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Paleg GS, Williams SA, Livingstone RW. Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:669. [PMID: 38928915 PMCID: PMC11203597 DOI: 10.3390/ijerph21060669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Children functioning at Gross Motor Function Classification System (GMFCS) levels IV-V cannot maintain an aligned standing position or take steps without support. Upright positioning and mobility devices have psycho-social significance for these children and their families, enhancing use of vision, communication, functioning and emotional well-being. Standers and supported stepping devices facilitate opportunities for biomechanical loading, potentially helping to build and maintain muscle and bone integrity, and they promote physical development. However, families are often required to choose between these two devices for their young child. This study aims to synthesize evidence for use and benefits of both supported standing and stepping devices through the lens of two contemporary theoretical frameworks to support clinical reasoning and implementation. The F-words for childhood development (functioning, family, fitness, fun, friends, future) and the interdependence-Human Activity Assistive Technology (iHAAT) models were combined to illustrate the complex interactions between the child, family, caregivers, peers and contextual factors when implementing standing and stepping devices with children at GMFCS levels IV and V. Supported standing and stepping devices provide complementary benefits, and both may be necessary starting at 9-15 months. We propose they both be included ON-Time, along with other age-appropriate positioning and mobility devices, to promote more equitable developmental opportunities for children with non-ambulant cerebral palsy.
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Affiliation(s)
| | - Sian A. Williams
- School of Allied Health, Curtin University, Perth, WA 6009, Australia;
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand
| | - Roslyn W. Livingstone
- Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
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Andries A, Deschrevel J, Maes K, De Beukelaer N, Corvelyn M, Staut L, De Houwer H, Costamagna D, Nijs S, Metsemakers WJ, Nijs E, Hens G, De Wachter E, Prinsen S, Desloovere K, Van Campenhout A, Gayan-Ramirez G. Histological analysis of the medial gastrocnemius muscle in young healthy children. Front Physiol 2024; 15:1336283. [PMID: 38651045 PMCID: PMC11034367 DOI: 10.3389/fphys.2024.1336283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction: Histological data on muscle fiber size and proportion in (very) young typically developing (TD) children is not well documented and data on capillarization and satellite cell content are also lacking. Aims: This study investigated the microscopic properties of the medial gastrocnemius muscle in growing TD children, grouped according to age and gender to provide normal reference values in healthy children. Methods: Microbiopsies of the medial gastrocnemius (MG) muscle were collected in 46 TD boys and girls aged 2-10 years subdivided into 4 age groups (2-4, 4-6, 6-8 and 8-10 years). Sections were immunostained to assess fiber type cross-sectional area (fCSA) and proportion, the number of satellite cells (SC), capillary to fiber ratio (C/F), capillary density for type I and II fiber (CFD), capillary domain, capillary-to-fiber perimeter exchange index (CFPE) and heterogeneity index. fCSA was normalized to fibula length2 and the coefficient of variation (CV) was calculated to reflect fCSA intrasubject variability. Results: Absolute fCSA of all fibers increased with age (r = 0.72, p < 0.001) but more in boys (+112%, p < 0.05) than in girls (+48%, p > 0.05) Normalized fCSA, CV and fiber proportion did not differ between age groups and gender. C/F was strongly correlated with age in boys (r = 0.83, p < 0.001), and to a lesser extent in girls (r = 0.37, p = 0.115), while other capillary parameters as well as the number of SC remained stable with increasing age in boys and girls. Discussion: This study provides reference values of histological measures in MG according to age in normally growing boys and girls. These data may be used as a reference to determine disease impact and efficacy of therapeutic approach on the muscle.
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Affiliation(s)
- Anke Andries
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
| | - Jorieke Deschrevel
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
| | - Karen Maes
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
| | - Nathalie De Beukelaer
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU-Leuven, Leuven, Belgium
| | - Marlies Corvelyn
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU-Leuven, Leuven, Belgium
| | - Lauraine Staut
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU-Leuven, Leuven, Belgium
| | - Hannah De Houwer
- Pediatric Orthopedics, Department of Development and Regeneration, KU-Leuven, Leuven, Belgium
| | - Domiziana Costamagna
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU-Leuven, Leuven, Belgium
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU-Leuven, Leuven, Belgium
- Exercise Physiology Research Group, Department of Movement Sciences, KU-Leuven, Leuven, Belgium
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Elga Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Greet Hens
- Department of Ear Nose Throat, University Hospitals Leuven, Leuven, Belgium
| | - Eva De Wachter
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sandra Prinsen
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU-Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Pediatric Orthopedics, Department of Development and Regeneration, KU-Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
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Deschrevel J, Andries A, Maes K, Peeters J, van Opstal A, Jiang D, De Beukelaer N, Corvelyn M, Staut L, De Houwer H, Costamagna D, Desloovere K, Van Campenhout A, Gayan-Ramirez G. Histological analysis of the gastrocnemius muscle in preschool and school age children with cerebral palsy compared with age-matched typically developing children. Am J Physiol Cell Physiol 2024; 326:C573-C588. [PMID: 38105751 DOI: 10.1152/ajpcell.00344.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
Inconsistent alterations in skeletal muscle histology have been reported in adolescents with cerebral palsy (CP) and whether alterations are present in young children and differ from older children is not yet known. This study aimed to define histological alterations in the medial gastrocnemius (MG) of ambulant CP (gross-motor classification system, GMFCS I-III) stratified in two age groups (preschool children, PS: 2-5 and school age children, SA: 6-9-yr old) compared with age-matched typically developing (TD) children. We hypothesized that alterations in muscle microscopic properties are already present in PS-CP and are GMFCS level specific. Ultrasound guided percutaneous microbiopsies were collected in 46 CP (24-PS) and 45 TD (13-PS) children. Sections were stained to determine fiber cross-sectional area (fCSA) and proportion, capillary, and satellite cell amount. Average absolute and normalized fCSA were similar in CP and TD, but a greater percentage of smaller fibers was found in CP. Coefficient of variation (CV) was significantly larger in PS-CP-GMFCS I-II and for type I fiber. In SA-CP, all fiber types contributed to the higher CV. Type IIx proportion was higher and type I was lower in PS-CP-GMFCS-III and for all SA-CP. Reduced capillary-to-fiber ratio was present in PS-CP-GMFCS II-III and in all SA-CP. Capillary fiber density was lower in SA-CP. Capillary domain was enhanced in all CP, but capillary spatial distribution was maintained as was satellite cell content. We concluded that MG histological alterations are already present in very young CP but are only partly specific for GMFCS level and age.NEW & NOTEWORTHY Inconsistent histological alterations have been reported in children with cerebral palsy (CP) but whether they are present in very young and ambulant CP children and differ from those reported in old CP children is not known. This study highlighted for the first time that enhanced muscle fiber size variability and loss of capillaries are already present in very young CP children, even in the most ambulant ones, and these alterations seem to extend with age.
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Affiliation(s)
- Jorieke Deschrevel
- Laboratory of Respiratory Diseases and Thoracic surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
| | - Anke Andries
- Laboratory of Respiratory Diseases and Thoracic surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
| | - Karen Maes
- Laboratory of Respiratory Diseases and Thoracic surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
| | - Jules Peeters
- Laboratory of Respiratory Diseases and Thoracic surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
| | - Axel van Opstal
- Laboratory of Respiratory Diseases and Thoracic surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
| | - Dina Jiang
- Laboratory of Respiratory Diseases and Thoracic surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
| | - Nathalie De Beukelaer
- Neurorehabilitation group, Department of Rehabilitation Sciences, KU-Leuven, Leuven, Belgium
| | - Marlies Corvelyn
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU-Leuven, Leuven, Belgium
| | - Lauraine Staut
- Neurorehabilitation group, Department of Rehabilitation Sciences, KU-Leuven, Leuven, Belgium
| | - Hannah De Houwer
- Pediatric Orthopedics, Department of Development and Regeneration, KU-Leuven, Leuven, Belgium
| | - Domiziana Costamagna
- Neurorehabilitation group, Department of Rehabilitation Sciences, KU-Leuven, Leuven, Belgium
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU-Leuven, Leuven, Belgium
- Exercise Physiology Research group, Department of Movement Sciences, KU-Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Neurorehabilitation group, Department of Rehabilitation Sciences, KU-Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Pediatric Orthopedics, Department of Development and Regeneration, KU-Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic surgery, Department of Chronic Diseases and Metabolism, KU-Leuven, Leuven, Belgium
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Kahn RE, Krater T, Larson JE, Encarnacion M, Karakostas T, Patel NM, Swaroop VT, Dayanidhi S. Resident muscle stem cell myogenic characteristics in postnatal muscle growth impairments in children with cerebral palsy. Am J Physiol Cell Physiol 2023; 324:C614-C631. [PMID: 36622072 PMCID: PMC9942895 DOI: 10.1152/ajpcell.00499.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023]
Abstract
Children with cerebral palsy (CP), a perinatal brain alteration, have impaired postnatal muscle growth, with some muscles developing contractures. Functionally, children are either able to walk or primarily use wheelchairs. Satellite cells are muscle stem cells (MuSCs) required for postnatal development and source of myonuclei. Only MuSC abundance has been previously reported in contractured muscles, with myogenic characteristics assessed only in vitro. We investigated whether MuSC myogenic, myonuclear, and myofiber characteristics in situ differ between contractured and noncontractured muscles, across functional levels, and compared with typically developing (TD) children with musculoskeletal injury. Open muscle biopsies were obtained from 36 children (30 CP, 6 TD) during surgery; contracture correction for adductors or gastrocnemius, or from vastus lateralis [bony surgery in CP, anterior cruciate ligament (ACL) repair in TD]. Muscle cross sections were immunohistochemically labeled for MuSC abundance, activation, proliferation, nuclei, myofiber borders, type-1 fibers, and collagen content in serial sections. Although MuSC abundance was greater in contractured muscles, primarily in type-1 fibers, their myogenic characteristics (activation, proliferation) were lower compared with noncontractured muscles. Overall, MuSC abundance, activation, and proliferation appear to be associated with collagen content. Myonuclear number was similar between all muscles, but only in contractured muscles were there associations between myonuclear number, MuSC abundance, and fiber cross-sectional area. Puzzlingly, MuSC characteristics were similar between ambulatory and nonambulatory children. Noncontractured muscles in children with CP had a lower MuSC abundance compared with TD-ACL injured children, but similar myogenic characteristics. Contractured muscles may have an intrinsic deficiency in developmental progression for postnatal MuSC pool establishment, needed for lifelong efficient growth and repair.
