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Liu W, Wu HD, Ling YT, Shea QTK, Nazari V, Zheng YP, Ma CZH. Reliability and validity of assessing lower-limb muscle architecture of patients with cerebral palsy (CP) using ultrasound: A systematic review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1212-1222. [PMID: 37334435 DOI: 10.1002/jcu.23498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023]
Abstract
AIMS To investigate the reliability, validity, and level of evidence of applying ultrasound in assessing the lower-limb muscles of patients with cerebral palsy (CP). METHOD Publications in Medline, PubMed, Web of Science, and Embase were searched on May 10, 2023, to identify and examine relevant studies investigating the reliability/validity of ultrasound in evaluating the architecture of CP lower-limb muscles systematically, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. RESULTS Out of 897 records, 9 publications with 111 CP participants aged 3.8-17.0 years were included (8 focused on intra-rater and inter-rater reliability, 2 focused on validity, and 4 were with high quality). The ultrasound-based measurements of muscle thickness (intra-rater only), muscle length, cross-sectional area, muscle volume, fascicle length, and pennation angle showed high reliability, with the majority of intraclass correlation coefficient (ICC) values being larger than 0.9. Moderate-to-good correlations between ultrasound and magnetic resonance imaging measurements existed in muscle thickness and cross-sectional area (0.62 ≤ ICC ≤ 0.82). INTERPRETATION Generally, ultrasound has high reliability and validity in evaluating the CP muscle architecture, but this is mainly supported by moderate and limited levels of evidence. More high-quality future studies are needed.
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Affiliation(s)
- Wei Liu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Prosthetic and Orthotic Engineering, School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Hui Dong Wu
- Department of Prosthetic and Orthotic Engineering, School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Yan To Ling
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Queenie Tsung Kwan Shea
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Vaheh Nazari
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
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Howard IM, Patel AT. Spasticity evaluation and management tools. Muscle Nerve 2023; 67:272-283. [PMID: 36807901 DOI: 10.1002/mus.27792] [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: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/21/2023]
Abstract
Spasticity is a complex and often disabling symptom for patients with upper motor neuron syndromes. Although spasticity arises from neurological disease, it often cascades into muscle and soft tissue changes, which may exacerbate symptoms and further hamper function. Effective management therefore hinges on early recognition and treatment. To this end, the definition of spasticity has expanded over time to more accurately reflect the spectrum of symptoms experienced by persons with this disorder. Once identified, clinical and research quantitative assessments of spasticity are hindered by the uniqueness of presentations both for individuals and for specific neurological diagnoses. Objective measures in isolation often fail to reflect the complex functional impact of spasticity. Multiple tools exist to quantitatively or qualitatively assess the severity of spasticity, including clinician and patient-reported measures as well as electrodiagnostic, mechanical, and ultrasound measures. A combination of objective and patient-reported outcomes is likely required to better reflect the burden of spasticity symptoms in an individual. Therapeutic options exist for the treatment of spasticity along a broad spectrum from nonpharmacologic to interventional procedures. Treatment strategies may include exercise, physical agent modalities, oral medications, injections, pumps, and surgery. Optimal spasticity management most often requires a multimodal approach, combining pharmacological management with interventions that match the functional needs, goals, and preferences of the patient. Physicians and other healthcare providers who manage spasticity must be familiarized with the full array of spasticity interventions and must frequently reassess results of treatment to ensure the patient's goals of treatment are met.
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Affiliation(s)
- Ileana M Howard
- Rehabilitation Care Services, Veterans Affairs Sound, Seattle, Washington, DC, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Atul T Patel
- Kansas Institute of Research, Overland Park, Kansas, USA
- Research Associate Professor, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
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Hanssen B, Peeters N, Dewit T, Huyghe E, Dan B, Molenaers G, Van Campenhout A, Bar-On L, Van den Broeck C, Calders P, Desloovere K. Reliability of 3D freehand ultrasound to assess lower limb muscles in children with spastic cerebral palsy and typical development. J Anat 2023; 242:986-1002. [PMID: 36807218 PMCID: PMC10184546 DOI: 10.1111/joa.13839] [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: 10/05/2022] [Revised: 12/29/2022] [Accepted: 01/20/2023] [Indexed: 02/22/2023] Open
Abstract
This study investigated the reliability of 3-dimensional freehand ultrasound (3DfUS) to quantify the size (muscle volume [MV] and anatomical cross-sectional area [aCSA]), length (muscle length [ML], tendon length [TL], and muscle tendon unit length [MTUL]), and echo-intensity (EI, whole muscle and 50% aCSA), of lower limb muscles in children with spastic cerebral palsy (SCP) and typical development (TD). In total, 13 children with SCP (median age 14.3 (7.3) years) and 13 TD children (median age 11.1 (1.7) years) participated. 3DfUS scans of rectus femoris, semitendinosus, medial gastrocnemius, and tibialis anterior were performed by two raters in two sessions. The intra- and inter-rater and intra- and inter-session reliability were defined with relative and absolute reliability measures, that is, intra-class correlation coefficients (ICCs) and absolute and relative standard error of measurement (SEM and SEM%), respectively. Over all conditions, ICCs for muscle size measures ranged from 0.818 to 0.999 with SEM%s of 12.6%-1.6%. For EI measures, ICCs varied from 0.233 to 0.967 with SEM%s of 15.6%-1.7%. Length measure ICCs ranged from 0.642 to 0.999 with SEM%s of 16.0%-0.5%. In general, reliability did not differ between the TD and SCP cohort but the influence of different muscles, raters, and sessions was not constant for all 3DfUS parameters. Muscle length and muscle tendon unit length were the most reliable length parameters in all conditions. MV and aCSA showed comparable SEM%s over all muscles, where tibialis anterior MV was most reliable. EI had low-relative reliability, but absolute reliability was better, with better reliability for the distal muscles in comparison to the proximal muscles. Combining these results with earlier studies describing muscle morphology assessed in children with SCP, 3DfUS seems sufficiently reliable to determine differences between cohorts and functional levels. The applicability on an individual level, for longitudinal follow-up and after interventions is dependent on the investigated muscle and parameter. Moreover, the semitendinosus, the acquisition, and processing of multiple sweeps, and the definition of EI and TL require further investigation. In general, it is recommended, especially for longitudinal follow-up studies, to keep the rater the same, while standardizing acquisition settings and positioning of the subject.
