1
|
Cenni F, Alexander N, Laatikainen-Raussi I, Sukanen M, Finni T. Wearing an ultrasound probe during walking does not influence lower limb joint kinematics in adolescents with cerebral palsy and typically developing peers. Gait Posture 2024; 112:134-139. [PMID: 38772125 DOI: 10.1016/j.gaitpost.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/26/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Enhancing traditional three-dimensional gait analysis with a portable ultrasound device at the lower-limb muscle-tendon level enables direct measurement of muscle and tendon lengths during walking. However, it is important to consider that the size of the ultrasound probe and its attachment on the lower limb may potentially influence gait pattern. RESEARCH QUESTION What is the effect of wearing an ultrasound probe at the lower limb in adolescents with cerebral palsy and typically developing peers? METHODS Eleven individuals with cerebral palsy and nine age-matched typically developing peers walking barefoot at their self-selected speed were analyzed. Data collection occurred under three conditions: the reference condition (GAIT), and two conditions involving placement of the ultrasound probe over the distal medial gastrocnemius-Achilles tendon junction (MTJ) and over the medial gastrocnemius mid-belly to capture fascicles (FAS). Data processing included calculating differences between conditions using root mean square error (RMSE) for joint kinematics and comparing them to the overall mean difference. Additionally, Spearman correlations were calculated to examine the relationship between kinematic RMSEs and walking speed. RESULTS No significant differences in stance phase duration or walking speed were observed among the three conditions. Average RMSEs were below 5° for all parameters and condition comparisons in both groups. In both the TD and CP groups, RMSE values during the swing phase were higher than those during the stance phase for all joints. No significant correlations were found between height or body mass and swing phase RMSEs. In the CP group, there was a significant correlation between joint kinematics RMSEs and differences in walking speed at the hip, knee and ankle joints when comparing the MTJ condition with the GAIT condition. SIGNIFICANCE This study confirms joint kinematics alterations are smaller than 5° due to wearing to the leg an ultrasound probe during walking.
Collapse
Affiliation(s)
- Francesco Cenni
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Nathalie Alexander
- Laboratory for Motion Analysis, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | | | - Maria Sukanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
2
|
Cenni F, Alexander N, Sukanen M, Mustafaoglu A, Wang Z, Wang R, Finni T. ISB clinical biomechanics award winner 2023: Medial gastrocnemius muscle and Achilles tendon interplay during gait in cerebral palsy. Clin Biomech (Bristol, Avon) 2024; 111:106158. [PMID: 38061205 DOI: 10.1016/j.clinbiomech.2023.106158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The interplay between the medial gastrocnemius muscle and the Achilles tendon is crucial for efficient walking. In cerebral palsy, muscle and tendon remodelling alters the role of contractile and elastic components. The aim was to investigate the length changes of medial gastrocnemius belly and fascicles, and Achilles tendon to understand their interplay to gait propulsion in individuals with cerebral palsy. METHODS Twelve young individuals with cerebral palsy and 12 typically developed peers were assessed during multiple gait cycles using 3D gait analysis combined with a portable ultrasound device. By mapping ultrasound image locations into the shank reference frame, the medial gastrocnemius belly, fascicle, and Achilles tendon lengths were estimated throughout the gait cycle. Participants with cerebral palsy were classified into equinus and non-equinus groups based on their sagittal ankle kinematics. FINDINGS In typically developed participants, the Achilles tendon undertook most of the muscle-tendon unit lengthening during stance, whereas in individuals with cerebral palsy, this lengthening was shared between the medial gastrocnemius belly and Achilles tendon, which was more evident in the equinus group. The lengthening behaviour of the medial gastrocnemius fascicles resembled that of the Achilles tendon in cerebral palsy. INTERPRETATION The findings revealed similar length changes of the medial gastrocnemius fascicles and Achilles tendon, highlighting the enhanced role of the muscle in absorbing energy during stance in cerebral palsy. These results, together with the current knowledge of increased intramuscular stiffness, suggest the exploitation of intramuscular passive forces for such energy absorption.
Collapse
Affiliation(s)
- Francesco Cenni
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Nathalie Alexander
- Laboratory for Motion Analysis, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Maria Sukanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Afet Mustafaoglu
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Zhongzheng Wang
- KTH MoveAbility Lab, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ruoli Wang
- KTH MoveAbility Lab, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Taija Finni
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
3
|
Mooijekind B, Flux E, Buizer AI, van der Krogt MM, Bar-On L. The influence of wearing an ultrasound device on gait in children with cerebral palsy and typically developing children. Gait Posture 2023; 101:138-144. [PMID: 36841120 DOI: 10.1016/j.gaitpost.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Ultrasonography with motion analysis enables dynamic imaging of medial gastrocnemius (MG) muscles and tendons during gait. This revealed pathological muscle-tendon dynamics in children with spastic cerebral palsy (CP) compared to typically developing (TD) children. However, wearing an ultrasound probe on the lower leg could interfere with gait and bias muscle length changes observed with ultrasound. RESEARCH QUESTION Does wearing an ultrasound probe on the MG influence gait in children with CP and TD children? METHODS Eighteen children with spastic CP and 16 age-matched TD children walked at comfortable walking speed on an instrumented treadmill. One baseline gait condition (BASE) and two conditions with an ultrasound probe and custom-made probe holder were measured: on the mid-muscle fascicles (FAS) and on the muscle-tendon junction (MTJ). The effect of condition and group on spatiotemporal parameters, hip, knee and ankle kinematics, ankle moment, ankle power, and modeled MG muscle-tendon unit (MTU) length was assessed using two-way repeated measures ANOVA's. Statistical non-parametric mapping was applied for time-series. Post-hoc paired-samples t-tests were conducted, and the root mean square difference was calculated for significant parts. RESULTS Children took wider steps during FAS (CP, TD) and MTJ (TD) compared to BASE, and during FAS compared to MTJ (CP). Hip extension was lower (2.7°) during terminal stance for MTJ compared to FAS for TD only. There was less swing knee flexion (FAS 4.9°; MTJ 4.0°) and ankle plantarflexion around toe-off (FAS 3.0°; MTJ 2.4°) for both ultrasound placements, with no group effect. Power absorption during loading response was slightly increased for both ultrasound placements (0.12 W/kg), with no group effect. MTU shortened less in swing for both ultrasound placements (FAS 3.6 mm; MTJ 3.7 mm), with no group effect. SIGNIFICANCE Wearing an ultrasound probe causes minimal lower-limb gait alterations and MTU length changes that are mostly similar in CP and TD.
