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Boulay C, Gracies JM, Garcia L, Authier G, Ulian A, Pradines M, Vieira TM, Pinto T, Gazzoni M, Desnous B, Parratte B, Pesenti S. Serious Game with Electromyography Feedback and Physical Therapy in Young Children with Unilateral Spastic Cerebral Palsy and Equinus Gait: A Prospective Open-Label Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:1513. [PMID: 38475049 DOI: 10.3390/s24051513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/01/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
The clinical effects of a serious game with electromyography feedback (EMGs_SG) and physical therapy (PT) was investigated prospectively in children with unilateral spastic cerebral palsy (USCP). An additional aim was to better understand the influence of muscle shortening on function. Thirty children with USCP (age 7.6 ± 2.1 years) received four weeks of EMGs_SG sessions 2×/week including repetitive, active alternating training of dorsi- and plantar flexors in a seated position. In addition, each child received usual PT treatment ≤ 2×/week, involving plantar flexor stretching and command strengthening on dorsi- and plantar flexors. Five-Step Assessment parameters, including preferred gait velocity (normalized by height); plantar flexor extensibility (XV1); angle of catch (XV3); maximal active ankle dorsiflexion (XA); and derived coefficients of shortening, spasticity, and weakness for both soleus and gastrosoleus complex (GSC) were compared pre and post treatment (t-tests). Correlations were explored between the various coefficients and gait velocities at baseline. After four weeks of EMGs_SG + PT, there was an increase in normalized gait velocity from 0.72 ± 0.13 to 0.77 ± 0.13 m/s (p = 0.025, d = 0.43), a decrease in coefficients of shortening (soleus, 0.10 ± 0.07 pre vs. 0.07 ± 0.08 post, p = 0.004, d = 0.57; GSC 0.16 ± 0.08 vs. 0.13 ± 0.08, p = 0.003, d = 0.58), spasticity (soleus 0.14 ± 0.06 vs. 0.12 ± 0.07, p = 0.02, d = 0.46), and weakness (soleus 0.14 ± 0.07 vs. 0.11 ± 0.07, p = 0.005, d = 0.55). At baseline, normalized gait velocity correlated with the coefficient of GSC shortening (R = -0.43, p = 0.02). Four weeks of EMGs_SG and PT were associated with improved gait velocity and decreased plantar flexor shortening. A randomized controlled trial comparing EMGs_SG and conventional PT is needed.
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Affiliation(s)
- Christophe Boulay
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Jean-Michel Gracies
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94000 Créteil, France
| | - Lauren Garcia
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Guillaume Authier
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Alexis Ulian
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Maud Pradines
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94000 Créteil, France
| | - Taian Martins Vieira
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunication, Politecnico di Torino, 10129 Turin, Italy
- PoliToBIOMed Laboratory, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Talita Pinto
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94000 Créteil, France
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro 22281-100, Brazil
| | - Marco Gazzoni
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunication, Politecnico di Torino, 10129 Turin, Italy
- PoliToBIOMed Laboratory, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Béatrice Desnous
- Pediatric Neurology Department, Timone Children Hospital, 13005 Marseille, France
| | - Bernard Parratte
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
| | - Sébastien Pesenti
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
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Kaya Keles CS, Ates F. How mechanics of individual muscle-tendon units define knee and ankle joint function in health and cerebral palsy-a narrative review. Front Bioeng Biotechnol 2023; 11:1287385. [PMID: 38116195 PMCID: PMC10728775 DOI: 10.3389/fbioe.2023.1287385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
This study reviews the relationship between muscle-tendon biomechanics and joint function, with a particular focus on how cerebral palsy (CP) affects this relationship. In healthy individuals, muscle size is a critical determinant of strength, with muscle volume, cross-sectional area, and moment arm correlating with knee and ankle joint torque for different isometric/isokinetic contractions. However, in CP, impaired muscle growth contributes to joint pathophysiology even though only a limited number of studies have investigated the impact of deficits in muscle size on pathological joint function. As muscles are the primary factors determining joint torque, in this review two main approaches used for muscle force quantification are discussed. The direct quantification of individual muscle forces from their relevant tendons through intraoperative approaches holds a high potential for characterizing healthy and diseased muscles but poses challenges due to the invasive nature of the technique. On the other hand, musculoskeletal models, using an inverse dynamic approach, can predict muscle forces, but rely on several assumptions and have inherent limitations. Neither technique has become established in routine clinical practice. Nevertheless, identifying the relative contribution of each muscle to the overall joint moment would be key for diagnosis and formulating efficient treatment strategies for patients with CP. This review emphasizes the necessity of implementing the intraoperative approach into general surgical practice, particularly for joint correction operations in diverse patient groups. Obtaining in vivo data directly would enhance musculoskeletal models, providing more accurate force estimations. This integrated approach can improve the clinicians' decision-making process and advance treatment strategies by predicting changes at the muscle and joint levels before interventions, thus, holding the potential to significantly enhance clinical outcomes.
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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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Costamagna D, Bastianini V, Corvelyn M, Duelen R, Deschrevel J, De Beukelaer N, De Houwer H, Sampaolesi M, Gayan-Ramirez G, Campenhout AV, Desloovere K. Botulinum Toxin Treatment of Adult Muscle Stem Cells from Children with Cerebral Palsy and hiPSC-Derived Neuromuscular Junctions. Cells 2023; 12:2072. [PMID: 37626881 PMCID: PMC10453788 DOI: 10.3390/cells12162072] [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: 06/16/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Botulinum neurotoxin type-A (BoNT) injections are commonly used as spasticity treatment in cerebral palsy (CP). Despite improved clinical outcomes, concerns regarding harmful effects on muscle morphology have been raised, and the BoNT effect on muscle stem cells remains not well defined. This study aims at clarifying the impact of BoNT on growing muscles (1) by analyzing the in vitro effect of BoNT on satellite cell (SC)-derived myoblasts and fibroblasts obtained from medial gastrocnemius microbiopsies collected in young BoNT-naïve children (t0) compared to age ranged typically developing children; (2) by following the effect of in vivo BoNT administration on these cells obtained from the same children with CP at 3 (t1) and 6 (t2) months post BoNT; (3) by determining the direct effect of a single and repeated in vitro BoNT treatment on neuromuscular junctions (NMJs) differentiated from hiPSCs. In vitro BoNT did not affect myogenic differentiation or collagen production. The fusion index significantly decreased in CP at t2 compared to t0. In NMJ cocultures, BoNT treatment caused axonal swelling and fragmentation. Repeated treatments impaired the autophagic-lysosomal system. Further studies are warranted to understand the long-term and collateral effects of BoNT in the muscles of children with CP.
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Affiliation(s)
- Domiziana Costamagna
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (D.C.); (V.B.); (N.D.B.)
- Stem Cell and Developmental Biology Unit, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (M.C.); (R.D.); (M.S.)
| | - Valeria Bastianini
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (D.C.); (V.B.); (N.D.B.)
| | - Marlies Corvelyn
- Stem Cell and Developmental Biology Unit, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (M.C.); (R.D.); (M.S.)
| | - Robin Duelen
- Stem Cell and Developmental Biology Unit, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (M.C.); (R.D.); (M.S.)
- Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Jorieke Deschrevel
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (J.D.); (G.G.-R.)
| | - Nathalie De Beukelaer
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (D.C.); (V.B.); (N.D.B.)
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, 1211 Geneva, Switzerland
| | - Hannah De Houwer
- Department of Orthopedic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium; (H.D.H.); (A.V.C.)
| | - Maurilio Sampaolesi
- Stem Cell and Developmental Biology Unit, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (M.C.); (R.D.); (M.S.)
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (J.D.); (G.G.-R.)
| | - Anja Van Campenhout
- Department of Orthopedic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium; (H.D.H.); (A.V.C.)
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Kaat Desloovere
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (D.C.); (V.B.); (N.D.B.)
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Moreau NG, Friel KM, Fuchs RK, Dayanidhi S, Sukal-Moulton T, Grant-Beuttler M, Peterson MD, Stevenson RD, Duff SV. Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy I: Key Ingredients for Bone and Muscle Health. Behav Sci (Basel) 2023; 13:539. [PMID: 37503986 PMCID: PMC10376586 DOI: 10.3390/bs13070539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023] Open
Abstract
Physical activity of a sufficient amount and intensity is essential to health and the prevention of a sedentary lifestyle in all children as they transition into adolescence and adulthood. While fostering a fit lifestyle in all children can be challenging, it may be even more so for those with cerebral palsy (CP). Evidence suggests that bone and muscle health can improve with targeted exercise programs for children with CP. Yet, it is not clear how musculoskeletal improvements are sustained into adulthood. In this perspective, we introduce key ingredients and guidelines to promote bone and muscle health in ambulatory children with CP (GMFCS I-III), which could lay the foundation for sustained fitness and musculoskeletal health as they transition from childhood to adolescence and adulthood. First, one must consider crucial characteristics of the skeletal and muscular systems as well as key factors to augment bone and muscle integrity. Second, to build a better foundation, we must consider critical time periods and essential ingredients for programming. Finally, to foster the sustainability of a fit lifestyle, we must encourage commitment and self-initiated action while ensuring the attainment of skill acquisition and function. Thus, the overall objective of this perspective paper is to guide exercise programming and community implementation to truly alter lifelong fitness in persons with CP.
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Affiliation(s)
- Noelle G. Moreau
- Department of Physical Therapy, School of Allied Health Professions, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Kathleen M. Friel
- Burke Neurological Institute, Weill Cornell Medicine, White Plains, NY 10605, USA;
| | - Robyn K. Fuchs
- Division of Biomedical Science, College of Osteopathic Medicine, Marian University, Indianapolis, IN 46222, USA;
| | | | - Theresa Sukal-Moulton
- Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL 60611, USA;
| | - Marybeth Grant-Beuttler
- Department of Physical Therapy, Oregon Institute of Technology, Klamath Falls, OR 97601, USA;
| | - Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Richard D. Stevenson
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA;
| | - Susan V. Duff
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA;
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Dick TJM, Hug F. Advances in imaging for assessing the design and mechanics of skeletal muscle in vivo. J Biomech 2023; 155:111640. [PMID: 37244210 DOI: 10.1016/j.jbiomech.2023.111640] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/29/2023]
Abstract
Skeletal muscle is the engine that powers what is arguably the most essential and defining feature of human and animal life-locomotion. Muscles function to change length and produce force to enable movement, posture, and balance. Despite this seemingly simple role, skeletal muscle displays a variety of phenomena that still remain poorly understood. These phenomena are complex-the result of interactions between active and passive machinery, as well as mechanical, chemical and electrical processes. The emergence of imaging technologies over the past several decades has led to considerable discoveries regarding how skeletal muscles function in vivo where activation levels are submaximal, and the length and velocity of contracting muscle fibres are transient. However, our knowledge of the mechanisms of muscle behaviour during everyday human movements remains far from complete. In this review, we discuss the principal advancements in imaging technology that have led to discoveries to improve our understanding of in vivo muscle function over the past 50 years. We highlight the knowledge that has emerged from the development and application of various techniques, including ultrasound imaging, magnetic resonance imaging, and elastography to characterise muscle design and mechanical properties. We emphasize that our inability to measure the forces produced by skeletal muscles still poses a significant challenge, and that future developments to accurately and reliably measure individual muscle forces will promote newfrontiers in biomechanics, physiology, motor control, and robotics. Finally, we identify critical gaps in our knowledge and future challenges that we hope can be solved as a biomechanics community in the next 50 years.
