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Kuska EC, Steele KM. Does crouch alter the effects of neuromuscular impairments on gait? A simulation study. J Biomech 2024; 165:112015. [PMID: 38394953 PMCID: PMC10939721 DOI: 10.1016/j.jbiomech.2024.112015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 12/18/2023] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
Cerebral palsy (CP) is a neurologic injury that impacts control of movement. Individuals with CP also often develop secondary impairments like weakness and contracture. Both altered motor control and secondary impairments influence how an individual walks after neurologic injury. However, understanding the complex interactions between and relative effects of these impairments makes analyzing and improving walking capacity in CP challenging. We used a sagittal-plane musculoskeletal model and neuromuscular control framework to simulate crouch and nondisabled gait. We perturbed each simulation by varying the number of synergies controlling each leg (altered control), and imposed weakness and contracture. A Bayesian Additive Regression Trees (BART) model was also used to parse the relative effects of each impairment on the muscle activations required for each gait pattern. By using these simulations to evaluate gait-pattern specific effects of neuromuscular impairments, we identified some advantages of crouch gait. For example, crouch tolerated 13 % and 22 % more plantarflexor weakness than nondisabled gait without and with altered control, respectively. Furthermore, BART demonstrated that plantarflexor weakness had twice the effect on total muscle activity required during nondisabled gait than crouch gait. However, crouch gait was also disadvantageous in the presence of vasti weakness: crouch gait increased the effects of vasti weakness on gait without and with altered control. These simulations highlight gait-pattern specific effects and interactions between neuromuscular impairments. Utilizing computational techniques to understand these effects can elicit advantages of gait deviations, providing insight into why individuals may select their gait pattern and possible interventions to improve energetics.
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Affiliation(s)
- Elijah C Kuska
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States.
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
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2
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Kaya Keles CS, Ates F. How mechanics of individual muscle-tendon units define knee and ankle joint function in health and cerebral palsy-a narrative review. Front Bioeng Biotechnol 2023; 11:1287385. [PMID: 38116195 PMCID: PMC10728775 DOI: 10.3389/fbioe.2023.1287385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
This study reviews the relationship between muscle-tendon biomechanics and joint function, with a particular focus on how cerebral palsy (CP) affects this relationship. In healthy individuals, muscle size is a critical determinant of strength, with muscle volume, cross-sectional area, and moment arm correlating with knee and ankle joint torque for different isometric/isokinetic contractions. However, in CP, impaired muscle growth contributes to joint pathophysiology even though only a limited number of studies have investigated the impact of deficits in muscle size on pathological joint function. As muscles are the primary factors determining joint torque, in this review two main approaches used for muscle force quantification are discussed. The direct quantification of individual muscle forces from their relevant tendons through intraoperative approaches holds a high potential for characterizing healthy and diseased muscles but poses challenges due to the invasive nature of the technique. On the other hand, musculoskeletal models, using an inverse dynamic approach, can predict muscle forces, but rely on several assumptions and have inherent limitations. Neither technique has become established in routine clinical practice. Nevertheless, identifying the relative contribution of each muscle to the overall joint moment would be key for diagnosis and formulating efficient treatment strategies for patients with CP. This review emphasizes the necessity of implementing the intraoperative approach into general surgical practice, particularly for joint correction operations in diverse patient groups. Obtaining in vivo data directly would enhance musculoskeletal models, providing more accurate force estimations. This integrated approach can improve the clinicians' decision-making process and advance treatment strategies by predicting changes at the muscle and joint levels before interventions, thus, holding the potential to significantly enhance clinical outcomes.
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3
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Miller T, Bello UM, Tsang CSL, Winser SJ, Ying MTC, Pang MYC. Using ultrasound elastography to assess non-invasive, non-pharmacological interventions for musculoskeletal stiffness: a systematic review and meta-analysis. Disabil Rehabil 2023:1-15. [PMID: 37668241 DOI: 10.1080/09638288.2023.2252744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To evaluate the current evidence regarding the use of ultrasound elastography for assessing non-invasive, non-pharmacological interventions for eliciting changes in musculoskeletal stiffness. METHODS A systematic search of MEDLINE, CINAHL, EMBASE, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Information on measurement and intervention procedures was extracted. Bias was assessed using Cochrane Risk of Bias or Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tools for studies with true or quasi-experimental designs, respectively. Analyses were conducted for adequately powered subgroups based on intervention type, measurement site, and population assessed. RESULTS Twenty-one studies were included in the review. Overall risk of bias was low for true experimental studies and moderate for quasi-experimental studies. Subgroup analyses indicated a large overall effect for interventions involving manual physiotherapy and taping/splinting for reducing masseter muscle stiffness in patients with masticatory muscle disorders (g = 1.488, 95% CI = 0.320-2.655, p = 0.013). Analyses for other intervention types and patient groups were underpowered. CONCLUSION Ultrasound elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness. However, the comparative efficacy of these interventions for modulating tissue stiffness remains inconclusive.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Umar M Bello
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Stanley J Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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4
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Modification of the locomotor pattern when deviating from the characteristic heel-to-toe rolling pattern during walking. Eur J Appl Physiol 2023:10.1007/s00421-023-05169-5. [PMID: 36869884 DOI: 10.1007/s00421-023-05169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/27/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Humans are amongst few animals that step first on the heel, and then roll on the ball of the foot and toes. While this heel-to-toe rolling pattern has been shown to render an energetic advantage during walking, the effect of different foot contact strategies, on the neuromuscular control of adult walking gaits has received less attention. We hypothesised that deviating from heel-to-toe rolling pattern affects the energy transduction and weight acceptance and re-propulsive phases in gait along with the modification of spinal motor activity. METHODS Ten subjects walked on a treadmill normally, then placed their feet flat on the ground at each step and finally walked on the balls of the feet. RESULTS Our results show that when participants deviate from heel-to-toe rolling pattern strategy, the mechanical work increases on average 85% higher (F = 15.5; p < 0.001), mainly linked to a lack of propulsion at late stance. This modification of the mechanical power is related to a differential involvement of lumbar and sacral segment activation. Particularly, the delay between the major bursts of activation is on average 65% smaller, as compared to normal walking (F = 43.2; p < 0.001). CONCLUSION Similar results are observable in walking plantigrade animals, but also at the onset of independent stepping in toddlers, where the heel-to-toe rolling pattern is not yet established. These indications seem to bring arguments to the fact that the rolling of the foot during human locomotion has evolved to optimise gait, following selective pressures from the evolution of bipedal posture.
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Ebrahimi A, Schwartz MH, Martin JA, Novacheck TF, Thelen DG. Atypical triceps surae force and work patterns underlying gait in children with cerebral palsy. J Orthop Res 2022; 40:2763-2770. [PMID: 35212418 PMCID: PMC9402799 DOI: 10.1002/jor.25307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/25/2021] [Accepted: 02/21/2022] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to quantitatively assess Achilles tendon mechanical behavior during gait in children with cerebral palsy (CP). We used a newly designed noninvasive sensor to measure Achilles tendon force in 11 children with CP (4F, 8-16 years old) and 15 typically developing children (controls) (9F, 8-17 years old) during overground walking. Mechanical work loop plots (force-displacement plots) were generated by combining muscle-tendon kinetics, kinematics, and EMG activity to evaluate the Achilles tendon work generated about the ankle. Work loop patterns in children with CP were substantially different than those seen in controls. Notably, children with CP showed significantly diminished work production at their preferred speed compared to controls at their preferred speed and slower speeds. Despite testing a heterogeneous population of children with CP, we observed a homogenous spring-like muscle-tendon behavior in these participants. This is in contrast with control participants who used their plantar flexors like a motor during gait. Statement of Clinical Significance: These data demonstrate the potential for using skin-mounted sensors to objectively evaluate muscle contributions to work production in pathological gait.
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Affiliation(s)
- Anahid Ebrahimi
- Mechanical Engineering DepartmentUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Michael H. Schwartz
- Center for Gait & Motion AnalysisGillette Children's Specialty HealthcareSt. PaulMinnesotaUSA
| | - Jack A. Martin
- Mechanical Engineering DepartmentUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Tom F. Novacheck
- Center for Gait & Motion AnalysisGillette Children's Specialty HealthcareSt. PaulMinnesotaUSA
| | - Darryl G. Thelen
- Mechanical Engineering DepartmentUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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Personalisation of Plantarflexor Musculotendon Model Parameters in Children with Cerebral Palsy. Ann Biomed Eng 2022; 51:938-950. [PMID: 36380165 PMCID: PMC10122634 DOI: 10.1007/s10439-022-03107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
AbstractNeuromusculoskeletal models can be used to evaluate aberrant muscle function in cerebral palsy (CP), for example by estimating muscle and joint contact forces during gait. However, to be accurate, models should include representative musculotendon parameters. We aimed to estimate personalised parameters that capture the mechanical behaviour of the plantarflexors in children with CP and typically developing (TD) children. Ankle angle (using motion capture), torque (using a load-cell), and medial gastrocnemius fascicle lengths (using ultrasound) were measured during slow passive ankle dorsiflexion rotation for thirteen children with spastic CP and thirteen TD children. Per subject, the measured rotation was input to a scaled OpenSim model to simulate the torque and fascicle length output. Musculotendon model parameters were personalised by the best match between simulated and experimental torque–angle and fascicle length-angle curves according to a least-squares fit. Personalised tendon slack lengths were significantly longer and optimal fibre lengths significantly shorter in CP than model defaults and than in TD. Personalised tendon compliance was substantially higher in both groups compared to the model default. The presented method to personalise musculotendon parameters will likely yield more accurate simulations of subject-specific muscle mechanics, to help us understand the effects of altered musculotendon properties in CP.
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Elnaggar RK, Alghamdi MS, Alenazi AM, Alghadier M, Mahmoud MZ, Elsayed AEA, Hassan IAM, Abonour AA. Mechanical and Morphological Changes of the Plantar Flexor Musculotendinous Unit in Children with Unilateral Cerebral Palsy Following 12 Weeks of Plyometric Exercise: A Randomized Controlled Trial. CHILDREN 2022; 9:children9111604. [PMID: 36360332 PMCID: PMC9688148 DOI: 10.3390/children9111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
To investigate how plyometric exercise (PLYO-Ex) affects mechanics and morphometrics of the plantar flexor musculotendinous unit in children with unilateral cerebral palsy, 38 participants (aged 10–16 years) were allocated at random to either the PLYO-Ex group (n = 19; received 24 sessions of plyometric muscle loading, conducted 2 times a week for 3 months in succession) or the control group (n = 19; underwent traditional physical therapy for the same frequency and duration). Measurements were taken pre- and post-intervention. Standard ultrasound imaging was applied to evaluate morphometrics of the gastrocnemius muscle and Achilles tendon unit and an isokinetic dynamometer was used to evaluate maximum voluntary isometric plantar flexors contraction (IVCmax). With controlling for pre-treatment values, significant post-treatment changes favoring the PLYO-Ex group were observed for morphological (tendon (p = 0.003, η2p = 0.23) length; belly length (p = 0.001, η2p = 0.27); tendon thickness (p = 0.035, η2p = 0.35); muscle thickness (p = 0.013, η2p = 0.17); fascicle length (p = 0.009, η2p = 0.18); pennation angle (p = 0.015, η2p = 0.16)) and mechanical and material properties (IVCmax (p = 0.009, η2p = 0.18); tendon’s elongation (p = 0.012, η2p = 0.17), stiffness (p = 0.027, η2p = 0.13); stress (p = 0.006, η2p = 0.20); strain (p = 0.004, η2p = 0.21)). In conclusion, plyometric exercise induces significant adaptations within the musculotendinous unit of the plantar flexors in children with unilateral cerebral palsy. These adaptations could improve muscular efficiency and consequently optimize physical/functional performance.