Collapse
Affiliation(s)
- Babette Mooijekind
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands; Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium.
| | - Eline Flux
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands; Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Lynn Bar-On
- Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium
| |
Collapse
|
4
|
Boulay C, Sangeux M, Authier G, Jacquemier M, Merlo A, Chabrol B, Jouve JL, Gracies JM, Pesenti S. Improved Gait and Radiological Measurements After injection of Botulinum Toxin Into Peroneus Longus in Young Children With USCP and Equinovalgus Gait. Pediatr Neurol 2023; 142:1-9. [PMID: 36848724 DOI: 10.1016/j.pediatrneurol.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/08/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Children with cerebral palsy develop foot deformities due to a combination of factors including muscle shortening, hypertonia, weakness, and cocontraction of muscles acting at the ankle joint resulting in an altered gait pattern. We hypothesized these factors affect the peroneus longus (PL) and tibialis anterior (TA) muscles couple in children who develop equinovalgus gait first followed by planovalgus foot deformities. Our aim was to evaluate the effects of abobotulinum toxin A injection to the PL muscle, in a cohort of children with unilateral spastic cerebral palsy and equinovalgus gait. METHODS This was a prospective cohort study. The children were examined within 12 months before and after injection to their PL muscle. Twenty-five children of mean age 3.4 (S.D.: 1.1) years were recruited. RESULTS We found significant improvement in foot radiology measures. Passive extensibility of the triceps surae did not change, whereas active dorsiflexion increased significantly. Nondimensional walking speed increased by 0.1 (95% confidence interval [CI], [0.07, 0.16]; P < 0.001), and the Edinburgh visual gait score improved by 2.8 (95% CI, [-4.06, -1.46]; P < 0.001). Electromyography showed increased recruitment for gastrocnemius medialis (GM) and TA but not for PL during the reference exercises (standing on tip toes for GM/PL, active dorsiflexion for TA) and decreased activation percentages for PL/GM and TA across sub-phases of gait. CONCLUSIONS One key advantage of treating the PL muscle only might be to address foot deformities without interfering with the main plantar flexors that are instrumental to support body weight during gait.
Collapse
Affiliation(s)
- Christophe Boulay
- Pediatric Neurology Department, Timone Children's Hospital, Marseille, France; Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France.
| | - Morgan Sangeux
- Murdoch Children's Research Institute, Melbourne, Australia; University Children's Hospital Basel, Basel, Switzerland
| | - Guillaume Authier
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Michel Jacquemier
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Andrea Merlo
- Gait&Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
| | - Brigitte Chabrol
- Pediatric Neurology Department, Timone Children's Hospital, Marseille, France
| | - Jean-Luc Jouve
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Jean-Michel Gracies
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France; UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
| | - Sébastien Pesenti
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Flux E, van der Krogt MM, Harlaar J, Buizer AI, Sloot LH. Functional assessment of stretch hyperreflexia in children with cerebral palsy using treadmill perturbations. J Neuroeng Rehabil 2021; 18:151. [PMID: 34663392 PMCID: PMC8522046 DOI: 10.1186/s12984-021-00940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As hyperactive muscle stretch reflexes hinder movement in patients with central nervous system disorders, they are a common target of treatment. To improve treatment evaluation, hyperactive reflexes should be assessed during activities as walking rather than passively. This study systematically explores the feasibility, reliability and validity of sudden treadmill perturbations to evoke and quantify calf muscle stretch reflexes during walking in children with neurological disorders. METHODS We performed an observational cross-sectional study including 24 children with cerebral palsy (CP; 6-16 years) and 14 typically developing children (TD; 6-15 years). Short belt accelerations were applied at three different intensities while children walked at comfortable speed. Lower leg kinematics, musculo-tendon lengthening and velocity, muscle activity and spatiotemporal parameters were measured to analyze perturbation responses. RESULTS We first demonstrated protocol feasibility: the protocol was completed by all but three children who ceased participation due to fatigue. All remaining children were able to maintain their gait pattern during perturbation trials without anticipatory adaptations in ankle kinematics, spatiotemporal parameters and muscle activity. Second, we showed the protocol's reliability: there was no systematic change in muscle response over time (P = 0.21-0.54) and a bootstrapping procedure indicated sufficient number of perturbations, as the last perturbation repetition only reduced variability by ~ 2%. Third, we evaluated construct validity by showing that responses comply with neurophysiological criteria for stretch reflexes: perturbations superimposed calf muscle lengthening (P < 0.001 for both CP and TD) in all but one participant. This elicited increased calf muscle activity (359 ± 190% for CP and 231 ± 68% for TD, both P < 0.001) in the gastrocnemius medialis muscle, which increased with perturbation intensity (P < 0.001), according to the velocity-dependent nature of stretch reflexes. Finally, construct validity was shown from a clinical perspective: stretch reflexes were 1.7 times higher for CP than TD for the gastrocnemius medialis muscle (P = 0.017). CONCLUSIONS The feasibility and reliability of the protocol, as well as the construct validity-shown by the exaggerated velocity-dependent nature of the measured responses-strongly support the use of treadmill perturbations to quantify stretch hyperreflexia during gait. We therefore provided a framework which can be used to inform clinical decision making and treatment evaluation.
Collapse
Affiliation(s)
- Eline Flux
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands.