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Affiliation(s)
- Taylor J M Dick
- The University of Queensland, School of Biomedical Sciences, Brisbane, QLD, Australia.
| | - François Hug
- The University of Queensland, School of Biomedical Sciences, Brisbane, QLD, Australia; Université Côte d'Azur, LAMHESS, Nice, France
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Kahn RE, Krater T, Larson JE, Encarnacion M, Karakostas T, Patel NM, Swaroop VT, Dayanidhi S. Resident muscle stem cell myogenic characteristics in postnatal muscle growth impairments in children with cerebral palsy. Am J Physiol Cell Physiol 2023; 324:C614-C631. [PMID: 36622072 PMCID: PMC9942895 DOI: 10.1152/ajpcell.00499.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023]
Abstract
Children with cerebral palsy (CP), a perinatal brain alteration, have impaired postnatal muscle growth, with some muscles developing contractures. Functionally, children are either able to walk or primarily use wheelchairs. Satellite cells are muscle stem cells (MuSCs) required for postnatal development and source of myonuclei. Only MuSC abundance has been previously reported in contractured muscles, with myogenic characteristics assessed only in vitro. We investigated whether MuSC myogenic, myonuclear, and myofiber characteristics in situ differ between contractured and noncontractured muscles, across functional levels, and compared with typically developing (TD) children with musculoskeletal injury. Open muscle biopsies were obtained from 36 children (30 CP, 6 TD) during surgery; contracture correction for adductors or gastrocnemius, or from vastus lateralis [bony surgery in CP, anterior cruciate ligament (ACL) repair in TD]. Muscle cross sections were immunohistochemically labeled for MuSC abundance, activation, proliferation, nuclei, myofiber borders, type-1 fibers, and collagen content in serial sections. Although MuSC abundance was greater in contractured muscles, primarily in type-1 fibers, their myogenic characteristics (activation, proliferation) were lower compared with noncontractured muscles. Overall, MuSC abundance, activation, and proliferation appear to be associated with collagen content. Myonuclear number was similar between all muscles, but only in contractured muscles were there associations between myonuclear number, MuSC abundance, and fiber cross-sectional area. Puzzlingly, MuSC characteristics were similar between ambulatory and nonambulatory children. Noncontractured muscles in children with CP had a lower MuSC abundance compared with TD-ACL injured children, but similar myogenic characteristics. Contractured muscles may have an intrinsic deficiency in developmental progression for postnatal MuSC pool establishment, needed for lifelong efficient growth and repair.
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Affiliation(s)
| | | | - Jill E Larson
- Shirley Ryan AbilityLab, Chicago, Illinois
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Tasos Karakostas
- Shirley Ryan AbilityLab, Chicago, Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Neeraj M Patel
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Vineeta T Swaroop
- Shirley Ryan AbilityLab, Chicago, Illinois
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sudarshan Dayanidhi
- Shirley Ryan AbilityLab, Chicago, Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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De Beukelaer N, Vandekerckhove I, Huyghe E, Molenberghs G, Peeters N, Hanssen B, Ortibus E, Van Campenhout A, Desloovere K. Morphological Medial Gastrocnemius Muscle Growth in Ambulant Children with Spastic Cerebral Palsy: A Prospective Longitudinal Study. J Clin Med 2023; 12:jcm12041564. [PMID: 36836099 PMCID: PMC9963346 DOI: 10.3390/jcm12041564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Only cross-sectional studies have demonstrated muscle deficits in children with spastic cerebral palsy (SCP). The impact of gross motor functional limitations on altered muscle growth remains unclear. This prospective longitudinal study modelled morphological muscle growth in 87 children with SCP (age range 6 months to 11 years, Gross Motor Function Classification System [GMFCS] level I/II/III = 47/22/18). Ultrasound assessments were performed during 2-year follow-up and repeated for a minimal interval of 6 months. Three-dimensional freehand ultrasound was applied to assess medial gastrocnemius muscle volume (MV), mid-belly cross-sectional area (CSA) and muscle belly length (ML). Non-linear mixed models compared trajectories of (normalized) muscle growth between GMFCS-I and GMFCS-II&III. MV and CSA growth trajectories showed a piecewise model with two breakpoints, with the highest growth before 2 years and negative growth rates after 6-9 years. Before 2 years, children with GMFCS-II&III already showed lower growth rates compared to GMFCS-I. From 2 to 9 years, the growth rates did not differ between GMFCS levels. After 9 years, a more pronounced reduction in normalized CSA was observed in GMFCS-II&III. Different trajectories in ML growth were shown between the GMFCS level subgroups. These longitudinal trajectories highlight monitoring of SCP muscle pathology from early ages and related to motor mobility. Treatment planning and goals should stimulate muscle growth.
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Affiliation(s)
- Nathalie De Beukelaer
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-474033110
| | | | - Ester Huyghe
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), KU Leuven, 3000 Leuven, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium
| | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Anja Van Campenhout
- Department of Orthopedics, University Hospitals Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, 3000 Leuven, Belgium
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Boulay C, Sangeux M, Authier G, Jacquemier M, Merlo A, Chabrol B, Jouve JL, Gracies JM, Pesenti S. Improved Gait and Radiological Measurements After injection of Botulinum Toxin Into Peroneus Longus in Young Children With USCP and Equinovalgus Gait. Pediatr Neurol 2023; 142:1-9. [PMID: 36848724 DOI: 10.1016/j.pediatrneurol.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/08/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Children with cerebral palsy develop foot deformities due to a combination of factors including muscle shortening, hypertonia, weakness, and cocontraction of muscles acting at the ankle joint resulting in an altered gait pattern. We hypothesized these factors affect the peroneus longus (PL) and tibialis anterior (TA) muscles couple in children who develop equinovalgus gait first followed by planovalgus foot deformities. Our aim was to evaluate the effects of abobotulinum toxin A injection to the PL muscle, in a cohort of children with unilateral spastic cerebral palsy and equinovalgus gait. METHODS This was a prospective cohort study. The children were examined within 12 months before and after injection to their PL muscle. Twenty-five children of mean age 3.4 (S.D.: 1.1) years were recruited. RESULTS We found significant improvement in foot radiology measures. Passive extensibility of the triceps surae did not change, whereas active dorsiflexion increased significantly. Nondimensional walking speed increased by 0.1 (95% confidence interval [CI], [0.07, 0.16]; P < 0.001), and the Edinburgh visual gait score improved by 2.8 (95% CI, [-4.06, -1.46]; P < 0.001). Electromyography showed increased recruitment for gastrocnemius medialis (GM) and TA but not for PL during the reference exercises (standing on tip toes for GM/PL, active dorsiflexion for TA) and decreased activation percentages for PL/GM and TA across sub-phases of gait. CONCLUSIONS One key advantage of treating the PL muscle only might be to address foot deformities without interfering with the main plantar flexors that are instrumental to support body weight during gait.
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Affiliation(s)
- Christophe Boulay
- Pediatric Neurology Department, Timone Children's Hospital, Marseille, France; Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France.
| | - Morgan Sangeux
- Murdoch Children's Research Institute, Melbourne, Australia; University Children's Hospital Basel, Basel, Switzerland
| | - Guillaume Authier
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Michel Jacquemier
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Andrea Merlo
- Gait&Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
| | - Brigitte Chabrol
- Pediatric Neurology Department, Timone Children's Hospital, Marseille, France
| | - Jean-Luc Jouve
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Jean-Michel Gracies
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France; UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
| | - Sébastien Pesenti
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children's Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
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10
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Golubova TF, Vlasenko SV, Marusich II, Otinov MD, Vlasenko FS, Osmanov EA. [Current approaches to the use of robotic devices in rehabilitation complex of children with cerebral palsy]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:36-44. [PMID: 38016055 DOI: 10.17116/kurort202310005136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Cerebral palsy is a neurological disease that is associated with multiple motor impairments and dysfunctions in children. The effective recovery of motor activity in both the upper and lower limbs is an important condition for the patient's social independence throughout his life. Robotic systems are new devices which are becoming increasingly popular as a part of the treatment of cerebral palsy. They have become a good addition to comprehensive rehabilitation therapy, including conducted at the sanatorium-resort stage. Further research is needed to clarify and prove the extent to which these devices help in treatment of children with cerebral palsy.
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Affiliation(s)
- T F Golubova
- Research Institute of Children's Balneology, Physiotherapy and Medical Rehabilitation, Yevpatoria, Russia
| | - S V Vlasenko
- Research Institute of Children's Balneology, Physiotherapy and Medical Rehabilitation, Yevpatoria, Russia
| | - I I Marusich
- Research Institute of Children's Balneology, Physiotherapy and Medical Rehabilitation, Yevpatoria, Russia
| | - M D Otinov
- Research Institute of Children's Balneology, Physiotherapy and Medical Rehabilitation, Yevpatoria, Russia
| | - F S Vlasenko
- Technologies of Health and Rehabilitation (Structural Subdivision) of V.I. Vernadsky Crimean Federal University, Simferopol, Russia
| | - E A Osmanov
- Research Institute of Children's Balneology, Physiotherapy and Medical Rehabilitation, Yevpatoria, Russia
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11
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Ebrahimi A, Schwartz MH, Martin JA, Novacheck TF, Thelen DG. Atypical triceps surae force and work patterns underlying gait in children with cerebral palsy. J Orthop Res 2022; 40:2763-2770. [PMID: 35212418 PMCID: PMC9402799 DOI: 10.1002/jor.25307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/25/2021] [Accepted: 02/21/2022] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to quantitatively assess Achilles tendon mechanical behavior during gait in children with cerebral palsy (CP). We used a newly designed noninvasive sensor to measure Achilles tendon force in 11 children with CP (4F, 8-16 years old) and 15 typically developing children (controls) (9F, 8-17 years old) during overground walking. Mechanical work loop plots (force-displacement plots) were generated by combining muscle-tendon kinetics, kinematics, and EMG activity to evaluate the Achilles tendon work generated about the ankle. Work loop patterns in children with CP were substantially different than those seen in controls. Notably, children with CP showed significantly diminished work production at their preferred speed compared to controls at their preferred speed and slower speeds. Despite testing a heterogeneous population of children with CP, we observed a homogenous spring-like muscle-tendon behavior in these participants. This is in contrast with control participants who used their plantar flexors like a motor during gait. Statement of Clinical Significance: These data demonstrate the potential for using skin-mounted sensors to objectively evaluate muscle contributions to work production in pathological gait.