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Affiliation(s)
| | | | - Jill E Larson
- Shirley Ryan AbilityLab, Chicago, Illinois
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Tasos Karakostas
- Shirley Ryan AbilityLab, Chicago, Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Neeraj M Patel
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Vineeta T Swaroop
- Shirley Ryan AbilityLab, Chicago, Illinois
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sudarshan Dayanidhi
- Shirley Ryan AbilityLab, Chicago, Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ebrahimi A, Martin JA, Schwartz MH, Novacheck TF, Thelen DG. American Society of Biomechanics Clinical Biomechanics Award 2021: Redistribution of muscle-tendon work in children with cerebral palsy who walk in crouch. Clin Biomech (Bristol, Avon) 2023; 102:105871. [PMID: 36701840 PMCID: PMC10017182 DOI: 10.1016/j.clinbiomech.2023.105871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/22/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Previous study showed the triceps surae exhibits spring-like behavior about the ankle during walking in children with cerebral palsy. Thus, the work generated by the triceps surae is diminished relative to typically developing children. This study investigated whether the quadriceps offset the lack of triceps surae work production in children with cerebral palsy who walk in crouch. METHODS Seven children with cerebral palsy (8-16 yrs) and 14 typically developing controls (8-17 yrs) walked overground at their preferred speed in a motion analysis laboratory. Shear wave tensiometers were used to track patellar and Achilles tendon loading throughout the gait cycle. Tendon force measures were coupled with muscle-tendon kinematic estimates to characterize the net work generated by the quadriceps and triceps surae about the knee and ankle, respectively. FINDINGS Children with cerebral palsy generated significantly less triceps surae work when compared to controls (P < 0.001). The reverse was true at the knee. Children with cerebral palsy generated positive net work from the quadriceps about the knee, which exceeded the net quadriceps work generated by controls (P = 0.028). INTERPRETATION There was a marked difference in functional behavior of the triceps surae and quadriceps in children with cerebral palsy who walk in crouch. In particular, the triceps surae of children with cerebral palsy exhibited spring-like behavior about the ankle while the quadriceps exhibited more motor-like behavior about the knee. This redistribution in work could partly be associated with the elevated energetic cost of walking in children with cerebral palsy and is relevant to consider when planning treatments to correct crouch gait.
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Affiliation(s)
| | | | - Michael H Schwartz
- Gillette Children's, St. Paul, MN, USA; University of Minnesota, Minneapolis, MN, USA
| | - Tom F Novacheck
- Gillette Children's, St. Paul, MN, USA; University of Minnesota, Minneapolis, MN, USA
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6
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Acute Response to One Bout of Dynamic Standing Exercise on Blood Glucose and Blood Lactate Among Children and Adolescents With Cerebral Palsy Who are Nonambulant. Pediatr Exerc Sci 2022; 34:93-98. [PMID: 35016158 DOI: 10.1123/pes.2021-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the acute exercise effects of dynamic standing exercise on blood glucose and blood lactate among children and adolescents with cerebral palsy who are nonambulant. METHODS Twenty-four participants with cerebral palsy who are nonambulant performed 30 minutes of dynamic standing exercise using a motorized device enabling assisted passive movements in an upright weight-bearing position. Capillary blood samples were taken from the fingertip for measurement of blood glucose and blood lactate at rest and at the end of exercise. RESULTS At rest, the participants had hyperlactatemia that was unaffected after exercise, presented as median and interquartile range at rest 1.8 (1.3:2.7) mmol/L, and after exercise 2.0 (1.1:2.5) mmol/L. Children and adolescents with Gross Motor Function Classification System, level V, had higher lactate levels at rest (2.5 [1.8:2.9] vs 1.4 [1.0:2.0]; P = .030) and after exercise (2.3 [2.0:2.6] vs 1.2 [0.9:2.2]; P = .032) compared with children and adolescents with Gross Motor Function Classification System, level IV, respectively. A statistically significant larger decrease in blood lactate levels after exercise was observed in children and adolescents with higher resting blood lactate levels (ρ = .56; P = .004). There were no statistically significant changes in blood glucose. CONCLUSIONS Forty percentage of the participants had mild hyperlactatemia at rest and participants with the highest blood lactate levels at rest had the greatest decrease in blood lactate levels after one bout of exercise. Children and adolescents who were classified with the highest level of the Gross Motor Function Classification Scale had higher blood lactate levels. More studies are needed on how to prevent chronically high resting levels of lactate with exercise in children with cerebral palsy who are nonambulant.
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Handsfield GG, Williams S, Khuu S, Lichtwark G, Stott NS. Muscle architecture, growth, and biological Remodelling in cerebral palsy: a narrative review. BMC Musculoskelet Disord 2022; 23:233. [PMID: 35272643 PMCID: PMC8908685 DOI: 10.1186/s12891-022-05110-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy (CP) is caused by a static lesion to the brain occurring in utero or up to the first 2 years of life; it often manifests as musculoskeletal impairments and movement disorders including spasticity and contractures. Variable manifestation of the pathology across individuals, coupled with differing mechanics and treatments, leads to a heterogeneous collection of clinical phenotypes that affect muscles and individuals differently. Growth of muscles in CP deviates from typical development, evident as early as 15 months of age. Muscles in CP may be reduced in volume by as much as 40%, may be shorter in length, present longer tendons, and may have fewer sarcomeres in series that are overstretched compared to typical. Macroscale and functional deficits are likely mediated by dysfunction at the cellular level, which manifests as impaired growth. Within muscle fibres, satellite cells are decreased by as much as 40-70% and the regenerative capacity of remaining satellite cells appears compromised. Impaired muscle regeneration in CP is coupled with extracellular matrix expansion and increased pro-inflammatory gene expression; resultant muscles are smaller, stiffer, and weaker than typical muscle. These differences may contribute to individuals with CP participating in less physical activity, thus decreasing opportunities for mechanical loading, commencing a vicious cycle of muscle disuse and secondary sarcopenia. This narrative review describes the effects of CP on skeletal muscles encompassing substantive changes from whole muscle function to cell-level effects and the effects of common treatments. We discuss growth and mechanics of skeletal muscles in CP and propose areas where future work is needed to understand these interactions, particularly the link between neural insult and cell-level manifestation of CP.
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Affiliation(s)
- Geoffrey G Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand.
| | - Sîan Williams
- Liggins Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
- School of Allied Health, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Stephanie Khuu
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
| | - Glen Lichtwark
- School of Human Movement and Nutrition Sciences, University of Queensland, QLD, St Lucia, 4072, Australia
| | - N Susan Stott
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
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Rivares C, Vignaud A, Noort W, Koopmans B, Loos M, Kalinichev M, Jaspers RT. Glycine receptor subunit-ß -deficiency in a mouse model of spasticity results in attenuated physical performance, growth and muscle strength. Am J Physiol Regul Integr Comp Physiol 2022; 322:R368-R388. [PMID: 35108108 PMCID: PMC9054346 DOI: 10.1152/ajpregu.00242.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Spasticity is the most common neurological disorder associated with increased muscle contraction causing impaired movement and gait. The aim of this study was to characterize the physical performance, skeletal muscle function, and phenotype of mice with a hereditary spastic mutation (B6.Cg-Glrbspa/J). Motor function, gait, and physical activity of juvenile and adult spastic mice and the morphological, histological, and mechanical characteristics of their soleus and gastrocnemius medialis muscles were compared with those of their wild-type (WT) littermates. Spastic mice showed attenuated growth, impaired motor function, and low physical activity. Gait of spastic mice was characterized by a typical hopping pattern. Spastic mice showed lower muscle forces, which were related to the smaller physiological cross-sectional area of spastic muscles. The muscle-tendon complex length-force relationship of adult gastrocnemius medialis was shifted toward shorter lengths, which was explained by attenuated longitudinal tibia growth. Spastic gastrocnemius medialis was more fatigue resistant than WT gastrocnemius medialis. This was largely explained by a higher mitochondrial content in muscle fibers and relatively higher percentage of slow-type muscle fibers. Muscles of juvenile spastic mice showed similar differences compared with WT juvenile mice, but these were less pronounced than between adult mice. This study shows that in spastic mice, disturbed motor function and gait is likely to be the result of hyperactivity of skeletal muscle and impaired skeletal muscle growth, which progress with age.
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Affiliation(s)
- Cintia Rivares
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - Wendy Noort
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - Maarten Loos
- Sylics (Synaptologics BV), Amsterdam, the Netherlands
| | | | - Richard T Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Ruhde L, Hulla R. An overview of the effects of whole-body vibration on individuals with cerebral palsy. J Pediatr Rehabil Med 2022; 15:193-210. [PMID: 35275570 DOI: 10.3233/prm-201508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this review is to examine how whole-body vibration can be used as a tool in therapy to help improve common physical weaknesses in balance, bone density, gait, spasticity, and strength experienced by individuals with cerebral palsy. Cerebral palsy is the most common movement disorder in children, and whole-body vibration is quickly becoming a potential therapeutic tool with some advantages compared to traditional therapies for individuals with movement disorders. The advantages of whole-body vibration include less strain and risk of injury, more passive training activity, and reduced time to complete an effective therapeutic session, all of which are appealing for populations with physiological impairments that cause physical weakness, including individuals with cerebral palsy. This review involves a brief overview of cerebral palsy, whole-body vibration's influence on physical performance measures, its influence on physical performance in individuals with cerebral palsy, and then discusses the future directions of whole-body vibration therapy in the cerebral palsy population.