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Affiliation(s)
- Ragab K. Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Correspondence:
| | - Mohammed S. Alghamdi
- Department of Physical Therapy, College of Applied Medical Sciences, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Aqeel M. Alenazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Mshari Alghadier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Mustafa Z. Mahmoud
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Abbas Elbakry A. Elsayed
- Pediatric Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
- Pediatric Department, Faculty of Medicine, Alazhar University, Assiut 71524, Egypt
| | - Ismail Abdelfattah M. Hassan
- Pediatric and Neonatology Specialist, New Medical Center, Royal hospital, Khalifa City, Abu Dhabi 35233, United Arab Emirates
| | - Asmaa A. Abonour
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
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8
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Individual muscle force–energy rate is altered during crouch gait: A neuro-musculoskeletal evaluation. J Biomech 2022; 139:111141. [DOI: 10.1016/j.jbiomech.2022.111141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/19/2022]
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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] [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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Hamard R, Hug F, Kelp NY, Feigean R, Aeles J, J. M. Dick T. Inclusion of image-based in-vivo experimental data into the Hill-type muscle model affects the estimation of individual force-sharing strategies during walking. J Biomech 2022; 135:111033. [DOI: 10.1016/j.jbiomech.2022.111033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
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11
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Kuska EC, Mehrabi N, Schwartz MH, Steele KM. Number of synergies impacts sensitivity of gait to weakness and contracture. J Biomech 2022; 134:111012. [PMID: 35219146 PMCID: PMC8976766 DOI: 10.1016/j.jbiomech.2022.111012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
Muscle activity during gait can be described by a small set of synergies, weighted groups of muscles, that are theorized to reflect underlying neural control. For people with neurologic injuries, like cerebral palsy or stroke, even fewer synergies are required to explain muscle activity during gait. This reduction in synergies is thought to reflect altered control and is associated with impairment severity and treatment outcomes. Individuals with neurologic injuries also develop secondary musculoskeletal impairments, like weakness or contracture, that can impact gait. Yet, the combined impacts of altered control and musculoskeletal impairments on gait remains unclear. In this study, we use a two-dimensional musculoskeletal model constrained to synergy control to simulate unimpaired gait. We vary the number of synergies, while simulating muscle weakness and contracture to examine how altered control impacts sensitivity to musculoskeletal impairment while tracking unimpaired gait. Results demonstrate that reducing the number of synergies increases sensitivity to weakness and contracture for specific muscle groups. For example, simulations using five-synergy control tolerated 40% and 51% more knee extensor weakness than those using four- or three-synergy control, respectively. Furthermore, when constrained to four- or three-synergy control, the model was increasingly sensitive to contracture and weakness of proximal muscles, such as the hamstring and hip flexors. Contrastingly, neither the amount of generalized nor plantarflexor weakness tolerated was affected by the number of synergies. These findings highlight the interactions between altered control and musculoskeletal impairments, emphasizing the importance of measuring and incorporating both in future simulation and experimental studies.
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Affiliation(s)
- Elijah C Kuska
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States.
| | - Naser Mehrabi
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Michael H Schwartz
- Center for Gait & Motional Analysis, Gillette Children's Specialty Healthcare, St. Paul, MN, United States
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
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12
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Howard JJ, Graham K, Shortland AP. Understanding skeletal muscle in cerebral palsy: a path to personalized medicine? Dev Med Child Neurol 2022; 64:289-295. [PMID: 34499350 DOI: 10.1111/dmcn.15018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 12/11/2022]
Abstract
Until recently, there has been little interest in understanding the intrinsic features associated with the pathomorphology of skeletal muscle in cerebral palsy (CP). Coupled with emerging evidence that challenges the role of spasticity as a determinant of gross motor function and in the development of fixed muscle contractures, it has become increasingly important to further elucidate the underlying mechanisms responsible for muscle alterations in CP. This knowledge can help clinicians to understand and apply treatment modalities that take these aspects into account. Thus, the inherent heterogeneity of the CP phenotype allows for the potential of personalized medicine through the understanding of muscle pathomorphology on an individual basis and tailoring treatment approaches accordingly. This review aims to summarize recent developments in the understanding of CP muscle and their relationship to musculoskeletal manifestations, in addition to proposing a treatment paradigm that incorporates this new knowledge.
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Affiliation(s)
- Jason J Howard
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Kerr Graham
- Department of Orthopaedic Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Hugh Williamson Gait Laboratory, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Adam P Shortland
- Paediatric Neurosciences, Guy's and St Thomas' Foundation NHS Trust, Evelina Children's Hospital, London, UK
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13
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Konno RN, Nigam N, Wakeling JM, Ross SA. The Contributions of Extracellular Matrix and Sarcomere Properties to Passive Muscle Stiffness in Cerebral Palsy. Front Physiol 2022; 12:804188. [PMID: 35153814 PMCID: PMC8827041 DOI: 10.3389/fphys.2021.804188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy results from an upper motor neuron lesion and significantly affects skeletal muscle stiffness. The increased stiffness that occurs is partly a result of changes in the microstructural components of muscle. In particular, alterations in extracellular matrix, sarcomere length, fibre diameter, and fat content have been reported; however, experimental studies have shown wide variability in the degree of alteration. Many studies have reported changes in the extracellular matrix, while others have reported no differences. A consistent finding is increased sarcomere length in cerebral palsy affected muscle. Often many components are altered simultaneously, making it difficult to determine the individual effects on muscle stiffness. In this study, we use a three dimensional modelling approach to isolate individual effects of microstructural alterations typically occurring due to cerebral palsy on whole muscle behaviour; in particular, the effects of extracellular matrix volume fraction, stiffness, and sarcomere length. Causation between the changes to the microstructure and the overall muscle response is difficult to determine experimentally, since components of muscle cannot be manipulated individually; however, utilising a modelling approach allows greater control over each factor. We find that extracellular matrix volume fraction has the largest effect on whole muscle stiffness and mitigates effects from sarcomere length.
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Affiliation(s)
- Ryan N. Konno
- Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada
- *Correspondence: Ryan N. Konno
| | - Nilima Nigam
- Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada
| | - James M. Wakeling
- Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Stephanie A. Ross
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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14
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Bell M, Al Masruri G, Fernandez J, Williams SA, Agur AM, Stott NS, Hajarizadeh B, Mirjalili A. Typical m. triceps surae morphology and architecture measurement from 0 to 18 years: A narrative review. J Anat 2021; 240:746-760. [PMID: 34750816 PMCID: PMC8930835 DOI: 10.1111/joa.13584] [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: 07/04/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022] Open
Abstract
The aim of this review was to report on the imaging modalities used to assess morphological and architectural properties of the m. triceps surae muscle in typically developing children, and the available reliability analyses. Scopus and MEDLINE (Pubmed) were searched systematically for all original articles published up to September 2020 measuring morphological and architectural properties of the m. triceps surae in typically developing children (18 years or under). Thirty eligible studies were included in this analysis, measuring fibre bundle length (FBL) (n = 11), pennation angle (PA) (n = 10), muscle volume (MV) (n = 16) and physiological cross‐sectional area (PCSA) (n = 4). Three primary imaging modalities were utilised to assess these architectural parameters in vivo: two‐dimensional ultrasound (2DUS; n = 12), three‐dimensional ultrasound (3DUS; n = 9) and magnetic resonance imaging (MRI; n = 6). The mean age of participants ranged from 1.4 years to 18 years old. There was an apparent increase in m. gastrocnemius medialis MV and pCSA with age; however, no trend was evident with FBL or PA. Analysis of correlations of muscle variables with age was limited by a lack of longitudinal data and methodological variations between studies affecting outcomes. Only five studies evaluated the reliability of the methods. Imaging methodologies such as MRI and US may provide valuable insight into the development of skeletal muscle from childhood to adulthood; however, variations in methodological approaches can significantly influence outcomes. Researchers wishing to develop a model of typical muscle development should carry out longitudinal architectural assessment of all muscles comprising the m. triceps surae utilising a consistent approach that minimises confounding errors.
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Affiliation(s)
- Matthew Bell
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ghaliya Al Masruri
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Sîan A Williams
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, Australia.,Faculty of Medical and Health Sciences, Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Anne M Agur
- Division of Anatomy, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ngaire S Stott
- Faculty of Medical and Health Sciences, Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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15
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Harkness-Armstrong C, Maganaris C, Walton R, Wright DM, Bass A, Baltzopoulos V, O'Brien TD. In vivo operating lengths of the gastrocnemius muscle during gait in children who idiopathically toe-walk. Exp Physiol 2021; 106:1806-1813. [PMID: 34159660 DOI: 10.1113/ep089658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
NEW FINDINGS What is the central question of this study? What are the in vivo operating lengths of the gastrocnemius muscle in children who idiopathically toe-walk? What is the main finding and its importance? Children who idiopathically toe-walk operate at more plantarflexed positions but at longer fascicle lengths than typically developing children during gait. However, these ranges utilised during gait correspond to where children who idiopathically toe-walk are optimally strong. This should be considered when prescribing clinical treatments to restore typical gait. ABSTRACT Children who idiopathically toe-walk (ITW) habitually operate at greater plantarflexion angles than typically developing (TD) children, which might result in shorter, sub-optimal gastrocnemius fascicle lengths. However, currently no experimental evidence exists to substantiate this notion. Five children who ITW and 14 TD children completed a gait analysis, whilst gastrocnemius fascicle behaviour was simultaneously quantified using ultrasound. The moment-angle (hip, knee and ankle) and moment-length (gastrocnemius) relationships were determined from isometric maximum voluntary contractions (MVC) on an isokinetic dynamometer combined with ultrasound. During gait, children who ITW operated at more plantarflexed angles (Δ = 20°; P = 0.013) and longer muscle fascicle lengths (Δ = 12 mm; P = 0.008) than TD children. During MVC, no differences in the peak moment of any joint were found. However, peak plantarflexor moment occurred at significantly more plantarflexed angles (-16 vs. 1°; P = 0.010) and at longer muscle fascicle lengths (44 vs. 37 mm; P = 0.001) in children who ITW than TD children. Observed alterations in the moment-angle and moment-length relationships of children who ITW coincided with the ranges used during gait. Therefore, the gastrocnemius muscle in children who ITW operates close to the peak of the force-length relationship, similarly to TD children. Thus, this study indicates that idiopathic toe-walking is truly an ankle joint pathology, and children who ITW present with substantial alterations in the gastrocnemius muscle functional properties, which appear well adapted to the characteristic demands of equinus gait. These findings should be considered when prescribing clinical treatments to restore typical gait.