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Affiliation(s)
- Anahid Ebrahimi
- Mechanical Engineering DepartmentUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Michael H. Schwartz
- Center for Gait & Motion AnalysisGillette Children's Specialty HealthcareSt. PaulMinnesotaUSA
| | - Jack A. Martin
- Mechanical Engineering DepartmentUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Tom F. Novacheck
- Center for Gait & Motion AnalysisGillette Children's Specialty HealthcareSt. PaulMinnesotaUSA
| | - Darryl G. Thelen
- Mechanical Engineering DepartmentUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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12
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Robinson KG, Marsh AG, Lee SK, Hicks J, Romero B, Batish M, Crowgey EL, Shrader MW, Akins RE. DNA Methylation Analysis Reveals Distinct Patterns in Satellite Cell-Derived Myogenic Progenitor Cells of Subjects with Spastic Cerebral Palsy. J Pers Med 2022; 12:jpm12121978. [PMID: 36556199 PMCID: PMC9780849 DOI: 10.3390/jpm12121978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Spastic type cerebral palsy (CP) is a complex neuromuscular disorder that involves altered skeletal muscle microanatomy and growth, but little is known about the mechanisms contributing to muscle pathophysiology and dysfunction. Traditional genomic approaches have provided limited insight regarding disease onset and severity, but recent epigenomic studies indicate that DNA methylation patterns can be altered in CP. Here, we examined whether a diagnosis of spastic CP is associated with intrinsic DNA methylation differences in myoblasts and myotubes derived from muscle resident stem cell populations (satellite cells; SCs). Twelve subjects were enrolled (6 CP; 6 control) with informed consent/assent. Skeletal muscle biopsies were obtained during orthopedic surgeries, and SCs were isolated and cultured to establish patient-specific myoblast cell lines capable of proliferation and differentiation in culture. DNA methylation analyses indicated significant differences at 525 individual CpG sites in proliferating SC-derived myoblasts (MB) and 1774 CpG sites in differentiating SC-derived myotubes (MT). Of these, 79 CpG sites were common in both culture types. The distribution of differentially methylated 1 Mbp chromosomal segments indicated distinct regional hypo- and hyper-methylation patterns, and significant enrichment of differentially methylated sites on chromosomes 12, 13, 14, 15, 18, and 20. Average methylation load across 2000 bp regions flanking transcriptional start sites was significantly different in 3 genes in MBs, and 10 genes in MTs. SC derived MBs isolated from study participants with spastic CP exhibited fundamental differences in DNA methylation compared to controls at multiple levels of organization that may reveal new targets for studies of mechanisms contributing to muscle dysregulation in spastic CP.
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Affiliation(s)
- Karyn G. Robinson
- Nemours Children’s Research, Nemours Children’s Health System, Wilmington, DE 19803, USA
| | - Adam G. Marsh
- Center for Bioinformatics and Computational Biology, University of Delaware, Newark, DE 19716, USA
| | - Stephanie K. Lee
- Nemours Children’s Research, Nemours Children’s Health System, Wilmington, DE 19803, USA
| | - Jonathan Hicks
- Center for Bioinformatics and Computational Biology, University of Delaware, Newark, DE 19716, USA
| | - Brigette Romero
- Medical and Molecular Sciences, University of Delaware, Newark, DE 19716, USA
| | - Mona Batish
- Medical and Molecular Sciences, University of Delaware, Newark, DE 19716, USA
| | - Erin L. Crowgey
- Nemours Children’s Research, Nemours Children’s Health System, Wilmington, DE 19803, USA
| | - M. Wade Shrader
- Department of Orthopedics, Nemours Children’s Hospital Delaware, Wilmington, DE 19803, USA
| | - Robert E. Akins
- Nemours Children’s Research, Nemours Children’s Health System, Wilmington, DE 19803, USA
- Correspondence: ; Tel.: +1-302-651-6779
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13
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Botulinum Toxin Intervention in Cerebral Palsy-Induced Spasticity Management: Projected and Contradictory Effects on Skeletal Muscles. Toxins (Basel) 2022; 14:toxins14110772. [PMID: 36356022 PMCID: PMC9692445 DOI: 10.3390/toxins14110772] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged muscle contraction. The persistent resistance of spastic muscles to stretching is often followed by structural and mechanical changes in musculature. This leads to functional limitations at the respective joint. Focal injection of botulinum toxin type-A (BTX-A) is effectively used to manage spasticity and improve the quality of life of the patients. By blocking acetylcholine release at the neuromuscular junction and causing temporary muscle paralysis, BTX-A aims to reduce spasticity and hereby improve joint function. However, recent studies have indicated some contradictory effects such as increased muscle stiffness or a narrower range of active force production. The potential of these toxin- and atrophy-related alterations in worsening the condition of spastic muscles that are already subjected to changes should be further investigated and quantified. By focusing on the effects of BTX-A on muscle biomechanics and overall function in children with CP, this review deals with which of these goals have been achieved and to what extent, and what can await us in the future.
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14
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Elnaggar RK, Alghamdi MS, Alenazi AM, Alghadier M, Mahmoud MZ, Elsayed AEA, Hassan IAM, Abonour AA. Mechanical and Morphological Changes of the Plantar Flexor Musculotendinous Unit in Children with Unilateral Cerebral Palsy Following 12 Weeks of Plyometric Exercise: A Randomized Controlled Trial. CHILDREN 2022; 9:children9111604. [PMID: 36360332 PMCID: PMC9688148 DOI: 10.3390/children9111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
To investigate how plyometric exercise (PLYO-Ex) affects mechanics and morphometrics of the plantar flexor musculotendinous unit in children with unilateral cerebral palsy, 38 participants (aged 10–16 years) were allocated at random to either the PLYO-Ex group (n = 19; received 24 sessions of plyometric muscle loading, conducted 2 times a week for 3 months in succession) or the control group (n = 19; underwent traditional physical therapy for the same frequency and duration). Measurements were taken pre- and post-intervention. Standard ultrasound imaging was applied to evaluate morphometrics of the gastrocnemius muscle and Achilles tendon unit and an isokinetic dynamometer was used to evaluate maximum voluntary isometric plantar flexors contraction (IVCmax). With controlling for pre-treatment values, significant post-treatment changes favoring the PLYO-Ex group were observed for morphological (tendon (p = 0.003, η2p = 0.23) length; belly length (p = 0.001, η2p = 0.27); tendon thickness (p = 0.035, η2p = 0.35); muscle thickness (p = 0.013, η2p = 0.17); fascicle length (p = 0.009, η2p = 0.18); pennation angle (p = 0.015, η2p = 0.16)) and mechanical and material properties (IVCmax (p = 0.009, η2p = 0.18); tendon’s elongation (p = 0.012, η2p = 0.17), stiffness (p = 0.027, η2p = 0.13); stress (p = 0.006, η2p = 0.20); strain (p = 0.004, η2p = 0.21)). In conclusion, plyometric exercise induces significant adaptations within the musculotendinous unit of the plantar flexors in children with unilateral cerebral palsy. These adaptations could improve muscular efficiency and consequently optimize physical/functional performance.
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Affiliation(s)
- Ragab K. Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Correspondence:
| | - Mohammed S. Alghamdi
- Department of Physical Therapy, College of Applied Medical Sciences, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Aqeel M. Alenazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Mshari Alghadier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Mustafa Z. Mahmoud
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Abbas Elbakry A. Elsayed
- Pediatric Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
- Pediatric Department, Faculty of Medicine, Alazhar University, Assiut 71524, Egypt
| | - Ismail Abdelfattah M. Hassan
- Pediatric and Neonatology Specialist, New Medical Center, Royal hospital, Khalifa City, Abu Dhabi 35233, United Arab Emirates
| | - Asmaa A. Abonour
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
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15
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Kruse A, Habersack A, Jaspers RT, Schrapf N, Weide G, Svehlik M, Tilp M. Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching of the Plantar Flexors on Ankle Range of Motion and Muscle-Tendon Behavior in Children with Spastic Cerebral Palsy-A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11599. [PMID: 36141875 PMCID: PMC9517397 DOI: 10.3390/ijerph191811599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Stretching is considered a clinically effective way to prevent muscle contracture development in children with spastic cerebral palsy (CP). Therefore, in this study, we assessed the effects of a single session of proprioceptive neuromuscular facilitation (PNF) or static stretching (SS) on ankle joint range of motion (RoM) and gastrocnemius muscle-tendon behavior in children with CP. During the SS (n = 8), the ankle joint was held in maximum dorsiflexion (30 s). During the PNF stretching (n = 10), an isometric contraction (3-5 s) was performed, followed by stretching (~25 s). Ten stretches were applied in total. We collected data via dynamometry, 3D motion capture, 2D ultrasound, and electromyography, before and after the stretching sessions. A mixed ANOVA was used for the statistical analysis. Both ankle RoM and maximum dorsiflexion increased over time (F(1,16) = 7.261, p < 0.05, η² = 0.312; and F(1,16) = 4.900, p < 0.05, η² = 0.234, respectively), without any difference between groups. An interaction effect (F(1,12) = 4.768, p = 0.05, η² = 0.284) was observed for muscle-tendon unit elongation (PNF: -8.8%; SS: +14.6%). These findings suggest a positive acute effect of stretching on ankle function. However, SS acutely increased muscle-tendon unit elongation, while this decreased after PNF stretching, indicating different effects on the spastic muscles. Whether PNF stretching has the potential to cause positive alterations in individuals with CP should be elucidated in future studies.
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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, 8010 Graz, Austria
| | - Andreas Habersack
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Richard T. Jaspers
- Department of Human Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 HZ Amsterdam, The Netherlands
| | - Norbert Schrapf
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
| | - Guido Weide
- Department of Human Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 HZ Amsterdam, The Netherlands
| | - Martin Svehlik
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Markus Tilp
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
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16
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Hayami N, Williams HE, Shibagaki K, Vette AH, Suzuki Y, Nakazawa K, Nomura T, Milosevic M. Development and Validation of a Closed-Loop Functional Electrical Stimulation-Based Controller for Gait Rehabilitation Using a Finite State Machine Model. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1642-1651. [PMID: 35709114 DOI: 10.1109/tnsre.2022.3183571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Functional electrical stimulation (FES) can be used to initiate lower limb muscle contractions and has been widely applied in gait rehabilitation. Establishing the correct timing of FES activation during each phase of the gait (walking) cycle remains challenging as most FES systems rely on open-loop control, whereby the controller receives no feedback about joint kinematics and instead relies on predetermined/timed muscle stimulation. The objective of this study was to develop and validate a closed-loop FES-based control solution for gait rehabilitation using a finite state machine (FSM) model. A two-phased study approach was taken: (1) Experimentally-Informed Study: A neuromuscular-derived FSM model was developed to drive closed-loop FES-based control for gait rehabilitation. The finite states were determined using electromyography and joint kinematics data of 12 non-disabled adults, collected during treadmill walking. The gait cycles were divided into four states, namely: swing-to-stance, push off, pre-swing, and toe up. (2) Simulation Study: A closed-loop FES-based control solution that employed the resulting FSM model, was validated through comparisons of neuro-musculo-skeletal computer simulations of impaired versus healthy gait. This closed-loop controller yielded steadier simulated impaired gait, in comparison to an open-loop alternative. The simulation results confirmed that accurate timing of FES activation during the gait cycle, as informed by kinematics data, is important to natural gait retraining. The closed-loop FES-based solution, introduced in this study, contributes to the repository of gait rehabilitation control options and offers the advantage of being simplistic to implement. Furthermore, this control solution is expected to integrate well with powered exoskeleton technologies.