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Affiliation(s)
- Logan Ruhde
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Ryan Hulla
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
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10
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An Emerging Role for Epigenetics in Cerebral Palsy. J Pers Med 2021; 11:jpm11111187. [PMID: 34834539 PMCID: PMC8625874 DOI: 10.3390/jpm11111187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
Cerebral palsy is a set of common, severe, motor disabilities categorized by a static, nondegenerative encephalopathy arising in the developing brain and associated with deficits in movement, posture, and activity. Spastic CP, which is the most common type, involves high muscle tone and is associated with altered muscle function including poor muscle growth and contracture, increased extracellular matrix deposition, microanatomic disruption, musculoskeletal deformities, weakness, and difficult movement control. These muscle-related manifestations of CP are major causes of progressive debilitation and frequently require intensive surgical and therapeutic intervention to control. Current clinical approaches involve sophisticated consideration of biomechanics, radiologic assessments, and movement analyses, but outcomes remain difficult to predict. There is a need for more precise and personalized approaches involving omics technologies, data science, and advanced analytics. An improved understanding of muscle involvement in spastic CP is needed. Unfortunately, the fundamental mechanisms and molecular pathways contributing to altered muscle function in spastic CP are only partially understood. In this review, we outline evidence supporting the emerging hypothesis that epigenetic phenomena play significant roles in musculoskeletal manifestations of CP.
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11
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von Walden F, Vechetti IJ, Englund D, Figueiredo VC, Fernandez-Gonzalo R, Murach K, Pingel J, Mccarthy JJ, Stål P, Pontén E. Reduced mitochondrial DNA and OXPHOS protein content in skeletal muscle of children with cerebral palsy. Dev Med Child Neurol 2021; 63:1204-1212. [PMID: 34176131 DOI: 10.1111/dmcn.14964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 02/06/2023]
Abstract
AIM To provide a detailed gene and protein expression analysis related to mitochondrial biogenesis and assess mitochondrial content in skeletal muscle of children with cerebral palsy (CP). METHOD Biceps brachii muscle samples were collected from 19 children with CP (mean [SD] age 15y 4mo [2y 6mo], range 9-18y, 16 males, three females) and 10 typically developing comparison children (mean [SD] age 15y [4y], range 7-21y, eight males, two females). Gene expression (quantitative reverse transcription polymerase chain reaction [PCR]), mitochondrial DNA (mtDNA) to genomic DNA ratio (quantitative PCR), and protein abundance (western blotting) were analyzed. Microarray data sets (CP/aging/bed rest) were analyzed with a focused query investigating metabolism- and mitochondria-related gene networks. RESULTS The mtDNA to genomic DNA ratio was lower in the children with CP compared to the typically developing group (-23%, p=0.002). Out of five investigated complexes in the mitochondrial respiratory chain, we observed lower protein levels of all complexes (I, III, IV, V, -20% to -37%; p<0.05) except complex II. Total peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) messenger RNA (p<0.004), isoforms PGC1α1 (p=0.05), and PGC1α4 (p<0.001) were reduced in CP. Transcriptional similarities were observed between CP, aging, and 90 days' bed rest. INTERPRETATION Mitochondrial biogenesis, mtDNA, and oxidative phosphorylation protein content are reduced in CP muscle compared with typically developing muscle. Transcriptional pathways shared between aging and long-term unloading suggests metabolic dysregulation in CP, which may guide therapeutic strategies for combatting CP muscle pathology. What this paper adds Cerebral palsy (CP) muscle contains fewer energy-generating organelles than typically developing muscle. Gene expression in CP muscle is similar to aging and long-term bed rest.
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Affiliation(s)
- Ferdinand von Walden
- Division of Pediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Physiology, University of Kentucky, Lexington, KY, USA.,Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
| | - Ivan J Vechetti
- Department of Physiology, University of Kentucky, Lexington, KY, USA.,Center for Muscle Biology, University of Kentucky, Lexington, KY, USA.,Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Davis Englund
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA.,Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
| | - Vandré C Figueiredo
- Department of Physiology, University of Kentucky, Lexington, KY, USA.,Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
| | - Rodrigo Fernandez-Gonzalo
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.,Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Kevin Murach
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA.,Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
| | - Jessica Pingel
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - John J Mccarthy
- Department of Physiology, University of Kentucky, Lexington, KY, USA.,Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
| | - Per Stål
- Department of Integrative Medical Biology, Laboratory of Muscle Biology, Umeå University, Umeå, Sweden
| | - Eva Pontén
- Division of Pediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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12
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Dayanidhi S, Buckner EH, Redmond RS, Chambers HG, Schenk S, Lieber RL. Skeletal muscle maximal mitochondrial activity in ambulatory children with cerebral palsy. Dev Med Child Neurol 2021; 63:1194-1203. [PMID: 33393083 DOI: 10.1111/dmcn.14785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/16/2022]
Abstract
AIM To compare skeletal muscle mitochondrial enzyme activity and mitochondrial content between independently ambulatory children with cerebral palsy (CP) and typically developing children. METHOD Gracilis biopsies were obtained from 12 children during surgery (n=6/group, children with CP: one female, five males, mean age 13y 4mo, SD 5y 1mo, 4y 1mo-17y 10mo; typically developing children: three females, three males, mean age 16y 5mo, SD 1y 4mo, 14y 6mo-18y 2mo). Spectrophotometric enzymatic assays were used to evaluate the activity of mitochondrial electron transport chain complexes. Mitochondrial content was evaluated using citrate synthase assay, mitochondrial DNA copy number, and immunoblots for specific respiratory chain proteins. RESULTS Maximal enzyme activity was significantly (50-80%) lower in children with CP versus typically developing children, for complex I (11nmol/min/mg protein, standard error of the mean [SEM] 1.7 vs 20.7nmol/min/mg protein, SEM 4), complex II (6.9nmol/min/mg protein, SEM 1.2 vs 21nmol/min/mg protein, SEM 2.7), complex III (31.9nmol/min/mg protein, SEM 7.4 vs 72.7nmol/min/mg protein, SEM 7.2), and complex I+III (7.4nmol/min/mg protein, SEM 2.5 vs 31.8nmol/min/mg protein, SEM 9.3). Decreased electron transport chain activity was not the result of lower mitochondrial content. INTERPRETATION Skeletal muscle mitochondrial electron transport chain enzymatic activity but not mitochondrial content is reduced in independently ambulatory children with CP. Decreased mitochondrial oxidative capacity might explain reported increased energetics of movement and fatigue in ambulatory children with CP. What this paper adds Skeletal muscle mitochondrial electron transport chain enzymatic activity is reduced in independently ambulatory children with cerebral palsy (CP). Mitochondrial content appears to be similar between children with CP and typically developing children.
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Affiliation(s)
- Sudarshan Dayanidhi
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA.,Department of Veterans Affairs Medical Center, San Diego, CA, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Elisa H Buckner
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA.,Biomedical Sciences Program, University of California, San Diego, CA, USA
| | | | - Henry G Chambers
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA.,Department of Orthopaedics, Rady Children's Hospital, San Diego, CA, USA
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA.,Biomedical Sciences Program, University of California, San Diego, CA, USA
| | - Richard L Lieber
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA.,Department of Veterans Affairs Medical Center, San Diego, CA, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Bioengineering, University of California, San Diego, CA, USA
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13
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Dayanidhi S. Skeletal Muscle Mitochondrial Physiology in Children With Cerebral Palsy: Considerations for Healthy Aging. Front Neurol 2021; 12:735009. [PMID: 34589051 PMCID: PMC8473886 DOI: 10.3389/fneur.2021.735009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Skeletal muscle contractile proteins require a constant supply of energy to produce force needed for movement. Energy (ATP) is primarily produced by mitochondrial organelles, located within and around muscle fibers, by oxidative phosphorylation that couples electron flux through the electron transport chain to create a proton gradient across the inner mitochondrial membrane that is in turn used by the ATP synthase. Mitochondrial networks increase in size by biogenesis to increase mitochondrial abundance and activity in response to endurance exercise, while their function and content reduce with constant inactivity, such as during muscle atrophy. During healthy aging, there is an overall decline in mitochondrial activity and abundance, increase in mitochondrial DNA mutations, potential increase in oxidative stress, and reduction in overall muscular capacity. Many of these alterations can be attenuated by consistent endurance exercise. Children with cerebral palsy (CP) have significantly increased energetics of movement, reduced endurance capacity, and increased perceived effort. Recent work in leg muscles in ambulatory children with CP show a marked reduction in mitochondrial function. Arm muscles show that mitochondrial protein content and mitochondria DNA copy number are lower, suggesting a reduction in mitochondrial abundance, along with a reduction in markers for mitochondrial biogenesis. Gene expression networks are reduced for glycolytic and mitochondrial pathways and share similarities with gene networks with aging and chronic inactivity. Given the importance of mitochondria for energy production and changes with aging, future work needs to assess changes in mitochondria across the lifespan in people with CP and the effect of exercise on promoting metabolic health.