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Affiliation(s)
- Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Tijl Dewit
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Ester Huyghe
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Bernard Dan
- Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Orthopaedic surgery, University Hospitals Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Orthopaedic surgery, University Hospitals Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
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Peeters N, Hanssen B, De Beukelaer N, Vandekerckhove I, Walhain F, Huyghe E, Dewit T, Feys H, Van Campenhout A, Van den Broeck C, Calders P, Desloovere K. A comprehensive normative reference database of muscle morphology in typically developing children aged 3-18 years-a cross-sectional ultrasound study. J Anat 2023; 242:754-770. [PMID: 36650912 PMCID: PMC10093158 DOI: 10.1111/joa.13817] [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: 07/22/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/19/2023] Open
Abstract
During childhood, muscle growth is stimulated by a gradual increase in bone length and body mass, as well as by other factors, such as physical activity, nutrition, metabolic, hormonal, and genetic factors. Muscle characteristics, such as muscle volume, anatomical cross-sectional area, and muscle belly length, need to continuously adapt to meet the daily functional demands. Pediatric neurological and neuromuscular disorders, like cerebral palsy and Duchenne muscular dystrophy, are characterized by impaired muscle growth, which requires treatment and close follow-up. Nowadays ultrasonography is a commonly used technique to evaluate muscle morphology in both pediatric pathologies and typically developing children, as it is a quick, easy applicable, and painless method. However, large normative datasets including different muscles and a large age range are lacking, making it challenging to monitor muscle over time and estimate the level of pathology. Moreover, in order to compare individuals with different body sizes as a result of age differences or pathology, muscle morphology is often normalized to body size. Yet, the usefulness and practicality of different normalization techniques are still unknown, and clear recommendations for normalization are lacking. In this cross-sectional cohort study, muscle morphology of four lower limb muscles (medial gastrocnemius, tibialis anterior, the distal compartment of the semitendinosus, rectus femoris) was assessed by 3D-freehand ultrasound in 118 typically developing children (mean age 10.35 ± 4.49 years) between 3 and 18 years of age. The development of muscle morphology was studied over the full age range, as well as separately for the pre-pubertal (3-10 years) and pubertal (11-18 years) cohorts. The assumptions of a simple linear regression were checked. If these assumptions were fulfilled, the cross-sectional growth curves were described by a simple linear regression equation. Additional ANCOVA analyses were performed to evaluate muscle- or gender-specific differences in muscle development. Furthermore, different scaling methods, to normalize muscle morphology parameters, were explored. The most appropriate scaling method was selected based on the smallest slope of the morphology parameter with respect to age, with a non-significant correlation coefficient. Additionally, correlation coefficients were compared by a Steiger's Z-test to identify the most efficient scaling technique. The current results revealed that it is valid to describe muscle volume (with exception of the rectus femoris muscle) and muscle belly length alterations over age by a simple linear regression equation till the age of 11 years. Normalizing muscle morphology data by allometric scaling was found to be most useful for comparing muscle volumes of different pediatric populations. For muscle lengths, normalization can be achieved by either allometric and ratio scaling. This study provides a unique normative database of four lower limb muscles in typically developing children between the age of 3 and 18 years. These data can be used as a reference database for pediatric populations and may also serve as a reference frame to better understand both physiological and pathological muscle development.
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Affiliation(s)
- Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | | | | | - Fenna Walhain
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Anatomy, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Ester Huyghe
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Tijl Dewit
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Pediatric Orthopedics, Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Patrick Calders
- Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
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Peeters N, Hanssen B, Bar-On L, De Groote F, De Beukelaer N, Coremans M, Van den Broeck C, Dan B, Van Campenhout A, Desloovere K. Associations between muscle morphology and spasticity in children with spastic cerebral palsy. Eur J Paediatr Neurol 2023; 44:1-8. [PMID: 36706682 DOI: 10.1016/j.ejpn.2023.01.007] [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: 08/18/2022] [Revised: 12/03/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Due to the heterogeneous clinical presentation of spastic cerebral palsy (SCP), which makes spasticity treatment challenging, more insight into the complex interaction between spasticity and altered muscle morphology is warranted. AIMS We studied associations between spasticity and muscle morphology and compared muscle morphology between commonly observed spasticity patterns (i.e. different muscle activation patterns during passive stretches). METHODS Spasticity and muscle morphology of the medial gastrocnemius (MG) and semitendinosus (ST) were defined in 74 children with SCP (median age 8 years 2 months, GMFCS I/II/III: 31/25/18, bilateral/unilateral: 46/27). Using an instrumented assessment, spasticity was quantified as the difference in muscle activation recorded during passive stretches at low and high velocities and was classified in mixed length-/velocity-dependent or pure velocity-dependent activation patterns. Three-dimensional freehand ultrasound was used to assess muscle morphology (volume and length) and echogenicity intensity (as a proxy for muscle quality). Spearman correlations and Mann-Whitney-U tests defined associations and group differences, respectively. RESULTS A moderate negative association (r = -0.624, p < 0.001) was found between spasticity and MG muscle volume, while other significant associations between spasticity and muscle morphology parameters were weak. Smaller normalized muscle volume (MG p = 0.004, ST p=<0.001) and reduced muscle belly length (ST p = 0.015) were found in muscles with mixed length-/velocity-dependent patterns compared to muscles with pure velocity-dependent patterns. DISCUSSION Higher spasticity levels were associated with smaller MG and ST volumes and shorter MG muscles. These muscle morphology alterations were more pronounced in muscles that activated during low-velocity stretches compared to muscles that only activated during high-velocity stretches.
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Affiliation(s)
- Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | | | - Marjan Coremans
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | | | - Bernard Dan
- Université Libre de Bruxelles (ULB), Faculty of Psychology and Education Science, Brussels, Belgium; Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Orthopedic Surgery, University Hospitals Leuven, Belgium.
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Belgium.
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Hanssen B, Peeters N, De Beukelaer N, Vannerom A, Peeters L, Molenaers G, Van Campenhout A, Deschepper E, Van den Broeck C, Desloovere K. Progressive resistance training for children with cerebral palsy: A randomized controlled trial evaluating the effects on muscle strength and morphology. Front Physiol 2022; 13:911162. [PMID: 36267577 PMCID: PMC9577365 DOI: 10.3389/fphys.2022.911162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Children with spastic cerebral palsy often present with muscle weakness, resulting from neural impairments and muscular alterations. While progressive resistance training (PRT) improves muscle weakness, the effects on muscle morphology remain inconclusive. This investigation evaluated the effects of a PRT program on lower limb muscle strength, morphology and gross motor function. Forty-nine children with spastic cerebral palsy were randomized by minimization. The intervention group (nparticipants = 26, age: 8.3 ± 2.0 years, Gross Motor Function Classification System [GMFCS] level I/II/III: 17/5/4, nlegs = 41) received a 12-week PRT program, consisting of 3-4 sessions per week, with exercises performed in 3 sets of 10 repetitions, aiming at 60%-80% of the 1-repetition maximum. Training sessions were performed under supervision with the physiotherapist and at home. The control group (nparticipants = 22, age: 8.5 ± 2.1 year, GMFCS level I/II/III: 14/5/3, nlegs = 36) continued usual care including regular physiotherapy and use of orthotics. We assessed pre- and post-training knee extension, knee flexion and plantar flexion isometric strength, rectus femoris, semitendinosus and medial gastrocnemius muscle morphology, as well as functional strength, gross motor function and walking capacity. Data processing was performed blinded. Linear mixed models were applied to evaluate the difference in evolution over time between the control and intervention group (interaction-effect) and within each group (time-effect). The α-level was set at p = 0.01. Knee flexion strength and unilateral heel raises showed a significant interaction-effect (p ≤ 0.008), with improvements in the intervention group (p ≤ 0.001). Moreover, significant time-effects were seen for knee extension and plantar flexion isometric strength, rectus femoris and medial gastrocnemius MV, sit-to-stand and lateral step-up in the intervention group (p ≤ 0.004). Echo-intensity, muscle lengths and gross motor function showed limited to no changes. PRT improved strength and MV in the intervention group, whereby strength parameters significantly or close to significantly differed from the control group. Although, relative improvements in strength were larger than improvements in MV, important effects were seen on the maintenance of muscle size relative to skeletal growth. In conclusion, this study proved the effectiveness of a home-based, physiotherapy supervised, PRT program to improve isometric and functional muscle strength in children with SCP without negative effects on muscle properties or any serious adverse events. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03863197.