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17
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Bachman JF, Chakkalakal JV. Insights into muscle stem cell dynamics during postnatal development. FEBS J 2022; 289:2710-2722. [PMID: 33811430 PMCID: PMC9947813 DOI: 10.1111/febs.15856] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
Abstract
During development, resident stem cell populations contribute to the growth and maturation of tissue and organs. In skeletal muscle, muscle stem cells, or satellite cells (SCs), are responsible for the maturation of postnatal myofibers. However, the role SCs play in later stages of postnatal growth, and thus, when they enter a mature quiescent state is controversial. Here, we discuss the current literature regarding the role SCs play in all stages of postnatal growth, from birth to puberty onset to young adulthood. We additionally highlight the implications of SC loss or dysfunction during developmental stages, both in the context of experimental paradigms and disease settings.
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Affiliation(s)
- John F Bachman
- Department of Pathology and Laboratory Medicine, Cell Biology of Disease Graduate Program, University of Rochester Medical Center, Rochester NY, United States.,Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester NY, United States
| | - Joe V Chakkalakal
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester NY, United States.,Department of Biomedical Engineering, University of Rochester, Rochester NY, United States.,Wilmot Cancer Institute, University of Rochester Medical Center, Rochester NY, United States.,Stem Cell and Regenerative Medicine Institute, and The Rochester Aging Research Center, University of Rochester Medical Center, Rochester NY, United States.,Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester NY, United States
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18
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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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19
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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: 12] [Impact Index Per Article: 6.0] [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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20
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Rivares C, Vignaud A, Noort W, Koopmans B, Loos M, Kalinichev M, Jaspers RT. Glycine receptor subunit-ß -deficiency in a mouse model of spasticity results in attenuated physical performance, growth and muscle strength. Am J Physiol Regul Integr Comp Physiol 2022; 322:R368-R388. [PMID: 35108108 PMCID: PMC9054346 DOI: 10.1152/ajpregu.00242.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Spasticity is the most common neurological disorder associated with increased muscle contraction causing impaired movement and gait. The aim of this study was to characterize the physical performance, skeletal muscle function, and phenotype of mice with a hereditary spastic mutation (B6.Cg-Glrbspa/J). Motor function, gait, and physical activity of juvenile and adult spastic mice and the morphological, histological, and mechanical characteristics of their soleus and gastrocnemius medialis muscles were compared with those of their wild-type (WT) littermates. Spastic mice showed attenuated growth, impaired motor function, and low physical activity. Gait of spastic mice was characterized by a typical hopping pattern. Spastic mice showed lower muscle forces, which were related to the smaller physiological cross-sectional area of spastic muscles. The muscle-tendon complex length-force relationship of adult gastrocnemius medialis was shifted toward shorter lengths, which was explained by attenuated longitudinal tibia growth. Spastic gastrocnemius medialis was more fatigue resistant than WT gastrocnemius medialis. This was largely explained by a higher mitochondrial content in muscle fibers and relatively higher percentage of slow-type muscle fibers. Muscles of juvenile spastic mice showed similar differences compared with WT juvenile mice, but these were less pronounced than between adult mice. This study shows that in spastic mice, disturbed motor function and gait is likely to be the result of hyperactivity of skeletal muscle and impaired skeletal muscle growth, which progress with age.
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Affiliation(s)
- Cintia Rivares
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - Wendy Noort
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - Maarten Loos
- Sylics (Synaptologics BV), Amsterdam, the Netherlands
| | | | - Richard T Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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21
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Aeles J, Bolsterlee B, Kelp NY, Dick TJM, Hug F. Regional variation in lateral and medial gastrocnemius muscle fibre lengths obtained from diffusion tensor imaging. J Anat 2022; 240:131-144. [PMID: 34411299 PMCID: PMC8655206 DOI: 10.1111/joa.13539] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 01/16/2023] Open
Abstract
Assessment of regional muscle architecture is primarily done through the study of animals, human cadavers, or using b-mode ultrasound imaging. However, there remain several limitations to how well such measurements represent in vivo human whole muscle architecture. In this study, we developed an approach using diffusion tensor imaging and magnetic resonance imaging to quantify muscle fibre lengths in different muscle regions along a muscle's length and width. We first tested the between-day reliability of regional measurements of fibre lengths in the medial (MG) and lateral gastrocnemius (LG) and found good reliability for these measurements (intraclass correlation coefficient [ICC] = 0.79 and ICC = 0.84, respectively). We then applied this approach to a group of 32 participants including males (n = 18), females (n = 14), young (24 ± 4 years) and older (70 ± 2 years) adults. We assessed the differences in regional muscle fibre lengths between different muscle regions and between individuals. Additionally, we compared regional muscle fibre lengths between sexes, age groups, and muscles. We found substantial variability in fibre lengths between different regions within the same muscle and between the MG and the LG across individuals. At the group level, we found no difference in mean muscle fibre length between males and females, nor between young and older adults, or between the MG and the LG. The high variability in muscle fibre lengths between different regions within the same muscle, possibly expands the functional versatility of the muscle for different task requirements. The high variability between individuals supports the use of subject-specific measurements of muscle fibre lengths when evaluating muscle function.
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Affiliation(s)
- Jeroen Aeles
- Laboratory “Movement, Interactions, Performance” (EA 4334)Nantes UniversityNantesFrance
| | - Bart Bolsterlee
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydneyNew South WalesAustralia
| | - Nicole Y. Kelp
- School of Biomedical SciencesThe University of QueenslandBrisbaneQueenslandAustralia
| | - Taylor J. M. Dick
- School of Biomedical SciencesThe University of QueenslandBrisbaneQueenslandAustralia
| | - François Hug
- Laboratory “Movement, Interactions, Performance” (EA 4334)Nantes UniversityNantesFrance
- School of Biomedical SciencesThe University of QueenslandBrisbaneQueenslandAustralia
- Institut Universitaire de France (IUF)ParisFrance
- LAMHESSUniversité Côte d'AzurNiceFrance
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22
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Zhu J, Bolsterlee B, Chow BVY, Cai C, Herbert RD, Song Y, Meijering E. Deep learning methods for automatic segmentation of lower leg muscles and bones from MRI scans of children with and without cerebral palsy. NMR IN BIOMEDICINE 2021; 34:e4609. [PMID: 34545647 DOI: 10.1002/nbm.4609] [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: 03/15/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
Cerebral palsy is a neurological condition that is known to affect muscle growth. Detailed investigations of muscle growth require segmentation of muscles from MRI scans, which is typically done manually. In this study, we evaluated the performance of 2D, 3D, and hybrid deep learning models for automatic segmentation of 11 lower leg muscles and two bones from MRI scans of children with and without cerebral palsy. All six models were trained and evaluated on manually segmented T1 -weighted MRI scans of the lower legs of 20 children, six of whom had cerebral palsy. The segmentation results were assessed using the median Dice similarity coefficient (DSC), average symmetric surface distance (ASSD), and volume error (VError) of all 13 labels of every scan. The best performance was achieved by H-DenseUNet, a hybrid model (DSC 0.90, ASSD 0.5 mm, and VError 2.6 cm3 ). The performance was equivalent to the inter-rater performance of manual segmentation (DSC 0.89, ASSD 0.6 mm, and VError 3.3 cm3 ). Models trained with the Dice loss function outperformed models trained with the cross-entropy loss function. Near-optimal performance could be attained using only 11 scans for training. Segmentation performance was similar for scans of typically developing children (DSC 0.90, ASSD 0.5 mm, and VError 2.8 cm3 ) and children with cerebral palsy (DSC 0.85, ASSD 0.6 mm, and VError 2.4 cm3 ). These findings demonstrate the feasibility of fully automatic segmentation of individual muscles and bones from MRI scans of children with and without cerebral palsy.
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Affiliation(s)
- Jiayi Zhu
- School of Computer Science and Engineering, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia (NeuRA), Sydney, Australia
| | - Bart Bolsterlee
- Neuroscience Research Australia (NeuRA), Sydney, Australia
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Brian V Y Chow
- Neuroscience Research Australia (NeuRA), Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Chengxue Cai
- School of Computer Science and Engineering, University of New South Wales, Sydney, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Yang Song
- School of Computer Science and Engineering, University of New South Wales, Sydney, Australia
| | - Erik Meijering
- School of Computer Science and Engineering, University of New South Wales, Sydney, Australia
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23
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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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24
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Sibley LA, Broda N, Gross WR, Menezes AF, Embry RB, Swaroop VT, Chambers HG, Schipma MJ, Lieber RL, Domenighetti AA. Differential DNA methylation and transcriptional signatures characterize impairment of muscle stem cells in pediatric human muscle contractures after brain injury. FASEB J 2021; 35:e21928. [PMID: 34559924 DOI: 10.1096/fj.202100649r] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 12/26/2022]
Abstract
Limb contractures are a debilitating and progressive consequence of a wide range of upper motor neuron injuries that affect skeletal muscle function. One type of perinatal brain injury causes cerebral palsy (CP), which affects a child's ability to move and is often painful. While several rehabilitation therapies are used to treat contractures, their long-term effectiveness is marginal since such therapies do not change muscle biological properties. Therefore, new therapies based on a biological understanding of contracture development are needed. Here, we show that myoblast progenitors from contractured muscle in children with CP are hyperproliferative. This phenotype is associated with DNA hypermethylation and specific gene expression patterns that favor cell proliferation over quiescence. Treatment of CP myoblasts with 5-azacytidine, a DNA hypomethylating agent, reduced this epigenetic imprint to TD levels, promoting exit from mitosis and molecular mechanisms of cellular quiescence. Together with previous studies demonstrating reduction in myoblast differentiation, this suggests a mechanism of contracture formation that is due to epigenetic modifications that alter the myogenic program of muscle-generating stem cells. We suggest that normalization of DNA methylation levels could rescue myogenesis and promote regulated muscle growth in muscle contracture and thus may represent a new nonsurgical approach to treating this devastating neuromuscular condition.