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Affiliation(s)
- Sudarshan Dayanidhi
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation and Physical Therapy and Human Movement Science, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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14
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Darras N, Nikaina E, Tziomaki M, Gkrimas G, Papavasiliou A, Pasparakis D. Development of Lower Extremity Strength in Ambulatory Children With Bilateral Spastic Cerebral Palsy in Comparison With Typically Developing Controls Using Absolute and Normalized to Body Weight Force Values. Front Neurol 2021; 12:617971. [PMID: 33815249 PMCID: PMC8017198 DOI: 10.3389/fneur.2021.617971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
This cross-sectional study aimed to examine the development of lower limb voluntary strength in 160 ambulatory patients with bilateral spastic cerebral palsy (CP) (106 diplegics/54 quadriplegics) and 86 typically developing (TD) controls, aged 7–16 years. Handheld dynamometry was used to measure isometric strength of seven muscle groups (hip adductors and abductors, hip extensors and flexors, knee extensors and flexors, and ankle dorsiflexors); absolute force (AF) values in pounds were collected, which were then normalized to body weight (NF). AF values increased with increasing age (p < 0.001 for all muscle groups), whereas NF values decreased through adolescence (p < 0.001 for all muscle groups except for hip abduction where p = 0.022), indicating that increases in weight through adolescence led to decreases in relative force. Both AF and NF values were significantly greater in TD subjects when compared with children with CP in all muscle and all age groups (p < 0.001). Diplegics and quadriplegics demonstrated consistently lower force values than TD subjects for all muscle groups, except for the hip extensors where TD children had similar values with diplegics (p = 0.726) but higher than quadriplegics (p = 0.001). Diplegic patients also exhibited higher values than quadriplegics in all muscles, except for the knee extensors where their difference was only indicative (p = 0.056). The conversion of CP subjects' force values as a percentage of the TD subjects' mean value revealed a pattern of significant muscle strength imbalance between the CP antagonist muscles, documented from the following deficit differences for the CP muscle couples: (hip extensors 13%) / (hip flexors 32%), (adductors 27%) / (abductors 52%), and (knee extensors 37%) / (knee flexors 53%). This pattern was evident in all age groups. Similarly, significant force deficiencies were identified in GMFCS III/IV patients when compared with TD children and GMFCS I/II patients. In this study, we demonstrated that children and adolescents with bilateral CP exhibited lower strength values in lower limb muscles when compared with their TD counterparts. This difference was more prevalent in quadriplegic patients and those with a more severe impairment. An important pattern of muscle strength imbalance between the antagonist muscles of the CP subjects was revealed.
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Affiliation(s)
| | - Eirini Nikaina
- First Department of Pediatrics, "Aghia Sophia" Children's Hospital, University of Athens, Athens, Greece
| | | | - Georgios Gkrimas
- Gait & Motion Analysis Center, ELEPAP, Athens, Greece.,Laboratory of Neuromuscular and Cardiovascular Study of Motion - LANECASM, Athens, Greece
| | | | - Dimitrios Pasparakis
- Gait & Motion Analysis Center, ELEPAP, Athens, Greece.,Pediatric Orthopaedic Department, Athens Medical Center, Athens, Greece
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15
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Jensen AK, Low CE, Pal P, Raczynski TN. Relation of Musculoskeletal Strength and Function to Postural Stability in Ambulatory Adults With Cerebral Palsy. Arch Rehabil Res Clin Transl 2021; 2:100074. [PMID: 33543099 PMCID: PMC7853373 DOI: 10.1016/j.arrct.2020.100074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Objective To understand the relation of musculoskeletal strength and function to postural stability in ambulatory adults with cerebral palsy (CP) who have already developed muscle atrophy and osteoporosis. Design Two independent group comparison of adults with CP and those without it. Setting Laboratory study. Participants Thirteen adults with CP with sex (9 women: 4 men), age (21-62y), and Gross Motor Function Classification System I-III, and 13 sex-, age-, and body-weight-matched control participants completed our study (N=26). Intervention Not applicable. Main Outcome Measure Bone mineral density (BMD), structural or geometrical deformities (at the proximal region of the femur at the hip joint), and maximal muscular strength (forearm and thigh) were measured. The primary outcome measure was postural stability (balance measured using an automated balance system and a Berg Balance Test). Results Femoral BMD was significantly lower in the CP group compared to the control group, whereas BMD at lumbar and forearm regions was similar between groups. Geometrical angles, lengths, and diameters at the proximal femur were significantly lower in the CP group. There was a direct relation between BMD in the femoral neck and knee extension peak torque in the control group with no relation in the CP group. Although the control group did not show a relation between muscular strength and balance test, the CP group showed a significant linear relation among improving postural stability with greater levels of muscular strength. Conclusion There were structural differences at the proximal femur and muscular weakness in adults with CP. In adults with CP, balance appears to be more influenced by structural alterations at the femur than muscular strength compared to the control group.
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Affiliation(s)
- Areum K Jensen
- Department of Kinesiology, San José State University, San José, CA
| | - Cory E Low
- Department of Kinesiology, San José State University, San José, CA
| | - Pooja Pal
- Department of Kinesiology, San José State University, San José, CA
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16
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Park TS, Joh S, Walter DM, Meyer NL, Dobbs MB. Selective Dorsal Rhizotomy for the Treatment of Spastic Hemiplegic Cerebral Palsy. Cureus 2020; 12:e9605. [PMID: 32923208 PMCID: PMC7479993 DOI: 10.7759/cureus.9605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Selective dorsal rhizotomy (SDR) can remove spasticity in cerebral palsy (CP). Spastic hemiplegia is associated with spasticity in the upper and lower limbs on one side. Only a single report described the outcome of SDR specifically in patients with spastic hemiplegic CP. The effect of SDR on spastic hemiplegia requires further investigation. Objectives To analyze the outcomes of motor functions, the quality of life, and satisfaction of patients who received SDR for the treatment of spastic hemiplegia. Methods A total of 29 children and 1 adult who received SDR were surveyed. The survey questionnaire asked about demographic information, patient's perception of SDR, functional outcomes, SDR surgical outcomes, pain, braces/orthotics, and post-SDR treatment. Results Our study included 30 patients. The age at the time of surgery was 2 to 36 years. The follow-up period ranged from one to six years. Of all parents, 90% of parents reported that SDR benefited their children, and 93% stated that they would recommend the SDR procedure to other families of children with hemiplegic CP. Of all patients, 90% reported improved walking, 63% reported improved sitting, and 87% reported improved balance and posture. In daily life functioning after the SDR, 67% were more independent and confident. Moreover, 33% of patients were pain-free and 43% had reduced pain in their legs and back. In activities of daily living, 93% transferred independently from one position to another. A majority of the patients reported regular strengthening and stretching of the lower limb, and 50% of the patients played sports. A majority (73%) of patients underwent post-SDR orthopedic surgery for heel cord, hamstring, and adductor contractures. Five patients experienced numbness in the small part of the lower limb after SDR. None reported that the numbness affected their daily activities. One child required surgical repair of the cerebrospinal fluid leak. Conclusions In our 29 children and 1 adult with spastic hemiplegia, SDR improved motor function and daily life function. Nearly all parents of children and the one adult felt that SDR was beneficial and that they would recommend surgery to other children with spastic hemiplegia.
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Affiliation(s)
- T S Park
- Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA
| | - Susan Joh
- Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA
| | - Deanna M Walter
- Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA
| | - Nicole L Meyer
- Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA
| | - Matthew B Dobbs
- Pediatric Orthopedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA
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17
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Klawonn MA, Klamar K, Turk MA. Trends in publications about cerebral palsy 1990 to 2020. J Pediatr Rehabil Med 2020; 13:107-117. [PMID: 32568124 DOI: 10.3233/prm-200697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cerebral palsy (CP) is associated with complex health care needs and, although improved, a continued shortened life expectancy. In order to quantify and understand advances in the diagnosis and management of CP, systematic literature searches of key word groupings in the PubMed database were completed and revealed a recent increased incidence of publications focusing on quality of life, physical activity, exercise, and treatment options. Our bibliometric exploration revealed growing emphasis on function, performance, aging, and health compared to earlier studies when diagnostic features and brain pathology dominated research. Our findings highlight the transition from diagnosis and identification to management of specific conditions and providing guidance for the continuum of needs our patients experience over the course of a lifetime. The field must be prepared to advance our understanding of best practices and implement evidence-based interventions and management options.
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Affiliation(s)
- Meghan A Klawonn
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Karl Klamar
- Pediatric Rehabilitation Medicine, Nationwide Children's Hospital, Physical Medicine and Rehabilitation, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Margaret A Turk
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
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18
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Vova JA, Leung E. A pragmatic approach to Botulinum Toxin safety. J Pediatr Rehabil Med 2020; 13:195-199. [PMID: 32568125 DOI: 10.3233/prm-200716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Botulinum Toxin (BoNT) is widely used to treat hypertonia in pediatric patients. Although serious adverse events (AEs) occur infrequently, they can lead to significant patient morbidity and mortality. This paper will discuss potential safety risks that may affect outcomes, medical comorbidities, medication dosing, targeting techniques, and muscle morphology. It is the responsibility of the physician to discuss risks and benefits regarding the use of BoNT and mitigate risks of AEs while maximizing the effectiveness of the medication.
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19
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Pingel J, Andersen IT, Broholm R, Harder A, Bartels EM, Bülow J, Harrison A. An acoustic myography functional assessment of cerebral palsy subjects compared to healthy controls during physical exercise. J Muscle Res Cell Motil 2019; 40:53-58. [PMID: 31123956 DOI: 10.1007/s10974-019-09516-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/06/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Jessica Pingel
- Department of Neuroscience, Copenhagen University, Copenhagen, Denmark.
| | - Ida Torp Andersen
- Department of Neuroscience, Copenhagen University, Copenhagen, Denmark
| | - Rikke Broholm
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Anja Harder
- Section for Pathobiological Sciences, Faculty of Health & Medical Sciences, Copenhagen University, Frederiksberg, Denmark
| | - Else Marie Bartels
- Department of Neurology and the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jens Bülow
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Adrian Harrison
- Section for Pathobiological Sciences, Faculty of Health & Medical Sciences, Copenhagen University, Frederiksberg, Denmark
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20
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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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21
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Sarcher A, Brochard S, Hug F, Letellier G, Raison M, Perrouin-Verbe B, Sangeux M, Gross R. Patterns of upper limb muscle activation in children with unilateral spastic cerebral palsy: Variability and detection of deviations. Clin Biomech (Bristol, Avon) 2018; 59:85-93. [PMID: 30216783 DOI: 10.1016/j.clinbiomech.2018.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/17/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was two-fold: (1) to quantify the variability of upper limb electromyographic patterns during elbow movements in typically developing children and children with unilateral spastic cerebral palsy, and to compare different amplitude normalization methods; (2) to develop a method using this variability to detect (a) deviations in the patterns of a child with unilateral spastic cerebral palsy from the average patterns of typically developing children, and (b) changes after treatment to reduce muscle activation. METHODS Twelve typically developing children ([6.7-15.9yo]; mean 11.0 SD 3.0yo) and six children with unilateral spastic cerebral palsy ([7.9-17.4yo]; mean 12.4 SD 4.0yo) attended two sessions during which they performed elbow extension-flexion and pronation-supination movements. Surface electromyography of the biceps, triceps, brachioradialis, pronator teres, pronator quadratus, and brachialis muscles was recorded. The Likelihood method was used to estimate the inter-trial, inter-session, and inter-subject variability of the electromyography patterns for each time point in the movement cycle. Deviations in muscle patterns from the patterns of typically developing children and changes following treatment were evaluated in a case study of a child with cerebral palsy. FINDINGS Normalization of electromyographic amplitude by the mean peak yielded the lowest variability. The variability data were then used in the case study. This method detected higher levels of activation in specific muscles compared with typically developing children, and a reduction in muscle activation after botulinum toxin A injections. INTERPRETATION Upper limb surface electromyography pattern analysis can be used for clinical applications in children with cerebral palsy.