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
- Department Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department Orthopedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lizeth H Sloot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands
- Institute for Computer Engineering, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
7
|
The reliability of measuring medial gastrocnemius muscle-tendon unit lengths during gait. Gait Posture 2021; 90:464-467. [PMID: 34619612 DOI: 10.1016/j.gaitpost.2021.09.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ultrasound imaging combined with 3D motion analysis allows for in-vivo assessment of muscle-tendon unit lengths during gait. The clinical relevance of analysing the medial gastrocnemius (MG) and Achilles muscle-tendon junction (MTJ), MG mid-muscle belly fascicles (FAS) and muscle thickness was shown. However, their reliability error estimations over the gait cycle is unknown. RESEARCH QUESTION What are the intra- and inter-session errors associated with extracting MG belly, thickness, FAS and tendon lengths using ultrasound during gait in healthy participants? METHODS 3D gait analysis was carried out in ten healthy adults as they walked on an instrumented treadmill at a comfortable walking speed. An ultrasound probe was secured on the leg and tracked by 3D motion analysis. Images were collected during two walking trials with the probe on the MG muscle-belly to estimate FAS lengths and muscle thickness, and during two trials with the probe on the MTJ to estimate muscle-belly and tendon lengths. A second session was performed after 5 ± 4 days where a different operator placed the ultrasound probe. The standard deviation (SD) of absolute and relative lengths changes during the gait cycle over different trials were calculated per participant. SD values averaged over participants represented intra- and inter-session errors. RESULTS For all assessed variables, the intra-session errors were <2.2 mm, except for the FAS lengths (3.1 mm). The inter-session errors were larger than the intra-session, with the highest values found for the absolute muscle-tendon unit lengths (5.6 mm). Relative length errors were smaller than absolute length errors. SIGNIFICANCE Intra-session errors, which may reflect natural variability and data processing errors, seem more critical when extracting absolute FAS than muscle-tendon lengths. Standardized probe positioning on the MTJ between sessions may improve the inter-session reliability. Expressing the lengths relative to their lengths as the beginning of the gait cycle reduces the inter-session errors.
Collapse
|
8
|
Ryan JM, Lavelle G, Theis N, Noorkoiv M, Kilbride C, Korff T, Baltzopoulos V, Shortland A, Levin W. Progressive resistance training for adolescents with cerebral palsy: the STAR randomized controlled trial. Dev Med Child Neurol 2020; 62:1283-1293. [PMID: 32588919 DOI: 10.1111/dmcn.14601] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the effect of progressive resistance training of the ankle plantarflexors on gait efficiency, activity, and participation in adolescents with cerebral palsy (CP). METHOD Sixty-four adolescents (10-19y; 27 females, 37 males; Gross Motor Function Classification System [GMFCS] levels I-III) were randomized to 30 sessions of resistance training (10 supervised and 20 unsupervised home sessions) over 10 weeks or usual care. The primary outcome was gait efficiency indicated by net nondimensional oxygen cost (NNcost). Secondary outcomes included physical activity, gross motor function, participation, muscle strength, muscle and tendon size, and muscle and tendon stiffness. Analysis was intention-to-treat. RESULTS Median attendance at the 10 supervised sessions was 80% (range 40-100%). There was no between-group difference in NNcost at 10 (mean difference: 0.02, 95% confidence interval [CI] -0.07 to 0.11, p=0.696) or 22 weeks (mean difference: -0.08, 95% CI -0.18 to 0.03, p=0.158). There was also no evidence of between-group differences in secondary outcomes at 10 or 22 weeks. There were 123 adverse events reported by 27 participants in the resistance training group. INTERPRETATION We found that 10 supervised sessions and 20 home sessions of progressive resistance training of the ankle plantarflexors did not improve gait efficiency, muscle strength, activity, participation, or any biomechanical outcome among adolescents with CP. WHAT THIS PAPER ADDS Thirty sessions of progressive resistance training of the ankle plantarflexors over 10 weeks did not improve gait efficiency among ambulatory adolescents with cerebral palsy. Resistance training did not improve muscle strength, activity, or participation. Ninety percent of participants experienced an adverse event. Most adverse events were expected and no serious adverse events were reported.
Collapse
Affiliation(s)
- Jennifer M Ryan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,College of Health and Life Sciences, Brunel University London, London, UK
| | - Grace Lavelle
- College of Health and Life Sciences, Brunel University London, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London, London, UK
| | | | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercises Sciences, Liverpool John Moores University, Liverpool, UK
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, London, UK
| | - Wendy Levin
- Department of Physiotherapy, Swiss Cottage School and Development and Research Centre, London, UK
| | | |
Collapse
|
9
|
Hösl M, Kruse A, Tilp M, Svehlik M, Böhm H, Zehentbauer A, Arampatzis A. Impact of Altered Gastrocnemius Morphometrics and Fascicle Behavior on Walking Patterns in Children With Spastic Cerebral Palsy. Front Physiol 2020; 11:518134. [PMID: 33178029 PMCID: PMC7597072 DOI: 10.3389/fphys.2020.518134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Spastic cerebral palsy (SCP) affects neural control, deteriorates muscle morphometrics, and may progressively impair functional walking ability. Upon passive testing, gastrocnemius medialis (GM) muscle bellies or fascicles are typically shorter, thinner, and less extensible. Relationships between muscle and gait parameters might help to understand gait pathology and pathogenesis of spastic muscles. The current aim was to link resting and dynamic GM morphometrics and contractile fascicle behavior (both excursion and velocity) during walking to determinants of gait. We explored the associations between gait variables and ultrasonography of the GM muscle belly captured during rest and during gait in children with SCP [n = 15, gross motor function classification system (GMFCS) levels I and II, age: 7–16 years] and age-matched healthy peers (n = 17). The SCP children’s plantar flexors were 27% weaker. They walked 12% slower with more knee flexion produced 42% less peak ankle push-off power (all p < 0.05) and 7/15 landed on their forefoot. During the stance phase, fascicles in SCP on average operated on 9% shorter length (normalized to rest length) and displayed less and slower fascicle shortening (37 and 30.6%, respectively) during push-off (all p ≤ 0.024). Correlation analyses in SCP patients revealed that (1) longer-resting fascicles and thicker muscle bellies are positively correlated with walking speed and negatively to knee flexion (r = 0.60–0.69, p < 0.0127) but not to better ankle kinematics; (2) reduced muscle strength was associated with the extent of eccentric fascicle excursion (r = −0.57, p = 0.015); and (3) a shorter operating length of the fascicles was correlated with push-off power (r = −0.58, p = 0.013). Only in controls, a correlation (r = 0.61, p = 0.0054) between slower fascicle shortening velocity and push-off power was found. Our results indicate that a thicker gastrocnemius muscle belly and longer gastrocnemius muscle fascicles may be reasonable morphometric properties that should be targeted in interventions for individuals with SCP, since GM muscle atrophy may be related to decreases in walking speed and undesired knee flexion during gait. Furthermore, children with SCP and weaker gastrocnemius muscle may be more susceptible to chronic eccentric muscle overloading. The relationship between shorter operating length of the fascicles and push-off power may further support the idea of a compensation mechanism for the longer sarcomeres found in children with SCP. Nevertheless, more studies are needed to support our explorative findings.