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Affiliation(s)
| | | | | | | | - Ryan B Embry
- NUseq Core, Northwestern University, Chicago, Illinois, USA
| | - Vineeta T Swaroop
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Henry G Chambers
- Rady Children's Hospital and Health Center, San Diego, California, USA
| | - Matthew J Schipma
- Rady Children's Hospital and Health Center, San Diego, California, USA
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA.,Hines VA Medical Center, Maywood, Illinois, USA
| | - Andrea A Domenighetti
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
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25
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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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26
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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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27
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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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28
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Dykstra PB, Dayanidhi S, Chambers HG, Lieber RL. Stretch-induced satellite cell deformation incontracturedmuscles in children with cerebral palsy. J Biomech 2021; 126:110635. [PMID: 34303895 DOI: 10.1016/j.jbiomech.2021.110635] [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: 04/28/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
Satellite cells (SCs) are quiescent, adult skeletal muscle stem cells responsible for postnatal muscle growth and repair. Children with cerebral palsy (CP) have muscle contractures with reduced SC abundance, extracellular matrix abnormalities and reduced serial sarcomere number resulting in greatly increased in vivo sarcomere length, perhaps due to impaired sarcomere addition, compared to children with typical development (TD). Stretch is a strong activator of SCs that leads to addition of sarcomeres during bone-muscle growth. Mechanical loading and subsequent deformation of intracellular structures can lead to activation and proliferation, perhaps by cytoskeletal transmissions of extracellular mechanical signals to the nuclei. The primary aim of this study was to determine the effect of ex vivo stretch-induced sarcomere length change on SC deformation in children with CP and TD. Muscle biopsies were obtained from twelve children (7 CP, 5 TD) during surgery. Fiber bundles were labeled with fluorescent antibodies for Pax7 (SC), DRAQ5 (nuclei), and alpha-actinin (sarcomere protein). Fibers were stretched using a custom jig and imaged using confocal microscopy. SC nuclear length, height and aspect ratio underwent increased deformation with increasing sarcomere length (p < 0.05) in both groups. Slopes of association for SC nuclear length, aspect ratio and sarcomere lengths were similar between CP and TD. Our results indicate that SC in children with CP undergo similar deformation as TD across sarcomere lengths.
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Affiliation(s)
- Peter B Dykstra
- Department of Bioengineering, University of California, San Diego, CA, USA; Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
| | - Sudarshan Dayanidhi
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA; Department of Veterans Affairs Medical Center, San Diego, CA, USA; Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Henry G Chambers
- Department of Orthopaedics, Rady Children's Hospital, San Diego, CA, USA
| | - Richard L Lieber
- Department of Bioengineering, University of California, San Diego, CA, USA; Department of Orthopaedic Surgery, University of California, San Diego, CA, USA; Department of Orthopaedics, Rady Children's Hospital, San Diego, CA, USA; Shirley Ryan AbilityLab, Chicago, IL, USA; Edward G Hines VA Medical Center, Maywood, IL, USA.
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29
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Willerslev-Olsen M, Lorentzen J, Røhder K, Ritterband-Rosenbaum A, Justiniano M, Guzzetta A, Lando AV, Jensen AMB, Greisen G, Ejlersen S, Pedersen LZ, Andersen B, Lipthay Behrend P, Nielsen JB. COpenhagen Neuroplastic TRaining Against Contractures in Toddlers (CONTRACT): protocol of an open-label randomised clinical trial with blinded assessment for prevention of contractures in infants with high risk of cerebral palsy. BMJ Open 2021; 11:e044674. [PMID: 34230015 PMCID: PMC8261878 DOI: 10.1136/bmjopen-2020-044674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Contractures are frequent causes of reduced mobility in children with cerebral palsy (CP) already at the age of 2-3 years. Reduced muscle use and muscle growth have been suggested as key factors in the development of contractures, suggesting that effective early prevention may have to involve stimuli that can facilitate muscle growth before the age of 1 year. The present study protocol was developed to assess the effectiveness of an early multicomponent intervention, CONTRACT, involving family-oriented and supervised home-based training, diet and electrical muscle stimulation directed at facilitating muscle growth and thus reduce the risk of contractures in children at high risk of CP compared with standard care. METHODS AND ANALYSIS A two-group, parallel, open-label randomised clinical trial with blinded assessment (n=50) will be conducted. Infants diagnosed with CP or designated at high risk of CP based on abnormal neuroimaging or absent fidgety movement determined as part of General Movement Assessment, age 9-17 weeks corrected age (CA) will be recruited. A balanced 1:1 randomisation will be made by a computer. The intervention will last for 6 months aiming to support parents in providing daily individualised, goal-directed activities and primarily in lower legs that may stimulate their child to move more and increase muscle growth. Guidance and education of the parents regarding the nutritional benefits of docosahexaenic acid (DHA) and vitamin D for the developing brain and muscle growth will be provided. Infants will receive DHA drops as nutritional supplements and neuromuscular stimulation to facilitate muscle growth. The control group will receive standard care as offered by their local hospital or community. Outcome measures will be taken at 9, 12, 18, 24, 36 and 48 months CA. Primary and secondary outcome measure will be lower leg muscle volume and stiffness of the triceps surae musculotendinous unit together with infant motor profile, respectively. ETHICS AND DISSEMINATION Full approval from the local ethics committee, Danish Committee System on Health Research Ethics, Region H (H-19041562). Experimental procedures conform with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT04250454. EXPECTED RECRUITMENT PERIOD 1 January 2021-1 January 2025.
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Affiliation(s)
- Maria Willerslev-Olsen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Katrine Røhder
- Department of Psychology, Unversity of Copenhagen, Copenhagen, Denmark
| | - Anina Ritterband-Rosenbaum
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Mikkel Justiniano
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Andrea Guzzetta
- Department of Neurology, Stella Maris Institute, Pisa, Italy
| | | | | | - Gorm Greisen
- Neonatatal Department, Rigshospitalet, Kobenhavn, Denmark
| | - Sofie Ejlersen
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | | | - Britta Andersen
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | | | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
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Hassan I, Bhanudeep S, Madaan P, Chhajed M, Saini L. Bilateral Calf Hypertrophy and Isolated Motor Delay: Think Beyond Muscular Dystrophy. J Pediatr Neurosci 2021; 16:173-174. [PMID: 35018192 PMCID: PMC8706592 DOI: 10.4103/jpn.jpn_171_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ijas Hassan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Singanamalla Bhanudeep
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Priyanka Madaan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.,Council of Scientific and Industrial Research, CSIR Complex, Library Avenue, Pusa, New Delhi, India
| | | | - Lokesh Saini
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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31
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Lorentzen J, Frisk RF, Nielsen JB, Barber L. Increased Ankle Plantar Flexor Stiffness Is Associated With Reduced Mechanical Response to Stretch in Adults With CP. Front Bioeng Biotechnol 2021; 9:604071. [PMID: 33842442 PMCID: PMC8026870 DOI: 10.3389/fbioe.2021.604071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Hyperexcitable stretch reflexes are often not present despite of other signs of spasticity in people with brain lesion. Here we looked for evidence that increased resistance to length change of the plantar flexor muscle-fascicles may contribute to a reduction in the stretch reflex response in adults with cerebral palsy (CP). A total of 17 neurologically intact (NI) adults (mean age 36.1; 12 female) and 13 ambulant adults with CP (7 unilateral; mean age 33.1; 5 female) participated in the study. Subjects were seated in a chair with the examined foot attached to a foot plate, which could be moved by a computer-controlled electromotor. An ultrasound probe was placed over the medial aspect of the leg to measure the length of medial gastrocnemius muscle fascicles. Slow (7 deg/s) and fast (200 deg/s) stretches with amplitude 6 deg of the plantar flexors were applied over an ankle range of 70 deg at 10 deg intervals between 60 and 130 deg plantarflexion. It was checked by EMG electrodes that the slow stretches were sufficiently slow not to elicit any activity and that the fast stretches were sufficiently quick to elicit a maximal stretch reflex in both groups. The torque elicited by the stretches was measured together with changes in the length of medial gastrocnemius muscle fascicles. Muscle fascicles increased significantly in length with increasing dorsiflexion position in both populations (p < 0.001), but the fascicles were shorter in the CP population at all positions. Slow stretches elicited significantly larger torque and significantly smaller length change of muscle fascicles as the ankle joint position was moved more towards dorsiflexion in CP than in NI (p < 0.001). Fast stretches elicited larger torque responses at ankle joint positions of 80–100 deg in the NI than in the CP group (p < 0.01). A significant negative correlation was observed between the torque response and muscle fascicle length change to slow stretch in CP (p < 0.05), but not in NI. These findings support that increased passive resistance of the ankle plantar flexor muscle-tendon unit and development of contractures may conceal stretch reflex response in adults with CP. We argue that this should be taken into account in the neurological examination of spasticity.
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Affiliation(s)
- Jakob Lorentzen
- Department for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Foundation, Charlottenlund, Denmark
| | - Rasmus Feld Frisk
- Department for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Foundation, Charlottenlund, Denmark
| | - Jens Bo Nielsen
- Department for Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Foundation, Charlottenlund, Denmark
| | - Lee Barber
- School of Applied Health Sciences, Griffith University, Brisbane, QLD, Australia
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32
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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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33
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The mechanisms of adaptation for muscle fascicle length changes with exercise: Implications for spastic muscle. Med Hypotheses 2020; 144:110199. [PMID: 33254508 DOI: 10.1016/j.mehy.2020.110199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/10/2020] [Accepted: 08/15/2020] [Indexed: 11/23/2022]
Abstract
We are proposing optimal training conditions that can lead to an increase in the number of serial sarcomeres (SSN) and muscle fascicle length (FL) in spastic muscles. Therapeutic interventions for increasing FL in clinical populations with neurological origin, in whom relative shortness of muscle fascicles contributed to the presentation of symptoms such as spasticity, contracture, and limited functional abilities, do not generally meet these conditions, and therefore, result in less than satisfactory outcomes. Based on a review of literature, we argue that protocols of exercise interventions that led to sarcomerogenesis, and increases in SSN and FL in healthy animal and human models satisfied three criteria: 1) all involved eccentric exercise at appropriately high velocity; 2) resulted in positive strain of muscle fascicles; and 3) momentary deactivation in the stretched muscle. Accordingly, to increase FL in spastic muscles, new exercise protocols in which the three presumed criteria are satisfied, must be developed, and long-term muscle architectural and functional adaptations to such trainings must be examined.
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Weide G, Huijing PA, Bar-On L, Sloot L, Buizer AI, Becher JG, Harlaar J, Jaspers RT. Gastrocnemius Medialis Muscle Geometry and Extensibility in Typically Developing Children and Children With Spastic Paresis Aged 6-13 Years. Front Physiol 2020; 11:528522. [PMID: 33329011 PMCID: PMC7719761 DOI: 10.3389/fphys.2020.528522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022] Open
Abstract
Gait of children with spastic paresis (SP) is frequently characterized by a reduced ankle range of motion, presumably due to reduced extensibility of the triceps surae (TS) muscle. Little is known about how morphological muscle characteristics in SP children are affected. The aim of this study was to compare gastrocnemius medialis (GM) muscle geometry and extensibility in children with SP with those of typically developing (TD) children and assess how GM morphology is related to its extensibility. Thirteen children with SP, of which 10 with a diagnosis of spastic cerebral palsy and three with SP of unknown etiology (mean age 9.7 ± 2.1 years; GMFCS: I-III), and 14 TD children (mean age 9.3 ± 1.7 years) took part in this study. GM geometry was assessed using 3D ultrasound imaging at 0 and 4 Nm externally imposed dorsal flexion ankle moments. GM extensibility was defined as its absolute length change between the externally applied 0 and 4 Nm moments. Anthropometric variables and GM extensibility did not differ between the SP and TD groups. While in both groups, GM muscle volume correlated with body mass, the slope of the regression line in TD was substantially higher than that in SP (TD = 3.3 ml/kg; SP = 1.3 ml/kg, p < 0.01). In TD, GM fascicle length increased with age, lower leg length and body mass, whereas in SP children, fascicle length did not correlate with any of these variables. However, the increase in GM physiological cross-sectional area as a function of body mass did not differ between SP and TD children. Increases in lengths of tendinous structures in children with SP exceeded those observed in TD children (TD = 0.85 cm/cm; SP = 1.16 cm/cm, p < 0.01) and even exceeded lower-leg length increases. In addition, only for children with SP, body mass (r = -0.61), height (r = -0.66), muscle volume (r = - 0.66), physiological cross-sectional area (r = - 0.59), and tendon length (r = -0.68) showed a negative association with GM extensibility. Such negative associations were not found for TD children. In conclusion, physiological cross-sectional area and length of the tendinous structures are positively associated with age and negatively associated with extensibility in children with SP.