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Affiliation(s)
- Aurélie Sarcher
- Motion Analysis Laboratory, Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France; Laboratory of Medical Information Processing (LaTIM), INSERM UMR 1101, Brest, France.
| | - Sylvain Brochard
- Laboratory of Medical Information Processing (LaTIM), INSERM UMR 1101, Brest, France; Physical Medicine and Rehabilitation, University Hospital of Brest, Brest, France.
| | - François Hug
- Laboratory of Movement - Interactions - Performance (MIP), EA 4334, University of Nantes, Nantes, France.
| | - Guy Letellier
- Pediatric rehabilitation center ESEAN, Nantes, France.
| | - Maxime Raison
- Rehabilitation Engineering Chair Applied to Pediatrics (RECAP), Sainte-Justine University Hospital and Ecole Polytechnique de Montréal, Montréal, QC, Canada.
| | - Brigitte Perrouin-Verbe
- Motion Analysis Laboratory, Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France.
| | - Morgan Sangeux
- Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia.
| | - Raphaël Gross
- Motion Analysis Laboratory, Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France; Laboratory of Movement - Interactions - Performance (MIP), EA 4334, University of Nantes, Nantes, France.
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22
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Whitney DG, Hurvitz EA, Devlin MJ, Caird MS, French ZP, Ellenberg EC, Peterson MD. Age trajectories of musculoskeletal morbidities in adults with cerebral palsy. Bone 2018; 114:285-291. [PMID: 29981509 DOI: 10.1016/j.bone.2018.07.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/29/2018] [Accepted: 07/04/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Individuals with cerebral palsy (CP) are at an increased risk for age-related morbidities due to functional impairments, maladapted growth, and altered body composition. While musculoskeletal (MSK) deficits are present in children, little is understood about MSK morbidity throughout the lifespan in those with CP. The purpose of this study was to examine the age-related trajectories of MSK morbidity and multimorbidity throughout adulthood in those with CP. METHODS A clinic-based sample of adults with CP (n = 1395; ≥18 years) was examined to determine prevalence of MSK morbidities at the University of Michigan Medical Center. Logistic regression was used to determine the effects of age on individual MSK morbidities and multimorbidity (i.e., ≥2 morbidities) after adjusting for sex, race, weight, and smoking. RESULTS With the 18-30 year age group as the reference, the adjusted odds of osteopenia was lower in the 41-50 and >50 year age groups, the odds of osteoporosis and rheumatoid arthritis was higher in 41-50 and >50 year age groups, and the odds of osteoarthritis was higher in 31-40, 41-50, and >50 year age groups. The adjusted odds of MSK multimorbidity increased substantially with increasing age for 31-40 year olds (OR: 1.919; 95% CI 1.05-3.52), 41-50 year olds (OR: 4.30; 95% CI 2.40-7.69), and >50 year olds (OR: 6.05; 95% CI 3.56-10.27). CONCLUSIONS Adults with CP are at high risk for MSK morbidities across all ages. Future studies are needed to examine the global aging trajectories of MSK health among adults with CP. Study findings highlight the importance of maximizing MSK accretion, and developing programs to assist individuals with CP and their caregivers to maintain MSK mass and function throughout the lifespan.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Maureen J Devlin
- Department of Anthropology, University of Michigan, 101 West Hall, 1085 S. University Ave., Ann Arbor, MI 48109, United States
| | - Michelle S Caird
- Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, 1540 E Hospital Dr., Ann Arbor, MI 48109, United States
| | - Zachary P French
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Elie C Ellenberg
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States.
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23
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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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24
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Delcour M, Massicotte VS, Russier M, Bras H, Peyronnet J, Canu MH, Cayetanot F, Barbe MF, Coq JO. Early movement restriction leads to enduring disorders in muscle and locomotion. Brain Pathol 2018; 28:889-901. [PMID: 29437246 DOI: 10.1111/bpa.12594] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/21/2017] [Accepted: 02/09/2018] [Indexed: 01/01/2023] Open
Abstract
Motor control and body representation in the central nervous system (CNS) as well as musculoskeletal architecture and physiology are shaped during development by sensorimotor experience and feedback, but the emergence of locomotor disorders during maturation and their persistence over time remain a matter of debate in the absence of brain damage. By using transient immobilization of the hind limbs, we investigated the enduring impact of postnatal sensorimotor restriction (SMR) on gait and posture on treadmill, age-related changes in locomotion, musculoskeletal histopathology and Hoffmann reflex in adult rats without brain damage. SMR degrades most gait parameters and induces overextended knees and ankles, leading to digitigrade locomotion that resembles equinus. Based on variations in gait parameters, SMR appears to alter age-dependent plasticity of treadmill locomotion. SMR also leads to small but significantly decreased tibial bone length, chondromalacia, degenerative changes in the knee joint, gastrocnemius myofiber atrophy and muscle hyperreflexia, suggestive of spasticity. We showed that reduced and atypical patterns of motor outputs, and somatosensory inputs and feedback to the immature CNS, even in the absence of perinatal brain damage, play a pivotal role in the emergence of movement disorders and musculoskeletal pathologies, and in their persistence over time. Understanding how atypical sensorimotor development likely contributes to these degradations may guide effective rehabilitation treatments in children with either acquired (ie, with brain damage) or developmental (ie, without brain injury) motor disabilities.
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Affiliation(s)
- Maxime Delcour
- Neurosciences Intégratives et Adaptatives, UMR 7260, CNRS, Aix-Marseille Université, Marseille, France
| | - Vicky S Massicotte
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Michaël Russier
- Neurosciences Intégratives et Adaptatives, UMR 7260, CNRS, Aix-Marseille Université, Marseille, France
| | - Hélène Bras
- Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, Marseille, France
| | - Julie Peyronnet
- Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, Marseille, France
| | - Marie-Hélène Canu
- Université de Lille, EA 7369 « Activité Physique, Muscle et Santé » - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000 Lille, France
| | - Florence Cayetanot
- Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, Marseille, France
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Jacques-Olivier Coq
- Neurosciences Intégratives et Adaptatives, UMR 7260, CNRS, Aix-Marseille Université, Marseille, France.,Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille Université, Marseille, France
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25
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Odderson IR. Can botulinum toxin cause chronic muscle weakness? Muscle Nerve 2018; 57:350-352. [DOI: 10.1002/mus.25988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Ib R. Odderson
- Department of Rehabilitation Medicine; University of Washington, 1959 Northeast Pacific Street, Box 356490; Seattle Washington 98195 USA
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Zhou J, Butler EE, Rose J. Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment. Front Hum Neurosci 2017; 11:103. [PMID: 28367118 PMCID: PMC5355477 DOI: 10.3389/fnhum.2017.00103] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/20/2017] [Indexed: 01/17/2023] Open
Abstract
Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.
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Affiliation(s)
- Joanne Zhou
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
| | - Erin E Butler
- Thayer School of Engineering, Dartmouth CollegeHanover, NH, USA; Neukom Institute for Computational Sciences, Dartmouth CollegeHanover, NH, USA
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
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Rasool G, Afsharipour B, Suresh NL, Rymer WZ. Spatial Analysis of Multichannel Surface EMG in Hemiplegic Stroke. IEEE Trans Neural Syst Rehabil Eng 2017; 25:1802-1811. [PMID: 28320672 DOI: 10.1109/tnsre.2017.2682298] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We investigated spatial activation patterns of upper extremity muscles during isometric force generation in both intact persons and in hemispheric stroke survivors. We used a 128-channel surface electromyogram (EMG) grid to record the electrical activity of biceps brachii muscles during these contractions. EMG data were processed to develop 2-D root mean square (RMS) maps of muscle activity. Our objective was to determine whether motor impairments following stroke were associated with changes in the muscle activity maps and in the spatial distribution of muscular activation. We found that, for a given subject, spatial patterns in muscle activity maps were consistent across all measured contraction levels differing only the RMS EMG. However, the maps from opposite arms (stroke-affected versus non-affected) of stroke survivors were significantly different from each other, especially when compared with the differences observed intact participants. Our analyses revealed that chronic stroke altered the size and location of the active region in these maps. The former is potentially related to disruption of fiber and tissue structure, possibly linked to factors such as extracellular fat accumulation, connective tissue infiltration, muscle fiber atrophy, fiber shortening, and fiber loss. Changes in spatial patterns in muscle activity maps may also be linked to a shift in the location of the innervation zone or the endplate region of muscles. Furthermore, the textural analysis of EMG activity maps showed a larger pixel-to-pixel variability in stroke-affected muscles. Alterations in the muscle activity maps were also related to functional impairment (estimated using Fugl-Meyer score) and to the degree of spasticity (estimated using the modified Ashworth scale). Overall, our investigation revealed that the muscle architecture and morphology were significantly altered in the chronic stroke.