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Affiliation(s)
- Carla Harkness-Armstrong
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Constantinos Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Roger Walton
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - David M Wright
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Alfie Bass
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Thomas D O'Brien
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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16
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Musculoskeletal Health in Active Ambulatory Men with Cerebral Palsy and the Impact of Vitamin D. Nutrients 2021; 13:nu13072481. [PMID: 34371988 PMCID: PMC8308596 DOI: 10.3390/nu13072481] [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: 06/17/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose: (1) To determine the contribution of diet, time spent outdoors, and habitual physical activity (PA) on vitamin D status in men with cerebral palsy (CP) compared to physical activity matched controls (TDC) without neurological impairment; (2) to determine the role of vitamin D on musculoskeletal health, morphology, and function in men with CP compared to TDC. Materials and methods: A cross-sectional comparison study where 24 active, ambulant men with CP aged 21.0 ± 1.4 years (Gross Motor Function Classification Score (I–II) and 24 healthy TDC aged 25.3 ± 3.1 years completed in vivo assessment of musculoskeletal health, including: vastus lateralis anatomical cross-sectional area (VL ACSA), isometric knee extension maximal voluntary contraction (KE iMVC), 10 m sprint, vertical jumps (VJ), and radius and tibia bone ultrasound (US) Tus and Zus scores. Assessments of vitamin D status through venous samples of serum 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone, dietary vitamin D intake from food diary, and total sun exposure via questionnaire were also taken. Results: Men with CP had 40.5% weaker KE iMVC, 23.7% smaller VL ACSA, 22.2% lower VJ, 14.6% lower KE iMVC/VL ACSA ratio, 22.4% lower KE iMVC/body mass (BM) ratio, and 25.1% lower KE iMVC/lean body mass (LBM) ratio (all p < 0.05). Radius Tus and Zus scores were 1.75 and 1.57 standard deviations lower than TDC, respectively (p < 0.05), whereas neither tibia Tus nor Zus scores showed any difference compared to TDC (p > 0.05). The 25(OH)D was not different between groups, and 90.9% of men with CP and 91.7% of TDC had low 25(OH)D levels when compared to current UK recommendations. The 25(OH)D was positively associated with KE iMVC/LBM ratio in men with CP (r = 0.500, p = 0.020) but not in TDC (r = 0.281, p = 0.104). Conclusion: Musculoskeletal outcomes in men with CP were lower than TDC, and despite there being no difference in levels of 25(OH)D between the groups, 25 (OH)D was associated with strength (KE iMVC/LBM) in the CP group but not TDC. The findings suggest that vitamin D deficiency can accentuate some of the condition-specific impairments to musculoskeletal outcomes.
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17
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Willerslev-Olsen M, Lorentzen J, Røhder K, Ritterband-Rosenbaum A, Justiniano M, Guzzetta A, Lando AV, Jensen AMB, Greisen G, Ejlersen S, Pedersen LZ, Andersen B, Lipthay Behrend P, Nielsen JB. COpenhagen Neuroplastic TRaining Against Contractures in Toddlers (CONTRACT): protocol of an open-label randomised clinical trial with blinded assessment for prevention of contractures in infants with high risk of cerebral palsy. BMJ Open 2021; 11:e044674. [PMID: 34230015 PMCID: PMC8261878 DOI: 10.1136/bmjopen-2020-044674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Contractures are frequent causes of reduced mobility in children with cerebral palsy (CP) already at the age of 2-3 years. Reduced muscle use and muscle growth have been suggested as key factors in the development of contractures, suggesting that effective early prevention may have to involve stimuli that can facilitate muscle growth before the age of 1 year. The present study protocol was developed to assess the effectiveness of an early multicomponent intervention, CONTRACT, involving family-oriented and supervised home-based training, diet and electrical muscle stimulation directed at facilitating muscle growth and thus reduce the risk of contractures in children at high risk of CP compared with standard care. METHODS AND ANALYSIS A two-group, parallel, open-label randomised clinical trial with blinded assessment (n=50) will be conducted. Infants diagnosed with CP or designated at high risk of CP based on abnormal neuroimaging or absent fidgety movement determined as part of General Movement Assessment, age 9-17 weeks corrected age (CA) will be recruited. A balanced 1:1 randomisation will be made by a computer. The intervention will last for 6 months aiming to support parents in providing daily individualised, goal-directed activities and primarily in lower legs that may stimulate their child to move more and increase muscle growth. Guidance and education of the parents regarding the nutritional benefits of docosahexaenic acid (DHA) and vitamin D for the developing brain and muscle growth will be provided. Infants will receive DHA drops as nutritional supplements and neuromuscular stimulation to facilitate muscle growth. The control group will receive standard care as offered by their local hospital or community. Outcome measures will be taken at 9, 12, 18, 24, 36 and 48 months CA. Primary and secondary outcome measure will be lower leg muscle volume and stiffness of the triceps surae musculotendinous unit together with infant motor profile, respectively. ETHICS AND DISSEMINATION Full approval from the local ethics committee, Danish Committee System on Health Research Ethics, Region H (H-19041562). Experimental procedures conform with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT04250454. EXPECTED RECRUITMENT PERIOD 1 January 2021-1 January 2025.
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Affiliation(s)
- Maria Willerslev-Olsen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Katrine Røhder
- Department of Psychology, Unversity of Copenhagen, Copenhagen, Denmark
| | - Anina Ritterband-Rosenbaum
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Mikkel Justiniano
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Andrea Guzzetta
- Department of Neurology, Stella Maris Institute, Pisa, Italy
| | | | | | - Gorm Greisen
- Neonatatal Department, Rigshospitalet, Kobenhavn, Denmark
| | - Sofie Ejlersen
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | | | - Britta Andersen
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | | | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
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18
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Ebrahimi A, Kuchler RL, Pomeroy RL, Loegering IF, Martin JA, Thelen DG. Normative Achilles and patellar tendon shear wave speeds and loading patterns during walking in typically developing children. Gait Posture 2021; 88:185-191. [PMID: 34098404 PMCID: PMC8316302 DOI: 10.1016/j.gaitpost.2021.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Motion analysis is commonly used to evaluate joint kinetics in children with cerebral palsy who exhibit gait disorders. However, one cannot readily infer muscle-tendon forces from joint kinetics. This study investigates the use of shear wave tensiometry to characterize Achilles and patellar tendon forces during gait. RESEARCH QUESTION How do Achilles and patellar tendon wave speed and loading modulate with walking speed in typically developing children? METHODS Twelve typically developing children (9-16 years old) walked on an instrumented treadmill with shear wave tensiometers over their Achilles (n = 11) and patellar (n = 9) tendons. Wave speeds were recorded at five leg length-normalized walking speeds (very slow to very fast). Achilles and patellar tendon moment arms were measured with synchronized ultrasound and motion capture. The tendon wave speed-load relationship was calibrated at the typical walking speed and used to estimate tendon loading at other walking speeds. RESULTS Characteristic Achilles and patellar tendon wave speed trajectories exhibited two peaks over a gait cycle. Peak Achilles tendon force closely aligned with peak ankle plantarflexor moment during pushoff, though force exhibited less modulation with walking speed. A second peak in late swing Achilles loading, which was not evident from the ankle moment, increased significantly with walking speed (p < 0.001). The two peaks in patellar tendon loading occurred at 12 ± 1% and 68 ± 6% of the gait cycle, matching the timing of peak knee extension moment in early stance and early swing. Both patellar tendon load peaks increased significantly with walking speed (p < 0.05). SIGNIFICANCE This is the first study to use shear wave tensiometry to characterize Achilles and patellar tendon loading during gait in children. These data could serve as a normative comparison when using tensiometry to identify abnormal tendon loading patterns in individuals who exhibit equinus and/or crouch gait.
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Affiliation(s)
- Anahid Ebrahimi
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Robyn L Kuchler
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Robin L Pomeroy
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Isaac F Loegering
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Jack A Martin
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA,Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA,Correspondence: Darryl G Thelen, Room: 2107, Mechanical Engineering Building, 1513 University Avenue Madison, WI 53706,
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19
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Koussou A, Desailly E, Dumas R. Contribution of passive moments to inter-segmental moments during gait: A systematic review. J Biomech 2021; 122:110450. [PMID: 33930687 DOI: 10.1016/j.jbiomech.2021.110450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Abstract
Inter-segmental moments computed by inverse dynamic during gait come from active moments, due to muscle contraction, but also from passive moments, resulting from the resistance of the periarticular structures to their deformation. The evaluation of the proportion of the inter-segmental moments that can be attributed to passive moments has led to divergent results. Thus, the purpose of this study was to systematically search and synthesize the evidence of the contribution of passive moments to inter-segmental moments during healthy and pathological gait. A broad systematic search was performed including four databases. Thirteen studies met all inclusion criteria. Results showed that passive moments participate to inter-segmental moments during gait in a non-negligible way. For the ankle, the evaluation of the proportion of inter-segmental moment attributed to passive structures is 5-20% around the push-off. For the knee, this proportion is 40-98% during late swing and 10-80% during the single support phase. For the hip, it is 20-50% at push-off. For pathological population, it has been shown that this contribution may sometimes be more important, either due to a smaller inter-segmental moment or a larger passive moment. These results suggest that passive mechanisms can contribute substantially to normal human gait, facilitating the propulsion or the braking of the joint. Passive structures, acting as elastic springs, thus help to reduce the energy cost of gait. For pathological gait, studying the contribution of passive moments to inter-segmental moments can help to better understand the aetiology of the pathology.
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Affiliation(s)
- Axel Koussou
- Fondation Ellen Poidatz, Pôle Recherche & Innovation, Saint-Fargeau-Ponthierry, France; Univ Lyon, Univ Gustave Eiffel, LBMC UMR T9406, F69622 Lyon, France.
| | - Eric Desailly
- Fondation Ellen Poidatz, Pôle Recherche & Innovation, Saint-Fargeau-Ponthierry, France
| | - Raphaël Dumas
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR T9406, F69622 Lyon, France
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20
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Mechanical properties of ankle joint and gastrocnemius muscle in spastic children with unilateral cerebral palsy measured with shear wave elastography. J Biomech 2021; 124:110502. [PMID: 34126561 DOI: 10.1016/j.jbiomech.2021.110502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/22/2022]
Abstract
The aim of this study was to describe passive mechanical and morphological properties of the ankle joint and gastrocnemius medialis (GM) muscle in paretic and contralateral legs in highly functional children with unilateral cerebral palsy (UCP) using shear wave elastography (SWE). SWE measurements on the GM muscle were performed in both paretic and contralateral legs during passive ankle dorsiflexion using a dynamometer in 11 children (mean age: 10 years 6 months) with UCP. Torque-angle and shear modulus-angle relationships were fitted using an exponential model to determine passive ankle joint and GM muscle stiffness respectively. Based on shear-modulus-angle relationship, slack angle and shear modulus of GM muscle were compared between legs. GM and Achilles tendon length were determined at rest using ultrasonography. No significant difference was found between legs for passive ankle joint (p = 0.26; 11.2%; 95 %CI: 31.9, -9.4) and GM muscle passive stiffness (p = 0.62; -4.4%; 95 %CI: 14.7, -23.4). GM shear modulus at a common angle was significantly higher on the paretic leg (p = 0.02; +56.5%; 95 %CI: 100.5, 12.6). GM slack angle on the paretic leg was significantly shifted to a more plantarflexed position (p = 0.04; +25.5%; 95 %CI: 49.7, 1.3) and this was associated with a non-significant lower muscle length compared to the contralateral leg (p = 0.05; -4.5%; 95 %CI: -0.4, -8.7). Increased passive tension on the paretic leg when compared to the contralateral one may be explained in large part by muscle shortening. The role of altered mechanical properties remains unknown.