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Affiliation(s)
- Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Astrid Vannerom
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Leen Peeters
- CP Reference Center, University Hospitals Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Pediatric Orthopedics, Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Pediatric Orthopedics, Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
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Sorek G, Goudriaan M, Schurr I, Schless SH. Influence of the number of muscles and strides on selective motor control during gait in individuals with cerebral palsy. J Electromyogr Kinesiol 2022; 66:102697. [PMID: 36027660 DOI: 10.1016/j.jelekin.2022.102697] [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: 04/07/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To evaluate the influence of the number of muscles and strides on estimating motor control accuracy during treadmill-gait, in individuals with cerebral palsy (CP). METHODS Bilateral lower limb electromyography data were extracted for 44 children/adolescents with CP. The number of synergy solutions required to explain 90 % of the variance (tVAF-threshold) and the total variance accounted for by one synergy (tVAF1) were calculated for a different number of strides (between 5 and 50) and muscles both unilaterally (four to seven) and bilaterally (eight to 14). The kappa and intraclass correlation coefficients were used to assess similarities in tVAF-threshold and tVAF1 between the different number of strides and muscle sets. RESULTS In both analyses, the number of muscles influenced the tVAF-threshold. Additionally, using <30 strides led to only substantial-moderate agreement with 50 strides (k < 0.80). In both analyses, the mean tVAF1 values demonstrated high-agreement between the different number of muscles (intraclass-correlations = 0.88-0.93) and strides (intraclass-correlations = 0.96-0.99); In the group level, it may result in an error of ≤2.3 %. However, in the individual level, using different number of muscles or <40 strides may result in an error of ≥6 %. CONCLUSION Differing numbers of muscles and strides did not influence the group mean tVAF1 value, but it influenced the tVAF-threshold value. In addition, using different number of muscles or strides can lead to a large measurement error in the individual tVAF1 value.
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Affiliation(s)
- Gilad Sorek
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Paediatric and Adolescent Rehabilitation Research Centre (ALYN PARC), Jerusalem, Israel
| | - Marije Goudriaan
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Itai Schurr
- Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel
| | - Simon-Henri Schless
- Laboratory for Paediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Paediatric and Adolescent Rehabilitation Research Centre (ALYN PARC), Jerusalem, Israel; Clinical Motion Analysis Laboratory, ALYN Paediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel.
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Svane C, Forman CR, Rasul A, Nielsen JB, Lorentzen J. Muscle Contractures in Adults With Cerebral Palsy Characterized by Combined Ultrasound-Derived Echo Intensity and Handheld Dynamometry Measures. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:694-701. [PMID: 35065812 DOI: 10.1016/j.ultrasmedbio.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
We used ultrasound-derived echo intensity and hand-held dynamometry to characterize plantar flexor muscle contractures in adults with cerebral palsy (CP). Eleven adults with CP (aged 41 ± 12 y, Gross Motor Function Classification System I-II) and 11 neurologically intact adults (aged 35 ± 10 y) participated in the study. Echo intensity was measured from the medial gastrocnemius muscle using brightness mode ultrasound. Hand-held dynamometry was used to quantify plantar flexor passive muscle stiffness and ankle joint passive range of motion (pROM). Echo intensity correlated with both passive muscle stiffness (r = 0.57, p = 0.006) and pROM (r = -0.56, p = 0.006). Ultrasound echo intensity (p = 0.02, standardized mean difference [SMD] = 1.13) and passive muscle stiffness (p < 0.001, SMD = 1.99) were higher and ankle joint pROM (p < 0.001, SMD = 2.69) was lower in adults with CP than in neurologically intact adults. We conclude that combined ultrasound-derived echo intensity and hand-held dynamometry may be used to provide an objective characterization of muscle contractures.
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Affiliation(s)
- Christian Svane
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark.
| | - Christian Riis Forman
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark
| | - Aqella Rasul
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark
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9
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Handsfield GG, Williams S, Khuu S, Lichtwark G, Stott NS. Muscle architecture, growth, and biological Remodelling in cerebral palsy: a narrative review. BMC Musculoskelet Disord 2022; 23:233. [PMID: 35272643 PMCID: PMC8908685 DOI: 10.1186/s12891-022-05110-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy (CP) is caused by a static lesion to the brain occurring in utero or up to the first 2 years of life; it often manifests as musculoskeletal impairments and movement disorders including spasticity and contractures. Variable manifestation of the pathology across individuals, coupled with differing mechanics and treatments, leads to a heterogeneous collection of clinical phenotypes that affect muscles and individuals differently. Growth of muscles in CP deviates from typical development, evident as early as 15 months of age. Muscles in CP may be reduced in volume by as much as 40%, may be shorter in length, present longer tendons, and may have fewer sarcomeres in series that are overstretched compared to typical. Macroscale and functional deficits are likely mediated by dysfunction at the cellular level, which manifests as impaired growth. Within muscle fibres, satellite cells are decreased by as much as 40-70% and the regenerative capacity of remaining satellite cells appears compromised. Impaired muscle regeneration in CP is coupled with extracellular matrix expansion and increased pro-inflammatory gene expression; resultant muscles are smaller, stiffer, and weaker than typical muscle. These differences may contribute to individuals with CP participating in less physical activity, thus decreasing opportunities for mechanical loading, commencing a vicious cycle of muscle disuse and secondary sarcopenia. This narrative review describes the effects of CP on skeletal muscles encompassing substantive changes from whole muscle function to cell-level effects and the effects of common treatments. We discuss growth and mechanics of skeletal muscles in CP and propose areas where future work is needed to understand these interactions, particularly the link between neural insult and cell-level manifestation of CP.