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Affiliation(s)
- Guido Weide
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Peter A. Huijing
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lizeth Sloot
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Annemieke I. Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jules G. Becher
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Richard T. Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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35
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Hösl M, Kruse A, Tilp M, Svehlik M, Böhm H, Zehentbauer A, Arampatzis A. Impact of Altered Gastrocnemius Morphometrics and Fascicle Behavior on Walking Patterns in Children With Spastic Cerebral Palsy. Front Physiol 2020; 11:518134. [PMID: 33178029 PMCID: PMC7597072 DOI: 10.3389/fphys.2020.518134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Spastic cerebral palsy (SCP) affects neural control, deteriorates muscle morphometrics, and may progressively impair functional walking ability. Upon passive testing, gastrocnemius medialis (GM) muscle bellies or fascicles are typically shorter, thinner, and less extensible. Relationships between muscle and gait parameters might help to understand gait pathology and pathogenesis of spastic muscles. The current aim was to link resting and dynamic GM morphometrics and contractile fascicle behavior (both excursion and velocity) during walking to determinants of gait. We explored the associations between gait variables and ultrasonography of the GM muscle belly captured during rest and during gait in children with SCP [n = 15, gross motor function classification system (GMFCS) levels I and II, age: 7–16 years] and age-matched healthy peers (n = 17). The SCP children’s plantar flexors were 27% weaker. They walked 12% slower with more knee flexion produced 42% less peak ankle push-off power (all p < 0.05) and 7/15 landed on their forefoot. During the stance phase, fascicles in SCP on average operated on 9% shorter length (normalized to rest length) and displayed less and slower fascicle shortening (37 and 30.6%, respectively) during push-off (all p ≤ 0.024). Correlation analyses in SCP patients revealed that (1) longer-resting fascicles and thicker muscle bellies are positively correlated with walking speed and negatively to knee flexion (r = 0.60–0.69, p < 0.0127) but not to better ankle kinematics; (2) reduced muscle strength was associated with the extent of eccentric fascicle excursion (r = −0.57, p = 0.015); and (3) a shorter operating length of the fascicles was correlated with push-off power (r = −0.58, p = 0.013). Only in controls, a correlation (r = 0.61, p = 0.0054) between slower fascicle shortening velocity and push-off power was found. Our results indicate that a thicker gastrocnemius muscle belly and longer gastrocnemius muscle fascicles may be reasonable morphometric properties that should be targeted in interventions for individuals with SCP, since GM muscle atrophy may be related to decreases in walking speed and undesired knee flexion during gait. Furthermore, children with SCP and weaker gastrocnemius muscle may be more susceptible to chronic eccentric muscle overloading. The relationship between shorter operating length of the fascicles and push-off power may further support the idea of a compensation mechanism for the longer sarcomeres found in children with SCP. Nevertheless, more studies are needed to support our explorative findings.
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Affiliation(s)
- Matthias Hösl
- Gait and Motion Analysis Laboratory, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Annika Kruse
- Department of Biomechanics, Movement and Training Sciences, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Markus Tilp
- Department of Biomechanics, Movement and Training Sciences, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Martin Svehlik
- Paediatric Orthopaedics Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Harald Böhm
- Gait Laboratory, Orthopedic Children's Hospital Aschau, Aschau im Chiemgau, Germany
| | - Antonia Zehentbauer
- Human Movement Science, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt University of Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt University of Berlin, Berlin, Germany
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Cappellini G, Sylos-Labini F, Dewolf AH, Solopova IA, Morelli D, Lacquaniti F, Ivanenko Y. Maturation of the Locomotor Circuitry in Children With Cerebral Palsy. Front Bioeng Biotechnol 2020; 8:998. [PMID: 32974319 PMCID: PMC7462003 DOI: 10.3389/fbioe.2020.00998] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022] Open
Abstract
The first years of life represent an important phase of maturation of the central nervous system, processing of sensory information, posture control and acquisition of the locomotor function. Cerebral palsy (CP) is the most common group of motor disorders in childhood attributed to disturbances in the fetal or infant brain, frequently resulting in impaired gait. Here we will consider various findings about functional maturation of the locomotor output in early infancy, and how much the dysfunction of gait in children with CP can be related to spinal neuronal networks vs. supraspinal dysfunction. A better knowledge about pattern generation circuitries in infancy may improve our understanding of developmental motor disorders, highlighting the necessity for regulating the functional properties of abnormally developed neuronal locomotor networks as a target for early sensorimotor rehabilitation. Various clinical approaches and advances in biotechnology are also considered that might promote acquisition of the locomotor function in infants at risk for locomotor delays.
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Affiliation(s)
- Germana Cappellini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Arthur H Dewolf
- Centre of Space Bio-medicine and Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Irina A Solopova
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Moscow, Russia
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Centre of Space Bio-medicine and Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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Ultrasound Imaging and Rehabilitation of Muscle Disorders: Part 2: Nontraumatic Conditions. Am J Phys Med Rehabil 2020; 99:636-644. [PMID: 31764227 DOI: 10.1097/phm.0000000000001352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Because of its several advantages, ultrasound imaging has started to take place in the diagnostic and therapeutic algorithms of a wide range of musculoskeletal disorders. After the first part on traumatic conditions, in this review, the authors aim to discuss the applicability of ultrasound imaging for nontraumatic muscle disorders in the daily clinical/academic practice. While trying to summarize the whole spectrum (e.g., myofascial pain syndrome, inflammatory diseases, neuromuscular disorders), special emphasis will be given to sarcopenia, which is, by far, the most challenging clinical condition in the era of "aging world." Of note, rehabilitation with regard to the exemplified problems will also be briefed throughout.
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38
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Michelsen JS, Lund MC, Alkjaer T, Finni T, Nielsen JB, Lorentzen J. Wearable electromyography recordings during daily life activities in children with cerebral palsy. Dev Med Child Neurol 2020; 62:714-722. [PMID: 31989593 DOI: 10.1111/dmcn.14466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 01/27/2023]
Abstract
AIM To test whether wearable textile electromyography (EMG) recording systems may detect differences in muscle activity levels during daily activities between children with cerebral palsy (CP) and age-matched typically developing children. METHOD Wearable textile EMG recording systems were used to obtain leg muscle activity in 10 children with spastic CP (four females, six males; mean age 9y 6mo, standard deviation [SD] 2y 4mo, range: 6-13y; Gross Motor Function Classification System [GMFCS] level I and II) and 11 typically developing children (four females, seven males; mean age 9y 9mo, SD 1y 11mo, 7-12y) at rest and while performing seven daily activities. RESULTS Children with CP showed significantly lower absolute EMG levels during maximal voluntary contractions (MVCs) of muscles on the most affected side as compared to the least affected side and to typically developing children. None of the typically developing children or children with CP showed detectable EMG activity in resting situations. EMG activity relative to MVC was greater in children with CP during walking, jumping, and kicking on the most affected side as compared to the least affected side and to typically developing children. INTERPRETATION Wearable textile EMG recording systems may be used to determine differences in muscle activity during daily activities in children with CP. Children with CP showed reduced muscle activity during daily activities compared to their peers, but used a significantly larger part of their maximal voluntary muscle strength to perform these activities. WHAT THIS PAPER ADDS Wearable textile electromyography (EMG) systems are feasible for measurement of daily muscle activity in children with cerebral palsy (CP). Children with CP showed reduced EMG levels during maximal voluntary contractions. Neither typically developing children or children with CP showed EMG activity in resting situations. Children with CP used a larger part of their voluntary muscle strength during daily activities.
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Affiliation(s)
| | - Mai C Lund
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Elsass Foundation, Charlottenlund, Denmark
| | - Tine Alkjaer
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Taija Finni
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jens B Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Elsass Foundation, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Elsass Foundation, Charlottenlund, Denmark
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39
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Dayanidhi S, Kinney MC, Dykstra PB, Lieber RL. 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; 478:886-899. [PMID: 32011372 PMCID: PMC7282569 DOI: 10.1097/corr.0000000000001134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Children with cerebral palsy have impaired muscle growth and muscular contractures that limit their ROM. Contractures have a decreased number of serial sarcomeres and overstretched lengths, suggesting an association with a reduced ability to add the serial sarcomeres required for normal postnatal growth. Contractures also show a markedly reduced number of satellite cells-the muscle stem cells that are indispensable for postnatal muscle growth, repair, and regeneration. The potential role of the reduced number of muscle stem cells in impaired sarcomere addition leading to contractures must be evaluated. QUESTIONS/PURPOSES (1) Does a reduced satellite cell number impair the addition of serial sarcomeres during recovery from an immobilization-induced contracture? (2) Is the severity of contracture due to the decreased number of serial sarcomeres or increased collagen content? METHODS The hindlimbs of satellite cell-specific Cre-inducible mice (Pax7; Rosa26; n = 10) were maintained in plantarflexion with plaster casts for 2 weeks so that the soleus was chronically shortened and the number of its serial sarcomeres was reduced by approximately 20%. Subsequently, mice were treated with either tamoxifen to reduce the number of satellite cells or a vehicle (an injection and handling control). The transgenic mouse model with satellite cell ablation combined with a casting model to reduce serial sarcomere number recreates two features observed in muscular contractures in children with cerebral palsy. After 30 days, the casts were removed, the mice ankles were in plantarflexion, and the mice's ability to recover its ankle ROM by cage remobilization for 30 days were evaluated. We quantified the number of serial sarcomeres, myofiber area, and collagen content of the soleus muscle as well as maximal ankle dorsiflexion at the end of the recovery period. RESULTS Mice with reduced satellite cell numbers did not regain normal ankle ROM in dorsiflexion; that is, the muscles remained in plantarflexion contracture (-16° ± 13° versus 31° ± 39° for the control group, -47 [95% confidence interval -89 to -5]; p = 0.03). Serial sarcomere number of the soleus was lower on the casted side than the contralateral side of the mice with a reduced number of satellite cells (2214 ± 333 versus 2543 ± 206, -329 [95% CI -650 to -9]; p = 0.04) but not different in the control group (2644 ± 194 versus 2729 ± 249, -85 [95% CI -406 to 236]; p = 0.97). The degree of contracture was strongly associated with the number of sarcomeres and myofiber area (r =0.80; P < 0.01) rather than collagen content. No differences were seen between groups in terms of collagen content and the fraction of muscle area. CONCLUSIONS We found that a reduced number of muscle stem cells in a transgenic mouse model impaired the muscle's ability to add sarcomeres in series and thus to recover from an immobilization-induced contracture. CLINICAL RELEVANCE The results of our study in transgenic mouse muscle suggests there may be a mechanistic relationship between a reduced number of satellite cells and a reduced number of serial sarcomeres. Contracture development, secondary to impaired sarcomere addition in muscles in children with cerebral palsy may be due to a reduced number of muscle stem cells.
