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Chow BVY, Morgan C, Rae C, Warton DI, Novak I, Davies S, Lancaster A, Popovic GC, Rizzo RRN, Rizzo CY, Kyriagis M, Herbert RD, Bolsterlee B. Human lower leg muscles grow asynchronously. J Anat 2024; 244:476-485. [PMID: 37917014 PMCID: PMC10862152 DOI: 10.1111/joa.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/08/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
Muscle volume must increase substantially during childhood growth to generate the power required to propel the growing body. One unresolved but fundamental question about childhood muscle growth is whether muscles grow at equal rates; that is, if muscles grow in synchrony with each other. In this study, we used magnetic resonance imaging (MRI) and advances in artificial intelligence methods (deep learning) for medical image segmentation to investigate whether human lower leg muscles grow in synchrony. Muscle volumes were measured in 10 lower leg muscles in 208 typically developing children (eight infants aged less than 3 months and 200 children aged 5 to 15 years). We tested the hypothesis that human lower leg muscles grow synchronously by investigating whether the volume of individual lower leg muscles, expressed as a proportion of total lower leg muscle volume, remains constant with age. There were substantial age-related changes in the relative volume of most muscles in both boys and girls (p < 0.001). This was most evident between birth and five years of age but was still evident after five years. The medial gastrocnemius and soleus muscles, the largest muscles in infancy, grew faster than other muscles in the first five years. The findings demonstrate that muscles in the human lower leg grow asynchronously. This finding may assist early detection of atypical growth and allow targeted muscle-specific interventions to improve the quality of life, particularly for children with neuromotor conditions such as cerebral palsy.
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Affiliation(s)
- Brian V. Y. Chow
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- School of Biomedical Sciences, University of New South WalesSydneyNew South WalesAustralia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent HealthThe University of SydneySydneyNew South WalesAustralia
| | - Caroline Rae
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- School of Psychology, University of New South WalesSydneyNew South WalesAustralia
| | - David I. Warton
- School of Mathematics and StatisticsUniversity of New South WalesSydneyNew South WalesAustralia
- Evolution & Ecology Research CentreUniversity of New South WalesSydneyNew South WalesAustralia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent HealthThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Suzanne Davies
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
| | - Ann Lancaster
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
| | - Gordana C. Popovic
- Stats Central, Mark Wainwright Analytical CentreUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rodrigo R. N. Rizzo
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- School of Biomedical Sciences, University of New South WalesSydneyNew South WalesAustralia
| | - Claudia Y. Rizzo
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
| | - Maria Kyriagis
- Rehab2Kids, Sydney Children's HospitalSydneyNew South WalesAustralia
| | - Robert D. Herbert
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- School of Biomedical Sciences, University of New South WalesSydneyNew South WalesAustralia
| | - Bart Bolsterlee
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- Graduate School of Biomedical Engineering, University of New South WalesSydneyNew South WalesAustralia
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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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Tobaiqi MA, Albadawi EA, Fadlalmola HA, Albadrani MS. Application of Virtual Reality-Assisted Exergaming on the Rehabilitation of Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7091. [PMID: 38002703 PMCID: PMC10672287 DOI: 10.3390/jcm12227091] [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: 09/27/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Rehabilitation programs for children with cerebral palsy (CP) aim to improve their motor and cognitive skills through repeated and progressively challenging exercises. However, these exercises can be tedious and demotivating, which can affect the effectiveness and feasibility of the programs. To overcome this problem, virtual reality VR-assisted exergaming has emerged as a novel modality of physiotherapy that combines fun and motivation with physical activity. VR exergaming allows children with CP to perform complex movements in a secure and immersive environment, where they can interact with virtual objects and scenarios. This enhances their active engagement and learning, as well as their self-confidence and enjoyment. We aim to provide a comprehensive overview of the current state of research on VR exergaming for CP rehabilitation. The specific objectives are: To identify and describe the existing studies that have investigated the effects of VR exergaming on motor function and participation outcomes in children with CP. In addition, we aim to identify and discuss the main gaps, challenges, and limitations in the current research on VR exergaming for CP rehabilitation. Finally, we aim to provide recommendations and suggestions for future research and practice in this field. METHODS In June 2023, we conducted a systematic search on Scopus, Web of Science, PubMed, Cochrane, and Embase for randomized trials and cohort studies that applied VR-assisted exergaming to rehabilitating patients with CP. The inclusion criteria encompassed the following: (1) Randomized controlled trials (RCTs) and