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21
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Lorentzen J, Frisk RF, Nielsen JB, Barber L. Increased Ankle Plantar Flexor Stiffness Is Associated With Reduced Mechanical Response to Stretch in Adults With CP. Front Bioeng Biotechnol 2021; 9:604071. [PMID: 33842442 PMCID: PMC8026870 DOI: 10.3389/fbioe.2021.604071] [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: 09/08/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Hyperexcitable stretch reflexes are often not present despite of other signs of spasticity in people with brain lesion. Here we looked for evidence that increased resistance to length change of the plantar flexor muscle-fascicles may contribute to a reduction in the stretch reflex response in adults with cerebral palsy (CP). A total of 17 neurologically intact (NI) adults (mean age 36.1; 12 female) and 13 ambulant adults with CP (7 unilateral; mean age 33.1; 5 female) participated in the study. Subjects were seated in a chair with the examined foot attached to a foot plate, which could be moved by a computer-controlled electromotor. An ultrasound probe was placed over the medial aspect of the leg to measure the length of medial gastrocnemius muscle fascicles. Slow (7 deg/s) and fast (200 deg/s) stretches with amplitude 6 deg of the plantar flexors were applied over an ankle range of 70 deg at 10 deg intervals between 60 and 130 deg plantarflexion. It was checked by EMG electrodes that the slow stretches were sufficiently slow not to elicit any activity and that the fast stretches were sufficiently quick to elicit a maximal stretch reflex in both groups. The torque elicited by the stretches was measured together with changes in the length of medial gastrocnemius muscle fascicles. Muscle fascicles increased significantly in length with increasing dorsiflexion position in both populations (p < 0.001), but the fascicles were shorter in the CP population at all positions. Slow stretches elicited significantly larger torque and significantly smaller length change of muscle fascicles as the ankle joint position was moved more towards dorsiflexion in CP than in NI (p < 0.001). Fast stretches elicited larger torque responses at ankle joint positions of 80–100 deg in the NI than in the CP group (p < 0.01). A significant negative correlation was observed between the torque response and muscle fascicle length change to slow stretch in CP (p < 0.05), but not in NI. These findings support that increased passive resistance of the ankle plantar flexor muscle-tendon unit and development of contractures may conceal stretch reflex response in adults with CP. We argue that this should be taken into account in the neurological examination of spasticity.
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Affiliation(s)
- Jakob Lorentzen
- Department for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Foundation, Charlottenlund, Denmark
| | - Rasmus Feld Frisk
- Department for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Foundation, Charlottenlund, Denmark
| | - Jens Bo Nielsen
- Department for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Foundation, Charlottenlund, Denmark
| | - Lee Barber
- School of Applied Health Sciences, Griffith University, Brisbane, QLD, Australia
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22
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Miller T, Ying M, Sau Lan Tsang C, Huang M, Pang MYC. Reliability and Validity of Ultrasound Elastography for Evaluating Muscle Stiffness in Neurological Populations: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:5928445. [PMID: 33508855 DOI: 10.1093/ptj/pzaa188] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/04/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Ultrasound elastography is an emerging diagnostic technology used to investigate the biomechanical properties of the musculoskeletal system. The purpose of this study was to systematically review the psychometric properties of ultrasound elastography techniques for evaluating muscle stiffness in people with neurological conditions. METHODS A systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using software, reviewers independently screened citations for inclusion. Peer-reviewed studies that evaluated in vivo muscle stiffness in people with neurological conditions and reported relevant psychometric properties were considered for inclusion. Twenty-one articles were included for final review. Data relevant to measurement technique, site, and neurological condition were extracted. The Consensus-Based Standards for the Selection of Health Measurement Instruments checklist was used to rate the methodological quality of included studies. The level of evidence for specific measurement outcomes was determined using a best-evidence synthesis approach. RESULTS Reliability varied across populations, ultrasound systems, and assessment conditions (ie, joint/body positions, active/passive muscle conditions, probe orientation), with most studies indicating moderate to good reliability (ICC = 0.5-0.9, n = 13). Meta-analysis results showed a good overall correlation across studies (r = 0.78, 95% confidence interval = 0.64-0.86), with no between-group difference based on population (Q1 = 0.00). Convergent validity was demonstrated by strong correlations between stiffness values and measures of spasticity (n = 5), functional motor recovery or impairment (n = 5), and grayscale or color histogram pixel intensities (n = 3). Discriminant or known-groups validity was also established for multiple studies and indicated either significant between-group differences in stiffness values (n = 12) or within-group differences between more and less affected limbs (n = 6). Responsiveness was observed in all intervention studies reporting posttreatment stiffness changes (n = 6). CONCLUSIONS Overall, ultrasound elastography techniques showed moderate reliability in evaluating in vivo muscle stiffness, good convergent validity with relevant clinical assessments, and good divergent validity in discriminating tissue changes within and between groups. IMPACT Ultrasound elastography has clinical utility in assessing muscle stiffness, monitoring its temporal changes, and measuring the response to intervention in people with neurological conditions.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Michael Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, S.A.R
| | - Charlotte Sau Lan Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Meizhen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
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23
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Obst SJ, Bickell R, Florance K, Boyd RN, Read F, Barber L. The size and echogenicity of the tibialis anterior muscle is preserved in both limbs in young children with unilateral spastic cerebral palsy. Disabil Rehabil 2020; 44:3430-3439. [PMID: 33356649 DOI: 10.1080/09638288.2020.1863482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The primary of this study was to compare the volume, length, echo intensity, and growth rate of the medial gastrocnemius (MG) and tibialis anterior (TA) muscle of both limbs (more-involved and less-involved) in children with unilateral spastic cerebral palsy (USCP), with those of an age-matched typically developing (TD) group. A secondary aim in the USCP group was to explore the associations between these muscle parameters and discrete ankle positions during phase of gait. METHODS Muscle parameters were assessed using 3D ultrasound. Maximal ankle dorsiflexion in stance and swing during walking were determined from 2D video analysis. Group differences in muscle size and echo intensity were assessed using a two-way analysis of covariance (age-by-group), with the interaction term used to compare muscle growth rates. Associations between muscle parameters and maximal ankle dorsiflexion in stance and swing were assessed using backwards multiple linear regression analyses. RESULTS The MG of both limbs in children with USCP had signs of impaired muscle development (smaller volume and length, higher echo intensity and lower growth rate). There was no evidence of impaired muscle development of TA between limbs or compared the TD children. Tibialis anterior volume, length, echo intensity and MG volume explained 66% and 83% of the variance in maximal ankle dorsiflexion position in the stance and swing phases of walking, respectively. CONCLUSIONS Unlike the MG, the TA volume and growth rate in children with USCP are equivalent between limbs and compared to TD children. For the more-involved limb only, TA volume, length, and echo intensity appear associated with maximal ankle dorsiflexion during walking and represent important muscle parameters that could be targeted in with early exercise therapy.Implications for rehabilitationTibialis anterior (TA) size and echogenicity appear normal in both limbs in young children with unilateral spastic cerebral palsy (USCP); findings that could indicate sufficient mechanical stimulus and muscle anabolism to maintain normal muscle growth.Tibialis anterior size and echogenicity are associated with maximal ankle dorsiflexion in both stance and swing phase of walking in young children with USCP; though such relations appear isolated to the more-involved limb.Early therapeutic interventions that target TA are likely to be successful in maintaining muscle size and may offset the negative effects of medial gastrocnemius atrophy in the development of fixed ankle equinus of the more-involved limb and improve ankle positioning during gait.
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Affiliation(s)
- Steven J Obst
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Australia.,Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Reuben Bickell
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Australia
| | - Kaysie Florance
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Australia
| | - Roslyn N Boyd
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Australia
| | - Felicity Read
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Australia
| | - Lee Barber
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Australia.,Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,School of Allied Health Sciences, Griffith University, Brisbane, Australia
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24
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Weide G, Huijing PA, Bar-On L, Sloot L, Buizer AI, Becher JG, Harlaar J, Jaspers RT. Gastrocnemius Medialis Muscle Geometry and Extensibility in Typically Developing Children and Children With Spastic Paresis Aged 6–13 Years. Front Physiol 2020; 11:528522. [PMID: 33329011 PMCID: PMC7719761 DOI: 10.3389/fphys.2020.528522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022] Open
Abstract
Gait of children with spastic paresis (SP) is frequently characterized by a reduced ankle range of motion, presumably due to reduced extensibility of the triceps surae (TS) muscle. Little is known about how morphological muscle characteristics in SP children are affected. The aim of this study was to compare gastrocnemius medialis (GM) muscle geometry and extensibility in children with SP with those of typically developing (TD) children and assess how GM morphology is related to its extensibility. Thirteen children with SP, of which 10 with a diagnosis of spastic cerebral palsy and three with SP of unknown etiology (mean age 9.7 ± 2.1 years; GMFCS: I–III), and 14 TD children (mean age 9.3 ± 1.7 years) took part in this study. GM geometry was assessed using 3D ultrasound imaging at 0 and 4 Nm externally imposed dorsal flexion ankle moments. GM extensibility was defined as its absolute length change between the externally applied 0 and 4 Nm moments. Anthropometric variables and GM extensibility did not differ between the SP and TD groups. While in both groups, GM muscle volume correlated with body mass, the slope of the regression line in TD was substantially higher than that in SP (TD = 3.3 ml/kg; SP = 1.3 ml/kg, p < 0.01). In TD, GM fascicle length increased with age, lower leg length and body mass, whereas in SP children, fascicle length did not correlate with any of these variables. However, the increase in GM physiological cross-sectional area as a function of body mass did not differ between SP and TD children. Increases in lengths of tendinous structures in children with SP exceeded those observed in TD children (TD = 0.85 cm/cm; SP = 1.16 cm/cm, p < 0.01) and even exceeded lower-leg length increases. In addition, only for children with SP, body mass (r = −0.61), height (r = −0.66), muscle volume (r = − 0.66), physiological cross-sectional area (r = − 0.59), and tendon length (r = −0.68) showed a negative association with GM extensibility. Such negative associations were not found for TD children. In conclusion, physiological cross-sectional area and length of the tendinous structures are positively associated with age and negatively associated with extensibility in children with SP.