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Pingel J, Harrison A, Von Walden F, Hjalmarsson E, Bartels EM. Multi-frequency bioimpedance: a non-invasive tool for muscle-health assessment of adults with cerebral palsy. J Muscle Res Cell Motil 2020; 41:211-219. [PMID: 32221759 DOI: 10.1007/s10974-020-09579-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/14/2020] [Indexed: 12/13/2022]
Abstract
Muscle contracture development is a major complication for individuals with cerebral palsy (CP) and has lifelong implications. In order to recognize contracture development early and to follow up on preventive interventions aimed at muscle health development, non-invasive, and easy to use methods are needed. The aim of the present study was to assess whether multi-frequency Bioimpedance (mfBIA) can be used to detect differences between skeletal muscle of individuals with CP and healthy controls. The mfBIA technique was applied to the medial gastrocnemius muscle of n = 24 adults with CP and n = 20 healthy controls of both genders. The phase angle (PA) and the centre frequency (fc) were significantly lower in individuals with CP when compared to controls; PA: - 25% for women and - 31.8% for men (P < 0.0001); fc: - 5.6% for women and - 5.2% for men (P < 0.009). The reactance (Xc) and the extracellular resistance (Re) of skeletal muscle from individuals with CP were significantly higher when compared to controls; Xc: + 9.9% for women and + 28.9% for men (P < 0.0001); Re: + 39.7% for women and + 91.2% for men (P < 0.0001). The present study shows that several mfBIA parameters differ significantly between individuals with CP and healthy controls. Furthermore, these changes correlated significantly with the severity of CP, as assessed using the GMFCS scale. The present data indicate that mfBIA shows promise in terms of being a useful diagnostic tool, capable of characterizing muscle health and its development in individuals with cerebral palsy.
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Affiliation(s)
- Jessica Pingel
- Department of Neuroscience, Faculty of Health & Medical Sciences, University of Copenhagen, Blegdamsvej 3.33.3.50, 2200, Copenhagen N, Denmark.
| | - Adrian Harrison
- PAS, Physiology, Faculty of Health & Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Ferdinand Von Walden
- Division of Pediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Emma Hjalmarsson
- Division of Pediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Functional Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Else Marie Bartels
- Department of Neurology & The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Falisse A, Pitto L, Kainz H, Hoang H, Wesseling M, Van Rossom S, Papageorgiou E, Bar-On L, Hallemans A, Desloovere K, Molenaers G, Van Campenhout A, De Groote F, Jonkers I. Physics-Based Simulations to Predict the Differential Effects of Motor Control and Musculoskeletal Deficits on Gait Dysfunction in Cerebral Palsy: A Retrospective Case Study. Front Hum Neurosci 2020; 14:40. [PMID: 32132911 PMCID: PMC7040166 DOI: 10.3389/fnhum.2020.00040] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/27/2020] [Indexed: 12/05/2022] Open
Abstract
Physics-based simulations of walking have the theoretical potential to support clinical decision-making by predicting the functional outcome of treatments in terms of walking performance. Yet before using such simulations in clinical practice, their ability to identify the main treatment targets in specific patients needs to be demonstrated. In this study, we generated predictive simulations of walking with a medical imaging based neuro-musculoskeletal model of a child with cerebral palsy presenting crouch gait. We explored the influence of altered muscle-tendon properties, reduced neuromuscular control complexity, and spasticity on gait dysfunction in terms of joint kinematics, kinetics, muscle activity, and metabolic cost of transport. We modeled altered muscle-tendon properties by personalizing Hill-type muscle-tendon parameters based on data collected during functional movements, simpler neuromuscular control by reducing the number of independent muscle synergies, and spasticity through delayed muscle activity feedback from muscle force and force rate. Our simulations revealed that, in the presence of aberrant musculoskeletal geometries, altered muscle-tendon properties rather than reduced neuromuscular control complexity and spasticity were the primary cause of the crouch gait pattern observed for this child, which is in agreement with the clinical examination. These results suggest that muscle-tendon properties should be the primary target of interventions aiming to restore an upright gait pattern for this child. This suggestion is in line with the gait analysis following muscle-tendon property and bone deformity corrections. Future work should extend this single case analysis to more patients in order to validate the ability of our physics-based simulations to capture the gait patterns of individual patients pre- and post-treatment. Such validation would open the door for identifying targeted treatment strategies with the aim of designing optimized interventions for neuro-musculoskeletal disorders.
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Affiliation(s)
| | - Lorenzo Pitto
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Hans Kainz
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Hoa Hoang
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | | | - Sam Van Rossom
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | | | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Orthopaedic Surgery, UZ Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Orthopaedic Surgery, UZ Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Ilse Jonkers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
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Abstract
PURPOSE OF REVIEW The goal of this review is to highlight the deficits in muscle and bone in children with cerebral palsy (CP), discuss the muscle-bone relationship in the CP population, and identify muscle-based intervention strategies that may stimulate an improvement in their bone development. RECENT FINDINGS The latest research suggests that muscle and bone are both severely underdeveloped and weak in children with CP, even in ambulatory children with mild forms of the disorder. The small and low-performing muscles and limited participation in physical activity are likely the major contributors to the poor bone development in children with CP. However, the muscle-bone relationship may be complicated by other factors, such as a high degree of fat and collagen infiltration of muscle, atypical muscle activation, and muscle spasticity. Muscle-based interventions, such as resistance training, vibration, and nutritional supplementation, have the potential to improve bone development in children with CP, especially if they are initiated before puberty. Studies are needed to identify the muscle-related factors with the greatest influence on bone development in children with CP. Identifying treatment strategies that capitalize on the relationship between muscle and bone, while also improving balance, coordination, and physical activity participation, is an important step toward increasing bone strength and minimizing fractures in children with CP.
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Affiliation(s)
- Christopher M Modlesky
- Department of Kinesiology, University of Georgia, 330 River Road, Room 353, Athens, GA, 30602, USA.
| | - Chuan Zhang
- Department of Kinesiology, University of Georgia, 330 River Road, Room 353, Athens, GA, 30602, USA
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43
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Lorentzen J, Willerslev-Olsen M, Hüche Larsen H, Farmer SF, Nielsen JB. Maturation of feedforward toe walking motor program is impaired in children with cerebral palsy. Brain 2020; 142:526-541. [PMID: 30726881 DOI: 10.1093/brain/awz002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/02/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Voluntary toe walking in adults is characterized by feedforward control of ankle muscles in order to ensure optimal stability of the ankle joint at ground impact. Toe walking is frequently observed in children with cerebral palsy, but the mechanisms involved have not been clarified. Here, we investigated maturation of voluntary toe walking in typically-developing children and typically-developed adults and compared it to involuntary toe walking in children with cerebral palsy. Twenty-eight children with cerebral palsy (age 3-14 years), 24 typically-developing children (age 2-14 years) and 15 adults (mean age 30.7 years) participated in the study. EMG activity was measured from the tibialis anterior and soleus muscles together with knee and ankle joint position during treadmill walking. In typically-developed adults, low step-to-step variability of the drop of the heel after ground impact was correlated with low tibialis anterior and high soleus EMG with no significant coupling between the antagonist muscle EMGs. Typically-developing children showed a significant age-related decline in EMG amplitude reaching an adult level at 10-12 years of age. The youngest typically-developing children showed a broad peak EMG-EMG synchronization (>100 ms) associated with large 5-15 Hz coherence between antagonist muscle activities. EMG coherence declined with age and at the age of 10-12 years no correlation was observed similar to adults. This reduction in coherence was closely related to improved step-to-step stability of the ankle joint position. Children with cerebral palsy generally showed lower EMG levels than typically-developing children and larger step-to-step variability in ankle joint position. In contrast to typically-developing children, children with cerebral palsy showed no age-related decline in tibialis anterior EMG amplitude. Motor unit synchronization and 5-15 Hz coherence between antagonist EMGs was observed more frequently in children with cerebral palsy when compared to typically-developing children and in contrast to typically-developing participants there was no age-related decline. We conclude that typically-developing children develop mature feedforward control of ankle muscle activity as they age, such that at age 10-12 years there is little agonist-antagonist muscle co-contraction around the time of foot-ground contact during toe walking. Children with cerebral palsy, in contrast, continue to co-contract agonist and antagonist ankle muscles when toe walking. We speculate that children with cerebral palsy maintain a co-contraction activation pattern when toe walking due to weak muscles and insufficient motor and sensory signalling necessary for optimization of feedforward motor programs. These findings are important for understanding of the pathophysiology and treatment of toe walking.
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Affiliation(s)
- Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | - Maria Willerslev-Olsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | | | - Simon Francis Farmer
- Department of Clinical and Movement Neuroscience, Institute of Neurology, University College London, London, UK.,Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, UK
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
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Park KB, Joo SY, Park H, Rhee I, Shin JK, Abdel-Baki SW, Kim HW. Architecture of the Triceps Surae Muscles Complex in Patients with Spastic Hemiplegia: Implication for the Limited Utility of the Silfverskiöld Test. J Clin Med 2019; 8:jcm8122096. [PMID: 31805732 PMCID: PMC6947161 DOI: 10.3390/jcm8122096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022] Open
Abstract
The Silfverskiöld test has long been used as an important tool for determining the affected muscles of the triceps surae in patients with equinus deformity. However, the test may not reflect the altered interactions between the muscles of the triceps which are affected by spasticity. The purpose of this study was to compare the architectural properties of the triceps surae muscles complex using ultrasonography, between hemiplegic patients and typically-developing children. Specifically, we wished to examine any differences in the architecture of the three muscles with various angle configurations of the knee and ankle joints. Ultrasound images of the medial gastrocnemius, lateral gastrocnemius, and soleus were acquired from paretic (group I) and non-paretic (group II) legs of ten patients and the legs (group III) of 10 age-matched normal children. A mixed model was used to evaluate the differences in the measurements of muscle architecture among the groups and the effects of various joint configurations on the measurements within the muscles. Compared to the results of measurements in groups II and III, the fascicle length was not different in the medial gastrocnemius of a paretic leg but it was longer in the lateral gastrocnemius and shorter in the soleus; the pennation angle was smaller in both medial and lateral gastrocnemii and was not different in the soleus; and the muscle thickness was found to be reduced in the three muscles of the paretic leg. Contrary to the observations in both the medial and lateral gastrocnemii, the fascicle length was increased and the pennation angle was decreased in the soleus with an increase of knee flexion. Through the current simulation study of the Silfverskiöld test using ultrasonography, we found that the changes detected in the architectural properties of the three muscles induced by systematic variations of the position at the ankle and the knee joints were variable. We believe that the limited utility of the Silfverskiöld test should be considered in determining an appropriate operative procedure to correct the equinus deformity in patients with altered architecture of the muscles in conditions such as cerebral palsy, as the differing muscle architectures of the triceps surae complex may affect the behavior of the muscles during the Silfverskiöld test.