cohort studies involving the rehabilitation of children with CP; (2) the application of VR-based exergaming on the rehabilitation; (3) in comparison with conventional rehabilitation/usual care. The quality of the selected RCTs was evaluated using Cochrane's tool for risk of bias assessment bias includes. Whereas the quality of cohort studies was assessed using the National Institutes of Health (NIH) tool. RESULTS The systematic search of databases retrieved a total of 2576 studies. After removing 863 duplicates, 1713 studies underwent title and abstract screening, and 68 studies were then selected as eligible for full-text screening. Finally, 45 studies were involved in this review (n = 1580), and 24 of those were included in the quantitative analysis. The majority of the included RCTs had a low risk of bias regarding study reporting, participants' attrition, and generating a random sequence. Nearly half of the RCTs ensured good blinding of outcomes assessors. However, almost all the RCTs were unclear regarding the blinding of the participants and the study personnel. The 2020 retrospective cohort study conducted at Samsung Changwon Hospital, investigating the effects of virtual reality-based rehabilitation on upper extremity function in children with cerebral palsy, demonstrated fair quality in its methodology and findings. VR-assisted exergaming was more effective than conventional physiotherapy in improving the Gross Motor Function Measurement (GMFM)-88 score (MD = 0.81; 95% CI [0.15, 1.47], p-value = 0.02) and the GMFM walking and standing dimensions (MD = 1.45; 95% CI [0.48, 2.24], p-value = 0.003 and MD = 3.15; 95% CI [0.87, 5.42], p-value = 0.007), respectively. The mobility and cognitive domains of the Pediatric Evaluation of Disability Inventory score (MD = 1.32; 95% CI [1.11, 1.52], p-value < 0.001) and (MD = 0.81; 95% CI [0.50, 1.13], p-value < 0.0001) were also improved. The Canadian Occupational Performance Measure performance domain (MD = 1.30; 95% CI [1.04, 1.56], p-value < 0.001), the WeeFunctional Independence Measure total score (MD = 6.67; 95% CI [6.36, 6.99], p-value < 0.0001), and the Melbourne Assessment of Unilateral Upper Limb Function-2 score (p-value < 0.001) improved as well. This new intervention is similarly beneficial as conventional therapy in improving other efficacy measures. CONCLUSIONS Our findings suggest that VR-assisted exergaming may have some advantages over conventional rehabilitation in improving CP children's functioning and performance in daily life activities, upper and lower limb mobility, and cognition. VR-assisted exergaming seems to be as effective as conventional physiotherapy in the other studied function measures. With its potential efficacy, better feasibility, no reported side effects, and entertaining experience, VR-assisted exergaming may be a viable complementary approach to conventional physiotherapy in rehabilitating children with CP.
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Affiliation(s)
- Muhammad Abubaker Tobaiqi
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia
| | - Emad Ali Albadawi
- Department of Anatomy, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia;
| | - Hammad Ali Fadlalmola
- Department of Community Health Nursing, Nursing College, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia;
| | - Muayad Saud Albadrani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia
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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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Davico G, Lloyd DG, Carty CP, Killen BA, Devaprakash D, Pizzolato C. Multi-level personalization of neuromusculoskeletal models to estimate physiologically plausible knee joint contact forces in children. Biomech Model Mechanobiol 2022; 21:1873-1886. [PMID: 36229699 DOI: 10.1007/s10237-022-01626-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/05/2022] [Indexed: 11/02/2022]
Abstract
Neuromusculoskeletal models are a powerful tool to investigate the internal biomechanics of an individual. However, commonly used neuromusculoskeletal models are generated via linear scaling of generic templates derived from elderly adult anatomies and poorly represent a child, let alone children with a neuromuscular disorder whose musculoskeletal structures and muscle activation patterns are profoundly altered. Model personalization can capture abnormalities and appropriately describe the underlying (altered) biomechanics of an individual. In this work, we explored the effect of six different levels of neuromusculoskeletal model personalization on estimates of muscle forces and knee joint contact forces to tease out the importance of model personalization for normal and abnormal musculoskeletal structures and muscle activation patterns. For six children, with and without cerebral palsy, generic scaled models were developed and progressively personalized by (1) tuning and calibrating musculotendon units' parameters, (2) implementing an electromyogram-assisted approach to synthesize muscle activations, and (3) replacing generic anatomies with image-based bony geometries, and physiologically and physically plausible muscle kinematics. Biomechanical simulations of gait were performed in the OpenSim and CEINMS software on ten overground walking trials per participant. A mixed-ANOVA test, with Bonferroni corrections, was conducted to compare all models' estimates. The model with the highest level of personalization produced the most physiologically plausible estimates. Model personalization is crucial to produce physiologically plausible estimates of internal biomechanical quantities. In particular, personalization of musculoskeletal anatomy and muscle activation patterns had the largest effect overall. Increased research efforts are needed to ease the creation of personalized neuromusculoskeletal models.