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Affiliation(s)
- Geoffrey G Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand.
| | - Sîan Williams
- Liggins Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
- School of Allied Health, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Stephanie Khuu
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
| | - Glen Lichtwark
- School of Human Movement and Nutrition Sciences, University of Queensland, QLD, St Lucia, 4072, Australia
| | - N Susan Stott
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
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Williams SA, Bell M, Kim HK, Salim Al Masruri G, Stott N, Fernandez J, Mirjalili SA. The reliability and validity of triceps surae muscle volume assessment using freehand three-dimensional ultrasound in typically developing infants. J Anat 2022; 240:567-578. [PMID: 34693531 PMCID: PMC8819047 DOI: 10.1111/joa.13565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/15/2022] Open
Abstract
This study assessed the intra-acquirer, intra- and inter-processor reliability, and validity of the in vivo assessment of the medial gastrocnemius (MG), lateral gastrocnemius (LG) and soleus (SOL) muscle volumes using freehand 3D ultrasound (3DUS) in typically developing infants. Reliability assessments of freehand 3DUS were undertaken in infants across three ages groups: three, six and twelve months of age, with validity testing completed against magnetic resonance imaging (MRI) in infants at 3 months of age. Freehand 3DUS scanning was carried out by a single acquirer, with two independent processors manually segmenting images to render volumes. MRI images were segmented independently by a separate processor, with the volumes compared to those obtained via freehand 3DUS. Reliability was assessed using intraclass correlation (ICC), coefficient of variance (CV) and minimal detectable change (MDC) across each assessment time point. Validity was assessed using the limits of agreement. ICCs for intra-acquirer reliability of the acquisition process for freehand 3DUS ranged from 0.91 to 0.99 across all muscles. ICCs for intra-processor and inter-processor reliability for the segmentation process of freehand 3DUS ranged from 0.80 to 0.98 across all muscles. Acceptable levels of agreement between muscle volume obtained by freehand 3DUS and MRI were found for all muscles; however, freehand 3DUS overestimated muscle volume of MG and LG and underestimate the SOL compared with MRI, with average absolute differences of MG = 0.3 ml, LG = 0.3 ml and Sol = 1.2 ml. Freehand 3DUS is a reliable method for measuring in vivo triceps surae muscle volume in typically developing infants. We conclude that freehand 3DUS is a useful tool to assess changes in muscle volume in response to growth and interventions in infants.
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Affiliation(s)
- Sîan A. Williams
- Curtin School of Allied HealthFaculty of Health SciencesCurtin UniversityPerthAustralia
- Liggins InstituteUniversity of AucklandAucklandNew Zealand
| | - Matthew Bell
- Department of Anatomy and Medical ImagingFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Hyun K. Kim
- Kinesiology DepartmentIowa State UniversityAmesIowaUSA
| | - Ghaliya Salim Al Masruri
- Department of Anatomy and Medical ImagingFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - N. Susan Stott
- Department of SurgeryFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Justin Fernandez
- Auckland Bioengineering InstituteUniversity of AucklandAucklandNew Zealand
- Department of Engineering ScienceUniversity of AucklandAucklandNew Zealand
| | - S. Ali Mirjalili
- Department of Anatomy and Medical ImagingFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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11
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De Beukelaer N, Weide G, Huyghe E, Vandekerckhove I, Hanssen B, Peeters N, Uytterhoeven J, Deschrevel J, Maes K, Corvelyn M, Costamagna D, Gayan-Ramirez G, Van Campenhout A, Desloovere K. Reduced Cross-Sectional Muscle Growth Six Months after Botulinum Toxin Type-A Injection in Children with Spastic Cerebral Palsy. Toxins (Basel) 2022; 14:139. [PMID: 35202166 PMCID: PMC8876834 DOI: 10.3390/toxins14020139] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/10/2022] [Indexed: 12/17/2022] Open
Abstract
Botulinum Neurotoxin type-A (BoNT-A) injections are widely used as first-line spasticity treatment in spastic cerebral palsy (SCP). Despite improved clinical outcomes, concerns regarding harmful effects on muscle morphology have been raised. Yet, the risk of initiating BoNT-A to reduce muscle growth remains unclear. This study investigated medial gastrocnemius (MG) morphological muscle growth in children with SCP (n = 26, median age of 5.2 years (3.5)), assessed by 3D-freehand ultrasound prior to and six months post-BoNT-A injections. Post-BoNT-A MG muscle growth of BoNT-A naive children (n = 11) was compared to (a) muscle growth of children who remained BoNT-A naive after six months (n = 11) and (b) post-BoNT-A follow-up data of children with a history of BoNT-A treatment (n = 15). Six months after initiating BoNT-A injection, 17% decrease in mid-belly cross-sectional area normalized to skeletal growth and 5% increase in echo-intensity were illustrated. These muscle outcomes were only significantly altered when compared with children who remained BoNT-A naive (+4% and -3%, respectively, p < 0.01). Muscle length growth persevered over time. This study showed reduced cross-sectional growth post-BoNT-A treatment suggesting that re-injections should be postponed at least beyond six months. Future research should extend follow-up periods investigating muscle recovery in the long-term and should include microscopic analysis.
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Affiliation(s)
- Nathalie De Beukelaer
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (G.W.); (E.H.); (I.V.); (B.H.); (N.P.); (J.U.); (D.C.); (K.D.)
| | - Guido Weide
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (G.W.); (E.H.); (I.V.); (B.H.); (N.P.); (J.U.); (D.C.); (K.D.)
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 Amsterdam, The Netherlands
| | - Ester Huyghe
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (G.W.); (E.H.); (I.V.); (B.H.); (N.P.); (J.U.); (D.C.); (K.D.)
| | - Ines Vandekerckhove
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (G.W.); (E.H.); (I.V.); (B.H.); (N.P.); (J.U.); (D.C.); (K.D.)
| | - Britta Hanssen
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (G.W.); (E.H.); (I.V.); (B.H.); (N.P.); (J.U.); (D.C.); (K.D.)
- Department of Rehabilitation Science, Ghent University, 9000 Ghent, Belgium
| | - Nicky Peeters
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (G.W.); (E.H.); (I.V.); (B.H.); (N.P.); (J.U.); (D.C.); (K.D.)
- Department of Rehabilitation Science, Ghent University, 9000 Ghent, Belgium
| | - Julie Uytterhoeven
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (G.W.); (E.H.); (I.V.); (B.H.); (N.P.); (J.U.); (D.C.); (K.D.)
| | - Jorieke Deschrevel
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (J.D.); (K.M.); (G.G.-R.)
| | - Karen Maes
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (J.D.); (K.M.); (G.G.-R.)
| | - Marlies Corvelyn
- Stem Cell Biology and Embryology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium;
| | - Domiziana Costamagna
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (G.W.); (E.H.); (I.V.); (B.H.); (N.P.); (J.U.); (D.C.); (K.D.)