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Affiliation(s)
- Guido Weide
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Peter A. Huijing
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lizeth Sloot
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Annemieke I. Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jules G. Becher
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Richard T. Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- *Correspondence: Richard T. Jaspers,
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Zhang Q, Iyer A, Kim K, Sharma N. Evaluation of Non-Invasive Ankle Joint Effort Prediction Methods for Use in Neurorehabilitation Using Electromyography and Ultrasound Imaging. IEEE Trans Biomed Eng 2020; 68:1044-1055. [PMID: 32759078 DOI: 10.1109/tbme.2020.3014861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Reliable measurement of voluntary human effort is essential for effective and safe interaction between the wearer and an assistive robot. Existing voluntary effort prediction methods that use surface electromyography (sEMG) are susceptible to prediction inaccuracies due to non-selectivity in measuring muscle responses. This technical challenge motivates an investigation into alternative non-invasive effort prediction methods that directly visualize the muscle response and improve effort prediction accuracy. The paper is a comparative study of ultrasound imaging (US)-derived neuromuscular signals and sEMG signals for their use in predicting isometric ankle dorsiflexion moment. Furthermore, the study evaluates the prediction accuracy of model-based and model-free voluntary effort prediction approaches that use these signals. METHODS The study evaluates sEMG signals and three US imaging-derived signals: pennation angle, muscle fascicle length, and echogenicity and three voluntary effort prediction methods: linear regression (LR), feedforward neural network (FFNN), and Hill-type neuromuscular model (HNM). RESULTS In all the prediction methods, pennation angle and fascicle length significantly improve the prediction accuracy of dorsiflexion moment, when compared to echogenicity. Also, compared to LR, both FFNN and HNM improve dorsiflexion moment prediction accuracy. CONCLUSION The findings indicate FFNN or HNM approach and using pennation angle or fascicle length predict human ankle movement intent with higher accuracy. SIGNIFICANCE The accurate ankle effort prediction will pave the path to safe and reliable robotic assistance in patients with drop foot.
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Harkness-Armstrong C, Debelle HA, Maganaris CN, Walton R, Wright DM, Bass A, Baltzopoulos V, O'Brien TD. Effective Mechanical Advantage About the Ankle Joint and the Effect of Achilles Tendon Curvature During Toe-Walking. Front Physiol 2020; 11:407. [PMID: 32508666 PMCID: PMC7248361 DOI: 10.3389/fphys.2020.00407] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/06/2020] [Indexed: 12/11/2022] Open
Abstract
Aim: To study the causes of locomotor dysfunction, estimate muscle forces, or understand the influence of altered sarcomere and muscle properties and behaviours on whole body function, it is necessary to examine the leverage with which contractile forces operate. At the ankle joint, current methods to quantify this leverage for the plantarflexors do not account for curvature of the Achilles tendon, and so may not be appropriate when studying equinus gait. Thus, novel methodologies need to be developed and implemented to quantify the Achilles tendon moment arm length during locomotion. Methods: Plantarflexor internal moment arm length and effective mechanical advantage of 11 typically developed young adults were calculated throughout stance, while heel-toe walking and voluntarily toe-walking on an instrumented treadmill. Achilles tendon moment arm was defined in two-ways: (1) assuming a straight tendon, defined between the gastrocnemius medialis myotendinous junction and Achilles tendon insertion point, and (2) accounting for tendon curvature, by tracking the initial path of the Achilles tendon from the calcaneal insertion. Results: When accounting for tendon curvature, Achilles tendon moment arm length and plantarflexor effective mechanical advantage did not differ between walking conditions (p > 0.05). In contrast, when assuming a straight tendon, Achilles tendon moment arm length (p = 0.043) and plantarflexor effective mechanical advantage (p = 0.007) were significantly greater when voluntary toe-walking than heel-toe walking in late stance. Discussion: Assuming a straight Achilles tendon led to a greater Achilles tendon moment arm length and plantarflexor effective mechanical advantage during late stance, compared to accounting for tendon curvature. Consequently, plantarflexor muscle force would appear smaller when assuming a straight tendon. This could lead to erroneous interpretations of muscular function and fascicle force-length-velocity behaviour in vivo, and potentially inappropriate and ineffective clinical interventions for equinus gait.
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Affiliation(s)
- Carla Harkness-Armstrong
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Héloïse A Debelle
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Constantinos N Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Roger Walton
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - David M Wright
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Alfie Bass
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Thomas D O'Brien
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Kalkman BM, Bar-On L, O'Brien TD, Maganaris CN. Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? Front Physiol 2020; 11:131. [PMID: 32153428 PMCID: PMC7047287 DOI: 10.3389/fphys.2020.00131] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/06/2020] [Indexed: 12/27/2022] Open
Abstract
Hyper-resistance at the joint is one of the most common symptoms in children with cerebral palsy (CP). Alterations to the structure and mechanical properties of the musculoskeletal system, such as a decreased muscle length and an increased joint stiffness are typically managed conservatively, by means of physiotherapy involving stretching exercises. However, the effectiveness of stretching-based interventions for improving function is poor. This may be due to the behavior of a spastic muscle during stretch, which is poorly understood. The main aim of this paper is to provide a mechanistic explanation as to why the effectiveness of stretching is limited in children with CP and consider clinically relevant means by which this shortcoming can be tackled. To do this, we review the current literature regarding muscle and tendon plasticity in response to stretching in children with CP. First, we discuss how muscle and tendon interact based on their morphology and mechanical properties to provide a certain range of motion at the joint. We then consider the effect of traditional stretching exercises on these muscle and tendon properties. Finally, we examine possible strategies to increase the effectiveness of stretching therapies and we highlight areas of further research that have the potential to improve the outcome of non-invasive interventions in children with cerebral palsy.
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Affiliation(s)
- Barbara M Kalkman
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, VC University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Thomas D O'Brien
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Constantinos N Maganaris
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Falisse A, Pitto L, Kainz H, Hoang H, Wesseling M, Van Rossom S, Papageorgiou E, Bar-On L, Hallemans A, Desloovere K, Molenaers G, Van Campenhout A, De Groote F, Jonkers I. Physics-Based Simulations to Predict the Differential Effects of Motor Control and Musculoskeletal Deficits on Gait Dysfunction in Cerebral Palsy: A Retrospective Case Study. Front Hum Neurosci 2020; 14:40. [PMID: 32132911 PMCID: PMC7040166 DOI: 10.3389/fnhum.2020.00040] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/27/2020] [Indexed: 12/05/2022] Open
Abstract
Physics-based simulations of walking have the theoretical potential to support clinical decision-making by predicting the functional outcome of treatments in terms of walking performance. Yet before using such simulations in clinical practice, their ability to identify the main treatment targets in specific patients needs to be demonstrated. In this study, we generated predictive simulations of walking with a medical imaging based neuro-musculoskeletal model of a child with cerebral palsy presenting crouch gait. We explored the influence of altered muscle-tendon properties, reduced neuromuscular control complexity, and spasticity on gait dysfunction in terms of joint kinematics, kinetics, muscle activity, and metabolic cost of transport. We modeled altered muscle-tendon properties by personalizing Hill-type muscle-tendon parameters based on data collected during functional movements, simpler neuromuscular control by reducing the number of independent muscle synergies, and spasticity through delayed muscle activity feedback from muscle force and force rate. Our simulations revealed that, in the presence of aberrant musculoskeletal geometries, altered muscle-tendon properties rather than reduced neuromuscular control complexity and spasticity were the primary cause of the crouch gait pattern observed for this child, which is in agreement with the clinical examination. These results suggest that muscle-tendon properties should be the primary target of interventions aiming to restore an upright gait pattern for this child. This suggestion is in line with the gait analysis following muscle-tendon property and bone deformity corrections. Future work should extend this single case analysis to more patients in order to validate the ability of our physics-based simulations to capture the gait patterns of individual patients pre- and post-treatment. Such validation would open the door for identifying targeted treatment strategies with the aim of designing optimized interventions for neuro-musculoskeletal disorders.
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Affiliation(s)
| | - Lorenzo Pitto
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Hans Kainz
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Hoa Hoang
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | | | - Sam Van Rossom
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | | | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Orthopaedic Surgery, UZ Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Orthopaedic Surgery, UZ Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Ilse Jonkers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
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Increasing level of neuromusculoskeletal model personalisation to investigate joint contact forces in cerebral palsy: A twin case study. Clin Biomech (Bristol, Avon) 2020; 72:141-149. [PMID: 31877532 DOI: 10.1016/j.clinbiomech.2019.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/15/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebral palsy is a complex neuromuscular disorder that affects the sufferers in multiple different ways. Neuromusculoskeletal models are promising tools that can be used to plan patient-specific treatments for cerebral palsy. However, current neuromusculoskeletal models are typically scaled from generic adult templates that poorly represent paediatric populations. Furthermore, muscle activations are commonly computed via optimisation methods, which may not reproduce co-contraction observed in cerebral palsy. Alternatively, calibrated EMG-informed approaches within OpenSim can capture pathology-related muscle activation abnormalities, possibly enabling more feasible estimations of muscle and joint contact forces. METHODS Two identical twin brothers, aged 13, one with unilateral cerebral palsy and the other typically developing, were enrolled in the study. Four neuromusculoskeletal models with increasing subject-specificity were built in OpenSim and CEINMS combining literature findings, experimental motion capture, EMG and MR data for both participants. The physiological and biomechanical validity of each model was assessed by quantifying its ability to track experimental joint moments and muscle excitations. FINDINGS All developed models accurately tracked external joint moments; however EMG-informed models better tracked muscle excitations compared to neural solutions generated by static optimisation. Calibrating muscle-tendon unit parameters with EMG data allowed for more physiologically plausible joint contact forces estimates. Further scaling the maximal isometric force of muscles with MR-derived muscle volumes did not affect model predictions. INTERPRETATION Given their ability to identify atypical joint contact forces profiles and accurately reproduce experimental data, calibrated EMG-informed models should be preferred over generic models using optimisation methods in informing the management of cerebral palsy.
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Reliability outcomes and inter-limb differences in ankle joint stiffness in children with unilateral cerebral palsy depend on the method of analysis. J Electromyogr Kinesiol 2019; 49:102353. [DOI: 10.1016/j.jelekin.2019.102353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/23/2019] [Accepted: 08/22/2019] [Indexed: 11/24/2022] Open
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Ong CF, Geijtenbeek T, Hicks JL, Delp SL. Predicting gait adaptations due to ankle plantarflexor muscle weakness and contracture using physics-based musculoskeletal simulations. PLoS Comput Biol 2019; 15:e1006993. [PMID: 31589597 PMCID: PMC6797212 DOI: 10.1371/journal.pcbi.1006993] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/17/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022] Open
Abstract
Deficits in the ankle plantarflexor muscles, such as weakness and contracture, occur commonly in conditions such as cerebral palsy, stroke, muscular dystrophy, Charcot-Marie-Tooth disease, and sarcopenia. While these deficits likely contribute to observed gait pathologies, determining cause-effect relationships is difficult due to the often co-occurring biomechanical and neural deficits. To elucidate the effects of weakness and contracture, we systematically introduced isolated deficits into a musculoskeletal model and generated simulations of walking to predict gait adaptations due to these deficits. We trained a planar model containing 9 degrees of freedom and 18 musculotendon actuators to walk using a custom optimization framework through which we imposed simple objectives, such as minimizing cost of transport while avoiding falling and injury, and maintaining head stability. We first generated gaits at prescribed speeds between 0.50 m/s and 2.00 m/s that reproduced experimentally observed kinematic, kinetic, and metabolic trends for walking. We then generated a gait at self-selected walking speed; quantitative comparisons between our simulation and experimental data for joint angles, joint moments, and ground reaction forces showed root-mean-squared errors of less than 1.6 standard deviations and normalized cross-correlations above 0.8 except for knee joint moment trajectories. Finally, we applied mild, moderate, and severe levels of muscle weakness or contracture to either the soleus (SOL) or gastrocnemius (GAS) or both of these major plantarflexors (PF) and retrained the model to walk at a self-selected speed. The model was robust to all deficits, finding a stable gait in all cases. Severe PF weakness caused the model to adopt a slower, "heel-walking" gait. Severe contracture of only SOL or both PF yielded similar results: the model adopted a "toe-walking" gait with excessive hip and knee flexion during stance. These results highlight how plantarflexor weakness and contracture may contribute to observed gait patterns.