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Affiliation(s)
- Giorgio Davico
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy. .,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. .,School of Allied Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
| | - David G Lloyd
- School of Allied Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Christopher P Carty
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Orthopaedics, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Bryce A Killen
- School of Allied Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Daniel Devaprakash
- School of Allied Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Claudio Pizzolato
- School of Allied Health Sciences and Social Work, Griffith University, Gold Coast, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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6
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Longitudinal muscle growth in young children with spastic cerebral palsy: Evolution of medial gastrocnemius muscle volume. Gait Posture 2022. [DOI: 10.1016/j.gaitpost.2022.07.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Jung YG, Chang HJ, Jo ES, Kim DH. The Effect of a Horse-Riding Simulator with Virtual Reality on Gross Motor Function and Body Composition of Children with Cerebral Palsy: Preliminary Study. SENSORS 2022; 22:s22082903. [PMID: 35458888 PMCID: PMC9029300 DOI: 10.3390/s22082903] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
This study aimed to evaluate the effect of a horse-riding simulator (HRS) with virtual reality (VR) on gross motor function, balance control, and body composition in children with spastic cerebral palsy (CP). Seventeen preschool and school-aged children with spastic CP were included; 10 children in the intervention group (HRS group) received 30 min of HRS with VR training twice a week for a total of 16 sessions in addition to conventional physiotherapy. Seven children in the control group were instructed to perform home-based aerobic exercises twice a week for 8 weeks in addition to conventional physiotherapy. Gross motor function measure (GMFM) and body composition were evaluated before the first session and after the last session. Before and after the 2-month intervention, Pediatric Balance Scale and Timed Up and Go test were evaluated for the HRS group. GMFM scores and body composition changed significantly in the HRS group (p < 0.05). However, no significant differences were observed in the control group. Changes in the GMFM total scores, GMFM dimension D scores, and skeletal muscle mass significantly differed between the HRS and control groups (p < 0.05). HRS with VR may be an effective adjunctive therapeutic approach for the rehabilitation of children with CP.
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Affiliation(s)
- Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Hyun Jung Chang
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, School of Medicine, Sungkyunkwan University, Changwon 51353, Korea; (E.S.J.); (D.H.K.)
- Correspondence: ; Tel.: +82-55-233-5996
| | - Eun Sol Jo
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, School of Medicine, Sungkyunkwan University, Changwon 51353, Korea; (E.S.J.); (D.H.K.)
| | - Da Hye Kim
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, School of Medicine, Sungkyunkwan University, Changwon 51353, Korea; (E.S.J.); (D.H.K.)
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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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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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Jensen AK, Low CE, Pal P, Raczynski TN. Relation of Musculoskeletal Strength and Function to Postural Stability in Ambulatory Adults With Cerebral Palsy. Arch Rehabil Res Clin Transl 2021; 2:100074. [PMID: 33543099 PMCID: PMC7853373 DOI: 10.1016/j.arrct.2020.100074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Objective To understand the relation of musculoskeletal strength and function to postural stability in ambulatory adults with cerebral palsy (CP) who have already developed muscle atrophy and osteoporosis. Design Two independent group comparison of adults with CP and those without it. Setting Laboratory study. Participants Thirteen adults with CP with sex (9 women: 4 men), age (21-62y), and Gross Motor Function Classification System I-III, and 13 sex-, age-, and body-weight-matched control participants completed our study (N=26). Intervention Not applicable. Main Outcome Measure Bone mineral density (BMD), structural or geometrical deformities (at the proximal region of the femur at the hip joint), and maximal muscular strength (forearm and thigh) were measured. The primary outcome measure was postural stability (balance measured using an automated balance system and a Berg Balance Test). Results Femoral BMD was significantly lower in the CP group compared to the control group, whereas BMD at lumbar and forearm regions was similar between groups. Geometrical angles, lengths, and diameters at the proximal femur were significantly lower in the CP group. There was a direct relation between BMD in the femoral neck and knee extension peak torque in the control group with no relation in the CP group. Although the control group did not show a relation between muscular strength and balance test, the CP group showed a significant linear relation among improving postural stability with greater levels of muscular strength. Conclusion There were structural differences at the proximal femur and muscular weakness in adults with CP. In adults with CP, balance appears to be more influenced by structural alterations at the femur than muscular strength compared to the control group.