Collapse
Affiliation(s)
- Matthias Hösl
- Gait and Motion Analysis Laboratory, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Annika Kruse
- Department of Biomechanics, Movement and Training Sciences, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Markus Tilp
- Department of Biomechanics, Movement and Training Sciences, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Martin Svehlik
- Paediatric Orthopaedics Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Harald Böhm
- Gait Laboratory, Orthopedic Children's Hospital Aschau, Aschau im Chiemgau, Germany
| | - Antonia Zehentbauer
- Human Movement Science, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt University of Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt University of Berlin, Berlin, Germany
| |
Collapse
|
10
|
Medial gastrocnemius muscle and tendon interaction during gait in typically developing children and children with cerebral palsy. Gait Posture 2020. [DOI: 10.1016/j.gaitpost.2020.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Van Hooren B, Teratsias P, Hodson-Tole EF. Ultrasound imaging to assess skeletal muscle architecture during movements: a systematic review of methods, reliability, and challenges. J Appl Physiol (1985) 2020; 128:978-999. [PMID: 32163334 DOI: 10.1152/japplphysiol.00835.2019] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
B-mode ultrasound is often used to quantify muscle architecture during movements. Our objectives were to 1) systematically review the reliability of fascicle length (FL) and pennation angles (PA) measured using ultrasound during movements involving voluntary contractions; 2) systematically review the methods used in studies reporting reliability, discuss associated challenges, and provide recommendations to improve the reliability and validity of dynamic ultrasound measurements; and 3) provide an overview of computational approaches for quantifying fascicle architecture, their validity, agreement with manual quantification of fascicle architecture, and advantages and drawbacks. Three databases were searched until June 2019. Studies among healthy human individuals aged 17-85 yr that investigated the reliability of FL or PA in lower-extremity muscles during isoinertial movements and that were written in English were included. Thirty studies (n = 340 participants) were included for reliability analyses. Between-session reliability as measured by coefficient of multiple correlations (CMC), and coefficient of variation (CV) was FL CMC: 0.89-0.96; CV: 8.3% and PA CMC: 0.87-0.90; CV: 4.5-9.6%. Within-session reliability was FL CMC: 0.82-0.99; CV: 0.0-6.7% and PA CMC: 0.91; CV: 0.0-15.0%. Manual analysis reliability was FL CMC: 0.89-0.96; CV: 0.0-15.9%; PA CMC: 0.84-0.90; and CV: 2.0-9.8%. Computational analysis FL CMC was 0.82-0.99, and PA CV was 14.0-15.0%. Eighteen computational approaches were identified, and these generally showed high agreement with manual analysis and high validity compared with phantoms or synthetic images. B-mode ultrasound is a reliable method to quantify fascicle architecture during movement. Additionally, computational approaches can provide a reliable and valid estimation of fascicle architecture.
Collapse
Affiliation(s)
- Bas Van Hooren
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Panayiotis Teratsias
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Emma F Hodson-Tole
- Musculoskeletal Sciences and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| |
Collapse
|
13
|
Chakraborty S, Nandy A, Kesar TM. Gait deficits and dynamic stability in children and adolescents with cerebral palsy: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2020; 71:11-23. [PMID: 31677546 DOI: 10.1016/j.clinbiomech.2019.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/19/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies have demonstrated that ambulatory children and adolescents with cerebral palsy demonstrate atypical gait patterns. Out of numerous gait variables, identification of the most deteriorated gait parameters is important for targeted and effective gait rehabilitation. Therefore, this study aimed to identify the gait parameters with the most discriminating nature to distinguish cerebral palsy gait from normal gait. METHODS Multiple databases were searched to include studies on ambulatory children and adolescents with cerebral palsy that included gait (spatio-temporal, kinematic, and kinetic) and dynamic stability variables. FINDINGS Of 68 studies that met the inclusion criteria, 35 studies were included in the meta analysis. Effect size was used to assess the discriminative strength of each variable. A large effect (≥ 0.8) of cerebral palsy on double limb support time (Standardized Mean Difference = 0.98), step length (Standardized Mean Difference = 1.65), step width (Standardized Mean Difference = 1.21), stride length (Standardized Mean Difference = 1.75), and velocity (Standardized Mean Difference = 1.42) was observed at preferred-walking speed. At fast-walking speed, some gait variables (i.e. velocity and stride length) exhibited larger effect size compared to preferred-walking speed. For some kinematic variables (e.g. range of motion of pelvis), the effect size varied across the body planes. INTERPRETATION Our systematic review detects the most discriminative features of cerebral palsy gait. Non-uniform effects on joint kinematics across the anatomical planes support the importance of 3D gait analysis. Differential effects at fast versus preferred speeds emphasize the importance of measuring gait at a range of speeds.
