline. Assessments were conducted 1 week before, and 4 weeks, 13 weeks, and 25 weeks after BoNT-A treatment. RESULTS All children demonstrated positive clinical and functional gains. Muscle volume of the injected gastrocnemius was found to be significantly reduced at 4 weeks (-5.9%), 13 weeks (-9.4%), and 25 weeks (-6.8%). Significant increases in normalized soleus muscle volume were identified at each follow-up, while hamstrings showed significant increase at 4 weeks only. INTERPRETATION Absolute and normalized muscle volume of the injected muscle reduces after first BoNT-A exposure, and does not return to baseline volume by 25 weeks. Hypertrophy is seen in the soleus up to 25 weeks; the volume of the plantar flexor compartment is stable. WHAT THIS PAPER ADDS Muscle atrophy after first botulinum neurotoxin A (BoNT-A) exposure in children with cerebral palsy is noted. Mild BoNT-A-induced muscle atrophy is still apparent 6 months after BoNT-A exposure. Hypertrophy is evident in soleus after gastrocnemius BoNT-A exposure. Total plantarflexor volume is unchanged.
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Affiliation(s)
- Caroline Alexander
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine Elliott
- Department of Paediatric Rehabilitation, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia, Australia
| | - Jane Valentine
- Department of Paediatric Rehabilitation, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Katherine Stannage
- Department of Orthopaedic Surgery, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Clinical Research and Education, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Cyril J Donnelly
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Peter Shipman
- Department of Diagnostic Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Siobhan Reid
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
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61
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Massaad A, Assi A, Bakouny Z, Bizdikian AJ, Skalli W, Ghanem I. Alterations of treatment-naïve pelvis and thigh muscle morphology in children with cerebral palsy. J Biomech 2018; 82:178-185. [PMID: 30389259 DOI: 10.1016/j.jbiomech.2018.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 08/09/2018] [Accepted: 10/20/2018] [Indexed: 11/29/2022]
Abstract
Lower limb (LL) muscle morphology and growth are altered in children with cerebral palsy (CP). Muscle alterations differ with age and with severity of motor impairment, classified according to the gross motor classification system (GMFCS). Muscle alterations differ also with orthopedic intervention, frequently performed at the level of the shank muscles since an early age, such as the gastrocnemius. The aim was to investigate the alterations of treatment-naïve pelvis and thigh muscle lengths and volumes in children with GMFCS levels I and II, of varying ages. 17 children with CP (GMFCS I: N = 9, II: N = 8, age: 11.7 ± 4 years), age-matched to 17 typically developing (TD) children, underwent MRI of the LL. Three-dimensional reconstructions of the muscles were performed bilaterally. Muscle volumes and lengths were calculated in 3D and compared between groups. Linear regression between muscle volumes and age were computed. Adductor-brevis and gracilis lengths, as well as rectus-femoris volume, were decreased in GMFCS I compared to TD (p < 0.05). Almost all the reconstructed muscle volumes and lengths were found to be altered in GMFCS II compared to TD and GMFCS I. All muscle volumes showed significant increase with age in TD and GMFCS I (R2 range: 0.3-0.9, p < 0.05). Rectus-femoris, hamstrings and adductor-longus showed reduced increase in the muscle volume with age in GMFCS II when compared to TD and GMFCS I. Alterations of treatment-naïve pelvis and thigh muscle volumes and lengths, as well as muscle growth, seem to increase with the severity of motor impairment in ambulant children with CP.
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Affiliation(s)
- Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Ziad Bakouny
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Aren Joe Bizdikian
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
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62
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Pitcher CA, Elliott CM, Valentine JP, Stannage K, Williams SA, Shipman PJ, Reid SL. Muscle morphology of the lower leg in ambulant children with spastic cerebral palsy. Muscle Nerve 2018; 58:818-823. [DOI: 10.1002/mus.26293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Christian A. Pitcher
- School of Human Sciences; University of Western Australia; 35 Stirling Highway, Crawley, Perth Western Australia 6009 Australia
- School of Exercise Science; Australian Catholic University; Melbourne, Victoria Western Australia Australia
| | - Catherine M. Elliott
- School of Occupational Therapy and Social Work; Curtin University; Perth Western Australia Australia
- Department of Paediatric Rehabilitation; Perth Children's Hospital; Perth Western Australia Australia
| | - Jane P. Valentine
- Department of Paediatric Rehabilitation; Perth Children's Hospital; Perth Western Australia Australia
| | - Katherine Stannage
- Department of Orthopaedics; Perth Children's Hospital; Perth Western Australia Australia
| | - Sian A. Williams
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Peter J. Shipman
- Department of Diagnostic Imaging; Perth Children's Hospital; Perth Western Australia Australia
| | - Siobhán L. Reid
- School of Human Sciences; University of Western Australia; 35 Stirling Highway, Crawley, Perth Western Australia 6009 Australia
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63
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Skeletal Muscle Adaptations and Passive Muscle Stiffness in Cerebral Palsy: A Literature Review and Conceptual Model. J Appl Biomech 2018; 35:68–79. [PMID: 30207207 DOI: 10.1123/jab.2018-0049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This literature review focuses on the primary morphological and structural characteristics, and mechanical properties identified in muscles affected by spastic cerebral palsy (CP). CP is a non-progressive neurological disorder caused by brain damage and is commonly diagnosed at birth. Although the brain damage is not progressive, subsequent neuro-physiological developmental adaptations may initiate changes in muscle structure, function, and composition, causing abnormal muscle activity and coordination. The symptoms of CP vary among patients. However, muscle spasticity is commonly present and is one of the most debilitating effects of CP. Here, we present the current knowledge regarding the mechanical properties of skeletal tissue affected by spastic CP. An increase in sarcomere length, collagen content, and fascicle diameter, and a reduction in the number of satellite cells within spastic CP muscle were consistent findings in the literature. Studies differed, however, in changes in fascicle lengths and fiber diameters. We also present a conceptual mechanical model of fascicle force transmission that incorporates mechanisms that impact both serial and lateral force production, highlighting the connections between the macro and micro structures of muscle to assist in deducing specific mechanisms for property changes and reduced force production.
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Matsunaga N, Ito T, Noritake K, Sugiura H, Kamiya Y, Ito Y, Mizusawa J, Sugiura H. Correlation between the Gait Deviation Index and skeletal muscle mass in children with spastic cerebral palsy. J Phys Ther Sci 2018; 30:1176-1179. [PMID: 30214121 PMCID: PMC6127487 DOI: 10.1589/jpts.30.1176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/22/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to identify a simple and useful muscle parameter for use with
the Gait Deviation Index in assessment of ambulatory children with unilateral and
bilateral spastic cerebral palsy. [Participants and Methods] Twenty-eight patients (aged 6
to 18 years; 16 females and 12 males) participated in this cross-sectional study. Outcome
measurements included the Gait Deviation Index, grip strength, 5-repetition chair stand
test, upper limb skeletal muscle mass index, and lower limb skeletal muscle mass index.
[Results] By multiple regression analysis, significant independent correlations were
observed between the Gait Deviation Index and 5-repetition chair stand test and the Gait
Deviation Index and lower limb skeletal muscle mass index, but not between the Gait
Deviation Index and grip strength or upper limb skeletal muscle mass index. [Conclusion]
The Gait Deviation Index was correlated with lower limb muscle mass in children with
spastic cerebral palsy. Determination of lower limb muscle mass may be useful gait
evaluation.
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Affiliation(s)
- Naomichi Matsunaga
- Department of Physical Therapy, Graduate School of Medicine, Nagoya University: 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan.,Three-dimensional Motion Analysis Room, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Tadashi Ito
- Three-dimensional Motion Analysis Room, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Koji Noritake
- Department of Orthopedic Surgery, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Hiroshi Sugiura
- Department of Orthopedic Surgery, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Yasunari Kamiya
- Department of Orthopedic Surgery, Nagoya University Hospital, Japan
| | - Yuji Ito
- Department of Pediatrics, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Jun Mizusawa
- Department of Physical Therapy, Graduate School of Medicine, Nagoya University: 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan.,Three-dimensional Motion Analysis Room, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Japan
| | - Hideshi Sugiura
- Department of Physical Therapy, Graduate School of Medicine, Nagoya University: 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan
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65
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Willerslev-Olsen M, Choe Lund M, Lorentzen J, Barber L, Kofoed-Hansen M, Nielsen JB. Impaired muscle growth precedes development of increased stiffness of the triceps surae musculotendinous unit in children with cerebral palsy. Dev Med Child Neurol 2018; 60:672-679. [PMID: 29573407 DOI: 10.1111/dmcn.13729] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 10/17/2022]
Abstract
AIM If increased muscle stiffness and contractures in children with cerebral palsy (CP) are related to impaired muscle growth, reduced muscle growth should precede or coincide with increased muscle stiffness during development. Here, we compared the volume of the medial gastrocnemius muscle and the passive (non-neural) stiffness of the triceps surae musculotendinous unit in typically developing children and children with CP from birth until 4 years of age. METHOD Forty-one children with CP and 45 typically developing children were included. Freehand three-dimensional ultrasound was used to evaluate the volume of the medial gastrocnemius muscle. Biomechanical and electrophysiological measures were used to determine passive and reflex mediated stiffness of the triceps surae musculotendinous unit. RESULTS Medial gastrocnemius muscle volume increased with the same rate in typically developing and children with CP until 12 months of age, when a significant smaller rate of growth was observed in children with CP. Passive stiffness of the triceps surae musculotendinous unit showed a linear increase with age in typically developing children. Children with CP older than 27 months showed a significant increase in passive stiffness. Reflex mediated stiffness was only pathologically increased in four children with CP. INTERPRETATION The deviation of medial gastrocnemius muscle volume, earlier than musculotendinous unit stiffness, is consistent with the hypothesis. The data also point out that muscle atrophy and muscle stiffness already develops within the first 1 to 2 years. This emphasizes the necessity of early interventions to promote lower limb muscle growth in this population. WHAT THIS PAPER ADDS Medial gastrocnemius muscle growth is reduced in children with cerebral palsy (CP) around 12 months after birth. Triceps surae musculotendinous unit stiffness is increased in children with CP around 27 months after birth. Reflex excitability is rarely increased in children with CP. Reduced muscle growth may be involved in the pathophysiology of contractures.