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LaRosa DA, Ellery SJ, Walker DW, Dickinson H. Understanding the Full Spectrum of Organ Injury Following Intrapartum Asphyxia. Front Pediatr 2017; 5:16. [PMID: 28261573 PMCID: PMC5313537 DOI: 10.3389/fped.2017.00016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/23/2017] [Indexed: 11/13/2022] Open
Abstract
Birth asphyxia is a significant global health problem, responsible for ~1.2 million neonatal deaths each year worldwide. Those who survive often suffer from a range of health issues including brain damage-manifesting as cerebral palsy (CP)-respiratory insufficiency, cardiovascular collapse, and renal dysfunction, to name a few. Although the majority of research is directed toward reducing the brain injury that results from intrapartum birth asphyxia, the multi-organ injury observed in surviving neonates is of equal importance. Despite the advent of hypothermia therapy for the treatment of hypoxic-ischemic encephalopathy (HIE), treatment options following asphyxia at birth remain limited, particularly in low-resource settings where the incidence of birth asphyxia is highest. Furthermore, although cooling of the neonate results in improved neurological outcomes for a small proportion of treated infants, it does not provide any benefit to the other organ systems affected by asphyxia at birth. The aim of this review is to summarize the current knowledge of the multi-organ effects of intrapartum asphyxia, with particular reference to the findings from our laboratory using the precocial spiny mouse to model birth asphyxia. Furthermore, we reviewed the current treatments available for neonates who have undergone intrapartum asphyxia, and highlight the emergence of maternal dietary creatine supplementation as a preventative therapy, which has been shown to provide multi-organ protection from birth asphyxia-induced injury in our preclinical studies. This cheap and effective nutritional supplement may be the key to reducing birth asphyxia-induced death and disability, particularly in low-resource settings where current treatments are unavailable.
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Affiliation(s)
- Domenic A LaRosa
- Ritchie Centre, Department of Obstetrics and Gynaecology, Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia; Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Stacey J Ellery
- Ritchie Centre, Department of Obstetrics and Gynaecology, Hudson Institute of Medical Research, Monash University , Melbourne, VIC , Australia
| | - David W Walker
- Ritchie Centre, Department of Obstetrics and Gynaecology, Hudson Institute of Medical Research, Monash University , Melbourne, VIC , Australia
| | - Hayley Dickinson
- Ritchie Centre, Department of Obstetrics and Gynaecology, Hudson Institute of Medical Research, Monash University , Melbourne, VIC , Australia
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Maternal creatine supplementation during pregnancy prevents acute and long-term deficits in skeletal muscle after birth asphyxia: a study of structure and function of hind limb muscle in the spiny mouse. Pediatr Res 2016; 80:852-860. [PMID: 27466898 DOI: 10.1038/pr.2016.153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/10/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Maternal antenatal creatine supplementation protects the brain, kidney, and diaphragm against the effects of birth asphyxia in the spiny mouse. In this study, we examined creatine's potential to prevent damage to axial skeletal muscles. METHODS Pregnant spiny mice were fed a control or creatine-supplemented diet from mid-pregnancy, and 1 d before term (39 d), fetuses were delivered by c-section with or without 7.5 min of birth asphyxia. At 24 h or 33 ± 2 d after birth, gastrocnemius muscles were obtained for ex-vivo study of twitch-tension, muscle fatigue, and structural and histochemical analysis. RESULTS Birth asphyxia significantly reduced cross-sectional area of all muscle fiber types (P < 0.05), and increased fatigue caused by repeated tetanic contractions at 24 h of age (P < 0.05). There were fewer (P < 0.05) Type I and IIa fibers and more (P < 0.05) Type IIb fibers in male gastrocnemius at 33 d of age. Muscle oxidative capacity was reduced (P < 0.05) in males at 24 h and 33 d and in females at 24 h only. Maternal creatine treatment prevented all asphyxia-induced changes in the gastrocnemius, improved motor performance. CONCLUSION This study demonstrates that creatine loading before birth protects the muscle from asphyxia-induced damage at birth.
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Zogby AM, Dayanidhi S, Chambers HG, Schenk S, Lieber RL. Skeletal muscle fiber-type specific succinate dehydrogenase activity in cerebral palsy. Muscle Nerve 2016; 55:122-124. [PMID: 27515237 DOI: 10.1002/mus.25379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Children with cerebral palsy (CP) exhibit increased energy expenditure during movement, but whether this is due in part to decrements in skeletal muscle mitochondrial oxidative capacity is unknown. Accordingly, we compared fiber-type specific succinate dehydrogenase (SDH) activity in children with CP with typically developing (TD) children. METHODS SDH activity and myofiber areas of type 1 and 2A fibers were measured in semitendinosus biopsies of both groups (n = 5/group). RESULTS SDH activity was ∼35% higher in type 1 compared with type 2A fibers, but there were no differences between groups. Average myofiber area was 45% smaller in CP versus TD (P < 0.05), and type 2A fibers were 32% larger than type 1 fibers (P < 0.05) only in TD children. CONCLUSIONS Fiber-type specific SDH activity is similar between TD children and children with CP. This suggests that increased energy expenditure in children with CP is not related to impaired mitochondrial oxidative capacity. Muscle Nerve, 2016 Muscle Nerve 55: 122-124, 2017.
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Affiliation(s)
- Andrew M Zogby
- School of Medicine, University of California, San Diego, California, USA
| | - Sudarshan Dayanidhi
- Department of Orthopaedic Surgery, University of California, San Diego, California, USA.,Department of Veterans Affairs Medical Center, San Diego, California, USA
| | - Henry G Chambers
- Department of Orthopaedic Surgery, University of California, San Diego, California, USA.,Department of Orthopaedics, Rady Children's Hospital, San Diego, California, USA
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California, San Diego, California, USA.,Biomedical Sciences Program, University of California, San Diego, California, USA
| | - Richard L Lieber
- Department of Orthopaedic Surgery, University of California, San Diego, California, USA.,Department of Veterans Affairs Medical Center, San Diego, California, USA.,Department of Bioengineering, University of California, San Diego, California, USA
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31
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Fatiguing Effects on the Multi-Scale Entropy of Surface Electromyography in Children with Cerebral Palsy. ENTROPY 2016. [DOI: 10.3390/e18050177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sanchez GN, Sinha S, Liske H, Chen X, Nguyen V, Delp SL, Schnitzer MJ. In Vivo Imaging of Human Sarcomere Twitch Dynamics in Individual Motor Units. Neuron 2016; 88:1109-1120. [PMID: 26687220 DOI: 10.1016/j.neuron.2015.11.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/28/2015] [Accepted: 11/10/2015] [Indexed: 12/14/2022]
Abstract
Motor units comprise a pre-synaptic motor neuron and multiple post-synaptic muscle fibers. Many movement disorders disrupt motor unit contractile dynamics and the structure of sarcomeres, skeletal muscle's contractile units. Despite the motor unit's centrality to neuromuscular physiology, no extant technology can image sarcomere twitch dynamics in live humans. We created a wearable microscope equipped with a microendoscope for minimally invasive observation of sarcomere lengths and contractile dynamics in any major skeletal muscle. By electrically stimulating twitches via the microendoscope and visualizing the sarcomere displacements, we monitored single motor unit contractions in soleus and vastus lateralis muscles of healthy individuals. Control experiments verified that these evoked twitches involved neuromuscular transmission and faithfully reported muscle force generation. In post-stroke patients with spasticity of the biceps brachii, we found involuntary microscopic contractions and sarcomere length abnormalities. The wearable microscope facilitates exploration of many basic and disease-related neuromuscular phenomena never visualized before in live humans.
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Affiliation(s)
- Gabriel N Sanchez
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA; Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
| | - Supriyo Sinha
- Department of Biology, Stanford University, Stanford, CA 94305, USA; Department of Applied Physics, Stanford University, Stanford, CA 94305, USA
| | - Holly Liske
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
| | - Xuefeng Chen
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
| | - Viet Nguyen
- Department of Neurology, Stanford University, Stanford, CA 94305, USA
| | - Scott L Delp
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA; Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA.
| | - Mark J Schnitzer
- Department of Biology, Stanford University, Stanford, CA 94305, USA; Department of Applied Physics, Stanford University, Stanford, CA 94305, USA; Howard Hughes Medical Institute, Stanford University, Stanford, CA 94305, USA.
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Handsfield GG, Meyer CH, Abel MF, Blemker SS. Heterogeneity of muscle sizes in the lower limbs of children with cerebral palsy. Muscle Nerve 2016; 53:933-45. [DOI: 10.1002/mus.24972] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Geoffrey G. Handsfield
- Department of Biomedical Engineering, Health System; University of Virginia; P.O. Box 800759 Charlottesville Virginia 22908 USA
| | - Craig H. Meyer
- Department of Biomedical Engineering, Health System; University of Virginia; P.O. Box 800759 Charlottesville Virginia 22908 USA
- Department of Radiology and Medical Imaging; University of Virginia; Charlottesville Virginia USA
| | - Mark F. Abel
- Department of Orthopaedic Surgery; University of Virginia; Charlottesville Virginia USA
| | - Silvia S. Blemker
- Department of Biomedical Engineering, Health System; University of Virginia; P.O. Box 800759 Charlottesville Virginia 22908 USA
- Department of Orthopaedic Surgery; University of Virginia; Charlottesville Virginia USA
- Department of Mechanical and Aerospace Engineering; University of Virginia; Charlottesville Virginia USA
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Abstract
Cerebral palsy is the most common cause of childhood-onset, lifelong physical disability in most countries, affecting about 1 in 500 neonates with an estimated prevalence of 17 million people worldwide. Cerebral palsy is not a disease entity in the traditional sense but a clinical description of children who share features of a non-progressive brain injury or lesion acquired during the antenatal, perinatal or early postnatal period. The clinical manifestations of cerebral palsy vary greatly in the type of movement disorder, the degree of functional ability and limitation and the affected parts of the body. There is currently no cure, but progress is being made in both the prevention and the amelioration of the brain injury. For example, administration of magnesium sulfate during premature labour and cooling of high-risk infants can reduce the rate and severity of cerebral palsy. Although the disorder affects individuals throughout their lifetime, most cerebral palsy research efforts and management strategies currently focus on the needs of children. Clinical management of children with cerebral palsy is directed towards maximizing function and participation in activities and minimizing the effects of the factors that can make the condition worse, such as epilepsy, feeding challenges, hip dislocation and scoliosis. These management strategies include enhancing neurological function during early development; managing medical co-morbidities, weakness and hypertonia; using rehabilitation technologies to enhance motor function; and preventing secondary musculoskeletal problems. Meeting the needs of people with cerebral palsy in resource-poor settings is particularly challenging.