Collapse
Affiliation(s)
- Saikat Chakraborty
- Machine Intelligence and Bio-motion Research Lab., Department of Computer Science and Engineering, National Institute of Technology, Rourkela, India. saikat.scgmail.com
| | - Anup Nandy
- Machine Intelligence and Bio-motion Research Lab., Department of Computer Science and Engineering, National Institute of Technology, Rourkela, India
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
14
|
Cenni F, Bar-On L, Monari D, Schless SH, Kalkman BM, Aertbeliën E, Desloovere K, Bruyninckx H. Semi-automatic methods for tracking the medial gastrocnemius muscle-tendon junction using ultrasound: a validation study. Exp Physiol 2019; 105:120-131. [PMID: 31677311 DOI: 10.1113/ep088133] [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: 08/28/2019] [Accepted: 10/31/2019] [Indexed: 12/22/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is the proposed semi-automatic algorithm suitable for tracking the medial gastrocnemius muscle-tendon junction in ultrasound images collected during passive and active conditions? What is the main finding and its importance? The validation of a method allowing efficient tracking of the muscle-tendon junction in both passive and active conditions, in healthy as well as in pathological conditions. This method was tested in common acquisition conditions and the developed software made freely available. ABSTRACT Clinically relevant information can be extracted from ultrasound (US) images by tracking the displacement of the junction between muscle and tendon. This paper validated automatic methods for tracking the location of muscle-tendon junction (MTJ) between the medial gastrocnemius and the Achilles tendon during passive slow and fast stretches, and active ankle rotations while walking on a treadmill. First, an automatic algorithm based on an optical flow approach was applied on collected US images. Second, results of the automatic algorithm were evaluated and corrected using a quality measure that indicated which critical images need to be manually corrected. US images from 12 typically developed (TD) children, 12 children with spastic cerebral palsy (SCP) and eight healthy adults were analysed. Automatic and semi-automatic tracking methods were compared to manual tracking using root mean square errors (RMSE). For the automatic tracking, RMSE was less than 3.1 mm for the slow stretch and 5.2 mm for the fast stretch, the worst case being for SCP. The tracking results in the fast stretch condition were improved (especially in SCP) by using the semi-automatic approach, with an RMSE reduction of about 30%. During walking, the semi-automatic method also reduced errors, with a final RMSE of 3.6 mm. In all cases, data processing was considerably shorter using the semi-automatic method (2 min) compared to manual tracking (20 min). A quick manual correction considerably improves tracking of the MTJ during gait and allows to achieve results suitable for further analyses. The proposed algorithm is freely available.
Collapse
Affiliation(s)
- Francesco Cenni
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Lynn Bar-On
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001, Leuven, Belgium.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Davide Monari
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium.,KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300b, 3001, Leuven, Belgium
| | - Simon-Henri Schless
- Alyn Hospital, Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - Barbara M Kalkman
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Erwin Aertbeliën
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300b, 3001, Leuven, Belgium
| | - Kaat Desloovere
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium.,KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001, Leuven, Belgium
| | - Herman Bruyninckx
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300b, 3001, Leuven, Belgium
| |
Collapse
|
15
|
Noorkoiv M, Lavelle G, Theis N, Korff T, Kilbride C, Baltzopoulos V, Shortland A, Levin W, Ryan JM. Predictors of Walking Efficiency in Children With Cerebral Palsy: Lower-Body Joint Angles, Moments, and Power. Phys Ther 2019; 99:711-720. [PMID: 31155663 PMCID: PMC10468027 DOI: 10.1093/ptj/pzz041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 03/01/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND People with cerebral palsy (CP) experience increased muscle stiffness, muscle weakness, and reduced joint range of motion. This can lead to an abnormal pattern of gait, which can increase the energy cost of walking and contribute to reduced participation in physical activity. OBJECTIVE The aim of the study was to examine associations between lower-body joint angles, moments, power, and walking efficiency in adolescents with CP. DESIGN This was a cross-sectional study. METHODS Sixty-four adolescents aged 10 to 19 years with CP were recruited. Walking efficiency was measured as the net nondimensional oxygen cost (NNcost) during 6 minutes of overground walking at self-selected speed. Lower-body kinematics and kinetics during walking were collected with 3-dimensional motion analysis, synchronized with a treadmill with integrated force plates. The associations between the kinematics, kinetics, and NNcost were examined with multivariable linear regression. RESULTS After adjusting for age, sex, and Gross Motor Function Classification System level, maximum knee extension angle (β = -0.006), hip angle at midstance (β = -0.007), and maximum hip extension (β = -0.008) were associated with NNcost. Age was a significant modifier of the association between the NNcost and a number of kinematic variables. LIMITATIONS This study examined kinetic and kinematic variables in the sagittal plane only. A high interindividual variation in gait pattern could have influenced the results. CONCLUSIONS Reduced knee and hip joint extension are associated with gait inefficiency in adolescents with CP. Age is a significant factor influencing associations between ankle, knee, and hip joint kinematics and gait efficiency. Therapeutic interventions should investigate ways to increase knee and hip joint extension in adolescents with CP.