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Affiliation(s)
- Maria Willerslev-Olsen
- Institute for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | - Mai Choe Lund
- Institute for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Institute for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | | | - Jens Bo Nielsen
- Institute for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
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66
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Vigotsky AD, Schoenfeld BJ, Than C, Brown JM. Methods matter: the relationship between strength and hypertrophy depends on methods of measurement and analysis. PeerJ 2018; 6:e5071. [PMID: 29967737 PMCID: PMC6026459 DOI: 10.7717/peerj.5071] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/04/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose The relationship between changes in muscle size and strength may be affected by both measurement and statistical approaches, but their effects have not been fully considered or quantified. Therefore, the purpose of this investigation was to explore how different methods of measurement and analysis can affect inferences surrounding the relationship between hypertrophy and strength gain. Methods Data from a previous study-in which participants performed eight weeks of elbow flexor training, followed by an eight-week period of detraining-were reanalyzed using different statistical models, including standard between-subject correlations, analysis of covariance, and hierarchical linear modeling. Results The associative relationship between strength and hypertrophy is highly dependent upon both method/site of measurement and analysis; large differences in variance accounted for (VAF) by the statistical models were observed (VAF = 0-24.1%). Different sites and measurements of muscle size showed a range of correlations coefficients with one another (r = 0.326-0.945). Finally, exploratory analyses revealed moderate-to-strong relationships between within-individual strength-hypertrophy relationships and strength gained over the training period (ρ = 0.36-0.55). Conclusions Methods of measurement and analysis greatly influence the conclusions that may be drawn from a given dataset. Analyses that do not account for inter-individual differences may underestimate the relationship between hypertrophy and strength gain, and different methods of assessing muscle size will produce different results. It is suggested that robust experimental designs and analysis techniques, which control for different mechanistic sources of strength gain and inter-individual differences (e.g., muscle moment arms, muscle architecture, activation, and normalized muscle force), be employed in future investigations.
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Affiliation(s)
- Andrew D Vigotsky
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States of America
| | - Brad J Schoenfeld
- Department of Health Sciences, City University of New York, Herbert H. Lehman College, Bronx, NY, United States of America
| | - Christian Than
- School of Biomedical Sciences, University of Queensland, St. Lucia, Queensland, Australia
| | - J Mark Brown
- School of Biomedical Sciences, University of Queensland, St. Lucia, Queensland, Australia
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Verschuren O, Smorenburg AR, Luiking Y, Bell K, Barber L, Peterson MD. Determinants of muscle preservation in individuals with cerebral palsy across the lifespan: a narrative review of the literature. J Cachexia Sarcopenia Muscle 2018; 9:453-464. [PMID: 29392922 PMCID: PMC5989853 DOI: 10.1002/jcsm.12287] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/23/2017] [Accepted: 01/07/2018] [Indexed: 12/16/2022] Open
Abstract
In individuals with cerebral palsy (CP), smaller muscle and atrophy are present at young age. Many people with CP also experience a decline in gross motor function as they age, which might be explained by the loss of muscle mass. The clinical observation of muscle wasting has prompted a comparison with sarcopenia in older adults, and the term accelerated musculoskeletal ageing is often used to describe the hallmark phenotype of CP through the lifespan. However, there has been very little research emphasis on the natural history of ageing with CP and even less with respect to the determinants or prevention of muscle loss with CP. Considering the burgeoning interest in the science of muscle preservation, this paper aims to (i) describe the characteristics of accelerated musculoskeletal ageing in people with CP, (ii) describe the pathophysiology of sarcopenia and parallels with CP, and (iii) discuss possible therapeutic approaches, based on established approaches for sarcopenia.
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Affiliation(s)
- Olaf Verschuren
- Brain Center Rudolf Magnus, Center of Excellence for Rehabilitation Medicine, De Hoogstraat RehabilitationUniversity Medical Center UtrechtRembrandtkade 10Utrecht3583TMThe Netherlands
| | | | - Yvette Luiking
- Nutricia ResearchAdvanced Medical NutritionUtrechtThe Netherlands
| | - Kristie Bell
- Child Health Research CentreThe University of QueenslandBrisbaneAustralia
- Lady Cilento Children's HospitalSouth BrisbaneQueenslandAustralia
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Mark D. Peterson
- Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMIUSA
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Von Walden F, Gantelius S, Liu C, Borgström H, Björk L, Gremark O, Stål P, Nader GA, PontéN E. Muscle contractures in patients with cerebral palsy and acquired brain injury are associated with extracellular matrix expansion, pro‐inflammatory gene expression, and reduced rRNA synthesis. Muscle Nerve 2018; 58:277-285. [DOI: 10.1002/mus.26130] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Ferdinand Von Walden
- Department of Women's and Children's health, Division of Neurology/Pediatric Orthopedics, Karolinska Institute, ALB Q2:07Karolinska University Hospital17176Stockholm Sweden
| | - Stefan Gantelius
- Department of Women's and Children's health, Division of Neurology/Pediatric Orthopedics, Karolinska Institute, ALB Q2:07Karolinska University Hospital17176Stockholm Sweden
- Department of Pediatric Orthopedic SurgeryKarolinska University HospitalStockholm Sweden
| | - Chang Liu
- Department of Women's and Children's health, Division of Neurology/Pediatric Orthopedics, Karolinska Institute, ALB Q2:07Karolinska University Hospital17176Stockholm Sweden
| | - Hanna Borgström
- Department of Women's and Children's health, Division of Neurology/Pediatric Orthopedics, Karolinska Institute, ALB Q2:07Karolinska University Hospital17176Stockholm Sweden
| | - Lars Björk
- Department of Women's and Children's health, Division of Neurology/Pediatric Orthopedics, Karolinska Institute, ALB Q2:07Karolinska University Hospital17176Stockholm Sweden
| | - Ola Gremark
- Department of Orthopedic SurgeryDanderyd HospitalStockholm Sweden
| | - Per Stål
- Department of Integrative Medical Biology, Laboratory of Muscle BiologyUmeå University Sweden
| | - Gustavo A. Nader
- Department. of Kinesiology and Huck Institute of the Life SciencesThe Pennsylvania State UniversityUniversity Park Pennsylvania USA
| | - Eva PontéN
- Department of Women's and Children's health, Division of Neurology/Pediatric Orthopedics, Karolinska Institute, ALB Q2:07Karolinska University Hospital17176Stockholm Sweden
- Department of Pediatric Orthopedic SurgeryKarolinska University HospitalStockholm Sweden
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69
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Muscle Shortening and Spastic Cocontraction in Gastrocnemius Medialis and Peroneus Longus in Very Young Hemiparetic Children. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2328601. [PMID: 29951529 PMCID: PMC5987331 DOI: 10.1155/2018/2328601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/15/2018] [Accepted: 04/12/2018] [Indexed: 11/17/2022]
Abstract
Objectives Muscle shortening and spastic cocontraction in ankle plantar flexors may alter gait since early childhood in cerebral palsy (CP). We evaluated gastrosoleus complex (GSC) length, and gastrocnemius medialis (GM) and peroneus longus (PL) activity during swing phase, in very young hemiparetic children with equinovalgus. Methods This was an observational, retrospective, and monocentric outpatient study in a pediatric hospital. Ten very young hemiparetic children (age 3 ± 1 yrs) were enrolled. These CP children were assessed for muscle extensibility (Tardieu scale XV1) in GSC (angle of arrest during slow-speed passive ankle dorsiflexion with the knee extended) and monitored for GM and PL electromyography (EMG) during the swing phase of gait. The swing phase was divided into three periods (T1, T2, and T3), in which we measured a cocontraction index (CCI), ratio of the Root Mean Square EMG (RMS-EMG) from each muscle during that period to the peak 500 ms RMS-EMG obtained from voluntary plantar flexion during standing on tiptoes (from several 5-second series, the highest RMS value was computed over 500 ms around the peak). Results On the paretic side: (i) the mean XV1-GSC was 100° (8°) (median (SD)) versus 106° (3°) on the nonparetic side (p = 0.032, Mann-Whitney); (ii) XV1-GSC diminished with age between ages of 2 and 5 (Spearman, ρ = 0.019); (iii) CCIGM and CCIPL during swing phase were higher than on the nonparetic side (CCIGM, 0.32 (0.20) versus 0.15 (0.09), p < 0.01; CCIPL, 0.52 (0.30) versus 0.24 (0.17), p < 0.01), with an early difference significant for PL from T1 (p = 0.03). Conclusions In very young hemiparetic children, the paretic GSC may rapidly shorten in the first years of life. GM and PL cocontraction during swing phase are excessive, which contributes to dynamic equinovalgus. Muscle extensibility (XV1) may have to be monitored and preserved in the first years of life in children with CP. Additional measurements of cocontraction may further help target treatments with botulinum toxin, especially in peroneus longus.