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Valentine J, Stannage K, Fabian V, Ellis K, Reid S, Pitcher C, Elliott C. Muscle histopathology in children with spastic cerebral palsy receiving botulinum toxin type A. Muscle Nerve 2016; 53:407-14. [PMID: 26154631 DOI: 10.1002/mus.24763] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 06/19/2015] [Accepted: 07/06/2015] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Botulinum toxin A (BoNTA) is routine treatment for hypertonicity in children with cerebral palsy (CP). METHODS This single-blind, prospective, cross-sectional study of 10 participants (mean age 11 years 7 months) was done to determine the relationship between muscle histopathology and BoNTA in treated medial gastrocnemius muscle of children with CP. Open muscle biopsies were taken from medial gastrocnemius muscle and vastus lateralis (control) during orthopedic surgery. RESULTS Neurogenic atrophy in the medial gastrocnemius was seen in 6 participants between 4 months and 3 years post-BoNTA. Type 1 fiber loss with type 2 fiber predominance was significantly related to the number of BoNTA injections (r = 0.89, P < 0.001). CONCLUSIONS The impact of these changes in muscle morphology on muscle function in CP is not clear. It is important to consider rotating muscle selection or injection sites within the muscle or allowing longer time between injections.
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Affiliation(s)
- Jane Valentine
- Department of Paediatric Rehabilitation, Princess Margaret Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Katherine Stannage
- Department of Orthopedic Surgery, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Vicki Fabian
- Neuropathology Section, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Kevin Ellis
- Neuropathology Section, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Siobhan Reid
- School of Sport Science, Exercise & Health, University of Western Australia, Perth, Western Australia, Australia
| | - Christian Pitcher
- School of Sport Science, Exercise & Health, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine Elliott
- Department of Paediatric Rehabilitation, Princess Margaret Hospital, Perth, Western Australia, Australia.,Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
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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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Tao W, Zhang X, Chen X, Wu D, Zhou P. Multi-scale complexity analysis of muscle coactivation during gait in children with cerebral palsy. Front Hum Neurosci 2015; 9:367. [PMID: 26257622 PMCID: PMC4510417 DOI: 10.3389/fnhum.2015.00367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/09/2015] [Indexed: 11/13/2022] Open
Abstract
The objective of this study is to characterize complexity of lower-extremity muscle coactivation and coordination during gait in children with cerebral palsy (CP), children with typical development (TD) and healthy adults, by applying recently developed multivariate multi-scale entropy (MMSE) analysis to surface electromyographic (EMG) signals. Eleven CP children (CP group), eight TD children and seven healthy adults (considered as an entire control group) were asked to walk while surface EMG signals were collected from five thigh muscles and three lower leg muscles on each leg (16 EMG channels in total). The 16-channel surface EMG data, recorded during a series of consecutive gait cycles, were simultaneously processed by multivariate empirical mode decomposition (MEMD), to generate fully aligned data scales for subsequent MMSE analysis. In order to conduct extensive examination of muscle coactivation complexity using the MEMD-enhanced MMSE, 14 data analysis schemes were designed by varying partial muscle combinations and time durations of data segments. Both TD children and healthy adults showed almost consistent MMSE curves over multiple scales for all the 14 schemes, without any significant difference (p > 0.09). However, distinct diversity in MMSE curve was observed in the CP group when compared with the control group. There appears to be diverse neuropathological processes in CP that may affect dynamical complexity of muscle coactivation and coordination during gait. The abnormal complexity patterns emerging in the CP group can be attributed to different factors such as motor control impairments, loss of muscle couplings, and spasticity or paralysis in individual muscles. This study expands our knowledge of neuropathology of CP from a novel point of view of muscle co-activation complexity, which might be useful to derive a quantitative index for assessing muscle activation characteristics as well as motor function in CP.
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Affiliation(s)
- Wen Tao
- Neuromuscular Control Laboratory, Department of Electronic Science and Technology, University of Science and Technology of ChinaHefei, China
| | - Xu Zhang
- Neuromuscular Control Laboratory, Department of Electronic Science and Technology, University of Science and Technology of ChinaHefei, China
| | - Xiang Chen
- Neuromuscular Control Laboratory, Department of Electronic Science and Technology, University of Science and Technology of ChinaHefei, China
| | - De Wu
- Department of pediatrics, First Affiliated Hospital of Anhui Medical UniversityHefei, China
| | - Ping Zhou
- Neuromuscular Control Laboratory, Department of Electronic Science and Technology, University of Science and Technology of ChinaHefei, China
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, TIRR Memorial Hermann Research CenterHouston, TX, USA
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Dayanidhi S, Dykstra PB, Lyubasyuk V, McKay BR, Chambers HG, Lieber RL. Reduced satellite cell number in situ in muscular contractures from children with cerebral palsy. J Orthop Res 2015; 33:1039-45. [PMID: 25732238 DOI: 10.1002/jor.22860] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/08/2015] [Indexed: 02/04/2023]
Abstract
Satellite cells (SC) are quiescent adult muscle stem cells critical for postnatal development. Children with cerebral palsy have impaired muscular growth and develop contractures. While flow cytometry previously demonstrated a reduced SC population, extracellular matrix abnormalities may influence the cell isolation methods used, systematically isolating fewer cells from CP muscle and creating a biased result. Consequently, the purpose of this study was to use immunohistochemistry on serial muscle sections to quantify SC in situ. Serial cross-sections from human gracilis muscle biopsies (n = 11) were labeled with fluorescent antibodies for Pax7 (SC transcriptional marker), laminin (basal lamina), and 4',6-diamidino-2-phenylindole (nuclei). Fluorescence microscopy under high magnification was used to identify SC based on labeling and location. Mean SC/100 myofibers was reduced by ∼70% (p < 0.001) in children with CP (2.89 ± 0.39) compared to TD children (8.77 ± 0.79). Furthermore, SC distribution across fields was different (p < 0.05) with increased percentage of SC in fields being solitary cells (p < 0.01) in children with CP. Quantification of SC number in situ, without any other tissue manipulation confirms children with spastic CP have a reduced number. This stem cell loss may, in part, explain impaired muscle growth and apparent decreased responsiveness of CP muscle to exercise.
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Affiliation(s)
- Sudarshan Dayanidhi
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California.,Department of Veterans Affairs Medical Center, San Diego, California
| | - Peter B Dykstra
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California
| | - Vera Lyubasyuk
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California
| | - Bryon R McKay
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Henry G Chambers
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California.,Department of Orthopaedics, Rady Children's Hospital, San Diego, La Jolla, California
| | - Richard L Lieber
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California.,Department of Veterans Affairs Medical Center, San Diego, California.,Department of Bioengineering, University of California, San Diego, California
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Ultrasound characterization of medial gastrocnemius tissue composition in children with spastic cerebral palsy. Muscle Nerve 2015; 52:397-403. [DOI: 10.1002/mus.24549] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/23/2014] [Accepted: 12/15/2014] [Indexed: 11/07/2022]
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Mathewson MA, Chambers HG, Girard PJ, Tenenhaus M, Schwartz AK, Lieber RL. Stiff muscle fibers in calf muscles of patients with cerebral palsy lead to high passive muscle stiffness. J Orthop Res 2014; 32:1667-74. [PMID: 25138654 DOI: 10.1002/jor.22719] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/08/2014] [Indexed: 02/04/2023]
Abstract
Cerebral palsy (CP), caused by an injury to the developing brain, can lead to alterations in muscle function. Subsequently, increased muscle stiffness and decreased joint range of motion are often seen in patients with CP. We examined mechanical and biochemical properties of the gastrocnemius and soleus muscles, which are involved in equinus muscle contracture. Passive mechanical testing of single muscle fibers from gastrocnemius and soleus muscle of patients with CP undergoing surgery for equinus deformity showed a significant increase in fiber stiffness (p<0.01). Bundles of fibers that included their surrounding connective tissues showed no stiffness difference (p=0.28).). When in vivo sarcomere lengths were measured and fiber and bundle stiffness compared at these lengths, both fibers and bundles of patients with CP were predicted to be much stiffer in vivo compared to typically developing (TD) individuals. Interestingly, differences in fiber and bundle stiffness were not explained by typical biochemical measures such as titin molecular weight (a giant protein thought to impact fiber stiffness) or collagen content (a proxy for extracellular matrix amount). We suggest that the passive mechanical properties of fibers and bundles are thus poorly understood.
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Affiliation(s)
- Margie A Mathewson
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093-0412
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de Bruin M, Smeulders MJ, Kreulen M, Huijing PA, Jaspers RT. Intramuscular connective tissue differences in spastic and control muscle: a mechanical and histological study. PLoS One 2014; 9:e101038. [PMID: 24977410 PMCID: PMC4076209 DOI: 10.1371/journal.pone.0101038] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/03/2014] [Indexed: 12/18/2022] Open
Abstract
Cerebral palsy (CP) of the spastic type is a neurological disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks. Secondary to the spasticity, muscle adaptation is presumed to contribute to limitations in the passive range of joint motion. However, the mechanisms underlying these limitations are unknown. Using biopsies, we compared mechanical as well as histological properties of flexor carpi ulnaris muscle (FCU) from CP patients (n = 29) and healthy controls (n = 10). The sarcomere slack length (mean 2.5 µm, SEM 0.05) and slope of the normalized sarcomere length-tension characteristics of spastic fascicle segments and single myofibre segments were not different from those of control muscle. Fibre type distribution also showed no significant differences. Fibre size was significantly smaller (1933 µm2, SEM 190) in spastic muscle than in controls (2572 µm2, SEM 322). However, our statistical analyses indicate that the latter difference is likely to be explained by age, rather than by the affliction. Quantities of endomysial and perimysial networks within biopsies of control and spastic muscle were unchanged with one exception: a significant thickening of the tertiary perimysium (3-fold), i.e. the connective tissue reinforcement of neurovascular tissues penetrating the muscle. Note that this thickening in tertiary perimysium was shown in the majority of CP patients, however a small number of patients (n = 4 out of 23) did not have this feature. These results are taken as indications that enhanced myofascial loads on FCU is one among several factors contributing in a major way to the aetiology of limitation of movement at the wrist in CP and the characteristic wrist position of such patients.