Collapse
Affiliation(s)
- Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, Uxbridge UB8 3PH, United Kingdom
| | - Grace Lavelle
- College of Health and Life Sciences, Brunel University London
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Gloucester, Gloucestershire, United Kingdom
| | | | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, London, United Kingdom
| | - Wendy Levin
- Department of Physiotherapy, Swiss Cottage School and Development and Research Centre, London, United Kingdom
| | - Jennifer M Ryan
- College of Health and Life Sciences, Brunel University London; and Department of Public Health and Epidemiology, RCSI, Dublin, Ireland
| |
Collapse
|
16
|
Combining muscle morphology and neuromotor symptoms to explain abnormal gait at the ankle joint level in cerebral palsy. Gait Posture 2019; 68:531-537. [PMID: 30623848 DOI: 10.1016/j.gaitpost.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/24/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with spastic cerebral palsy (CP) have neuromotor symptoms contributing towards their gait patterns. However, the role of altered muscle morphology alongside these symptoms is yet to be fully investigated. RESEARCH QUESTION To what extent can medial gastrocnemius and tibialis anterior volume and echo-intensity, plantar/dorsiflexion strength and selective motor control, plantarflexion spasticity and passive ankle dorsiflexion explain abnormal ankle gait. METHOD In thirty children and adolescents with spastic CP (8.6 ± 3.4 y/mo) and ten typically developing peers (9.9 ± 2.4 y/mo), normalised muscle volume and echo-intensity were estimated. Both cohorts also underwent three-dimensional gait analysis, whilst for participants with spastic CP, plantar/dorsi-flexion strength and selective motor control, plantarflexion spasticity and maximum ankle dorsiflexion were also measured. The combined contribution of these parameters towards five clinically meaningful features of gait were evaluated, using backwards multiple regression analyses. RESULTS With respect to the typically developing cohort, the participants with spastic CP had deficits in normalised medial gastrocnemius and tibialis anterior volume of 40% and 33%, and increased echo-intensity values of 19% and 16%, respectively. The backwards multiple regression analyses revealed that the combination of reduced ankle dorsiflexion, muscle volume, plantarflexion strength and dorsiflexion selective motor control could account for 12-62% of the variance in the chosen features of gait. SIGNIFICANCE The combination of altered muscle morphology and neuromotor symptoms partly explained abnormal gait at the ankle in children with spastic CP. Both should be considered as important measures for informed treatment decision-making, but further work is required to better unravel the complex pathophysiology.
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Lorentzen J, Willerslev-Olsen M, Hüche Larsen H, Svane C, Forman C, Frisk R, Farmer SF, Kersting U, Nielsen JB. Feedforward neural control of toe walking in humans. J Physiol 2018; 596:2159-2172. [PMID: 29572934 DOI: 10.1113/jp275539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
KEY POINTS Activation of ankle muscles at ground contact during toe walking is unaltered when sensory feedback is blocked or the ground is suddenly dropped. Responses in the soleus muscle to transcranial magnetic stimulation, but not peripheral nerve stimulation, are facilitated at ground contact during toe walking. We argue that toe walking is supported by feedforward control at ground contact. ABSTRACT Toe walking requires careful control of the ankle muscles in order to absorb the impact of ground contact and maintain a stable position of the joint. The present study aimed to clarify the peripheral and central neural mechanisms involved. Fifteen healthy adults walked on a treadmill (3.0 km h-1 ). Tibialis anterior (TA) and soleus (Sol) EMG, knee and ankle joint angles, and gastrocnemius-soleus muscle fascicle lengths were recorded. Peripheral and central contributions to the EMG activity were assessed by afferent blockade, H-reflex testing, transcranial magnetic brain stimulation (TMS) and sudden unloading of the planter flexor muscle-tendon complex. Sol EMG activity started prior to ground contact and remained high throughout stance. TA EMG activity, which is normally seen around ground contact during heel strike walking, was absent. Although stretch of the Achilles tendon-muscle complex was observed after ground contact, this was not associated with lengthening of the ankle plantar flexor muscle fascicles. Sol EMG around ground contact was not affected by ischaemic blockade of large-diameter sensory afferents, or the sudden removal of ground support shortly after toe contact. Soleus motor-evoked potentials elicited by TMS were facilitated immediately after ground contact, whereas Sol H-reflexes were not. These findings indicate that at the crucial time of ankle stabilization following ground contact, toe walking is governed by centrally mediated motor drive rather than sensory driven reflex mechanisms. These findings have implications for our understanding of the control of human gait during voluntary toe walking.
Collapse
Affiliation(s)
- Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | - Maria Willerslev-Olsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | | | - Christian Svane
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Christian Forman
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Frisk
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | - Simon Francis Farmer
- Sobell Department of Motor Neuroscience & Movement Disorders, Institute of Neurology, University College London & Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Uwe Kersting
- Department of sensory-motor interaction, Aalborg university, Aalborg, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| |
Collapse
|
20
|
Bar-On L, Kalkman BM, Cenni F, Schless SH, Molenaers G, Maganaris CN, Bass A, Holmes G, Barton GJ, O'Brien TD, Desloovere K. The Relationship Between Medial Gastrocnemius Lengthening Properties and Stretch Reflexes in Cerebral Palsy. Front Pediatr 2018; 6:259. [PMID: 30338247 PMCID: PMC6180247 DOI: 10.3389/fped.2018.00259] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022] Open
Abstract
Stretch reflex hyperactivity in the gastrocnemius of children with spastic cerebral palsy (CP) is commonly evaluated by passively rotating the ankle joint into dorsiflexion at different velocities, such as applied in conventional clinical spasticity assessments. However, surface electromyography (sEMG) collected from the medial gastrocnemius (MG) during such examination reveals unexplained heterogeneity in muscle activation between patients. Recent literature also highlights altered muscle tensile behavior in children with spastic CP. We aimed to document MG muscle and tendon lengthening during passive ankle motion at slow and fast velocity and explore its interdependence with the elicited hyperactive stretch reflex. The ankle of 15 children with CP (11 ± 3 years, GMFCS 9I 6II, 8 bilateral, 7 unilateral) and 16 typically developing children (TDC) was passively rotated over its full range of motion at slow and fast velocity. Ultrasound, synchronized with motion-analysis, was used to track the movement of the MG muscle-tendon junction and extract the relative lengthening of muscle and tendon during joint rotation. Simultaneously, MG sEMG was measured. Outcome parameters included the angular and muscle lengthening velocities 30 ms before EMG onset and the gain in root mean square EMG during stretch, as a measure of stretch reflex activity. Compared to slow rotation, the muscle lengthened less and stretch reflex activity was higher during fast rotation. These velocity-induced changes were more marked in CP compared to TDC. In the CP group, muscle-lengthening velocity had higher correlation coefficients with stretch reflex hyperactivity than joint angular velocity. Muscles with greater relative muscle lengthening during slow rotation had earlier and stronger stretch reflexes during fast rotation. These initial results suggest that ankle angular velocity is not representative of MG muscle lengthening velocity and is less related to stretch reflex hyperactivity than MG muscle lengthening. In addition, muscles that lengthened more during slow joint rotation were more likely to show a velocity-dependent stretch reflex. This interdependence of muscle lengthening and stretch reflexes may be important to consider when administering treatment. However, muscle and tendon lengthening properties alone could not fully explain the variability in stretch reflexes, indicating that other factors should also be investigated.
