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Chow BVY, Morgan C, Rae C, Warton DI, Novak I, Davies S, Lancaster A, Popovic GC, Rizzo RRN, Rizzo CY, Kyriagis M, Herbert RD, Bolsterlee B. Human lower leg muscles grow asynchronously. J Anat 2024; 244:476-485. [PMID: 37917014 PMCID: PMC10862152 DOI: 10.1111/joa.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/08/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
Muscle volume must increase substantially during childhood growth to generate the power required to propel the growing body. One unresolved but fundamental question about childhood muscle growth is whether muscles grow at equal rates; that is, if muscles grow in synchrony with each other. In this study, we used magnetic resonance imaging (MRI) and advances in artificial intelligence methods (deep learning) for medical image segmentation to investigate whether human lower leg muscles grow in synchrony. Muscle volumes were measured in 10 lower leg muscles in 208 typically developing children (eight infants aged less than 3 months and 200 children aged 5 to 15 years). We tested the hypothesis that human lower leg muscles grow synchronously by investigating whether the volume of individual lower leg muscles, expressed as a proportion of total lower leg muscle volume, remains constant with age. There were substantial age-related changes in the relative volume of most muscles in both boys and girls (p < 0.001). This was most evident between birth and five years of age but was still evident after five years. The medial gastrocnemius and soleus muscles, the largest muscles in infancy, grew faster than other muscles in the first five years. The findings demonstrate that muscles in the human lower leg grow asynchronously. This finding may assist early detection of atypical growth and allow targeted muscle-specific interventions to improve the quality of life, particularly for children with neuromotor conditions such as cerebral palsy.
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Affiliation(s)
- Brian V. Y. Chow
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- School of Biomedical Sciences, University of New South WalesSydneyNew South WalesAustralia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent HealthThe University of SydneySydneyNew South WalesAustralia
| | - Caroline Rae
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- School of Psychology, University of New South WalesSydneyNew South WalesAustralia
| | - David I. Warton
- School of Mathematics and StatisticsUniversity of New South WalesSydneyNew South WalesAustralia
- Evolution & Ecology Research CentreUniversity of New South WalesSydneyNew South WalesAustralia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent HealthThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Suzanne Davies
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
| | - Ann Lancaster
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
| | - Gordana C. Popovic
- Stats Central, Mark Wainwright Analytical CentreUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rodrigo R. N. Rizzo
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- School of Biomedical Sciences, University of New South WalesSydneyNew South WalesAustralia
| | - Claudia Y. Rizzo
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
| | - Maria Kyriagis
- Rehab2Kids, Sydney Children's HospitalSydneyNew South WalesAustralia
| | - Robert D. Herbert
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- School of Biomedical Sciences, University of New South WalesSydneyNew South WalesAustralia
| | - Bart Bolsterlee
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- Graduate School of Biomedical Engineering, University of New South WalesSydneyNew South WalesAustralia
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Corvelyn M, Meirlevede J, Deschrevel J, Huyghe E, De Wachter E, Gayan-Ramirez G, Sampaolesi M, Van Campenhout A, Desloovere K, Costamagna D. Ex vivo adult stem cell characterization from multiple muscles in ambulatory children with cerebral palsy during early development of contractures. Differentiation 2023; 133:25-39. [PMID: 37451110 DOI: 10.1016/j.diff.2023.06.003] [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: 11/23/2022] [Revised: 05/25/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
Cerebral palsy (CP) is one of the most common conditions leading to lifelong childhood physical disability. Literature reported previously altered muscle properties such as lower number of satellite cells (SCs), with altered fusion capacity. However, these observations highly vary among studies, possibly due to heterogeneity in patient population, lack of appropriate control data, methodology and different assessed muscle. In this study we aimed to strengthen previous observations and to understand the heterogeneity of CP muscle pathology. Myogenic differentiation of SCs from the Medial Gastrocnemius (MG) muscle of patients with CP (n = 16, 3-9 years old) showed higher fusion capacity compared to age-matched typically developing children (TD, n = 13). Furthermore, we uniquely assessed cells of two different lower limb muscles and showed a decreased myogenic potency in cells from the Semitendinosus (ST) compared to the MG (TD: n = 3, CP: n = 6). Longitudinal assessments, one year after the first botulinum toxin treatment, showed slightly reduced SC representations and lower fusion capacity (n = 4). Finally, we proved the robustness of our data, by assessing in parallel the myogenic capacity of two samples from the same TD muscle. In conclusion, these data confirmed previous findings of increased SC fusion capacity from MG muscle of young patients with CP compared to age-matched TD. Further elaboration is reported on potential factors contributing to heterogeneity, such as assessed muscle, CP progression and reliability of primary outcome parameters.