- Stem Cell Biology and Embryology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium;
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (J.D.); (K.M.); (G.G.-R.)
| | - Anja Van Campenhout
- Unit of Pediatric Orthopedics, Department of Orthopedics, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, 3212 Leuven, Belgium
| | - Kaat Desloovere
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (G.W.); (E.H.); (I.V.); (B.H.); (N.P.); (J.U.); (D.C.); (K.D.)
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, 3212 Leuven, Belgium
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12
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Current Status and Advancement of Ultrasound Imaging Technologies in Musculoskeletal Studies. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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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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14
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Hanssen B, De Beukelaer N, Schless SH, Cenni F, Bar-On L, Peeters N, Molenaers G, Van Campenhout A, Van den Broeck C, Desloovere K. Reliability of Processing 3-D Freehand Ultrasound Data to Define Muscle Volume and Echo-intensity in Pediatric Lower Limb Muscles with Typical Development or with Spasticity. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2702-2712. [PMID: 34112554 DOI: 10.1016/j.ultrasmedbio.2021.04.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
This investigation assessed the processer reliability of estimating muscle volume and echo-intensity of the rectus femoris, tibialis anterior and semitendinosus. The muscles of 10 typically developing children (8.15 [1.40] y) and 15 children with spastic cerebral palsy (7.67 [3.80] y; Gross Motor Function Classification System I = 5, II = 5, III = 5) were scanned with 3-D freehand ultrasonography. For the intra-processer analysis, the intra-class correlations coefficients (ICCs) for muscle volume ranged from 0.943-0.997, with relative standard errors of measurement (SEM%) ranging from 1.24%-8.97%. For the inter-processer analysis, these values were 0.853 to 0.988 and 3.47% to 14.02%, respectively. Echo-intensity had ICCs >0.947 and relative SEMs <4% for both analyses. Muscle volume and echo-intensity can be reliably extracted for the rectus femoris, semitendinosus and tibialis anterior in typically developing children and children with cerebral palsy. The need for a single processer to analyze all data is dependent on the size of the expected changes or differences.
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Affiliation(s)
- Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Nathalie De Beukelaer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Simon-Henri Schless
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Motion Analysis and Biofeedback Laboratory, ALYN Paediatric and Rehabilitation Hospital, Jerusalem, Israel
| | - Francesco Cenni
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Department of Mechanical Engineering, KU Leuven, Leuven, Belgium; Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | | | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
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15
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Obst SJ, Florance K, Barber L. Regional Variation in Muscle Echogenicity Is Related to Muscle Thickness in Young Children. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2467-2476. [PMID: 33941414 DOI: 10.1016/j.ultrasmedbio.2021.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
Quantitative ultrasound of muscle echogenicity may be influenced by the size of the muscle and, so, corrections may be required when comparing echogenicity between populations with different muscle size. This study examined the relationship between regional muscle echogenicity and geometry in young, typically developing children (n = 49, mean ± standard deviation [SD] age = 70.8 ± 30.0 mo). Three-dimensional ultrasound was used to measure mean echo intensity (EI) and echo variation (EV), together with muscle thickness, cross-sectional area (CSA) and width, over the entire muscle length for the medial gastrocnemius (MG), rectus femoris (RF) and tibialis anterior muscles. Pearson's correlation coefficient (r) was used to assess the strength of the relationship between echogenicity and geometry using all images taken over the entire muscle length. There were moderate-strong correlations (r = 0.67-0.90) between EI and EV and thickness for each muscle, with the strongest correlations evident for the MG and RF. EI and EV were moderately correlated with muscle CSA and weakly correlated with muscle width. Normalisation of echogenicity to muscle thickness may help delineate between regions of contractile and non-contractile tissue and provide a useful measure of muscle echogenicity when comparing muscles of different cross-sectional dimensions. We recommend that researchers consider controlling for muscle size-dependent effects on echogenicity, by normalising EI and EV to muscle thickness, or including the latter as a covariate when comparing between groups.
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Affiliation(s)
- Steven J Obst
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia.
| | - Kaysie Florance
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia
| | - Lee Barber
- School of Allied Health Sciences, Griffith Health, Griffith University, Brisbane, Queensland, Australia
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16
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Hanssen B, Peeters N, Vandekerckhove I, De Beukelaer N, Bar-On L, Molenaers G, Van Campenhout A, Degelaen M, Van den Broeck C, Calders P, Desloovere K. The Contribution of Decreased Muscle Size to Muscle Weakness in Children With Spastic Cerebral Palsy. Front Neurol 2021; 12:692582. [PMID: 34381414 PMCID: PMC8350776 DOI: 10.3389/fneur.2021.692582] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Muscle weakness is a common clinical symptom in children with spastic cerebral palsy (SCP). It is caused by impaired neural ability and altered intrinsic capacity of the muscles. To define the contribution of decreased muscle size to muscle weakness, two cohorts were recruited in this cross-sectional investigation: 53 children with SCP [median age, 8.2 (IQR, 4.1) years, 19/34 uni/bilateral] and 31 children with a typical development (TD) [median age, 9.7 (IQR, 2.9) years]. Muscle volume (MV) and muscle belly length for m. rectus femoris, semitendinosus, gastrocnemius medialis, and tibialis anterior were defined from three-dimensional freehand ultrasound acquisitions. A fixed dynamometer was used to assess maximal voluntary isometric contractions for knee extension, knee flexion, plantar flexion, and dorsiflexion from which maximal joint torque (MJT) was calculated. Selective motor control (SMC) was assessed on a 5-point scale for the children with SCP. First, the anthropometrics, strength, and muscle size parameters were compared between the cohorts. Significant differences for all muscle size and strength parameters were found (p ≤ 0.003), except for joint torque per MV for the plantar flexors. Secondly, the associations of anthropometrics, muscle size, gross motor function classification system (GMFCS) level, and SMC with MJT were investigated using univariate and stepwise multiple linear regressions. The associations of MJT with growth-related parameters like age, weight, and height appeared strongest in the TD cohort, whereas for the SCP cohort, these associations were accompanied by associations with SMC and GMFCS. The stepwise regression models resulted in ranges of explained variance in MJT from 29.3 to 66.3% in the TD cohort and from 16.8 to 60.1% in the SCP cohort. Finally, the MJT deficit observed in the SCP cohort was further investigated using the TD regression equations to estimate norm MJT based on height and potential MJT based on MV. From the total MJT deficit, 22.6–57.3% could be explained by deficits in MV. This investigation confirmed the disproportional decrease in muscle size and muscle strength around the knee and ankle joint in children with SCP, but also highlighted the large variability in the contribution of muscle size to muscle weakness.