Collapse
Affiliation(s)
- Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Barbara M Kalkman
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Francesco Cenni
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | | | - Guy Molenaers
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Constantinos N Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Alfie Bass
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Gill Holmes
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Gabor J Barton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Thomas D O'Brien
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
21
|
Obst SJ, Boyd R, Read F, Barber L. Quantitative 3-D Ultrasound of the Medial Gastrocnemius Muscle in Children with Unilateral Spastic Cerebral Palsy. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2814-2823. [PMID: 28967503 DOI: 10.1016/j.ultrasmedbio.2017.08.929] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/07/2017] [Accepted: 08/13/2017] [Indexed: 06/07/2023]
Abstract
Three-dimensional ultrasound (3-DUS) was used to examine the size and appearance of the medial gastrocnemius (MG) muscle in children with unilateral cerebral palsy (CP). Twenty-six children with CP and 10 typically developing (TD) children participated. Three-dimensional US images of both limbs in children with CP and the right limb in TD children were analysed using quantitative methods to determine muscle volume, global echo intensity, global echo pattern and regional echo intensity. Significant differences in MG volume and all echo parameters were found between TD and CP children. The more involved limb was smaller and had higher echo intensity and a more heterogenous echo pattern compared with the TD group. Compared with that of the more involved limb, the MG of the less involved limb was larger but had a similar echo appearance. The MG of both limbs in children with unilateral spastic CP is smaller and, based on quantitative ultrasound, structurally different from that of TD children.
Collapse
Affiliation(s)
- Steven J Obst
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia.
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Felicity Read
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
22
|
Impact of ankle foot orthosis stiffness on Achilles tendon and gastrocnemius function during unimpaired gait. J Biomech 2017; 64:145-152. [PMID: 29037441 DOI: 10.1016/j.jbiomech.2017.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/19/2017] [Accepted: 09/19/2017] [Indexed: 11/23/2022]
Abstract
Ankle foot orthoses (AFOs) are designed to improve gait for individuals with neuromuscular conditions and have also been used to reduce energy costs of walking for unimpaired individuals. AFOs influence joint motion and metabolic cost, but how they impact muscle function remains unclear. This study investigated the impact of different stiffness AFOs on medial gastrocnemius muscle (MG) and Achilles tendon (AT) function during two walking speeds. We performed gait analyses for eight unimpaired individuals. Each individual walked at slow and very slow speeds with a 3D printed AFO with no resistance (free hinge condition) and four levels of ankle dorsiflexion stiffness: 0.25Nm/°, 1Nm/°, 2Nm/°, and 3.7Nm/°. Motion capture, ultrasound, and musculoskeletal modeling were used to quantify MG and AT lengths with each AFO condition. Increasing AFO stiffness increased peak AFO dorsiflexion moment with decreased peak knee extension and peak ankle dorsiflexion angles. Overall musculotendon length and peak AT length decreased, while peak MG length increased with increasing AFO stiffness. Peak MG activity, length, and velocity significantly decreased with slower walking speed. This study provides experimental evidence of the impact of AFO stiffness and walking speed on joint kinematics and musculotendon function. These methods can provide insight to improve AFO designs and optimize musculotendon function for rehabilitation, performance, or other goals.
Collapse
|
23
|
Martín Lorenzo T, Rocon E, Martínez Caballero I, Ramírez Barragán A, Lerma Lara S. Prolonged stretching of the ankle plantarflexors elicits muscle-tendon adaptations relevant to ankle gait kinetics in children with spastic cerebral palsy. Med Hypotheses 2017; 109:65-69. [DOI: 10.1016/j.mehy.2017.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 12/21/2022]
|
24
|
Schless SH, Desloovere K, Bar-On L. In vivo muscle behaviour in cerebral palsy with an equinus gait: are we on track? Dev Med Child Neurol 2017; 59:781-782. [PMID: 28452050 DOI: 10.1111/dmcn.13447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Simon-Henri Schless
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
25
|
Barber L, Carty C, Modenese L, Walsh J, Boyd R, Lichtwark G. Medial gastrocnemius and soleus muscle-tendon unit, fascicle, and tendon interaction during walking in children with cerebral palsy. Dev Med Child Neurol 2017; 59:843-851. [PMID: 28369824 DOI: 10.1111/dmcn.13427] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 11/28/2022]
Abstract
AIM This study investigates the in vivo function of the medial gastrocnemius and soleus muscle-tendon units (MTU), fascicles, and tendons during walking in children with cerebral palsy (CP) and an equinus gait pattern. METHOD Fourteen children with CP (9 males, 5 females; mean age 10y 6mo, standard deviation [SD] 2y 11mo; GMFCS level I=8, II=6), and 10 typically developing (6 males, 4 females; mean age 10y, SD 2y 1mo) undertook full body 3D gait analysis and simultaneous B-mode ultrasound images of the medial gastrocnemius and soleus fascicles during level walking. Fascicle lengths were analysed using a semi-automated tracking algorithm and MTUs using OpenSim. Statistical parametric mapping (two-sample t-test) was used to compare differences between groups (p<0.05). RESULTS In the CP group medial gastrocnemius fascicles lengthened during mid-stance gait and remained longer into late-stance compared to the typically developing group (p<0.001). CP medial gastrocnemius fascicles shortened less during stance (1.16mm [SD 1.47mm]) compared to the typically developing group (4.48mm [SD 1.94mm], p<0.001). In the CP group the medial gastrocnemius and soleus MTU and tendon were longer during early- and mid-stance (p<0.001). Ankle power during push-off (p=0.015) and positive work (p<0.002) and net work (p<0.001) were significantly lower in the CP group. INTERPRETATION Eccentric action of the CP medial gastrocnemius muscle fascicles during mid-stance walking is consistent with reduced volume and neuromuscular control of impaired muscle. Reduced ankle push-off power and positive work in the children with CP may be attributed to reduced active medial gastrocnemius fascicle shortening. These findings suggest a reliance on passive force generation for forward propulsion during equinus gait.