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Affiliation(s)
- M Corvelyn
- Stem Cell and Developmental Biology, Dept. of Development and Regeneration, KU Leuven, Belgium
| | - J Meirlevede
- Stem Cell and Developmental Biology, Dept. of Development and Regeneration, KU Leuven, Belgium
| | - J Deschrevel
- Laboratory of Respiratory Diseases and Thoracic Surgery, Dept. of Chronic Diseases and Metabolism, KU Leuven, Belgium
| | - E Huyghe
- Research Group for Neurorehabilitation, Dept. of Rehabilitation Sciences, KU Leuven, Belgium
| | - E De Wachter
- Dept. of Orthopaedic Surgery, University Hospitals Leuven, Belgium
| | - G Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic Surgery, Dept. of Chronic Diseases and Metabolism, KU Leuven, Belgium
| | - M Sampaolesi
- Stem Cell and Developmental Biology, Dept. of Development and Regeneration, KU Leuven, Belgium
| | - A Van Campenhout
- Dept. of Orthopaedic Surgery, University Hospitals Leuven, Belgium; Dept. of Development and Regeneration, KU Leuven, Belgium
| | - K Desloovere
- Research Group for Neurorehabilitation, Dept. of Rehabilitation Sciences, KU Leuven, Belgium.
| | - D Costamagna
- Stem Cell and Developmental Biology, Dept. of Development and Regeneration, KU Leuven, Belgium; Research Group for Neurorehabilitation, Dept. of Rehabilitation Sciences, KU Leuven, Belgium.
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Kruse A, Habersack A, Weide G, Jaspers RT, Svehlik M, Tilp M. Eight weeks of proprioceptive neuromuscular facilitation stretching and static stretching do not affect muscle-tendon properties, muscle strength, and joint function in children with spastic cerebral palsy. Clin Biomech (Bristol, Avon) 2023; 107:106011. [PMID: 37329655 DOI: 10.1016/j.clinbiomech.2023.106011] [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: 12/12/2022] [Revised: 04/05/2023] [Accepted: 05/22/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND While the effect of static stretching for individuals with cerebral palsy is questionable, recent results suggest that the combination with activation seems promising to improve muscle-tendon properties and function. Therefore, this study analyzed the effects of 8-week proprioceptive neuromuscular facilitation stretching on the gastrocnemius medialis muscle-tendon properties, muscle strength, and the ankle joint in children with spastic cerebral palsy in comparison to static stretching. METHODS Initially, 24 children with spastic cerebral palsy were randomly assigned to a static stretching (10.7 ± 1.8 years) or proprioceptive neuromuscular facilitation stretching group (10.9 ± 2.6 years). Plantar flexors were manually stretched at home for 300 s and ∼ 250-270 s per day four times a week for eight weeks, respectively. Assessments of ankle joint function (e.g., range of motion), muscle-tendon properties, and isometric muscle strength were conducted using 3D motion capture, 2D ultrasound, dynamometry, and electromyography. A mixed analysis of variance was used for the statistical analysis. FINDINGS Stretching adherence was high in the proprioceptive neuromuscular facilitation stretching (93.1%) and static stretching group (94.4%). No significant changes (p > 0.05) were observed in ankle joint function, muscle-tendon properties, and isometric muscle strength after both interventions. Moreover, no differences (p > 0.05) were found between the stretching techniques. INTERPRETATION The findings support the idea that manual stretching (neither proprioceptive neuromuscular facilitation stretching nor static stretching) performed in isolation for eight weeks may not be appropriate to evoke significant changes in muscle-tendon properties, voluntary muscle strength, or joint function in children with spastic cerebral palsy. CLINICAL TRIAL REGISTRATION NUMBER NCT04570358.