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Affiliation(s)
- Carmichael F. Ong
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Thomas Geijtenbeek
- Department of Biomechatronics & Human-Machine Control, Delft University of Technology, Delft, The Netherlands
| | - Jennifer L. Hicks
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Scott L. Delp
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
- Department of Mechanical Engineering, Stanford University, Stanford, California, United States of America
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, United States of America
- * E-mail:
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32
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What causes increased passive stiffness of plantarflexor muscle–tendon unit in children with spastic cerebral palsy? Eur J Appl Physiol 2019; 119:2151-2165. [DOI: 10.1007/s00421-019-04208-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/06/2019] [Indexed: 01/31/2023]
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D'Souza A, Bolsterlee B, Lancaster A, Herbert RD. Muscle architecture in children with cerebral palsy and ankle contractures: an investigation using diffusion tensor imaging. Clin Biomech (Bristol, Avon) 2019; 68:205-211. [PMID: 31255994 DOI: 10.1016/j.clinbiomech.2019.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/27/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with cerebral palsy frequently have ankle contractures which may be caused by changes in architecture of calf muscles. Here, we compared the architecture of medial gastrocnemius muscles in children with unilateral cerebral palsy and typically developing children using novel imaging techniques. METHODS AND PROCEDURES Muscle volumes, fascicle lengths, pennation angles and physiological cross-sectional areas were measured from diffusion tensor images and mDixon scans obtained from 20 ambulant children with unilateral spastic cerebral palsy who had ankle contractures (age 11 ± 3 years; mean ± standard deviation) and 20 typically developing children (11 ± 4 years). FINDINGS In children with cerebral palsy, the more-affected side had, on average, 13° less dorsiflexion range and the medial gastrocnemius muscle had 4.9 mm shorter fascicles, 50 cm3 smaller volume and 9.5 cm2 smaller physiological cross-sectional area than the less-affected side. Compared to typically developing children, the more-affected side had 10° less dorsiflexion range and the medial gastrocnemius muscle had 4.2 mm shorter fascicles, 51 cm3 smaller volume and 10 cm2 smaller physiological cross-sectional area. We did not detect differences between the less-affected and typically developing legs. INTERPRETATION Three-dimensional measurement of whole medial gastrocnemius muscles confirmed that the architecture of muscles on the more-affected side of children with cerebral palsy differs from the less-affected side and from muscles of typically developing children. Reductions in fascicle length, muscle volume and physiological cross-sectional area may contribute to muscle contracture.
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Affiliation(s)
- Arkiev D'Souza
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia.
| | - Bart Bolsterlee
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia.
| | - Ann Lancaster
- Rehab2Kids, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia.
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Drazan JF, Hullfish TJ, Baxter JR. An automatic fascicle tracking algorithm quantifying gastrocnemius architecture during maximal effort contractions. PeerJ 2019; 7:e7120. [PMID: 31304054 PMCID: PMC6611451 DOI: 10.7717/peerj.7120] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/10/2019] [Indexed: 11/20/2022] Open
Abstract
Background Ultrasound has become a commonly used imaging modality for making dynamic measurements of muscle structure during functional movements in biomechanical studies. Manual measurements of fascicle length and pennation angle are time intensive which limits the clinical utility of this approach while also limiting sample sizes in research. The purpose of this study was to develop an automatic fascicle tracking program to quantify the length and pennation angle of a muscle fascicle during maximal effort voluntary contractions and to evaluate its repeatability between days and reproducibility between different examiners. Methods Five healthy adults performed maximal effort isometric and isokinetic contractions at 30, 120, 210, and 500 degrees per second about their ankle on an isokinetic dynamometer while their medial gastrocnemius muscle was observed using ultrasound. Individual muscle fascicles and the two aponeuroses were identified by the user in the first frame and automatically tracked by the algorithm by three observers on three separate days. Users also made manual measurements of the candidate fascicle for validation. Repeatability within examiners across days and reproducibility across examiners and days were evaluated using intra-class correlation coefficients (ICC). Agreement between manual and automatic tracking was evaluated using the coefficient of multiple correlations (CMC) and root-mean-square error. Supervised automatic tracking, where the program could be reinitialized if poor tracking was observed, was performed on all videos by one examiner to evaluate the performance of automatic tracking in a typical use case. We also compared the performance our program to a preexisting automatic tracking program. Results We found both manual and automatic measurements of fascicle length and pennation angle to be strongly repeatable within examiners and strongly reproducible across examiners and days (ICCs > 0.74). There was greater agreement between manual and automatic measurements of fascicle length than pennation angle, however the mean CMC value was found to be strong in both cases (CMC > 0.8). Supervision of automatic tracking showed very strong agreement between manual and automatic measurements of fascicle length and pennation angle (CMC > 0.94). It also had considerably less error relative to the preexisting automatic tracking program. Conclusions We have developed a novel automatic fascicle tracking algorithm that quantifies fascicle length and pennation angle of individual muscle fascicles during dynamic contractions during isometric and across a range of isokinetic velocities. We demonstrated that this fascicle tracking algorithm is strongly repeatable and reproducible across different examiners and different days and showed strong agreement with manual measurements, especially when tracking is supervised by the user so that tracking can be reinitialized if poor tracking quality is observed.
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Affiliation(s)
- John F Drazan
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Todd J Hullfish
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Josh R Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Chappell A, Gibson N, Williams G, Allison GT, Morris S. Propulsion strategy in running in children and adolescents with cerebral palsy. Gait Posture 2019; 70:305-310. [PMID: 30927640 DOI: 10.1016/j.gaitpost.2019.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/11/2019] [Accepted: 02/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Running is a fundamental movement skill important for participation in physical activity. Children with cerebral palsy (CP) who are classified at Gross Motor Function Classification Scale (GMFCS) level I and II are able to run but may be limited by neuromuscular impairments. RESEARCH QUESTION To describe the propulsion strategy (PS) during running of children and adolescents with CP. METHODS This cross-sectional study used kinematic and kinetic data collected during running from 40 children and adolescents with unilateral or bilateral CP and 21 typically developing (TD) children. Maximum speed, peak ankle power generation (A2), peak hip flexor power generation in swing (H3) and PS (PS = A2/(A2 + H3)) were calculated. Linear mixed models were developed to analyze differences between groups. RESULTS Maximum speed, A2 and PS were significantly less in children with CP GMFCS level I than in TD children and significantly less in children in GMFCS level II than level I. For children with CP, A2 and PS were significantly smaller in affected legs than non-affected legs. In affected legs, H3 was significantly larger in children in GMFCS level II than GMFCS level I but not different between TD children and children in GFMCS level II. SIGNIFICANCE The contribution of ankle plantarflexor power to forward propulsion in running is reduced in young people with CP and is related to GMFCS level. This deficit appears to be compensated in part by increased hip flexor power generation but limits maximum sprinting speed.
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Affiliation(s)
- A Chappell
- School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia.
| | - N Gibson
- Perth Children's Hospital, Locked Bag 2010, Nedlands, Western Australia 6909, Australia
| | - G Williams
- School of Health Sciences, University of Melbourne, Victoria 3010, Australia
| | - G T Allison
- School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia
| | - S Morris
- School of Physiotherapy and Exercise Sciences, Curtin University, Kent St., Bentley, Western Australia 6102, Australia
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Gillett JG, Lichtwark GA, Boyd RN, Carty CP, Barber LA. The effect of combined functional anaerobic and strength training on treadmill gait kinematics and kinetics in ambulatory young adults with cerebral palsy. Gait Posture 2019; 70:323-329. [PMID: 30947107 DOI: 10.1016/j.gaitpost.2019.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/25/2019] [Accepted: 03/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Leg muscle weakness is a major impairment for individuals with cerebral palsy (CP) and is related to reduced functional capacity. Evidence is limited regarding the translation of strength improvements following conventional resistance training to improved gait outcomes. RESEARCH QUESTION Does a combined functional anaerobic and lower limb strength training intervention improve gait kinematics and kinetics in individuals with CP aged 15-30 years? 17 young adults (21 ± 4 years, 9 males, GMFCS I = 11, II = 6) were randomized to 12 weeks, 3 sessions per week, of high intensity functional anaerobic and progressive resistance training of the lower limbs (n = 8), or a waitlist control group (n = 9). Pre- and post-training outcomes included maximum ankle dorsiflexion angle at foot contact and during stance, gait profile score, ankle and hip power generation during late stance, and the ratio of ankle to hip power generation. RESULTS There were no between-group differences after the intervention for any kinematic or kinetic gait outcome variable. Within-group analysis revealed an increase in peak ankle power during late stance (0.31 ± 0.28 W·kg-1, p = 0.043) and ankle to hip power ratio (0.43 ± 0.37, p = 0.034) following training in the intervention group. SIGNIFICANCE We have previously reported increased overground walking capacity, agility and sprint power, in the training group compared to the control group at 12-weeks. These changes in overground measures of functional capacity occurred in the absence of changes in treadmill gait kinematics and kinetics reported here. ANZCTR 12614001217695.
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Affiliation(s)
- Jarred G Gillett
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia.
| | - Glen A Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia.
| | - Christopher P Carty
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Queensland Children's Motion Analysis Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia; Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.
| | - Lee A Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia; School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia.
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Ultrasonographic Evaluation for the Effect of Extracorporeal Shock Wave Therapy on Gastrocnemius Muscle Spasticity in Patients With Chronic Stroke. PM R 2019; 11:363-371. [DOI: 10.1016/j.pmrj.2018.08.379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/12/2018] [Indexed: 11/15/2022]
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Leonard TR, Howard JJ, Larkin-Kaiser K, Joumaa V, Logan K, Orlik B, El-Hawary R, Gauthier L, Herzog W. Stiffness of hip adductor myofibrils is decreased in children with spastic cerebral palsy. J Biomech 2019; 87:100-106. [PMID: 30853092 DOI: 10.1016/j.jbiomech.2019.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/28/2019] [Accepted: 02/25/2019] [Indexed: 01/16/2023]
Abstract
Cerebral palsy (CP) is the result of a static brain lesion which causes spasticity and muscle contracture. The source of the increased passive stiffness in patients is not understood and while whole muscle down to single muscle fibres have been investigated, the smallest functional unit of muscle (the sarcomere) has not been. Muscle biopsies (adductor longus and gracilis) from pediatric patients were obtained (CP n = 9 and control n = 2) and analyzed for mechanical stiffness, in-vivo sarcomere length and titin isoforms. Adductor longus muscle was the focus of this study and the results for sarcomere length showed a significant increase in length for CP (3.6 µm) compared to controls (2.6 µm). Passive stress at the same sarcomere length for CP compared to control was significantly lower in CP and the elastic modulus for the physiological range of muscle was lower in CP compared to control (98.2 kPa and 166.1 kPa, respectively). Our results show that CP muscle at its most reduced level (the myofibril) is more compliant compared to normal, which is completely opposite to what is observed at higher structural levels (single fibres, muscle fibre bundles and whole muscle). It is noteworthy that at the in vivo sarcomere length in CP, the passive forces are greater than normal, purely as a functional of these more compliant sarcomeres operating at long lengths. Titin isoforms were not different between CP and non-CP adductor longus but titin:nebulin was reduced in CP muscle, which may be due to titin loss or an over-expression of nebulin in CP muscles.