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Affiliation(s)
- Britta Hanssen
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ines Vandekerckhove
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Nathalie De Beukelaer
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Medicine, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Guy Molenaers
- Department of Development and Regeneration, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Orthopaedic Section, University Hospitals Leuven, Leuven, Belgium
| | - Marc Degelaen
- Department of Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium.,Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.,University Hospital, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
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17
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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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18
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Boulard C, Mathevon L, Arnaudeau LF, Gautheron V, Calmels P. Reliability of Shear Wave Elastography and Ultrasound Measurement in Children with Unilateral Spastic Cerebral Palsy. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1204-1211. [PMID: 33579563 DOI: 10.1016/j.ultrasmedbio.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
In clinical practice, few data exist on the feasibility of performing reliable shear wave elastography (SWE) and ultrasonography (US) measurements in spastic muscles of children with cerebral palsy (CP). Ten children with unilateral CP took part in SWE and US assessment of the tibialis anterior and medialis gastrocnemius muscles during two sessions separated by a 1-wk interval. Intra- and inter-investigator reliability of shear modulus (µ) and muscle thickness (MT) measurements, at neutral and maximal dorsiflexion angles on both legs, was assessed by two investigators with different levels of experience. Reliability was assessed with the coefficient of variation (CV), standard error of measurement and intra-class correlation coefficient (ICC). Reliability of the µ measurement was insufficient, regardless of angle position (CV >10% and >20% for neutral and maximal dorsiflexion angles, respectively). The intra- and inter-investigator reliability of MT measurements was good (CV >10%, ICC >0.74) for both muscles in both legs. SWE measurements must be performed using a rigorous standardized protocol while MT should be considered an important parameter to monitor change in muscle morphology.
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Affiliation(s)
- Clément Boulard
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France; Pediatric and Adult Units, Department of Physical Medicine and Rehabilitation, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Laure Mathevon
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France; Centre Médico-Chirurgical de Réadaptation des Massues, Lyon, France
| | - Louis Florian Arnaudeau
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France
| | - Vincent Gautheron
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France; Pediatric and Adult Units, Department of Physical Medicine and Rehabilitation, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Paul Calmels
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France; Pediatric and Adult Units, Department of Physical Medicine and Rehabilitation, University Hospital of Saint-Etienne, Saint-Etienne, France
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19
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Paris MT, Mourtzakis M. Muscle Composition Analysis of Ultrasound Images: A Narrative Review of Texture Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:880-895. [PMID: 33451817 DOI: 10.1016/j.ultrasmedbio.2020.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 06/12/2023]
Abstract
Skeletal muscle composition, often characterized by the degree of intramuscular adipose tissue, deteriorates with aging and disease and contributes to impairments in function and metabolism. Ultrasound can provide surrogate measures of muscle composition through measurement of echo intensity; however, there are several limitations associated with its analysis. More complex image processing features, broadly known as texture analysis, can also provide surrogates of muscle composition and may circumvent some of the limitations associated with muscle echo intensity. Here, texture features from the intensity histogram, gray-level co-occurrence matrix, run-length matrix, local binary pattern, blob analysis, texture anisotropy index and wavelet analysis are discussed. The purpose of this review was to provide a conceptual understanding of texture analysis as it pertains to muscle composition of ultrasound images.
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Affiliation(s)
- Michael T Paris
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Marina Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Williams SA, Stott NS, Valentine J, Elliott C, Reid SL. Measuring skeletal muscle morphology and architecture with imaging modalities in children with cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:263-273. [PMID: 33107594 DOI: 10.1111/dmcn.14714] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/22/2022]
Abstract
AIM To investigate the use of ultrasound and magnetic resonance imaging (MRI) methodologies to assess muscle morphology and architecture in children with cerebral palsy (CP). METHOD A scoping review was conducted with systematic searches of Medline, Embase, Scopus, Web of Science, PubMed, and PsycInfo for all original articles published up to January 2019 utilizing ultrasound and/or MRI to determine morphological and architectural properties of lower limb skeletal muscle in children with CP. RESULTS Eighty papers used ultrasound (n=44), three-dimensional ultrasound (n=16), or MRI (n=20) to measure at least one muscle parameter in children and adolescents with CP. Most research investigated single muscles, predominantly the medial gastrocnemius muscle, included children classified in Gross Motor Function Classification System levels I (n=62) and II (n=65), and assessed fascicle length (n=35) and/or muscle volume (n=35). Only 21 papers reported reliability of imaging techniques. Forty-six papers assessed measures of Impairment (n=39), Activity (n=24), and Participation (n=3). INTERPRETATION Current research study design, variation in methodology, and preferences towards investigation of isolated muscles may oversimplify the complexities of CP muscle but provide a foundation for the understanding of the changes in muscle parameters in children with CP. WHAT THIS PAPER ADDS Current evidence is biased towards the medial gastrocnemius muscle and more functionally able children with cerebral palsy (CP). Variations in imaging techniques and joint positioning limit comparisons between studies. Clinimetric testing of parameters of CP muscle is not always considered. Assessment of parameter(s) of muscle with measures of participation is sparse.
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Affiliation(s)
- Sîan A Williams
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Starship Child Health, Auckland, New Zealand
| | - Jane Valentine
- Kids Rehab WA, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Catherine Elliott
- Kids Rehab WA, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Siobhán L Reid
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
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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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CORR Insights®: Does a Reduced Number of Muscle Stem Cells Impair the Addition of Sarcomeres and Recovery from a Skeletal Muscle Contracture? A Transgenic Mouse Model. Clin Orthop Relat Res 2020; 478:900-902. [PMID: 32118609 PMCID: PMC7282576 DOI: 10.1097/corr.0000000000001177] [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: 01/31/2023]
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Paris MT, Tandon P, Heyland DK, Furberg H, Premji T, Low G, Mourtzakis M. Automated body composition analysis of clinically acquired computed tomography scans using neural networks. Clin Nutr 2020; 39:3049-3055. [PMID: 32007318 DOI: 10.1016/j.clnu.2020.01.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The quantity and quality of skeletal muscle and adipose tissue is an important prognostic factor for clinical outcomes across several illnesses. Clinically acquired computed tomography (CT) scans are commonly used for quantification of body composition, but manual analysis is laborious and costly. The primary aim of this study was to develop an automated body composition analysis framework using CT scans. METHODS CT scans of the 3rd lumbar vertebrae from critically ill, liver cirrhosis, pancreatic cancer, and clear cell renal cell carcinoma patients, as well as renal and liver donors, were manually analyzed for body composition. Ninety percent of scans were used for developing and validating a neural network for the automated segmentation of skeletal muscle and adipose tissues. Network accuracy was evaluated with the remaining 10 percent of scans using the Dice similarity coefficient (DSC), which quantifies the overlap (0 = no overlap, 1 = perfect overlap) between human and automated segmentations. RESULTS Of the 893 patients, 44% were female, with a mean (±SD) age and body mass index of 52.7 (±15.8) years old and 28.0 (±6.1) kg/m2, respectively. In the testing cohort (n = 89), DSC scores indicated excellent agreement between human and network-predicted segmentations for skeletal muscle (0.983 ± 0.013), and intermuscular (0.900 ± 0.034), visceral (0.979 ± 0.019), and subcutaneous (0.986 ± 0.016) adipose tissue. Network segmentation took ~350 milliseconds/scan using modern computing hardware. CONCLUSIONS Our network displayed excellent ability to analyze diverse body composition phenotypes and clinical cohorts, which will create feasible opportunities to advance our capacity to predict health outcomes in clinical populations.