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Affiliation(s)
- Annika Kruse
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.
| | - Andreas Habersack
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria; Department of Othopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Guido Weide
- Department of Human Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Richard T Jaspers
- Department of Human Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Martin Svehlik
- Department of Othopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Markus Tilp
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
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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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Costamagna D, Casters V, Beltrà M, Sampaolesi M, Van Campenhout A, Ortibus E, Desloovere K, Duelen R. Autologous iPSC-Derived Human Neuromuscular Junction to Model the Pathophysiology of Hereditary Spastic Paraplegia. Cells 2022; 11:3351. [PMID: 36359747 PMCID: PMC9655384 DOI: 10.3390/cells11213351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 08/27/2023] Open
Abstract
Hereditary spastic paraplegia (HSP) is a heterogeneous group of genetic neurodegenerative disorders, characterized by progressive lower limb spasticity and weakness resulting from retrograde axonal degeneration of motor neurons (MNs). Here, we generated in vitro human neuromuscular junctions (NMJs) from five HSP patient-specific induced pluripotent stem cell (hiPSC) lines, by means of microfluidic strategy, to model disease-relevant neuropathologic processes. The strength of our NMJ model lies in the generation of lower MNs and myotubes from autologous hiPSC origin, maintaining the genetic background of the HSP patient donors in both cell types and in the cellular organization due to the microfluidic devices. Three patients characterized by a mutation in the SPG3a gene, encoding the ATLASTIN GTPase 1 protein, and two patients with a mutation in the SPG4 gene, encoding the SPASTIN protein, were included in this study. Differentiation of the HSP-derived lines gave rise to lower MNs that could recapitulate pathological hallmarks, such as axonal swellings with accumulation of Acetyl-α-TUBULIN and reduction of SPASTIN levels. Furthermore, NMJs from HSP-derived lines were lower in number and in contact point complexity, denoting an impaired NMJ profile, also confirmed by some alterations in genes encoding for proteins associated with microtubules and responsible for axonal transport. Considering the complexity of HSP, these patient-derived neuronal and skeletal muscle cell co-cultures offer unique tools to study the pathologic mechanisms and explore novel treatment options for rescuing axonal defects and diverse cellular processes, including membrane trafficking, intracellular motility and protein degradation in HSP.
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Affiliation(s)
- Domiziana Costamagna
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Valérie Casters
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Marc Beltrà
- Department of Clinical and Biological Sciences, University of Torino, 10125 Torino, Italy
| | - Maurilio Sampaolesi
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Anja Van Campenhout
- Locomotor and Neurological Disorder, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Orthopedic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Els Ortibus
- Locomotor and Neurological Disorder, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Pediatric Neurology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Kaat Desloovere
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Robin Duelen
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU Leuven, 3000 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] [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
- *Correspondence: Britta Hanssen, ; Kaat Desloovere,
| | - 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
- *Correspondence: Britta Hanssen, ; Kaat Desloovere,
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Peeters N, Papageorgiou E, Hanssen B, De Beukelaer N, Staut L, Degelaen M, Van den Broeck C, Calders P, Feys H, Van Campenhout A, Desloovere K. The Short-Term Impact of Botulinum Neurotoxin-A on Muscle Morphology and Gait in Children with Spastic Cerebral Palsy. Toxins (Basel) 2022; 14:676. [PMID: 36287944 PMCID: PMC9607504 DOI: 10.3390/toxins14100676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 08/27/2023] Open