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Affiliation(s)
| | | | | | - Venus Joumaa
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | | | | | | | - Walter Herzog
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
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Sahrmann AS, Stott NS, Besier TF, Fernandez JW, Handsfield GG. Soleus muscle weakness in cerebral palsy: Muscle architecture revealed with Diffusion Tensor Imaging. PLoS One 2019; 14:e0205944. [PMID: 30802250 PMCID: PMC6388915 DOI: 10.1371/journal.pone.0205944] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/24/2019] [Indexed: 11/28/2022] Open
Abstract
Cerebral palsy (CP) is associated with movement disorders and reduced muscle size. This latter phenomenon has been observed by computing muscle volumes from conventional MRI, with most studies reporting significantly reduced volumes in leg muscles. This indicates impaired muscle growth, but without knowing muscle fiber orientation, it is not clear whether muscle growth in CP is impaired in the along-fiber direction (indicating shortened muscles and limited range of motion) or the cross-fiber direction (indicating weak muscles and impaired strength). Using Diffusion Tensor Imaging (DTI) we can determine muscle fiber orientation and construct 3D muscle architectures which can be used to examine both along-fiber length and cross-sectional area. Such an approach has not been undertaken in CP. Here, we use advanced DTI sequences with fast imaging times to capture fiber orientations in the soleus muscle of children with CP and age-matched, able-bodied controls. Cross sectional areas perpendicular to the muscle fiber direction were reduced (37 ± 11%) in children with CP compared to controls, indicating impaired muscle strength. Along-fiber muscle lengths were not different between groups. This study is the first to demonstrate along-fiber and cross-fiber muscle architecture in CP using DTI and implicates impaired cross-sectional muscle growth in children with cerebral palsy.
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Affiliation(s)
- Annika S. Sahrmann
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Ngaire Susan Stott
- Department of Orthopaedic Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Thor F. Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
| | - Justin W. Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
| | - Geoffrey G. Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- * E-mail:
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40
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Frisk RF, Lorentzen J, Barber L, Nielsen JB. Characterization of torque generating properties of ankle plantar flexor muscles in ambulant adults with cerebral palsy. Eur J Appl Physiol 2019; 119:1127-1136. [PMID: 30778762 DOI: 10.1007/s00421-019-04102-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 02/12/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE Weakness of plantar flexor muscles is related to reduced push-off and forward propulsion during gait in persons with cerebral palsy (CP). It has not been clarified to what an extent altered muscle contractile properties contribute to this muscle weakness. Here, we investigated the torque generating capacity and muscle fascicle length in the triceps surae muscle throughout ankle range of motion (ROM) in adults with CP using maximal single muscle twitches elicited by electrical nerve stimulation and ultrasonography. METHODS Fourteen adults with CP (age 36, SD 10.6, GMFCS I-III) and 17 neurological intact (NI) adults (age 36, SD 4.5) participated. Plantar flexor torque during supramaximal stimulation of the tibial nerve was recorded in a dynamometer at 8 ankle angles throughout ROM. Medial gastrocnemius (MG) fascicle length was tracked using ultrasonography. RESULTS Adults with CP showed reduced plantar flexor torque and fascicle shortening during supramaximal stimulation throughout ROM. The largest torque generation was observed at the ankle joint position where the largest shortening of MG fascicles was observed in both groups. This was at a more plantarflexed position in the CP group. CONCLUSION Reduced torque and fascicle shortening during supramaximal stimulation of the tibial nerve indicate impaired contractile properties of plantar flexor muscles in adults with CP. Maximal torque was observed at a more plantarflexed position in adults with CP indicating an altered torque-fascicle length/ankle angle relation. The findings suggest that gait rehabilitation in adults with CP may require special focus on improvement of muscle contractility.
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Affiliation(s)
- Rasmus Feld Frisk
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen N, Denmark. .,Professionshøjskolen Absalon, Roskilde, Denmark. .,Elsass Institute, Charlottenlund, Denmark.
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen N, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | - Lee Barber
- School of Health, Medical and Allied Sciences, Central Queensland University, Bundaberg, Australia.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen N, Denmark.,Elsass Institute, Charlottenlund, Denmark
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The Effect of Functional Home-Based Strength Training Programs on the Mechano-Morphological Properties of the Plantar Flexor Muscle-Tendon Unit in Children With Spastic Cerebral Palsy. Pediatr Exerc Sci 2019; 31:67-76. [PMID: 30424684 DOI: 10.1123/pes.2018-0106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of functional progressive resistance training (PRT) and high-intensity circuit training (HICT) on the mechano-morphological properties of the plantar flexor muscle-tendon unit in children with spastic cerebral palsy. METHODS Twenty-two children (12.8 [2.6] y old, Gross Motor Function Classification System levels I/II = 19/3) were randomly assigned to either a PRT group or an HICT group. The interventions consisted of functional lower limb exercises, which were performed at home 3 times per week for 8 weeks. Measurements at baseline, preintervention, postintervention, and follow-up were taken to assess ankle joint range of motion and the properties of the gastrocnemius medialis, vastus lateralis, rectus femoris, and Achilles tendon (eg, thickness, strength, stiffness). RESULTS Despite a nonsignificant increase in active torque in the HICT group, neither gastrocnemius medialis morphology nor Achilles tendon properties were significantly altered after the interventions. Vastus lateralis thickness increased following PRT only. CONCLUSIONS Functional home-based strength training did not lead to significant changes at the muscular level in children with cerebral palsy. We therefore assume that a more specific stimulus of higher intensity combined with a longer training duration might be necessary to evoke changes in muscles and tendons in individuals with cerebral palsy.
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42
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Barber L, Alexander C, Shipman P, Boyd R, Reid S, Elliott C. Validity and reliability of a freehand 3D ultrasound system for the determination of triceps surae muscle volume in children with cerebral palsy. J Anat 2018; 234:384-391. [PMID: 30525186 DOI: 10.1111/joa.12927] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 11/30/2022] Open
Abstract
This study assessed the validity, intra-rater and inter-rater reliability of segmentation of in vivo medial gastrocnemius (MG), lateral gastrocnemius (LG) and soleus (SOL) muscle volume measurement using a single sweep freehand 3D ultrasound (3DUS) in children with cerebral palsy (CP). The MG, LG and SOL of both limbs of 18 children with CP (age 8 years 4 months ± 1 year 10 months, 11 males, unilateral CP = 9, bilateral CP = 9, Gross Motor Functional Classification System I = 11, II = 7) were scanned using freehand 3DUS and magnetic resonance imaging (MRI). All freehand 3DUS and MRI images were segmented and volumes rendered by two raters. Validity was assessed using limits of agreement method. Intra-rater and inter-rater reliability was assessed using intra-class correlation (ICC), coefficient of variance (CV) and minimal detectable change (MDC). Freehand 3DUS overestimated muscle volume of the MG and LG by < 0.3 mL (1%) and underestimated SOL by < 1.3 mL (1.5%) compared with MRI. ICCs for intra-rater reliability of the segmentation process for the freehand 3DUS system and MRI for muscle volume were > 0.98 and 0.99, respectively, for all muscles. ICCs for inter-rater reliability of the segmentation process for freehand 3DUS and MRI volumes were > 0.96 and 0.98, respectively, for all muscles. MDCs for single rater freehand 3DUS and MRI were < 4.0 mL (14%) and 3.2 mL (11%), respectively, in all muscles. Freehand 3DUS is a valid and reliable method for the measurement of lower leg muscle volume that can be measured with a single sweep in children with CP in vivo. It can be used as an alternative to MRI for the detection of clinically relevant changes in calf muscle volume as the result of growth and interventions.
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Affiliation(s)
- L Barber
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - C Alexander
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - P Shipman
- Diagnostic Imaging, Princess Margaret Hospital, Subiaco, WA, Australia
| | - R Boyd
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - S Reid
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - C Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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43
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Cenni F, Bar-On L, Schless SH, Kalkman B, Aertbelien E, Bruyninckx H, Desloovere K. Medial Gastrocnemius Muscle-Tendon Junction and Fascicle Lengthening across the Range of Motion Analyzed in 2-D and 3-D Ultrasound Images. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2505-2518. [PMID: 30172570 DOI: 10.1016/j.ultrasmedbio.2018.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/23/2018] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound imaging modalities offer a clinically viable method to visualize musculoskeletal structures. However, proper data comparison between investigations is compromised because of a lack of measurement error documentation and method standardization. This investigation analyzes the reliability and validity of extracting medial gastrocnemius belly and fascicle lengths and pennation angles in different ankle joint positions, across the full range of motion, in a cohort of 11 children with spastic cerebral palsy and 11 typically developed children. Each of these parameters was extracted from two consecutive acquisitions, using both 2-D and 3-D ultrasound images. The findings suggest that the muscle tendon junction extraction in 2-D images can be a suitable parameter for analyzing medial gastrocnemius muscle length in typically developed children and children with spastic cerebral palsy, although averaging over multiple measurements is recommended to reduce variability. More caution should be taken when performing analyses based on fascicle length.
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Affiliation(s)
- Francesco Cenni
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium.
| | - Lynn Bar-On
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Simon-Henri Schless
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Barbara Kalkman
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Erwin Aertbelien
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | | | - Kaat Desloovere
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Yılmaz Topçuoğlu MS, Krautwurst BK, Klotz M, Dreher T, Wolf SI. How do children with bilateral spastic cerebral palsy manage walking on inclines? Gait Posture 2018; 66:172-180. [PMID: 30195221 DOI: 10.1016/j.gaitpost.2018.08.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking on inclined surfaces is an everyday task, which challenges stability and propulsion even in healthy adults. Children with cerebral palsy adapt similarly to inclines like healthy children do. However, how stability and propulsion in these subjects are influenced by different inclines remained unaddressed as of yet. RESEARCH QUESTION The aim was to examine the feeling of safety, stability and propulsion of children with cerebral palsy when walking on inclines to gain insight into the challenges they might face on these conditions. METHODS Eighteen children with bilateral spastic cerebral palsy with gross motor function classification scale level I and II and nineteen healthy children underwent instrumented 3D gait analysis on level ground and on a 5° and a 10° incline. A mixed linear model was used to draw between and within group comparisons. RESULTS Reduced lateral trunk sway, a relative lengthening of the lower limb at initial contact and a controlled walking speed were employed during downhill gait compared to level walking. Patients showed an increased sagittal ROM of trunk (3-4°) and pelvis (2-3°) and a decreased sagittal knee ROM (13°) compared to the typically developed children. During uphill gait, an insufficient increase of push-off power at the ankle (increase by 0.48 W/kg) was noted in children with CP, which appeared to lead to particularly shorter strides (about 0.1 m) in patients compared to healthy children (increase by 1.32 W/kg). SIGNIFICANCE Depending on inclination angle, children with cerebral palsy managed to walk on inclines in a controlled manner. The steeper the incline, the more the gait appeared to be affected: decreased feeling of safety, increased need for stabilising mechanisms for downhill gait and less sufficient uphill propulsion were seen. Helping these patients to attain better control during downhill gait and strengthening uphill gait mechanisms may support their participation in everyday life.