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70
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Kruse A, Schranz C, Tilp M, Svehlik M. Muscle and tendon morphology alterations in children and adolescents with mild forms of spastic cerebral palsy. BMC Pediatr 2018; 18:156. [PMID: 29743109 PMCID: PMC5941654 DOI: 10.1186/s12887-018-1129-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Early detection of changes at the muscular level before a contracture develops is important to gain knowledge about the development of deformities in individuals with spasticity. However, little information is available about muscle morphology in children with spastic diplegic cerebral palsy (CP) without contracture or equinus gait. Therefore, the aim of this study was to compare the gastrocnemius medialis (GM) and Achilles tendon architecture of children and adolescents with spastic CP without contracture or equinus gait to that of typically developing (TD) children. Methods Two-dimensional ultrasonography was used to assess the morphological properties of the GM muscle and Achilles tendon in 10 children with spastic diplegic CP (Gross Motor Function Classification System level I–II) and 12 TD children (mean age 12.0 (2.8) and 11.3 (2.5) years, respectively). The children with CP were not restricted in the performance of daily tasks, and therefore had a high functional capacity. Mean muscle and tendon parameters were statistically compared (independent t-tests or Mann-Whitney U-tests). Results When normalized to lower leg length, muscle-tendon unit length and GM muscle belly length were found to be significantly shorter (p < 0.05, effect size (ES) = 1.00 and 0.98, respectively) in the children with spastic CP. Furthermore, there was a tendency for increased Achilles tendon length when expressed as a percentage of muscle-tendon unit length (p = 0.08, ES = − 0.80) in the individuals with CP. This group also showed shorter muscle fascicles (3.4 cm vs. 4.4 cm, p < 0.01, ES = 1.12) and increased fascicle pennation angle (21.9° vs. 18.1°, p < 0.01, ES = − 1.36, respectively). However, muscle thickness and Achilles tendon cross-sectional area did not differ between groups. Resting ankle joint angle was significantly more plantar flexed (− 26.2° vs. − 20.8°, p < 0.05, ES = 1.06) in the children with CP. Conclusions Morphological alterations of the plantar flexor muscle-tendon unit are also present in children and adolescents with mild forms of spastic CP. These alterations may contribute to functional deficits such as muscle weakness, and therefore have to be considered in the clinical decision-making process, as well as in the selection of therapeutic interventions.
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Affiliation(s)
- Annika Kruse
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Christian Schranz
- Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Markus Tilp
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria.
| | - Martin Svehlik
- Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
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71
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Martín Lorenzo T, Rocon E, Martínez Caballero I, Lerma Lara S. Medial gastrocnemius structure and gait kinetics in spastic cerebral palsy and typically developing children: A cross-sectional study. Medicine (Baltimore) 2018; 97:e10776. [PMID: 29794756 PMCID: PMC6392514 DOI: 10.1097/md.0000000000010776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare medial gastrocnemius muscle-tendon structure, gait propulsive forces, and ankle joint gait kinetics between typically developing children and those with spastic cerebral palsy, and to describe significant associations between structure and function in children with spastic cerebral palsy.A sample of typically developing children (n = 9 /16 limbs) and a sample of children with spastic cerebral palsy (n = 29 /43 limbs) were recruited. Ultrasound and 3-dimensional motion capture were used to assess muscle-tendon structure, and propulsive forces and ankle joint kinetics during gait, respectively.Children with spastic cerebral palsy had shorter fascicles and muscles, and longer Achilles tendons than typically developing children. Furthermore, total negative power and peak negative power at the ankle were greater, while total positive power, peak positive power, net power, total vertical ground reaction force, and peak vertical and anterior ground reaction forces were smaller compared to typically developing children. Correlation analyses revealed that smaller resting ankle joint angles and greater maximum dorsiflexion in children with spastic cerebral palsy accounted for a significant decrease in peak negative power. Furthermore, short fascicles, small fascicle to belly ratios, and large tendon to fascicle ratios accounted for a decrease in propulsive force generation.Alterations observed in the medial gastrocnemius muscle-tendon structure of children with spastic cerebral palsy may impair propulsive mechanisms during gait. Therefore, conventional treatments should be revised on the basis of muscle-tendon adaptations.
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Affiliation(s)
- Teresa Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Arganda del Rey
| | | | - Sergio Lerma Lara
- Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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72
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Dick TJM, Wakeling JM. Geometric models to explore mechanisms of dynamic shape change in skeletal muscle. ROYAL SOCIETY OPEN SCIENCE 2018; 5:172371. [PMID: 29892420 PMCID: PMC5990834 DOI: 10.1098/rsos.172371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/06/2018] [Indexed: 05/29/2023]
Abstract
Skeletal muscle bulges when it contracts. These three-dimensional (3D) dynamic shape changes play an important role in muscle performance by altering the range of fascicle velocities over which a muscle operates. However traditional muscle models are one-dimensional (1D) and cannot fully explain in vivo shape changes. In this study we compared medial gastrocnemius behaviour during human cycling (fascicle length changes and rotations) predicted by a traditional 1D Hill-type model and by models that incorporate two-dimensional (2D) and 3D geometric constraints to in vivo measurements from B-mode ultrasound during a range of mechanical conditions ranging from 14 to 44 N m and 80 to 140 r.p.m. We found that a 1D model predicted fascicle lengths and pennation angles similar to a 2D model that allowed the aponeurosis to stretch, and to a 3D model that allowed for aponeurosis stretch and variable shape changes to occur. This suggests that if the intent of a model is to predict fascicle behaviour alone, then the traditional 1D Hill-type model may be sufficient. Yet, we also caution that 1D models are limited in their ability to infer the mechanisms by which shape changes influence muscle mechanics. To elucidate the mechanisms governing muscle shape change, future efforts should aim to develop imaging techniques able to characterize whole muscle 3D geometry in vivo during active contractions.
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Affiliation(s)
- Taylor J. M. Dick
- School of Biomedical Sciences, University of Queensland, St Lucia, Australia
| | - James M. Wakeling
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
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73
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Gillett JG, Lichtwark GA, Boyd RN, Barber LA. Functional Capacity in Adults With Cerebral Palsy: Lower Limb Muscle Strength Matters. Arch Phys Med Rehabil 2018; 99:900-906.e1. [DOI: 10.1016/j.apmr.2018.01.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/03/2018] [Accepted: 01/17/2018] [Indexed: 11/17/2022]
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74
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Choe YR, Kim JS, Kim KH, Yi TI. Relationship Between Functional Level and Muscle Thickness in Young Children With Cerebral Palsy. Ann Rehabil Med 2018; 42:286-295. [PMID: 29765882 PMCID: PMC5940605 DOI: 10.5535/arm.2018.42.2.286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the relationship between functional level and muscle thickness (MT) of the rectus femoris (RF) and the gastrocnemius (GCM) in young children with cerebral palsy (CP). Methods The study participants were comprised of 26 children (50 legs) with spastic CP, aged 3–6 years, and 25 age-matched children with typical development (TD, 50 legs). The MT of the RF, medial GCM, and lateral GCM was measured with ultrasound imaging. The functional level was evaluated using the Gross Motor Function Measurement-88 (GMFM-88), Gross Motor Function Classification System (GMFCS), and based on the mobility area of the Korean version of the Modified Barthel Index (K-MBI). The measurement of spasticity was evaluated with the Modified Ashworth Scale (MAS). Results We note that the height, weight, body mass index, and MT of the RF, and the medial and lateral GCM were significantly higher in the TD group (p<0.05). There was a direct relationship between MT of the RF and medial GCM and the GMFM-88, GMFCS, and mobility scores of the K-MBI in individuals with early CP. In addition, we have noted that there was a direct relationship between MT of the lateral GCM and the GMFM-88 and GMFCS. Although there was a tendency toward lower MT with increasing MAS ratings in the knee and ankle, the correlation was not statistically significant. Conclusion In young children with CP, MT of the RF and GCM was lower than in age-matched children with TD. Furthermore, it is noted with confidence that a significant positive correlation existed between MT and functional level as evaluated using the GMFM-88, GMFCS, and mobility area of K-MBI.