Abstract
Children with spastic cerebral palsy (SCP) are often treated with intramuscular Botulinum Neurotoxin type-A (BoNT-A). Recent studies demonstrated BoNT-A-induced muscle atrophy and variable effects on gait pathology. This group-matched controlled study in children with SCP compared changes in muscle morphology 8-10 weeks post-BoNT-A treatment (n = 25, median age 6.4 years, GMFCS level I/II/III (14/9/2)) to morphological changes of an untreated control group (n = 20, median age 7.6 years, GMFCS level I/II/III (14/5/1)). Additionally, the effects on gait and spasticity were assessed in all treated children and a subgroup (n = 14), respectively. BoNT-A treatment was applied following an established integrated approach. Gastrocnemius and semitendinosus volume and echogenicity intensity were assessed by 3D-freehand ultrasound, spasticity was quantified through electromyography during passive muscle stretches at different velocities. Ankle and knee kinematics were evaluated by 3D-gait analysis. Medial gastrocnemius (p = 0.018, -5.2%) and semitendinosus muscle volume (p = 0.030, -16.2%) reduced post-BoNT-A, but not in the untreated control group, while echogenicity intensity did not change. Spasticity reduced and ankle gait kinematics significantly improved, combined with limited effects on knee kinematics. This study demonstrated that BoNT-A reduces spasticity and partly improves pathological gait but reduces muscle volume 8-10 weeks post-injections. Close post-BoNT-A follow-up and well-considered treatment selection is advised before BoNT-A application in SCP.
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Affiliation(s)
- Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | | | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | | | - Lauraine Staut
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
| | - Marc Degelaen
- Inkendaal Rehabilitation Hospital, 1602 Vlezenbeek, Belgium
- Rehabilitation Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | | | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Orthopedic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, 3212 Leuven, Belgium
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8
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Straathof EJM, Hamer EG, Heineman KR, Hadders-Algra M. Atypical knee jerk responses in high-risk children: A longitudinal EMG-study. Eur J Paediatr Neurol 2022; 40:11-17. [PMID: 35872514 DOI: 10.1016/j.ejpn.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/05/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We previously found that atypical responses to the knee jerk reflex, i.e., tonic responses (TRs), clonus and contralateral responses in very high-risk (VHR) infants were associated with cerebral palsy (CP) at 21 months. The current study aimed for a better understanding of pathophysiology of atypical knee jerk responses by evaluating whether infant atypical knee jerk responses are associated with CP and atypical knee jerk responses at school-age. METHODS 31 VHR-children, who had also been assessed longitudinally during infancy, and 24 typically developing children, were assessed at 7-10 years (school-age). We continuously recorded surface EMG of thigh muscles during knee jerk responses longitudinally during infancy and once at school-age. Neurological condition was assessed with age-appropriate neurological examinations. It included the diagnosis of CP at 21 months corrected age and school-age. CP's type and severity (Gross Motor Function Classification System (GMFCS)) were reported. RESULTS Persistent TRs in infancy were associated with CP at school-age. TR prevalence decreased from infancy to childhood. At school-age it was no longer associated with CP. Clonus prevalence in VHR-children did not change with increasing age; it was significantly higher in children without than those with CP. Reflex irradiation was common in all school-age children, and its prevalence in contralateral muscles in VHR-children decreased between infancy and childhood. CONCLUSIONS In infancy, TRs indicated an increased risk of CP, but at school-age TRs were not associated with CP. In general, spinal hyperexcitability, expressed as reflex irradiation and TRs, decreased between infancy and school-age.