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Affiliation(s)
- Michael T Paris
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Puneeta Tandon
- Department of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Daren K Heyland
- Department of Critical Care, Kingston General Hospital, Kingston, ON, Canada; Clinical Evaluation Research Unit, Queens University, Kingston, ON, Canada
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tahira Premji
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Gavin Low
- Department of Radiology, University of Alberta, Edmonton, AB, Canada
| | - Marina Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
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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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25
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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.
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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
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26
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Schless SH, Cenni F, Bar-On L, Hanssen B, Kalkman B, O'brien T, Aertbeliën E, Van Campenhout A, Molenaers G, Desloovere K. Medial gastrocnemius volume and echo-intensity after botulinum neurotoxin A interventions in children with spastic cerebral palsy. Dev Med Child Neurol 2019; 61:783-790. [PMID: 30320442 DOI: 10.1111/dmcn.14056] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
AIM This cross-sectional investigation evaluated whether recurrent botulinum neurotoxin A (BoNT-A) interventions to the medial gastrocnemius have an influence on muscle morphology, beyond Gross Motor Function Classification System (GMFCS) level. METHOD A cohort of typically developing children (n=67; 43 males, 24 females; median age 9y 11mo [range 7y 10mo-11y 6mo]), a cohort of children with spastic cerebral palsy (CP) naive to BoNT-A interventions (No-BoNT-A; n=19; 10 males, nine females; median age 9y 3mo [range 8y 5mo-10y 10mo]) and a cohort of children with spastic CP with a minimum of three recurrent BoNT-A interventions to the medial gastrocnemius (BoNT-A; n=19; 13 males, six females; median age 9y 8mo [range 7y 3mo-10y 7mo]) were recruited. Three-dimensional freehand ultrasound was used to estimate medial gastrocnemius volume normalized to body mass and echo-intensity. RESULTS Normalized medial gastrocnemius volume and echo-intensity significantly differed between the two spastic CP cohorts (p≤0.05), with the BoNT-A cohort having larger alterations. Associations between normalized medial gastrocnemius volume and echo-intensity were highest in the No-BoNT-A cohort, followed by the BoNT-A cohort. Multiple regression analyses revealed that both GMFCS level and BoNT-A intervention history were significantly associated with smaller normalized medial gastrocnemius volume and higher echo-intensity. INTERPRETATION Recurrent BoNT-A interventions may induce alterations to medial gastrocnemius volume and echo-intensity beyond the natural history of the spastic CP pathology. WHAT THIS PAPER ADDS In spastic cerebral palsy, medial gastrocnemius volumes are smaller and echo-intensities higher compared with typical development. Alterations after botulinum neurotoxin A intervention (BoNT-A) are larger than in no BoNT-A intervention. Gross Motor Function Classification System level and BoNT-A history significantly associate with medial gastrocnemius and echo-intensity alterations.
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Affiliation(s)
- Simon-Henri Schless
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Francesco Cenni
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium.,Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Barbara Kalkman
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Thomas O'brien
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Erwin Aertbeliën
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium.,Department of Orthopaedic Medicine, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Orthopaedic Medicine, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
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Pingel J, Andersen IT, Broholm R, Harder A, Bartels EM, Bülow J, Harrison A. An acoustic myography functional assessment of cerebral palsy subjects compared to healthy controls during physical exercise. J Muscle Res Cell Motil 2019; 40:53-58. [PMID: 31123956 DOI: 10.1007/s10974-019-09516-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/06/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Jessica Pingel
- Department of Neuroscience, Copenhagen University, Copenhagen, Denmark.
| | - Ida Torp Andersen
- Department of Neuroscience, Copenhagen University, Copenhagen, Denmark
| | - Rikke Broholm
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Anja Harder
- Section for Pathobiological Sciences, Faculty of Health & Medical Sciences, Copenhagen University, Frederiksberg, Denmark
| | - Else Marie Bartels
- Department of Neurology and the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jens Bülow
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Adrian Harrison
- Section for Pathobiological Sciences, Faculty of Health & Medical Sciences, Copenhagen University, Frederiksberg, Denmark
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Muscle fibre morphology and microarchitecture in cerebral palsy patients obtained by 3D synchrotron X-ray computed tomography. Comput Biol Med 2019; 107:265-269. [PMID: 30878888 DOI: 10.1016/j.compbiomed.2019.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Synchrotron X-ray computed tomography (SXCT) allows for three-dimensional imaging of objects at a very high resolution and in large field-of-view. PURPOSE The aim of this study was to use SXCT imaging for morphological analysis of muscle tissue, in order to investigate whether the analysis reveals complementary information to two-dimensional microscopy. METHODS Three-dimensional SXCT images of muscle biopsies were taken from participants with cerebral palsy and from healthy controls. We designed morphological measures from the two-dimensional slices and three-dimensional volumes of the images and measured the muscle fibre organization, which we term orientation consistency. RESULTS The muscle fibre cross-sectional areas were significantly larger in healthy participants than in participants with cerebral palsy when carrying out the analysis in three dimensions. However, a similar analysis carried out in two dimensions revealed no patient group difference. The present study also showed that three-dimensional orientation consistency was significantly larger for healthy participants than for participants with cerebral palsy. CONCLUSION Individuals with CP have smaller muscle fibres than healthy control individuals. We argue that morphometric measures of muscle fibres in two dimensions are generally trustworthy only if the fibres extend perpendicularly to the slice plane, and otherwise three-dimensional aspects should be considered. In addition, the muscle tissue of individuals with CP showed a decreased level of orientation consistency when compared to healthy control tissue. We suggest that the observed disorganization of the tissue may be induced by atrophy caused by physical inactivity and insufficient neural activation.
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29
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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.