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Affiliation(s)
- Yeo Reum Choe
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Joo Sup Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Kee Hoon Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Tae Im Yi
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
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Domenighetti AA, Mathewson MA, Pichika R, Sibley LA, Zhao L, Chambers HG, Lieber RL. Loss of myogenic potential and fusion capacity of muscle stem cells isolated from contractured muscle in children with cerebral palsy. Am J Physiol Cell Physiol 2018; 315:C247-C257. [PMID: 29694232 DOI: 10.1152/ajpcell.00351.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cerebral palsy (CP) is the most common cause of pediatric neurodevelopmental and physical disability in the United States. It is defined as a group of motor disorders caused by a nonprogressive perinatal insult to the brain. Although the brain lesion is nonprogressive, there is a progressive, lifelong impact on skeletal muscles, which are shorter, spastic, and may develop debilitating contractures. Satellite cells are resident muscle stem cells that are indispensable for postnatal growth and regeneration of skeletal muscles. Here we measured the myogenic potential of satellite cells isolated from contractured muscles in children with CP. When compared with typically developing (TD) children, satellite cell-derived myoblasts from CP differentiated more slowly (slope: 0.013 (SD 0.013) CP vs. 0.091 (SD 0.024) TD over 24 h, P < 0.001) and fused less (fusion index: 21.3 (SD 8.6) CP vs. 81.3 (SD 7.7) TD after 48 h, P < 0.001) after exposure to low-serum conditions that stimulated myotube formation. This impairment was associated with downregulation of several markers important for myoblast fusion and myotube formation, including DNA methylation-dependent inhibition of promyogenic integrin-β 1D (ITGB1D) protein expression levels (-50% at 42 h), and ~25% loss of integrin-mediated focal adhesion kinase phosphorylation. The cytidine analog 5-Azacytidine (5-AZA), a demethylating agent, restored ITGB1D levels and promoted myogenesis in CP cultures. Our data demonstrate that muscle contractures in CP are associated with loss of satellite cell myogenic potential that is dependent on DNA methylation patterns affecting expression of genetic programs associated with muscle stem cell differentiation and muscle fiber formation.
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Affiliation(s)
- Andrea A Domenighetti
- The Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Physical Medicine & Rehabilitation, Northwestern University , Chicago, Illinois.,Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California
| | - Margie A Mathewson
- Bioengineering Department, University of California, San Diego, La Jolla, California
| | | | | | - Leyna Zhao
- ACEA Biosciences Incorporated, San Diego, California
| | | | - Richard L Lieber
- The Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Physical Medicine & Rehabilitation, Northwestern University , Chicago, Illinois.,Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California
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76
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Kawano A, Yanagizono T, Kadouchi I, Umezaki T, Chosa E. Ultrasonographic evaluation of changes in the muscle architecture of the gastrocnemius with botulinum toxin treatment for lower extremity spasticity in children with cerebral palsy. J Orthop Sci 2018; 23:389-393. [PMID: 29146092 DOI: 10.1016/j.jos.2017.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/02/2017] [Accepted: 10/24/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Botulinum toxin A treatment involves injecting botulinum toxin A to relax muscle spasticity. Using ultrasonography, this study examined changes in the muscle architecture before and after treatment to evaluate the influence of botulinum toxin A injection on muscles. METHODS The participants included 18 children (mean age, 6.2 years) with cerebral palsy who were treated with botulinum toxin A for lower extremity spasticity and 27 healthy children (mean age, 6.4 years) as a control group. In all cases, botulinum toxin A was injected into the gastrocnemius muscle. The muscle length, muscle width, and pennation angle (which indicates the degree of muscle fiber tone), were measured using B-mode ultrasonography before and 12 weeks after injection. RESULTS The muscle length and muscle width were shorter in the cerebral palsy group than in the control group. The pennation angle in the cerebral palsy group significantly decreased after injection from 28.2 ± 3.6° to 25.8 ± 2.5° in the resting position of the ankle and from 18.6 ± 2.8° to 15.9 ± 1.7° in the maximum dorsiflexion position of the ankle. In the control group, the pennation angle was 25.9 ± 3.2° in the resting position of the ankle and 15.1 ± 2.5° in the maximum dorsiflexion position of the ankle. The rate of increase of fascicle length during passive movement from the resting position of the ankle to the maximum dorsiflexion position was 143.9% in the cerebral palsy group, which was significantly less than the value of 157.7% in the control group. After botulinum toxin A treatment, the rate of increase of fascicle length in the cerebral palsy group increased to 155.1%. CONCLUSIONS The decrease in the pennation angle after botulinum toxin A treatment is considered to be the result of a reduction of spasticity and subsequent structural changes in flaccid muscle fibers.
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Affiliation(s)
- Akihiro Kawano
- Division of Orthopedic Surgery, Miyazaki Prefecture Center for Disabled Children, Miyazaki 889-1601, Japan.
| | - Taiichiro Yanagizono
- Division of Orthopedic Surgery, Miyazaki Prefecture Center for Disabled Children, Miyazaki 889-1601, Japan
| | - Ichiro Kadouchi
- Division of Orthopedic Surgery, Miyazaki Prefecture Center for Disabled Children, Miyazaki 889-1601, Japan
| | - Tetsuya Umezaki
- Division of Orthopedic Surgery, Miyazaki Prefecture Center for Disabled Children, Miyazaki 889-1601, Japan
| | - Etsuo Chosa
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan
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77
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Chen Y, He L, Xu K, Li J, Guan B, Tang H. Comparison of calf muscle architecture between Asian children with spastic cerebral palsy and typically developing peers. PLoS One 2018; 13:e0190642. [PMID: 29304114 PMCID: PMC5755874 DOI: 10.1371/journal.pone.0190642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare the muscle thickness, fascicle length, and pennation angle of the gastrocnemius, soleus, and tibialis anterior between Asian children with spastic cerebral palsy (CP) and typically developing (TD) peers. METHODS This cross-sectional study involved a total of 72 children with hemiplegic CP (n = 24), and diplegic CP (n = 24) and their TD peers (n = 24). Muscle architecture was measured at rest using ultrasound. Clinical measures included gross motor function and a modified Ashworth scale. RESULTS The thicknesses of the tibialis anterior and medial gastrocnemius muscles were smaller in the affected calf of children with CP (p<0.05) than in those of their TD peers. Additionally, the lengths of the lateral gastrocnemius and soleus fascicle were shorter (p<0.05) in children with diplegic CP than in their TD peers. The fascicle length was shorter in the affected calf of children with CP (p<0.05) than in the calves of their TD peers or the unaffected calf of children with hemiplegic CP. However, the length of the lateral gastrocnemius fascicle was similar between the two legs of children with hemiplegic CP. The pennation angles of the medial gastrocnemius and soleus muscles were larger (p<0.05) in the affected calf in children with hemiplegic CP than in the calves of their TD peers. The fascicle length of the lateral gastrocnemius and the thickness of the soleus muscle were positively correlated with gross motor function scores in children with CP (p<0.05). CONCLUSIONS Muscle thickness and fascicle length were lower in the affected tibialis anterior, gastrocnemius, and soleus in children with spastic CP. These changes may limit the ability to stand and walk, and indicate a need to strengthen the affected muscle.
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Affiliation(s)
- Ying Chen
- Department of Rehabilitation, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lu He
- Department of Rehabilitation, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- * E-mail:
| | - Jinling Li
- Department of Rehabilitation, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Buyun Guan
- Department of Ultrasonography, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongmei Tang
- Department of Rehabilitation, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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Cenni F, Schless SH, Bar-On L, Molenaers G, Van Campenhout A, Aertbeliën E, Bruyninckx H, Hanssen B, Desloovere K. Can in Vivo Medial Gastrocnemius Muscle-Tendon Unit Lengths be Reliably Estimated by Two Ultrasonography Methods? A Within-Session Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:110-118. [PMID: 29122315 DOI: 10.1016/j.ultrasmedbio.2017.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
A clinically feasible method to reliably estimate muscle-tendon unit (MTU) lengths could provide essential diagnostic and treatment planning information. A 3-D freehand ultrasound (3-DfUS) method was previously validated for extracting in vivo medial gastrocnemius (MG) lengths, although the processing time can be considered substantial for the clinical environment. This investigation analyzed a quicker and simpler method using the US transducer as a spatial pointer (US-PaP), where the within-session reliability of extracting the muscle-tendon unit (MTU) and tendon lengths are estimated. MG MTU lengths were extracted in a group of 14 healthy adults using both 3-DfUS and US-PaP. Two consecutive acquisitions were performed per participant, and the data processed by two researchers independently. The intra-class correlation coefficients were above 0.97, and the standard error of measurements below 3.6 mm (1.5%). This investigation proposes that the simplified US-PaP method is a viable alternative for estimating MG MTU lengths.
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Affiliation(s)
- Francesco Cenni
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium.
| | - Simon-Henri Schless
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Development and Regeneration, University Hospital, Leuven, Belgium; Department of Orthopaedic Surgery, University Hospital, Leuven, Belgium
| | - Anja Van Campenhout
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Development and Regeneration, University Hospital, Leuven, Belgium; Department of Orthopaedic Surgery, University Hospital, Leuven, Belgium
| | - Erwin Aertbeliën
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | | | - Britta Hanssen
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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79
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Vanmechelen IM, Shortland AP, Noble JJ. Lower limb muscle volume estimation from maximum cross-sectional area and muscle length in cerebral palsy and typically developing individuals. Clin Biomech (Bristol, Avon) 2018; 51:40-44. [PMID: 29179032 DOI: 10.1016/j.clinbiomech.2017.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/05/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deficits in muscle volume may be a significant contributor to physical disability in young people with cerebral palsy. However, 3D measurements of muscle volume using MRI or 3D ultrasound may be difficult to make routinely in the clinic. We wished to establish whether accurate estimates of muscle volume could be made from a combination of anatomical cross-sectional area and length measurements in samples of typically developing young people and young people with bilateral cerebral palsy. METHODS Lower limb MRI scans were obtained from the lower limbs of 21 individuals with cerebral palsy (14.7±3years, 17 male) and 23 typically developing individuals (16.8±3.3years, 16 male). The volume, length and anatomical cross-sectional area were estimated from six muscles of the left lower limb. FINDINGS Analysis of Covariance demonstrated that the relationship between the length*cross-sectional area and volume was not significantly different depending on the subject group. Linear regression analysis demonstrated that the product of anatomical cross-sectional area and length bore a strong and significant relationship to the measured muscle volume (R2 values between 0.955 and 0.988) with low standard error of the estimates of 4.8 to 8.9%. INTERPRETATION This study demonstrates that muscle volume may be estimated accurately in typically developing individuals and individuals with cerebral palsy by a combination of anatomical cross-sectional area and muscle length. 2D ultrasound may be a convenient method of making these measurements routinely in the clinic.