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Affiliation(s)
- Elisabeth J M Straathof
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Elisa G Hamer
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands; Department of Neurology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Kirsten R Heineman
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Dokter Denekampweg 20, 8025 BV, Zwolle, the Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
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9
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Greve KR, Joseph CF, Berry BE, Schadl K, Rose J. Neuromuscular electrical stimulation to augment lower limb exercise and mobility in individuals with spastic cerebral palsy: A scoping review. Front Physiol 2022; 13:951899. [PMID: 36111153 PMCID: PMC9468780 DOI: 10.3389/fphys.2022.951899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Neuromuscular Electrical Stimulation (NMES) is an emerging assistive technology applied through surface or implanted electrodes to augment skeletal muscle contraction. NMES has the potential to improve function while reducing the neuromuscular impairments of spastic cerebral palsy (CP). This scoping review examines the application of NMES to augment lower extremity exercises for individuals with spastic CP and reports the effects of NMES on neuromuscular impairments and function in spastic CP, to provide a foundation of knowledge to guide research and development of more effective treatment. Methods: A literature review of Scopus, Medline, Embase, and CINAHL databases were searched from 2001 to 2 November 2021 with identified inclusion and exclusion criteria. Results: Out of 168 publications identified, 33 articles were included. Articles on three NMES applications were identified, including NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction. NMES-assisted strengthening included the use of therapeutic exercises and cycling. NMES-assisted gait included the use of NMES to improve gait patterns. NMES-spasticity reduction included the use of transcutaneous electrical stimulation or NMES to decrease tone. Thirteen studies investigated NMES-assisted strengthening, eleven investigated therapeutic exercise and demonstrated significant improvements in muscle structure, strength, gross motor skills, walking speed, and functional mobility; three studies investigated NMES-assisted cycling and demonstrated improved gross motor skills and walking distance or speed. Eleven studies investigated NMES-assisted gait and demonstrated improved muscle structure, strength, selective motor control, gross motor skills, and gait mechanics. Seven studies investigated NMES for spasticity reduction, and five of the seven studies demonstrated reduced spasticity. Conclusion: A growing body of evidence supports the use of NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction to improve functional mobility for individuals with spastic CP. Evidence for NMES to augment exercise in individuals with spastic CP remains limited. NMES protocols and parameters require further clarity to translate knowledge to clinicians. Future research should be completed to provide richer evidence to transition to more robust clinical practice.
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Affiliation(s)
- Kelly R. Greve
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, United States
- *Correspondence: Kelly R. Greve,
| | - Christopher F. Joseph
- Department of Physical Therapy, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Blake E. Berry
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, United States
| | - Kornel Schadl
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Motion and Gait Analysis Lab, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, CA, United States
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
- Motion and Gait Analysis Lab, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, CA, United States
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10
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Howard JJ, Graham K, Shortland AP. Understanding skeletal muscle in cerebral palsy: a path to personalized medicine? Dev Med Child Neurol 2022; 64:289-295. [PMID: 34499350 DOI: 10.1111/dmcn.15018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 12/11/2022]
Abstract
Until recently, there has been little interest in understanding the intrinsic features associated with the pathomorphology of skeletal muscle in cerebral palsy (CP). Coupled with emerging evidence that challenges the role of spasticity as a determinant of gross motor function and in the development of fixed muscle contractures, it has become increasingly important to further elucidate the underlying mechanisms responsible for muscle alterations in CP. This knowledge can help clinicians to understand and apply treatment modalities that take these aspects into account. Thus, the inherent heterogeneity of the CP phenotype allows for the potential of personalized medicine through the understanding of muscle pathomorphology on an individual basis and tailoring treatment approaches accordingly. This review aims to summarize recent developments in the understanding of CP muscle and their relationship to musculoskeletal manifestations, in addition to proposing a treatment paradigm that incorporates this new knowledge.
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Affiliation(s)
- Jason J Howard
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Kerr Graham
- Department of Orthopaedic Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Hugh Williamson Gait Laboratory, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Adam P Shortland
- Paediatric Neurosciences, Guy's and St Thomas' Foundation NHS Trust, Evelina Children's Hospital, London, UK
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11
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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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12
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Shortland AP. Specificity of association and plausibility in paediatric neurodisability. Dev Med Child Neurol 2021; 63:242. [PMID: 33354781 DOI: 10.1111/dmcn.14777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Adam P Shortland
- Guy's & St Thomas' NHS Foundation Trust - One Small Step Laboratory, Guy's Hospital, London, UK
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