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Affiliation(s)
- Kun-Bo Park
- Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Sun Young Joo
- Department of Orthopaedic Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Incheon 21431, Korea;
| | - Hoon Park
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (H.P.); (J.-K.S.)
| | - Isaac Rhee
- Medical course, University of Melbourne Melbourne Medical School, 3010 Melbourne, Australia;
| | - Jong-Kwan Shin
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (H.P.); (J.-K.S.)
| | - Sharkawy Wagih Abdel-Baki
- Department of Orthopaedic Surgery, Aswan University Hospital, Aswan University Faculty of Medicine, Aswan 81528, Egypt;
| | - Hyun Woo Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2228-2180
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Botulinum Toxin Injection in Children with Hemiplegic Cerebral Palsy: Correction of Growth through Comparison of Treated and Unaffected Limbs. Toxins (Basel) 2019; 11:toxins11120688. [PMID: 31771177 PMCID: PMC6950586 DOI: 10.3390/toxins11120688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 11/25/2022] Open
Abstract
Botulinum toxin type A (BoNT-A) injections in children with cerebral palsy (CP) may negatively affect muscle growth and strength. We injected BoNT-A into the affected limbs of 14 children (4.57 ± 2.28 years) with hemiplegic CP and exhibiting tip-toeing gait on the affected side and investigated the morphological alterations in the medial head of the gastrocnemius muscle (GCM). We assessed thickness of the GCM, fascicle length, and fascicle angle on the affected and unaffected sides at baseline at 4 and 12 weeks after BoNT-A injections. The primary outcome measure was the change (percentage) in GCM thickness in the affected side treated with BoNT-A in comparison with the unaffected side. The percentage of treated GCM thickness became significantly thinner at 4 and 12 weeks after BoNT-A injection than baseline. However, the percentage of fascicle length and angle in treated limbs showed no significant change from baseline 4 and 12 weeks after the injection. BoNT-A injections might reduce muscle thickness in children with spastic hemiplegic CP. Fascicle length and angle might not be affected by BoNT-A injections after correction of normal growth of the children.
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Ong CF, Geijtenbeek T, Hicks JL, Delp SL. Predicting gait adaptations due to ankle plantarflexor muscle weakness and contracture using physics-based musculoskeletal simulations. PLoS Comput Biol 2019; 15:e1006993. [PMID: 31589597 PMCID: PMC6797212 DOI: 10.1371/journal.pcbi.1006993] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/17/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022] Open
Abstract
Deficits in the ankle plantarflexor muscles, such as weakness and contracture, occur commonly in conditions such as cerebral palsy, stroke, muscular dystrophy, Charcot-Marie-Tooth disease, and sarcopenia. While these deficits likely contribute to observed gait pathologies, determining cause-effect relationships is difficult due to the often co-occurring biomechanical and neural deficits. To elucidate the effects of weakness and contracture, we systematically introduced isolated deficits into a musculoskeletal model and generated simulations of walking to predict gait adaptations due to these deficits. We trained a planar model containing 9 degrees of freedom and 18 musculotendon actuators to walk using a custom optimization framework through which we imposed simple objectives, such as minimizing cost of transport while avoiding falling and injury, and maintaining head stability. We first generated gaits at prescribed speeds between 0.50 m/s and 2.00 m/s that reproduced experimentally observed kinematic, kinetic, and metabolic trends for walking. We then generated a gait at self-selected walking speed; quantitative comparisons between our simulation and experimental data for joint angles, joint moments, and ground reaction forces showed root-mean-squared errors of less than 1.6 standard deviations and normalized cross-correlations above 0.8 except for knee joint moment trajectories. Finally, we applied mild, moderate, and severe levels of muscle weakness or contracture to either the soleus (SOL) or gastrocnemius (GAS) or both of these major plantarflexors (PF) and retrained the model to walk at a self-selected speed. The model was robust to all deficits, finding a stable gait in all cases. Severe PF weakness caused the model to adopt a slower, "heel-walking" gait. Severe contracture of only SOL or both PF yielded similar results: the model adopted a "toe-walking" gait with excessive hip and knee flexion during stance. These results highlight how plantarflexor weakness and contracture may contribute to observed gait patterns.
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Affiliation(s)
- Carmichael F. Ong
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Thomas Geijtenbeek
- Department of Biomechatronics & Human-Machine Control, Delft University of Technology, Delft, The Netherlands
| | - Jennifer L. Hicks
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Scott L. Delp
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
- Department of Mechanical Engineering, Stanford University, Stanford, California, United States of America
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, United States of America
- * E-mail:
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47
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Abstract
The interpretation of cerebral palsy (CP) is closely linked to points of view that are no longer acceptable: 1) the idea that it is primarily a motor problem (posture and movement disorder); 2) the idea that it is only a central (cerebral) pathology; 3) the idea that it is a non-progressive disease (fixed encephalopathy). Actually, the problems that contribute to producing the CP clinical picture are several and complex. First of all, building of the action, starting from subject motivation, through motor imagery and subsequent project elaboration. Sequentially, executive planning, disorder often hidden under the most remarkable alteration of motor patterns and muscle tone. Finally, realization, conditioned by the idea that the locomotor apparatus is only and always the victim of an incapable central nervous system. Little known and very neglected perceptive components can contribute to compromising subject motor control. The influences that primitive changes of musculoskeletal system, often depending on site, nature, size and time of the lesion, exert on the possible choices of the central nervous system are often overlooked. Peripheral structures can in fact modify considerably the expression of palsy (understood as the form of adaptive functions) primitively. At least six different sources of error can be identified in the cerebral palsied child. For a rehabilitative intervention with greater possibilities of effectiveness, it is necessary to recognize and evaluate each of them. Especially as regards the prevention of secondary deformities, the responsibility attributed to physiotherapy must be re-evaluated.
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Affiliation(s)
- Adriano Ferrari
- Full Professor of Physical and Rehabilitation Medicine, CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy - .,UDGEE Mother-Child Department, S. Maria Nuova Hospital, IRCCS AUSL Reggio Emilia, Reggio Emilia, Italy -
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Multani I, Manji J, Tang MJ, Herzog W, Howard JJ, Graham HK. Sarcopenia, Cerebral Palsy, and Botulinum Toxin Type A. JBJS Rev 2019; 7:e4. [DOI: 10.2106/jbjs.rvw.18.00153] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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D'Souza A, Bolsterlee B, Lancaster A, Herbert RD. Muscle architecture in children with cerebral palsy and ankle contractures: an investigation using diffusion tensor imaging. Clin Biomech (Bristol, Avon) 2019; 68:205-211. [PMID: 31255994 DOI: 10.1016/j.clinbiomech.2019.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/27/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with cerebral palsy frequently have ankle contractures which may be caused by changes in architecture of calf muscles. Here, we compared the architecture of medial gastrocnemius muscles in children with unilateral cerebral palsy and typically developing children using novel imaging techniques. METHODS AND PROCEDURES Muscle volumes, fascicle lengths, pennation angles and physiological cross-sectional areas were measured from diffusion tensor images and mDixon scans obtained from 20 ambulant children with unilateral spastic cerebral palsy who had ankle contractures (age 11 ± 3 years; mean ± standard deviation) and 20 typically developing children (11 ± 4 years). FINDINGS In children with cerebral palsy, the more-affected side had, on average, 13° less dorsiflexion range and the medial gastrocnemius muscle had 4.9 mm shorter fascicles, 50 cm3 smaller volume and 9.5 cm2 smaller physiological cross-sectional area than the less-affected side. Compared to typically developing children, the more-affected side had 10° less dorsiflexion range and the medial gastrocnemius muscle had 4.2 mm shorter fascicles, 51 cm3 smaller volume and 10 cm2 smaller physiological cross-sectional area. We did not detect differences between the less-affected and typically developing legs. INTERPRETATION Three-dimensional measurement of whole medial gastrocnemius muscles confirmed that the architecture of muscles on the more-affected side of children with cerebral palsy differs from the less-affected side and from muscles of typically developing children. Reductions in fascicle length, muscle volume and physiological cross-sectional area may contribute to muscle contracture.
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Affiliation(s)
- Arkiev D'Souza
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia.
| | - Bart Bolsterlee
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia.
| | - Ann Lancaster
- Rehab2Kids, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia.
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50
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Abstract
During the past 25 years, botulinum toxin type A (BoNT-A) has become the most widely used medical intervention in children with cerebral palsy. In this review we consider the gaps in our knowledge in the use of BoNT-A and reasons why muscle morphology and function in children with cerebral palsy are impaired. We review limitations in our knowledge regarding the mechanisms underlying the development of contractures and the difficulty in preventing them. It is clear from this review that injection of BoNT-A in the large muscles of both the upper and lower limbs of children with cerebral palsy will result in a predictable decrease in muscle activity, which is usually reported as a reduction in spasticity, for between 3 and 6 months. These changes are noted by the use of clinical tools such as the Modified Ashworth Scale and the Modified Tardieu Scale. Decreased muscle over-activity usually results in improved range of motion in distal joints. Injection of the gastrocnemius muscle for toe-walking in a child with hemiplegia or diplegia usually has the effect of increasing the passive range of dorsiflexion at the ankle. In our review, we found that this may result in a measurable improvement in gait by the use of observational gait scales or gait analysis, in some children. However, improvements in gait function are not always achieved and are small in magnitude and short lived. We found that some of the differences in outcomes in clinical trials may relate to the use of adjunctive interventions such as serial casting, orthoses, night splints and intensive therapy. We note that the majority of clinical trials of the use of BoNT-A in children with cerebral palsy have focussed on a single injection cycle and this is insufficient to understand the balance between benefit and harm. Most outcomes were reported in terms of changes in muscle tone and there were fewer studies with robust methodology that reported improvements in function. Changes in the domains of activities and participation have rarely been reported in studies to date. There were no clinical reviews to date that consider the findings of studies in human volunteers and in experimental animals and their relevance to clinical protocols. In this review we found that studies in human volunteers and in experimental animals show muscle atrophy after an injection of BoNT-A for at least 12 months. Muscle atrophy was accompanied by loss of contractile elements in muscle and replacement with fat and connective tissue. It is not currently known if these changes, mediated at a molecular level, are reversible. We conclude that there is a need to revise clinical protocols by using BoNT-A more thoughtfully, less frequently and with greatly enhanced monitoring of the effects on injected muscle for both short-term and long-term benefits and harms.
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Affiliation(s)
- Iqbal Multani
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Orthopaedic Department, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Jamil Manji
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Orthopaedic Department, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Tandy Hastings-Ison
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Hugh Williamson Gait Laboratory, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Abhay Khot
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Orthopaedic Department, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Hugh Williamson Gait Laboratory, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Kerr Graham
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
- Orthopaedic Department, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
- Hugh Williamson Gait Laboratory, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
- University of Melbourne, Parkville, Australia.
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