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Affiliation(s)
- Inti M Vanmechelen
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London SE1 9RT, United Kingdom
| | - Adam P Shortland
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London SE1 9RT, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Jonathan J Noble
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London SE1 9RT, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, London SE1 7EH, United Kingdom.
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80
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Bar-On L, Kalkman BM, Cenni F, Schless SH, Molenaers G, Maganaris CN, Bass A, Holmes G, Barton GJ, O'Brien TD, Desloovere K. The Relationship Between Medial Gastrocnemius Lengthening Properties and Stretch Reflexes in Cerebral Palsy. Front Pediatr 2018; 6:259. [PMID: 30338247 PMCID: PMC6180247 DOI: 10.3389/fped.2018.00259] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022] Open
Abstract
Stretch reflex hyperactivity in the gastrocnemius of children with spastic cerebral palsy (CP) is commonly evaluated by passively rotating the ankle joint into dorsiflexion at different velocities, such as applied in conventional clinical spasticity assessments. However, surface electromyography (sEMG) collected from the medial gastrocnemius (MG) during such examination reveals unexplained heterogeneity in muscle activation between patients. Recent literature also highlights altered muscle tensile behavior in children with spastic CP. We aimed to document MG muscle and tendon lengthening during passive ankle motion at slow and fast velocity and explore its interdependence with the elicited hyperactive stretch reflex. The ankle of 15 children with CP (11 ± 3 years, GMFCS 9I 6II, 8 bilateral, 7 unilateral) and 16 typically developing children (TDC) was passively rotated over its full range of motion at slow and fast velocity. Ultrasound, synchronized with motion-analysis, was used to track the movement of the MG muscle-tendon junction and extract the relative lengthening of muscle and tendon during joint rotation. Simultaneously, MG sEMG was measured. Outcome parameters included the angular and muscle lengthening velocities 30 ms before EMG onset and the gain in root mean square EMG during stretch, as a measure of stretch reflex activity. Compared to slow rotation, the muscle lengthened less and stretch reflex activity was higher during fast rotation. These velocity-induced changes were more marked in CP compared to TDC. In the CP group, muscle-lengthening velocity had higher correlation coefficients with stretch reflex hyperactivity than joint angular velocity. Muscles with greater relative muscle lengthening during slow rotation had earlier and stronger stretch reflexes during fast rotation. These initial results suggest that ankle angular velocity is not representative of MG muscle lengthening velocity and is less related to stretch reflex hyperactivity than MG muscle lengthening. In addition, muscles that lengthened more during slow joint rotation were more likely to show a velocity-dependent stretch reflex. This interdependence of muscle lengthening and stretch reflexes may be important to consider when administering treatment. However, muscle and tendon lengthening properties alone could not fully explain the variability in stretch reflexes, indicating that other factors should also be investigated.
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Affiliation(s)
- Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Barbara M Kalkman
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Francesco Cenni
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | | | - Guy Molenaers
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Constantinos N Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Alfie Bass
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Gill Holmes
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Gabor J Barton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Thomas D O'Brien
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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81
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Noble JJ, Chruscikowski E, Fry NRD, Lewis AP, Gough M, Shortland AP. The relationship between lower limb muscle volume and body mass in ambulant individuals with bilateral cerebral palsy. BMC Neurol 2017; 17:223. [PMID: 29284423 PMCID: PMC5747099 DOI: 10.1186/s12883-017-1005-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/11/2017] [Indexed: 12/25/2022] Open
Abstract
Background Individuals with cerebral palsy have smaller muscle volumes normalised to body mass than their typically developing peers. The aim of this study is to investigate the relationship between lower limb muscle volume and body mass in young people with bilateral cerebral palsy and their typically developing peers. Methods Twenty-five participants with bilateral cerebral palsy (aged 14.7±3.0 years, GMFCS level I-III) and 25 of their typically developing peers (aged 16.8±3.3 years) took part in this study. None of the participants had undergone orthopaedic surgery, botulinum toxin injections, or serial casting in the previous year. All participants underwent magnetic resonance imaging of both lower limbs. Nine major muscles of each lower limb were individually manually segmented and the muscle volumes calculated. Results Body mass and total lower limb muscle volume were significantly linearly related in both the cerebral palsy (R2 = 0.75, p<0.001) and typically developing (R2 = 0.77, p<0.001) groups. The slope of the relationship between muscle volume and body mass was significantly shallower in the cerebral palsy group compared to the typically developing group (p=0.007). Conclusions This cross-sectional study suggests that the increase in size of lower limb muscles relative to body mass is reduced in adolescents and young adults with cerebral palsy. Longitudinal studies are required to further investigate altered muscle growth trajectories in this group and their impact on long-term mobility. Electronic supplementary material The online version of this article (10.1186/s12883-017-1005-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan J Noble
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK. .,Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK.
| | - Emily Chruscikowski
- Department of Medical Engineering and Physics, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Nicola R D Fry
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK
| | - Andrew P Lewis
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Martin Gough
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK
| | - Adam P Shortland
- One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, SE1 9RT, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
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82
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Obst SJ, Boyd R, Read F, Barber L. Quantitative 3-D Ultrasound of the Medial Gastrocnemius Muscle in Children with Unilateral Spastic Cerebral Palsy. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2814-2823. [PMID: 28967503 DOI: 10.1016/j.ultrasmedbio.2017.08.929] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/07/2017] [Accepted: 08/13/2017] [Indexed: 06/07/2023]
Abstract
Three-dimensional ultrasound (3-DUS) was used to examine the size and appearance of the medial gastrocnemius (MG) muscle in children with unilateral cerebral palsy (CP). Twenty-six children with CP and 10 typically developing (TD) children participated. Three-dimensional US images of both limbs in children with CP and the right limb in TD children were analysed using quantitative methods to determine muscle volume, global echo intensity, global echo pattern and regional echo intensity. Significant differences in MG volume and all echo parameters were found between TD and CP children. The more involved limb was smaller and had higher echo intensity and a more heterogenous echo pattern compared with the TD group. Compared with that of the more involved limb, the MG of the less involved limb was larger but had a similar echo appearance. The MG of both limbs in children with unilateral spastic CP is smaller and, based on quantitative ultrasound, structurally different from that of TD children.
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Affiliation(s)
- Steven J Obst
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia.
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Felicity Read
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Pingel J, Suhr F. Are mechanically sensitive regulators involved in the function and (patho)physiology of cerebral palsy-related contractures? J Muscle Res Cell Motil 2017; 38:317-330. [PMID: 29190010 DOI: 10.1007/s10974-017-9489-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022]
Abstract
Skeletal muscle tissue is mechanosensitive, as it is able to sense mechanical impacts and to translate these into biochemical signals making the tissue adapt. Among its mechanosensitive nature, skeletal muscle tissue is the largest metabolic organ of the human body. Disturbances in skeletal muscle mechanosensing and metabolism cause and contribute to many diseases, i.e. muscular dystrophies/myopathies, cardiovascular diseases, COPD or diabetes mellitus type 2. A less commonly focused muscle-related disorder is clinically known as muscle contractures that derive from cerebral palsy (CP) conditions in young and adults. Muscle contractures are characterized by gradually increasing passive muscle stiffness resulting in complete fixation of joints. Different mechanisms have been identified in CP-related contractures, i.e. altered calcium handling, altered metabolism or altered titin regulation. The muscle-related extracellular matrix (ECM), specifically collagens, plays a role in CP-related contractures. Herein, we focus on mechanically sensitive complexes, known as costameres (Cstms), and discuss their potential role in CP-related contractures. We extend our discussion to the ECM due to the limited knowledge of its role in CP-related contractures. The aims of this review are (1) to summarize CP-related contracture mechanisms, (2) to raise novel hypotheses on the genesis of contractures with a focus on Cstms, and (3) to stimulate novel approaches to study CP-related contractures.
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Affiliation(s)
- Jessica Pingel
- Motor Control Lab, Department of Neuroscience and Pharmacology, University of Copenhagen, Blegdamsvej 3b, 2200, Copenhagen N, Denmark.
| | - Frank Suhr
- Exercise Physiology Research Group, Department of Movement Sciences, Biomedical Sciences Group, KU Leuven, Tervuursevest 101, box 1500, 3001, Leuven, Belgium.