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Affiliation(s)
- Marije de Bruin
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark J. Smeulders
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel Kreulen
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Peter A. Huijing
- Laboratory for Myology, MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Richard T Jaspers
- Laboratory for Myology, MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- * E-mail:
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Stecco A, Stecco C, Raghavan P. Peripheral Mechanisms Contributing to Spasticity and Implications for Treatment. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0052-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Walsh SF, Scharf MG. Effects of a recreational ice skating program on the functional mobility of a child with cerebral palsy. Physiother Theory Pract 2013; 30:189-95. [DOI: 10.3109/09593985.2013.863414] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Robinson KG, Mendonca JL, Militar JL, Theroux MC, Dabney KW, Shah SA, Miller F, Akins RE. Disruption of basal lamina components in neuromotor synapses of children with spastic quadriplegic cerebral palsy. PLoS One 2013; 8:e70288. [PMID: 23976945 PMCID: PMC3745387 DOI: 10.1371/journal.pone.0070288] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 06/18/2013] [Indexed: 11/18/2022] Open
Abstract
Cerebral palsy (CP) is a static encephalopathy occurring when a lesion to the developing brain results in disordered movement and posture. Patients present with sometimes overlapping spastic, athetoid/dyskinetic, and ataxic symptoms. Spastic CP, which is characterized by stiff muscles, weakness, and poor motor control, accounts for ∼80% of cases. The detailed mechanisms leading to disordered movement in spastic CP are not completely understood, but clinical experience and recent studies suggest involvement of peripheral motor synapses. For example, it is recognized that CP patients have altered sensitivities to drugs that target neuromuscular junctions (NMJs), and protein localization studies suggest that NMJ microanatomy is disrupted in CP. Since CP originates during maturation, we hypothesized that NMJ disruption in spastic CP is associated with retention of an immature neuromotor phenotype later in life. Scoliosis patients with spastic CP or idiopathic disease were enrolled in a prospective, partially-blinded study to evaluate NMJ organization and neuromotor maturation. The localization of synaptic acetylcholine esterase (AChE) relative to postsynaptic acetylcholine receptor (AChR), synaptic laminin β2, and presynaptic vesicle protein 2 (SV2) appeared mismatched in the CP samples; whereas, no significant disruption was found between AChR and SV2. These data suggest that pre- and postsynaptic NMJ components in CP children were appropriately distributed even though AChE and laminin β2 within the synaptic basal lamina appeared disrupted. Follow up electron microscopy indicated that NMJs from CP patients appeared generally mature and similar to controls with some differences present, including deeper postsynaptic folds and reduced presynaptic mitochondria. Analysis of maturational markers, including myosin, syntrophin, myogenin, and AChR subunit expression, and telomere lengths, all indicated similar levels of motor maturation in the two groups. Thus, NMJ disruption in CP was found to principally involve components of the synaptic basal lamina and subtle ultra-structural modifications but appeared unrelated to neuromotor maturational status.
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Affiliation(s)
- Karyn G. Robinson
- Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Janet L. Mendonca
- Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Jaimee L. Militar
- Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Mary C. Theroux
- Department of Anesthesiology and Critical Care, Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Kirk W. Dabney
- Department of Orthopedic Surgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Suken A. Shah
- Department of Orthopedic Surgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Freeman Miller
- Department of Orthopedic Surgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Robert E. Akins
- Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
- * E-mail:
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Morris S. Ashworth And Tardieu Scales: Their Clinical Relevance For Measuring Spasticity In Adult And Paediatric Neurological Populations. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331902125001770] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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McDonald CM, Henricson EK, Abresch RT, Florence J, Eagle M, Gappmaier E, Glanzman AM, Spiegel R, Barth J, Elfring G, Reha A, Peltz SW. The 6-minute walk test and other clinical endpoints in duchenne muscular dystrophy: reliability, concurrent validity, and minimal clinically important differences from a multicenter study. Muscle Nerve 2013; 48:357-68. [PMID: 23674289 PMCID: PMC3826053 DOI: 10.1002/mus.23905] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2013] [Indexed: 11/10/2022]
Abstract
INTRODUCTION An international clinical trial enrolled 174 ambulatory males ≥5 years old with nonsense mutation Duchenne muscular dystrophy (nmDMD). Pretreatment data provide insight into reliability, concurrent validity, and minimal clinically important differences (MCIDs) of the 6-minute walk test (6MWT) and other endpoints. METHODS Screening and baseline evaluations included the 6-minute walk distance (6MWD), timed function tests (TFTs), quantitative strength by myometry, the PedsQL, heart rate-determined energy expenditure index, and other exploratory endpoints. RESULTS The 6MWT proved feasible and reliable in a multicenter context. Concurrent validity with other endpoints was excellent. The MCID for 6MWD was 28.5 and 31.7 meters based on 2 statistical distribution methods. CONCLUSIONS The ratio of MCID to baseline mean is lower for 6MWD than for other endpoints. The 6MWD is an optimal primary endpoint for Duchenne muscular dystrophy (DMD) clinical trials that are focused therapeutically on preservation of ambulation and slowing of disease progression.
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Affiliation(s)
- Craig M McDonald
- Department of Physical Medicine and Rehabilitation, Neuromuscular Medicine and Rehabilitation Research Center, University of California Davis School of Medicine, Davis, California, 95817, USA
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dos Santos AN, Pavão SL, Santiago PRP, Salvini TDF, Rocha NACF. Sit-to-stand movement in children with hemiplegic cerebral palsy: relationship with knee extensor torque and social participation. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2023-2032. [PMID: 23584182 DOI: 10.1016/j.ridd.2013.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/17/2013] [Accepted: 03/17/2013] [Indexed: 06/02/2023]
Abstract
This study aimed to investigate the relationship between sit-to-stand (STS) movement, knee extensor torque and social participation in children with cerebral palsy (CP). Seven spastic hemiplegic CP patients (8.0 ± 2.2 years), classified by the Gross Motor Function Classification System as I and II, and 18 typical children (8.4 ± 2.3 years) participated in this study. Trunk, hips, knees, and ankles angles and temporal variables of STS movement were obtained by means of kinematics evaluation. Isokinetic evaluation was performed at 60°/s in the concentric passive mode to measure knee extensors torque. Social participation was assessed by the Assessment of Life Habits for Children (LIFE-H) scale. Results showed that children with spastic hemiplegic CP have lower knee extensor torque in the affected limb and restriction in social participation in dimensions related with fine motor control and language skills when compared to their typical peers. Except for ankle excursion in frontal plane, and ankle excursion and range in transverse plane, patients were similar to typical children regarding the strategies adopted to perform the STS movement, as well as in the participation dimensions related with gross motor function. Moreover, we found a significant non-linear correlation between knee extensors torque and some lower limb and trunk angles for children with CP. Therefore, during evaluation and rehabilitation processes, impairments in body functions and structures should be related with how much they affect a child's ability to perform functional activities, so rehabilitation protocols could be focused on individual needs.
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Affiliation(s)
- Adriana Neves dos Santos
- Department of Physiotherapy, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, 13565-905 São Carlos, SP, Brazil.
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Doix ACM, Gulliksen A, Brændvik SM, Roeleveld K. Fatigue and muscle activation during submaximal elbow flexion in children with cerebral palsy. J Electromyogr Kinesiol 2013; 23:721-6. [DOI: 10.1016/j.jelekin.2012.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 12/20/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022] Open
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BALEMANS ASTRIDCJ, VAN WELY LEONTIEN, DE HEER SUSANJA, VAN DEN BRINK JANNEKE, DE KONING JOSJ, BECHER JULESG, DALLMEIJER ANNETJ. Maximal Aerobic and Anaerobic Exercise Responses in Children with Cerebral Palsy. Med Sci Sports Exerc 2013; 45:561-8. [DOI: 10.1249/mss.0b013e3182732b2f] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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de Bruin M, Smeulders MJC, Kreulen M. Why is joint range of motion limited in patients with cerebral palsy? J Hand Surg Eur Vol 2013; 38:8-13. [PMID: 22526515 DOI: 10.1177/1753193412444401] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patients with spastic cerebral palsy of the upper limb typically present with various problems including an impaired range of motion that affects the positioning of the upper extremity. This impaired range of motion often develops into contractures that further limit functioning of the spastic hand and arm. Understanding why these contractures develop in cerebral palsy will affect the selection of patients suitable for surgical treatment as well as the choice for specific surgical procedures. The generally accepted hypothesis in patients with spastic cerebral palsy is that the hyper-excitability of the stretch reflex combined with increased muscle tone result in extreme angles of the involved joints at rest. Ultimately, these extreme joint angles are thought to result in fixed joint postures. There is no consensus in the literature concerning the pathophysiology of this process. Several hypotheses associated with inactivity and overactivity have been tested by examining the secondary changes in spastic muscle and its surrounding tissue. All hypotheses implicate different secondary changes that consequently require different clinical approaches. In this review, the different hypotheses concerning the development of limited joint range of motion in cerebral palsy are discussed in relation to their secondary changes on the musculoskeletal system.
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Affiliation(s)
- M de Bruin
- Department of Plastic, Reconstructive and Hand surgery, Academic Medical Centre, Amsterdam, the Netherlands.
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