Collapse
Affiliation(s)
- Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Chris Carty
- Queensland Children's Motion Analysis Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.,Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Gold Coast, Australia
| | - Luca Modenese
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Gold Coast, Australia.,Department of Mechanical Engineering and INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - John Walsh
- Queensland Children's Motion Analysis Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Glen Lichtwark
- School of Human Movement Studies, The University of Queensland, St Lucia, Australia
| |
Collapse
|
26
|
Zhou J, Butler EE, Rose J. Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment. Front Hum Neurosci 2017; 11:103. [PMID: 28367118 PMCID: PMC5355477 DOI: 10.3389/fnhum.2017.00103] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/20/2017] [Indexed: 01/17/2023] Open
Abstract
Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.
Collapse
Affiliation(s)
- Joanne Zhou
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
| | - Erin E Butler
- Thayer School of Engineering, Dartmouth CollegeHanover, NH, USA; Neukom Institute for Computational Sciences, Dartmouth CollegeHanover, NH, USA
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA
| |
Collapse
|
27
|
Sartori M, Fernandez JW, Modenese L, Carty CP, Barber LA, Oberhofer K, Zhang J, Handsfield GG, Stott NS, Besier TF, Farina D, Lloyd DG. Toward modeling locomotion using electromyography-informed 3D models: application to cerebral palsy. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2016; 9. [DOI: 10.1002/wsbm.1368] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 01/17/2023]
Affiliation(s)
- M. Sartori
- Department of Trauma Surgery; Orthopedics and Plastic Surgery, Neurorehabilitation Systems Research Group, University Medical Center Göttingen; Göttingen Germany
| | - J. W. Fernandez
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - L. Modenese
- Department of Mechanical Engineering; The University of Sheffield; Sheffield UK
- Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service; Children's Health Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
| | - C. P. Carty
- Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service; Children's Health Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
- School of Allied Health Sciences; Griffith University; Queensland Australia
| | - L. A. Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine; The University of Queensland; Brisbane Australia
| | - K. Oberhofer
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - J. Zhang
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - G. G. Handsfield
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - N. S. Stott
- School of Medicine; University of Auckland; Auckland New Zealand
| | - T. F. Besier
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - D. Farina
- Department of Bioengineering; Imperial College London; London UK
| | - D. G. Lloyd
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
- School of Allied Health Sciences; Griffith University; Queensland Australia
| |
Collapse
|
28
|
Ryan JM, Theis N, Kilbride C, Baltzopoulos V, Waugh C, Shortland A, Lavelle G, Noorkoiv M, Levin W, Korff T. Strength Training for Adolescents with cerebral palsy (STAR): study protocol of a randomised controlled trial to determine the feasibility, acceptability and efficacy of resistance training for adolescents with cerebral palsy. BMJ Open 2016; 6:e012839. [PMID: 27707836 PMCID: PMC5073599 DOI: 10.1136/bmjopen-2016-012839] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gait is inefficient in children with cerebral palsy, particularly as they transition to adolescence. Gait inefficiency may be associated with declines in gross motor function and participation among adolescents with cerebral palsy. Resistance training may improve gait efficiency through a number of biomechanical and neural mechanisms. The aim of the Strength Training for Adolescents with cerebral palsy (STAR) trial is to evaluate the effect of resistance training on gait efficiency, activity and participation in adolescents with cerebral palsy. We also aim to determine the biomechanical and neural adaptations that occur following resistance training and evaluate the feasibility and acceptability of such an intervention for adolescents with cerebral palsy. METHODS AND ANALYSIS 60 adolescents (Gross Motor Function Classification System level I-III) will be randomised to a 10-week resistance training group or a usual care control group according to a computer-generated random schedule. The primary outcome is gait efficiency. Secondary outcomes are habitual physical activity, participation, muscle-tendon mechanics and gross motor function. General linear models will be used to evaluate differences in continuous data between the resistance training and usual care groups at 10 and 22 weeks, respectively. A process evaluation will be conducted alongside the intervention. Fidelity of the resistance training programme to trial protocol will be quantified by observations of exercise sessions. Semistructured interviews will be conducted with participants and physiotherapists following the resistance training programme to determine feasibility and acceptability of the programme. ETHICS AND DISSEMINATION This trial has ethical approval from Brunel University London's Department of Clinical Sciences' Research Ethics Committee and the National Research Ethics Service (NRES) Committee London-Surrey Borders. The results of the trial will be submitted for publication in academic journals, presented at conferences and distributed to adolescents, families and healthcare professionals through the media with the assistance of the STAR advisory group. TRIAL REGISTRATION NUMBER ISRCTN90378161; Pre-results.
Collapse
Affiliation(s)
- Jennifer M Ryan
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Nicola Theis
- School of Sport, Health and Applied Science, St. Mary's University, Twickenham, UK
| | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London, London, UK
| | | | - Charlie Waugh
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Grace Lavelle
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Wendy Levin
- Department of Physiotherapy, Royal Free London NHS Foundation Trust, Swiss Cottage School Development and Research Centre, London, UK
| | - Thomas Korff
- College of Health and Life Sciences, Brunel University London, London, UK
| |
Collapse
|