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84
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Lieber RL, Roberts TJ, Blemker SS, Lee SSM, Herzog W. Skeletal muscle mechanics, energetics and plasticity. J Neuroeng Rehabil 2017; 14:108. [PMID: 29058612 PMCID: PMC5651624 DOI: 10.1186/s12984-017-0318-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/05/2017] [Indexed: 01/06/2023] Open
Abstract
The following papers by Richard Lieber (Skeletal Muscle as an Actuator), Thomas Roberts (Elastic Mechanisms and Muscle Function), Silvia Blemker (Skeletal Muscle has a Mind of its Own: a Computational Framework to Model the Complex Process of Muscle Adaptation) and Sabrina Lee (Muscle Properties of Spastic Muscle (Stroke and CP) are summaries of their representative contributions for the session on skeletal muscle mechanics, energetics and plasticity at the 2016 Biomechanics and Neural Control of Movement Conference (BANCOM 2016). Dr. Lieber revisits the topic of sarcomere length as a fundamental property of skeletal muscle contraction. Specifically, problems associated with sarcomere length non-uniformity and the role of sarcomerogenesis in diseases such as cerebral palsy are critically discussed. Dr. Roberts then makes us aware of the (often neglected) role of the passive tissues in muscles and discusses the properties of parallel elasticity and series elasticity, and their role in muscle function. Specifically, he identifies the merits of analyzing muscle deformations in three dimensions (rather than just two), because of the potential decoupling of the parallel elastic element length from the contractile element length, and reviews the associated implications for the architectural gear ratio of skeletal muscle contraction. Dr. Blemker then tackles muscle adaptation using a novel way of looking at adaptive processes and what might drive adaptation. She argues that cells do not have pre-programmed behaviors that are controlled by the nervous system. Rather, the adaptive responses of muscle fibers are determined by sub-cellular signaling pathways that are affected by mechanical and biochemical stimuli; an exciting framework with lots of potential. Finally, Dr. Lee takes on the challenging task of determining human muscle properties in vivo. She identifies the dilemma of how we can demonstrate the effectiveness of a treatment, specifically in cases of muscle spasticity following stroke or in children with cerebral palsy. She then discusses the merits of ultrasound based elastography, and the clinical possibilities this technique might hold. Overall, we are treated to a vast array of basic and clinical problems in skeletal muscle mechanics and physiology, with some solutions, and many suggestions for future research.
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Affiliation(s)
- Richard L Lieber
- Rehabilitation Institute of Chicago, Chicago, USA.,Northwestern University, Evanston, USA
| | | | | | | | - Walter Herzog
- University of Calgary, Faculty of Kinesiology, Calgary, Canada.
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Boyd RN, Davies PSW, Ziviani J, Trost S, Barber L, Ware R, Rose S, Whittingham K, Sakzewski L, Bell K, Carty C, Obst S, Benfer K, Reedman S, Edwards P, Kentish M, Copeland L, Weir K, Davenport C, Brooks D, Coulthard A, Pelekanos R, Guzzetta A, Fiori S, Wynter M, Finn C, Burgess A, Morris K, Walsh J, Lloyd O, Whitty JA, Scuffham PA. PREDICT-CP: study protocol of implementation of comprehensive surveillance to predict outcomes for school-aged children with cerebral palsy. BMJ Open 2017; 7:e014950. [PMID: 28706091 PMCID: PMC5734266 DOI: 10.1136/bmjopen-2016-014950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cerebral palsy (CP) remains the world's most common childhood physical disability with total annual costs of care and lost well-being of $A3.87b. The PREDICT-CP (NHMRC 1077257 Partnership Project: Comprehensive surveillance to PREDICT outcomes for school age children with CP) study will investigate the influence of brain structure, body composition, dietary intake, oropharyngeal function, habitual physical activity, musculoskeletal development (hip status, bone health) and muscle performance on motor attainment, cognition, executive function, communication, participation, quality of life and related health resource use costs. The PREDICT-CP cohort provides further follow-up at 8-12 years of two overlapping preschool-age cohorts examined from 1.5 to 5 years (NHMRC 465128 motor and brain development; NHMRC 569605 growth, nutrition and physical activity). METHODS AND ANALYSES This population-based cohort study undertakes state-wide surveillance of 245 children with CP born in Queensland (birth years 2006-2009). Children will be classified for Gross Motor Function Classification System; Manual Ability Classification System, Communication Function Classification System and Eating and Drinking Ability Classification System. Outcomes include gross motor function, musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function, communication difficulties, oropharyngeal dysphagia, dietary intake and body composition, participation, parent-reported and child-reported quality of life and medical and allied health resource use. These detailed phenotypical data will be compared with brain macrostructure and microstructure using 3 Tesla MRI (3T MRI). Relationships between brain lesion severity and outcomes will be analysed using multilevel mixed-effects models. ETHICS AND DISSEMINATION The PREDICT-CP protocol is a prospectively registered and ethically accepted study protocol. The study combines data at 1.5-5 then 8-12 years of direct clinical assessment to enable prediction of outcomes and healthcare needs essential for tailoring interventions (eg, rehabilitation, orthopaedic surgery and nutritional supplements) and the projected healthcare utilisation. TRIAL REGISTRATION NUMBER ACTRN: 12616001488493.
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Affiliation(s)
- Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Peter SW Davies
- Children's Nutrition Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Ziviani
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Stewart Trost
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Robert Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Stephen Rose
- CSIRO Australian e-Health Research Centre, Canberra, Australia
- Medical Imaging, Diagnostic and Interventional Neuroradiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Christopher Carty
- Queensland Children's Motion Analysis Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Steven Obst
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Priya Edwards
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Megan Kentish
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Lisa Copeland
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kelly Weir
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Clinical Governance, Education and Research, Gold Coast Health, Brisbane, Queensland, Australia
| | - Camilla Davenport
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Children's Nutrition Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Denise Brooks
- Children's Nutrition Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Alan Coulthard
- Medical Imaging, Diagnostic and Interventional Neuroradiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Rebecca Pelekanos
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Instituto Di Ricovero E Cura A Carattere Scientifico (IRCCS), Pisa, Italy
| | - Simona Fiori
- Department of Developmental Neuroscience, Instituto Di Ricovero E Cura A Carattere Scientifico (IRCCS), Pisa, Italy
| | - Meredith Wynter
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Christine Finn
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Kym Morris
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - John Walsh
- Medical Imaging, Diagnostic and Interventional Neuroradiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Queensland Children's Motion Analysis Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
- Department of Paediatric Orthopaedics, The Mater Health Services, Brisbane, Queensland, Australia
| | - Owen Lloyd
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Jennifer A Whitty
- Norwich Medical School, University of East Anglia, Norwich, UK
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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86
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von Walden F, Jalaleddini K, Evertsson B, Friberg J, Valero-Cuevas FJ, Pontén E. Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff. Front Comput Neurosci 2017; 11:30. [PMID: 28487645 PMCID: PMC5403928 DOI: 10.3389/fncom.2017.00030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/07/2017] [Indexed: 11/26/2022] Open
Abstract
Children with cerebral palsy (CP) often develop reduced passive range of motion with age. The determining factor underlying this process is believed to be progressive development of contracture in skeletal muscle that likely changes the biomechanics of the joints. Consequently, to identify the underlying mechanisms, we modeled the mechanical characteristics of the forearm flexors acting across the wrist joint. We investigated skeletal muscle strength (Grippit®) and passive stiffness and viscosity of the forearm flexors in 15 typically developing (TD) children (10 boys/5 girls, mean age 12 years, range 8–18 yrs) and nine children with CP Nine children (6 boys/3 girls, mean age 11 ± 3 years (yrs), range 7–15 yrs) using the NeuroFlexor® apparatus. The muscle stiffness we estimate and report is the instantaneous mechanical response of the tissue that is independent of reflex activity. Furthermore, we assessed cross-sectional area of the flexor carpi radialis (FCR) muscle using ultrasound. Age and body weight did not differ significantly between the two groups. Children with CP had a significantly weaker (−65%, p < 0.01) grip and had smaller cross-sectional area (−43%, p < 0.01) of the FCR muscle. Passive stiffness of the forearm muscles in children with CP was increased 2-fold (p < 0.05) whereas viscosity did not differ significantly between CP and TD children. FCR cross-sectional area correlated to age (R2 = 0.58, p < 0.01), body weight (R2 = 0.92, p < 0.0001) and grip strength (R2 = 0.82, p < 0.0001) in TD children but only to grip strength (R2 = 0.60, p < 0.05) in children with CP. We conclude that children with CP have weaker, thinner, and stiffer forearm flexors as compared to typically developing children.