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Affiliation(s)
- Miray-Su Yılmaz Topçuoğlu
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Britta K Krautwurst
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Matthias Klotz
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Thomas Dreher
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
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45
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Kalkman BM, Bar-On L, Cenni F, Maganaris CN, Bass A, Holmes G, Desloovere K, Barton GJ, O'Brien TD. Muscle and tendon lengthening behaviour of the medial gastrocnemius during ankle joint rotation in children with cerebral palsy. Exp Physiol 2018; 103:1367-1376. [DOI: 10.1113/ep087053] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/08/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Barbara M. Kalkman
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
- Department of Mechanical Engineering; University of Sheffield; Sheffield UK
| | - Lynn Bar-On
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
- Amsterdam UMC; Vrije Universiteit Amsterdam; Department of Rehabilitation Medicine; Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Francesco Cenni
- Department of Mechanical Engineering; KU Leuven; Leuven Belgium
| | | | - Alfie Bass
- Alder Hey Children's NHS Foundation Trust; Liverpool UK
| | - Gill Holmes
- Alder Hey Children's NHS Foundation Trust; Liverpool UK
| | - Kaat Desloovere
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Gabor J. Barton
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
| | - Thomas D. O'Brien
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
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Andersen IT, Harrison A, Broholm R, Harder A, Nielsen JB, Bülow J, Pingel J. Microvascularization is not a limiting factor for exercise in adults with cerebral palsy. J Appl Physiol (1985) 2018; 125:536-544. [DOI: 10.1152/japplphysiol.00827.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Muscle contractures are a common complication in patients with central nervous system (CNS) lesions which limit range of movement and cause joint deformities. Furthermore, it has previously been shown that muscles with contractures have a reduced number of capillaries, indicating decreased tissue vascularization. The aim of the present study was to investigate the microvascular volume (MV) at rest and after acute exercise in the muscle tissue of individuals with cerebral palsy (CP) and healthy control individuals. Contrast-enhanced ultrasound (CEUS) was used before and after 30 min of walking or running on a treadmill in 10 healthy control participants and 10 individuals with CP to detect MV of their skeletal muscle tissue. A significant increase in the MV was observed after exercise both in the adult CP group (21–53 yr) and in the control group (21–52 yr) (1.8 ± 0.8 ΔdB to 3.1 ± 0.9 ΔdB or 42.9% and 1.5 ± 0.6 ΔdB to 2.5 ± 0.9 ΔdB or 39.0%, respectively). Furthermore, a difference in the resting MV was observed between the most severe cases of CP [gross motor function classification scale (GMFCS) 3 and 4] (2.3 ± 0.5 ΔdB) and the less severe cases (GMFCS 1 and 2) (1.5 ± 0.2 ΔdB). When the CP group was walking (3.4 km/h), the lactate levels, Borg score, and heart rate matched the level of controls when they were running (9.8 km/h). In conclusion, individuals with CP become exhausted at much lower exercise intensities than healthy individuals. This is not explained by impaired microvascularization, since the MV of the individuals with CP respond normally to increased O2 demand during acute exercise. NEW & NOTEWORTHY Cerebral palsy (CP) patients were less physically active compared with typically developed individuals. This may affect the microvascularization. We observed that the CP group became exhausted at much lower exercise intensities compared with healthy individuals. However, impaired microvascularization was not the reason for the decreased physical activity as the CP group responded normally to increased O2 demand during acute exercise. These results indicate that walking may be recommended as an intervention to train and maintain skeletal muscle tissue in individuals with CP.
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Affiliation(s)
| | - Adrian Harrison
- MyoDynamik ApS, Copenhagen, Denmark
- Department of Veterinary & Animal Sciences, Faculty of Health & Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Rikke Broholm
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University, Copenhagen, Denmark
| | | | - Jens Bo Nielsen
- Center for Neuroscience, Copenhagen University, Copenhagen, Denmark
| | - Jens Bülow
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University, Copenhagen, Denmark
- Department of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Jessica Pingel
- Center for Neuroscience, Copenhagen University, Copenhagen, Denmark
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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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Muscle Shortening and Spastic Cocontraction in Gastrocnemius Medialis and Peroneus Longus in Very Young Hemiparetic Children. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2328601. [PMID: 29951529 PMCID: PMC5987331 DOI: 10.1155/2018/2328601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/15/2018] [Accepted: 04/12/2018] [Indexed: 11/17/2022]
Abstract
Objectives Muscle shortening and spastic cocontraction in ankle plantar flexors may alter gait since early childhood in cerebral palsy (CP). We evaluated gastrosoleus complex (GSC) length, and gastrocnemius medialis (GM) and peroneus longus (PL) activity during swing phase, in very young hemiparetic children with equinovalgus. Methods This was an observational, retrospective, and monocentric outpatient study in a pediatric hospital. Ten very young hemiparetic children (age 3 ± 1 yrs) were enrolled. These CP children were assessed for muscle extensibility (Tardieu scale XV1) in GSC (angle of arrest during slow-speed passive ankle dorsiflexion with the knee extended) and monitored for GM and PL electromyography (EMG) during the swing phase of gait. The swing phase was divided into three periods (T1, T2, and T3), in which we measured a cocontraction index (CCI), ratio of the Root Mean Square EMG (RMS-EMG) from each muscle during that period to the peak 500 ms RMS-EMG obtained from voluntary plantar flexion during standing on tiptoes (from several 5-second series, the highest RMS value was computed over 500 ms around the peak). Results On the paretic side: (i) the mean XV1-GSC was 100° (8°) (median (SD)) versus 106° (3°) on the nonparetic side (p = 0.032, Mann-Whitney); (ii) XV1-GSC diminished with age between ages of 2 and 5 (Spearman, ρ = 0.019); (iii) CCIGM and CCIPL during swing phase were higher than on the nonparetic side (CCIGM, 0.32 (0.20) versus 0.15 (0.09), p < 0.01; CCIPL, 0.52 (0.30) versus 0.24 (0.17), p < 0.01), with an early difference significant for PL from T1 (p = 0.03). Conclusions In very young hemiparetic children, the paretic GSC may rapidly shorten in the first years of life. GM and PL cocontraction during swing phase are excessive, which contributes to dynamic equinovalgus. Muscle extensibility (XV1) may have to be monitored and preserved in the first years of life in children with CP. Additional measurements of cocontraction may further help target treatments with botulinum toxin, especially in peroneus longus.
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Kruse A, Schranz C, Tilp M, Svehlik M. Muscle and tendon morphology alterations in children and adolescents with mild forms of spastic cerebral palsy. BMC Pediatr 2018; 18:156. [PMID: 29743109 PMCID: PMC5941654 DOI: 10.1186/s12887-018-1129-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Early detection of changes at the muscular level before a contracture develops is important to gain knowledge about the development of deformities in individuals with spasticity. However, little information is available about muscle morphology in children with spastic diplegic cerebral palsy (CP) without contracture or equinus gait. Therefore, the aim of this study was to compare the gastrocnemius medialis (GM) and Achilles tendon architecture of children and adolescents with spastic CP without contracture or equinus gait to that of typically developing (TD) children. Methods Two-dimensional ultrasonography was used to assess the morphological properties of the GM muscle and Achilles tendon in 10 children with spastic diplegic CP (Gross Motor Function Classification System level I–II) and 12 TD children (mean age 12.0 (2.8) and 11.3 (2.5) years, respectively). The children with CP were not restricted in the performance of daily tasks, and therefore had a high functional capacity. Mean muscle and tendon parameters were statistically compared (independent t-tests or Mann-Whitney U-tests). Results When normalized to lower leg length, muscle-tendon unit length and GM muscle belly length were found to be significantly shorter (p < 0.05, effect size (ES) = 1.00 and 0.98, respectively) in the children with spastic CP. Furthermore, there was a tendency for increased Achilles tendon length when expressed as a percentage of muscle-tendon unit length (p = 0.08, ES = − 0.80) in the individuals with CP. This group also showed shorter muscle fascicles (3.4 cm vs. 4.4 cm, p < 0.01, ES = 1.12) and increased fascicle pennation angle (21.9° vs. 18.1°, p < 0.01, ES = − 1.36, respectively). However, muscle thickness and Achilles tendon cross-sectional area did not differ between groups. Resting ankle joint angle was significantly more plantar flexed (− 26.2° vs. − 20.8°, p < 0.05, ES = 1.06) in the children with CP. Conclusions Morphological alterations of the plantar flexor muscle-tendon unit are also present in children and adolescents with mild forms of spastic CP. These alterations may contribute to functional deficits such as muscle weakness, and therefore have to be considered in the clinical decision-making process, as well as in the selection of therapeutic interventions.
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Affiliation(s)
- Annika Kruse
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Christian Schranz
- Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Markus Tilp
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria.
| | - Martin Svehlik
- Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
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Martín Lorenzo T, Rocon E, Martínez Caballero I, Lerma Lara S. Medial gastrocnemius structure and gait kinetics in spastic cerebral palsy and typically developing children: A cross-sectional study. Medicine (Baltimore) 2018; 97:e10776. [PMID: 29794756 PMCID: PMC6392514 DOI: 10.1097/md.0000000000010776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare medial gastrocnemius muscle-tendon structure, gait propulsive forces, and ankle joint gait kinetics between typically developing children and those with spastic cerebral palsy, and to describe significant associations between structure and function in children with spastic cerebral palsy.A sample of typically developing children (n = 9 /16 limbs) and a sample of children with spastic cerebral palsy (n = 29 /43 limbs) were recruited. Ultrasound and 3-dimensional motion capture were used to assess muscle-tendon structure, and propulsive forces and ankle joint kinetics during gait, respectively.Children with spastic cerebral palsy had shorter fascicles and muscles, and longer Achilles tendons than typically developing children. Furthermore, total negative power and peak negative power at the ankle were greater, while total positive power, peak positive power, net power, total vertical ground reaction force, and peak vertical and anterior ground reaction forces were smaller compared to typically developing children. Correlation analyses revealed that smaller resting ankle joint angles and greater maximum dorsiflexion in children with spastic cerebral palsy accounted for a significant decrease in peak negative power. Furthermore, short fascicles, small fascicle to belly ratios, and large tendon to fascicle ratios accounted for a decrease in propulsive force generation.Alterations observed in the medial gastrocnemius muscle-tendon structure of children with spastic cerebral palsy may impair propulsive mechanisms during gait. Therefore, conventional treatments should be revised on the basis of muscle-tendon adaptations.
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Affiliation(s)
- Teresa Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Arganda del Rey
| | | | - Sergio Lerma Lara
- Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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