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Pingel J, Andersen JD, Christiansen SL, Børsting C, Morling N, Lorentzen J, Kirk H, Doessing S, Wong C, Nielsen JB. Sequence variants in muscle tissue-related genes may determine the severity of muscle contractures in cerebral palsy. Am J Med Genet B Neuropsychiatr Genet 2019; 180:12-24. [PMID: 30467950 DOI: 10.1002/ajmg.b.32693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/20/2018] [Accepted: 09/20/2018] [Indexed: 12/30/2022]
Abstract
Muscle contractures are a common complication to cerebral palsy (CP). The purpose of this study was to evaluate whether individuals with CP carry specific gene variants of important structural genes that might explain the severity of muscle contractures. Next-generation-sequencing (NGS) of 96 candidate genes associated with muscle structure and metabolism were analyzed in 43 individuals with CP (Gross Motor Function classification system [GMFCS] I, n=10; GMFCS II, n=14; GMFCS III, n=19) and four control participants. In silico analysis of the identified variants was performed. The variants were classified into four categories ranging from likely benign (VUS0) to highly likely functional effect (VUS3). All individuals with CP were classified and grouped according to their GMFCS level: Statistical comparisons were made between GMFCS groups. Kruskal-Wallis tests showed significantly more VUS2 variants in the genes COL4 (GMFCS I-III; 1, 1, 5, respectively [p < .04]), COL5 (GMFCS I-III; 1, 1, 5 [p < .04]), COL6 (GMFCS I-III; 0, 4, 7 [p < .003]), and COL9 (GMFCS I-III; 1, 1, 5 [p < .04]), in individuals with CP within GMFCS Level III when compared to the other GMFCS levels. Furthermore, significantly more VUS3 variants in COL6 (GMFCS I-III; 0, 5, 2 [p < .01]) and COL7 (GMFCS I-III; 0, 3, 0 [p < .04]) were identified in the GMFCS II level when compared to the other GMFCS levels. The present results highlight several candidate gene variants in different collagen types with likely functional effects in individuals with CP.
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Affiliation(s)
- Jessica Pingel
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeppe Dyrberg Andersen
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Lindgren Christiansen
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Børsting
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Morling
- Department of Forensic Medicine, Section of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Helene Elsass Center, Charlottenlund, Denmark
| | - Henrik Kirk
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Helene Elsass Center, Charlottenlund, Denmark
| | - Simon Doessing
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christian Wong
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Helene Elsass Center, Charlottenlund, Denmark
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31
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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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Battisti N, Milletti D, Miceli M, Zenesini C, Cersosimo A. Usefulness of a Qualitative Ultrasound Evaluation of the Gastrocnemius-Soleus Complex with the Heckmatt Scale for Clinical Practice in Cerebral Palsy. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2548-2555. [PMID: 30253885 DOI: 10.1016/j.ultrasmedbio.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound is increasingly used for the evaluation of spastic muscles in cerebral palsy. Increased echo intensity is considered indicative of a muscle fibrous involution. The aim of this study was to highlight any correlation between increased echo intensity of the gastrocnemius-soleus complex and clinical tests for stiffness evaluation, age and functional level measured with the Gross Motor Function Classification System. We used the qualitative echo intensity grading system of the Heckmatt scale (HS) and tested its inter-rater reliability. The study group comprised 60 patients with cerebral palsy. We found a weak significant correlation between HS scores and clinical stiffness measures and between HS and age for all muscles studied, and between the HS and Gross Motor Function Classification System only for the soleus muscle. The study indicated moderate inter-rater reliability, with κ values between 0.60 and 0.73, for almost all muscles studied. Ultrasound provides a useful complementary survey of stiffness tests in cerebral palsy.
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Affiliation(s)
- Nicoletta Battisti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa Infantile, Bologna, Italy.
| | - David Milletti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa, Bologna, Italy
| | - Marco Miceli
- Azienda Unità sanitaria Locale di Bologna,UOC Radiologia, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Epidemiologia e Statistica, Bologna, Italy
| | - Antonella Cersosimo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa Infantile, Bologna, Italy
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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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Gollie JM, Harris-Love MO, Patel SS, Argani S. Chronic kidney disease: considerations for monitoring skeletal muscle health and prescribing resistance exercise. Clin Kidney J 2018; 11:822-831. [PMID: 30524717 PMCID: PMC6275456 DOI: 10.1093/ckj/sfy054] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/26/2018] [Indexed: 12/24/2022] Open
Abstract
Skeletal muscle wasting has gained interest as a primary consequence of chronic kidney disease (CKD) due to the relationship between skeletal muscle mass, mortality and major adverse cardiovascular events in this population. The combination of reductions in physical function, skeletal muscle performance and skeletal muscle mass places individuals with CKD at greater risk of sarcopenia. Therefore the monitoring of skeletal muscle composition and function may provide clinical insight into disease progression. Dual-energy X-ray absorptiometry and bioelectrical impedance analysis are frequently used to estimate body composition in people with CKD within clinical research environments, however, their translation into clinical practice has been limited. Proxy measures of skeletal muscle quality can be obtained using diagnostic ultrasound, providing a cost-effective and accessible imaging modality to aid further clinical research regarding changes in muscle composition. Clinicians and practitioners should evaluate the strengths and limitations of the available technology to determine which devices are most appropriate given their respective circumstances. Progressive resistance exercise has been shown to improve skeletal muscle hypertrophy of the lower extremities, muscular strength and health-related quality of life in end-stage renal disease, with limited evidence available in CKD predialysis. Fundamental principles (i.e. specificity, overload, variation, reversibility, individuality) can be used in the development of more advanced programs focused on improving specific neuromuscular and functional outcomes. Future research is needed to determine the applicability of skeletal muscle monitoring in clinical settings and the feasibility and efficacy of more advanced resistance exercise approaches in those with CKD predialysis.
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Affiliation(s)
- Jared M Gollie
- Muscle Morphology, Mechanics and Performance Laboratory, Human Performance Research Unit, Clinical Research Center, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- Correspondence and offprint requests to: Jared M. Gollie; E-mail: ; Twitter handle: @golliejm
| | - Michael O Harris-Love
- Muscle Morphology, Mechanics and Performance Laboratory, Human Performance Research Unit, Clinical Research Center, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Exercise and Nutritional Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Geriatrics and Extended Care Service/Research Service, Veterans Affairs Medical Center, Washington, DC, USA
| | - Samir S Patel
- Renal Service, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
| | - Sholey Argani
- Renal Service, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- Department of Medicine, School of Medicine, Uniform Services University of the Health Sciences, Bethesda, MD, USA
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Obst SJ, Heales LJ, Schrader BL, Davis SA, Dodd KA, Holzberger CJ, Beavis LB, Barrett RS. Are the Mechanical or Material Properties of the Achilles and Patellar Tendons Altered in Tendinopathy? A Systematic Review with Meta-analysis. Sports Med 2018; 48:2179-2198. [DOI: 10.1007/s40279-018-0956-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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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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