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Affiliation(s)
- Ferdinand von Walden
- Department of Women's and Children's Health, Karolinska InstituteStockholm, Sweden
| | - Kian Jalaleddini
- Division of Biokinesiology and Physical Therapy, University of Southern CaliforniaLos Angeles, CA, USA
| | - Björn Evertsson
- Department of Neurology, Karolinska Hospital HuddingeStockholm, Sweden.,Karolinska InstituteStockholm, Sweden
| | - Johanna Friberg
- Department of Women's and Children's Health, Karolinska InstituteStockholm, Sweden.,Karolinska InstituteStockholm, Sweden
| | - Francisco J Valero-Cuevas
- Division of Biokinesiology and Physical Therapy, University of Southern CaliforniaLos Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern CaliforniaLos Angeles, CA, USA
| | - Eva Pontén
- Department of Women's and Children's Health, Karolinska InstituteStockholm, Sweden.,Department of Pediatric orthopedic Surgery, Astrid Lindgren's Children HospitalStockholm, Sweden
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87
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Sartori M, Fernandez JW, Modenese L, Carty CP, Barber LA, Oberhofer K, Zhang J, Handsfield GG, Stott NS, Besier TF, Farina D, Lloyd DG. Toward modeling locomotion using electromyography-informed 3D models: application to cerebral palsy. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2016; 9. [DOI: 10.1002/wsbm.1368] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 01/17/2023]
Affiliation(s)
- M. Sartori
- Department of Trauma Surgery; Orthopedics and Plastic Surgery, Neurorehabilitation Systems Research Group, University Medical Center Göttingen; Göttingen Germany
| | - J. W. Fernandez
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - L. Modenese
- Department of Mechanical Engineering; The University of Sheffield; Sheffield UK
- Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service; Children's Health Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
| | - C. P. Carty
- Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service; Children's Health Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
- School of Allied Health Sciences; Griffith University; Queensland Australia
| | - L. A. Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine; The University of Queensland; Brisbane Australia
| | - K. Oberhofer
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - J. Zhang
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - G. G. Handsfield
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - N. S. Stott
- School of Medicine; University of Auckland; Auckland New Zealand
| | - T. F. Besier
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - D. Farina
- Department of Bioengineering; Imperial College London; London UK
| | - D. G. Lloyd
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
- School of Allied Health Sciences; Griffith University; Queensland Australia
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88
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Bar-On L, Slane LC. Shear wave elastography for the assessment of muscle stiffness in children with CP: insights and challenges. Dev Med Child Neurol 2016; 58:1209-1210. [PMID: 27435608 DOI: 10.1111/dmcn.13206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Laura C Slane
- Institute for Orthopaedic Research and Training, KU Leuven, Leuven, Belgium
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89
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Ong C, Lee JH, Leow MKS, Puthucheary ZA. Skeletal Muscle Ultrasonography in Nutrition and Functional Outcome Assessment of Critically Ill Children: Experience and Insights From Pediatric Disease and Adult Critical Care Studies. JPEN J Parenter Enteral Nutr 2016; 41:1091-1099. [DOI: 10.1177/0148607116683143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Chengsi Ong
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Nutrition and Dietetics, KK Women’s and Children’s Hospital, Singapore
| | - Jan Hau Lee
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
- Office of Clinical Sciences, Duke-NUS Medical School, Singapore
| | - Melvin K. S. Leow
- Office of Clinical Sciences, Duke-NUS Medical School, Singapore
- Clinical Nutrition Research Centre, A*STAR-NUHS, Centre for Translational Medicine, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Zudin A. Puthucheary
- Department of Critical Care Medicine, University College London Hospitals, London, UK
- Institute for Sport, Exercise and Health, University College London Hospitals, London, UK
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90
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Barber LA, Read F, Lovatt Stern J, Lichtwark G, Boyd RN. Medial gastrocnemius muscle volume in ambulant children with unilateral and bilateral cerebral palsy aged 2 to 9 years. Dev Med Child Neurol 2016; 58:1146-1152. [PMID: 27098082 DOI: 10.1111/dmcn.13132] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 12/23/2022]
Abstract
AIM Calf muscle growth in children with unilateral cerebral palsy (UCP) and bilateral cerebral palsy (BCP) is unknown. This cross-sectional study examines the medial gastrocnemius growth rates of ambulatory children with UCP and BCP compared with children with typical development (CTD), aged 2 to 9 years. METHOD Fifty children with UCP (mean age 66mo [SD 18], 29 males, Gross Motor Function Classification System [GMFCS] I=32, II=18), 50 children with BCP (age 64mo [SD 19], 31 males, GMFCS I=21, II=29), and 78 CTD (age 64mo [SD 16], 40 males) participated in the study. The medial gastrocnemius muscle volume was measured at rest using a validated freehand three-dimensional (3D) ultrasound method. RESULTS Normalized medial gastrocnemius muscle growth rate was significantly less in the children with UCP (0.001 mL/kg/mo) compared with the BCP (0.015 mL/kg/mo, p=0.001) and CTD (0.014 mL/kg/mo, p<0.001) groups. Normalized medial gastrocnemius muscle growth rate was the same in the BCP and CTD groups (p=0.77). INTERPRETATION The normalized growth rate of the medial gastrocnemius muscle in children aged 2 to 9 years with UCP is significantly lower compared with children with BCP and CTD. The growth rate differences in the children with UCP compared with BCP raises questions about the underlying mechanisms that lead to reduced growth in each cerebral palsy (CP) group and potential differences in muscle recovery response in UCP and BCP following treatment.
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Affiliation(s)
- Lee A Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia.
| | - Felicity Read
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia
| | - Jacquie Lovatt Stern
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia
| | - Glen Lichtwark
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Qld, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia
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91
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Gillett JG, Boyd RN, Carty CP, Barber LA. The impact of strength training on skeletal muscle morphology and architecture in children and adolescents with spastic cerebral palsy: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 56:183-196. [PMID: 27337690 DOI: 10.1016/j.ridd.2016.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/27/2016] [Accepted: 06/03/2016] [Indexed: 06/06/2023]
Abstract
AIM The aim of this study was to systematically review the current literature to determine the impact of strength training on skeletal muscle morphology and architecture in individuals aged 4-20 years with spastic type cerebral palsy. METHODS A comprehensive search for randomised and non-randomised controlled trials, cohort studies and cross-comparison trials was performed on five electronic databases. Included studies were graded according to level of evidence and assessed for methodological quality using the Downs and Black scale. Quantitative data was analysed using effect sizes. RESULTS Six of 304 articles met the inclusion criteria. Methodological quality of the included papers ranged from 14 to 19 (out of 32). A large effect was found on muscle cross-sectional area following strength training, with small to moderate effects on muscle volume and thickness. CONCLUSION AND IMPLICATIONS There is preliminary evidence that strength training leads to hypertrophy in children and adolescents with CP. A paucity of studies exist measuring morphological and architectural parameters following strength training in these individuals. Overall low study methodological quality along with heterogeneous study design, dissimilar outcome measures, and lack of adequate control groups, indicated that care is needed when interpreting the results of these studies in isolation.
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Affiliation(s)
- Jarred G Gillett
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, South Brisbane, Queensland, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, South Brisbane, Queensland, Australia
| | - Christopher P Carty
- Queensland Children's Motion Analysis Service, Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lee A Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, South Brisbane, Queensland, Australia
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92
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Kalsi G, Fry NR, Shortland AP. Gastrocnemius muscle-tendon interaction during walking in typically-developing adults and children, and in children with spastic cerebral palsy. J Biomech 2016; 49:3194-3199. [PMID: 27545082 DOI: 10.1016/j.jbiomech.2016.07.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Our understanding of the interaction of muscle bellies and their tendons in individuals with muscle pathology is limited. Knowledge of these interactions may inform us of the effects of musculoskeletal pathologies on muscle-tendon dynamics and the subsequent neurological control strategies used in gait. Here, we investigate gastrocnemius muscle-tendon interaction in typically-developing (TD) adults and children, and in children with spastic cerebral palsy (SCP). METHODS We recruited six TD adults (4 female; mean age: 34 yrs. (24-54)), eight TD children (5 female; mean age: 10 yrs. (6-12)) and eight independently ambulant children with SCP (5 female; mean age 9 yrs. (6-12); 3 unilaterally-affected). A combination of 3D motion capture and 2D real-time ultrasound imaging were used to compute the gastrocnemius musculo-tendinous unit (MTU) length and estimate muscle belly and tendon lengths during walking. For the TD subjects, the measurements were made for heel-toe walking and voluntary toe-walking. RESULTS The gastrocnemius muscle bellies of children with SCP lengthened during single support (p = 0.003). In contrast, the muscle bellies of TD subjects did not demonstrate an increase in length over the period of single support under heel-toe or toe-walking conditions. CONCLUSION We observed lengthening of the gastrocnemius muscle bellies in children with SCP during single support, a phase of the gait cycle in which the muscle is reported consistently to be active. Repeated lengthening of muscle bellies while they are active may lead to muscle damage and have implications for the natural history of gait in this group.
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Affiliation(s)
- Gursharan Kalsi
- Clinical Physics, Barts Health NHS Trust, The Royal London Hospital, 56-76 Ashfield Street, Whitechapel, London E1 1BB, UK; One Small Step Gait Laboratory, Guy׳s and St. Thomas' NHS Foundation Trust, Guy׳s Hospital, London SE1 9RT, UK.
| | - Nicola R Fry
- One Small Step Gait Laboratory, Guy׳s and St. Thomas' NHS Foundation Trust, Guy׳s Hospital, London SE1 9RT, UK
| | - Adam P Shortland
- One Small Step Gait Laboratory, Guy׳s and St. Thomas' NHS Foundation Trust, Guy׳s Hospital, London SE1 9RT, UK; Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King׳s College London, King׳s Health Partners,St. Thomas' Hospital, London SE1 7EH, UK
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93
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Eldridge F, Lavin N. How effective is stretching in maintaining range of movement for children with cerebral palsy? A critical review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.8.386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Fleur Eldridge
- Graduate physiotherapist, University of Bradford, Bradford, UK
| | - Nicole Lavin
- Physiotherapy lecturer, Division of Allied Health Professions and Sport, Faculty of Health Studies, University of Bradford, Bradford, UK
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94
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van der Krogt MM, Bar-On L, Kindt T, Desloovere K, Harlaar J. Neuro-musculoskeletal simulation of instrumented contracture and spasticity assessment in children with cerebral palsy. J Neuroeng Rehabil 2016; 13:64. [PMID: 27423898 PMCID: PMC4947289 DOI: 10.1186/s12984-016-0170-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 06/29/2016] [Indexed: 11/21/2022] Open
Abstract
Background Increased resistance in muscles and joints is an important phenomenon in patients with cerebral palsy (CP), and is caused by a combination of neural (e.g. spasticity) and non-neural (e.g. contracture) components. The aim of this study was to simulate instrumented, clinical assessment of the hamstring muscles in CP using a conceptual model of contracture and spasticity, and to determine to what extent contracture can be explained by altered passive muscle stiffness, and spasticity by (purely) velocity-dependent stretch reflex. Methods Instrumented hamstrings spasticity assessment was performed on 11 children with CP and 9 typically developing children. In this test, the knee was passively stretched at slow and fast speed, and knee angle, applied forces and EMG were measured. A dedicated OpenSim model was created with motion and muscles around the knee only. Contracture was modeled by optimizing the passive muscle stiffness parameters of vasti and hamstrings, based on slow stretch data. Spasticity was modeled using a velocity-dependent feedback controller, with threshold values derived from experimental data and gain values optimized for individual subjects. Forward dynamic simulations were performed to predict muscle behavior during slow and fast passive stretches. Results Both slow and fast stretch data could be successfully simulated by including subject-specific levels of contracture and, for CP fast stretches, spasticity. The RMS errors of predicted knee motion in CP were 1.1 ± 0.9° for slow and 5.9 ± 2.1° for fast stretches. CP hamstrings were found to be stiffer compared with TD, and both hamstrings and vasti were more compliant than the original generic model, except for the CP hamstrings. The purely velocity-dependent spasticity model could predict response during fast passive stretch in terms of predicted knee angle, muscle activity, and fiber length and velocity. Only sustained muscle activity, independent of velocity, was not predicted by our model. Conclusion The presented individually tunable, conceptual model for contracture and spasticity could explain most of the hamstring muscle behavior during slow and fast passive stretch. Future research should attempt to apply the model to study the effects of spasticity and contracture during dynamic tasks such as gait. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0170-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marjolein Margaretha van der Krogt
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Heverlee, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Thalia Kindt
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Heverlee, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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95
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Herskind A, Ritterband-Rosenbaum A, Willerslev-Olsen M, Lorentzen J, Hanson L, Lichtwark G, Nielsen JB. Muscle growth is reduced in 15-month-old children with cerebral palsy. Dev Med Child Neurol 2016; 58:485-91. [PMID: 26510820 DOI: 10.1111/dmcn.12950] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/28/2022]
Abstract
AIM Lack of muscle growth relative to bone growth may be responsible for development of contractures in children with cerebral palsy (CP). Here, we used ultrasonography to compare growth of the medial gastrocnemius muscle in children with and without CP. METHOD Twenty-six children with spastic CP (15 males, 11 females; mean age 35mo, range 8-65mo) and 101 typically developing children (47 males, 54 females; mean age 29mo, range 1-69mo) were included. Functional abilities of children with CP equalled levels I to III in the Gross Motor Function Classification System. Medial gastrocnemius muscle volume was constructed from serial, transverse, two-dimensional ultrasonography images. RESULTS In typically developing children, medial gastrocnemius volume increased linearly with age. Among children with CP, medial gastrocnemius volume increased less with age and deviated significantly from typically developing children at 15 months of age (p<0.05). Bone length increased with age without significant difference (p=0.49). INTERPRETATION Muscle growth in children with CP initially follows that of typically developing children, but decreases at 15 months of age. This may be related to reduced physical activity and neural activation of the muscle. Interventions stimulating muscle growth in young children with CP may be important to prevent contractures.
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Affiliation(s)
- Anna Herskind
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Lars Hanson
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Glen Lichtwark
- School of Human Movement Studies, University of Queensland, Brisbane, Qld, Australia
| | - Jens B Nielsen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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96
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Affiliation(s)
- Lee A Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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97
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Passmore E, Pandy MG, Graham HK, Sangeux M. Measuring Femoral Torsion In Vivo Using Freehand 3-D Ultrasound Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:619-623. [PMID: 26639301 DOI: 10.1016/j.ultrasmedbio.2015.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 06/05/2023]
Abstract
Despite variation in bone geometry, muscle and joint function is often investigated using generic musculoskeletal models. Patient-specific bone geometry can be obtained from computerised tomography, which involves ionising radiation, or magnetic resonance imaging (MRI), which is costly and time consuming. Freehand 3-D ultrasound provides an alternative to obtain bony geometry. The purpose of this study was to determine the accuracy and repeatability of 3-D ultrasound in measuring femoral torsion. Measurements of femoral torsion were performed on 10 healthy adults using MRI and 3-D ultrasound. Measurements of femoral torsion from 3-D ultrasound were, on average, smaller than those from MRI (mean difference = 1.8°; 95% confidence interval: -3.9°, 7.5°). MRI and 3-D ultrasound had Bland and Altman repeatability coefficients of 3.1° and 3.7°, respectively. Accurate measurements of femoral torsion were obtained with 3-D ultrasound offering the potential to acquire patient-specific bone geometry for musculoskeletal modelling. Three-dimensional ultrasound is non-invasive and relatively inexpensive and can be integrated into gait analysis.
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Affiliation(s)
- Elyse Passmore
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia.
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia
| | - H Kerr Graham
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Morgan Sangeux
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia
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98
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Tustin K, Patel A. A Critical Evaluation of the Updated Evidence for Casting for Equinus Deformity in Children with Cerebral Palsy. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 22. [DOI: 10.1002/pri.1646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/15/2015] [Accepted: 06/12/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Kylee Tustin
- Complex Motor Disorders Service, Guy's and St Thomas' NHS Foundation Trust; Evelina London Children's Hospital; 6th Floor Sky, Westminster Bridge Road London SE1 7EH UK
| | - Anita Patel
- Paediatric Neurosciences, Guy's and St Thomas' NHS Foundation Trust; Evelina London Children's Hospital; 6th Floor Sky, Westminster Bridge Road London SE1 7EH UK
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99
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Abstract
Patients with cerebral palsy present with a variety of adaptations to muscle structure and function. These pathophysiologic symptoms include functional deficits such as decreased force production and range of motion, in addition to changes in muscle structure such as decreased muscle belly size, increased sarcomere length, and altered extracellular matrix structure and composition. On a cellular level, patients with cerebral palsy have fewer muscle stem cells, termed satellite cells, and altered gene expression. Understanding the nature of these changes may present opportunities for the development of new muscle treatment therapies.
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Affiliation(s)
- Margie A Mathewson
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412, USA
| | - Richard L Lieber
- Department of Orthopaedic Surgery, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0863, USA; Department of Veteran's Affairs, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.
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100
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Haberfehlner H, Maas H, Harlaar J, Newsum IE, Becher JG, Buizer AI, Jaspers RT. Assessment of net knee moment-angle characteristics by instrumented hand-held dynamometry in children with spastic cerebral palsy and typically developing children. J Neuroeng Rehabil 2015; 12:67. [PMID: 26272620 PMCID: PMC4536590 DOI: 10.1186/s12984-015-0056-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/13/2015] [Indexed: 08/21/2023] Open
Abstract
Background The limited range of motion during walking in children with spastic cerebral palsy (SCP) may be the result of altered mechanical characteristics of muscles and connective tissues around the knee joint. Measurement of static net knee moment-angle relation will provide insights into these alterations, for which instrumented hand-held dynamometry may be applied. The aims of this study were: (1) to test the measurement error of the estimated net knee moment-angle characteristics, (2) to determine the correlation between knee extension angle measurement at a standardized knee moment and popliteal angle from common physical examination and (3) to compare net knee moment–angle characteristics in SCP versus typically developing children. Methods With the child lying in sideward position, the knee was extended by moving the lower leg by a hand-held force transducer on a low friction cart. Force data were collected for a range of knee angles. Data were excluded when activity (EMG) levels of knee extensor and flexor muscles exceeded the EMG level during rest by more than two standard deviations. The net knee flexion moments were calculated from recorded force data and measured moment arm. Reliability for knee angles corresponding with 0.5, 1, 2, 3, and 4 Nm knee net flexion moments was assessed by standard error of measurements (SEM) and smallest detectable difference (SDD). Results For between day comparison, SEMs were about 5° and SDDs were below 14° for knee angles at 1-4 Nm net knee flexion moments. In SCP children, the knee angle measured at 4 Nm knee flexion moment was not related to the popliteal angle (r = 0.52). The slope at 4 Nm of the knee moment-angle curve in SCP children was significantly higher than that in typically developing children. Conclusions The presented knee hand-held dynamometry allows assessment of net knee flexion moment-knee angle characteristics in typically developing and SCP children and can be used to identify clinically relevant changes as a result of treatment. Overall stiffness of structures that contribute to the net knee flexion moment at the knee (i.e. muscles, tendons, ligaments) is elevated in SCP children. Electronic supplementary material The online version of this article (doi:10.1186/s12984-015-0056-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helga Haberfehlner
- Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. .,Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
| | - Huub Maas
- Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
| | - Irene E Newsum
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
| | - Jules G Becher
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
| | - Richard T Jaspers
- Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands. .,MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 9, 1081, BT, Amsterdam, The Netherlands.
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