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Affiliation(s)
- Areum K Jensen
- Department of Kinesiology, San José State University, San José, CA
| | - Cory E Low
- Department of Kinesiology, San José State University, San José, CA
| | - Pooja Pal
- Department of Kinesiology, San José State University, San José, CA
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11
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Duran I, Martakis K, Stark C, Schafmeyer L, Rehberg M, Schoenau E. Effect of an interval rehabilitation program with home-based, vibration-assisted training on the development of muscle and bone in children with cerebral palsy - an observational study. J Pediatr Endocrinol Metab 2020; 33:/j/jpem.ahead-of-print/jpem-2020-0080/jpem-2020-0080.xml. [PMID: 32653878 DOI: 10.1515/jpem-2020-0080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/21/2020] [Indexed: 11/15/2022]
Abstract
Objectives In children with cerebral palsy (CP), the most common cause of physical impairment in childhood, less muscle and bone growth has been reported, when compared with typically developing children. The aim of this study was to evaluate the effect of an intensive rehabilitation program including physiotherapy in combination with 6 months of home-based, vibration-assisted training on muscle and bone growth in children with CP. Methods We included children with CP, who participated in a rehabilitation program utilizing whole-body vibration (WBV). Muscle mass was quantified by appendicular lean mass index (App-LMI) and bone mass by total-body-less-head bone mineral content (TBLH-BMC) assessed by Dual-energy X-ray absorptiometry (DXA) at the beginning of rehabilitation and one year later. To assess the functional muscle-bone unit, the relation of TBLH-BMC to TBLH lean body mass (TBLH-LBM) was used. Results The study population included 128 children (52 females, mean age 11.9 ± 2.7). App-LMI assessed in kg/m2 increased significantly after rehabilitation. The age-adjusted Z-score for App-LMI showed no significant change. TBLH-BMC assessed in gram increased significantly. The Z-scores for TBLH-BMC decreased lesser than expected by the evaluation of the cross-sectional data at the beginning of rehabilitation. The parameter T B L H - B M C T B L H - L B M $\frac{TBLH-BMC}{TBLH-LBM}$ did not change relevantly after 12 months. Conclusions Muscle growth and to a lesser extent bone growth could be increased in children with CP. The intensive rehabilitation program including WBV seemed to have no direct effect on the bone, but the observed anabolic effect on the bone, may only been mediated through the muscle.
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Affiliation(s)
- Ibrahim Duran
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, Cologne, Germany
| | - Kyriakos Martakis
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany
- Maastricht University, Department of International Health, School CAPHRI, Care and Public Health Research Institute, Maastricht, The Netherlands
- Justus-Liebig University, UKGM, Department for Pediatric Neurology, Epileptology and Social Pediatrics, Giessen, Germany
| | - Christina Stark
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany
- University of Cologne, Medical Faculty and University Hospital, Cologne Centre for Musculoskeletal Biomechanics (CCMB), Cologne, Germany
| | - Leonie Schafmeyer
- University of Oldenburg, Medical Faculty and University Hospital, Department of Pediatrics, Oldenburg, Germany
| | - Mirko Rehberg
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany
| | - Eckhard Schoenau
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, Cologne, Germany
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany
- University of Cologne, Medical Faculty and University Hospital, Cologne Centre for Musculoskeletal Biomechanics (CCMB), Cologne, Germany
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Duran I, Martakis K, Rehberg M, Stark C, Koy A, Schoenau E. The Appendicular Lean Mass Index Is a Suitable Surrogate for Muscle Mass in Children with Cerebral Palsy. J Nutr 2019; 149:1863-1868. [PMID: 31204786 DOI: 10.1093/jn/nxz127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/22/2019] [Accepted: 05/16/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Densitometrically measured lean body mass (LBM) is often used to quantify skeletal muscle mass in children with cerebral palsy (CP). Since LBM depends on the individual's height, the evaluation of $\frac{{{\rm{LBM}}}}{{heigh{t^2}}}\ $ (lean BMI) is often recommended. However, LBM includes not only skeletal muscle mass but also the mass of skin, internal organs, tendons, and other components. This limitation applies to a far lesser extent to the appendicular lean mass index (LMIapp). OBJECTIVES The aim of the study was to evaluate skeletal muscle mass in children with CP using total lean BMI (LMItot) and LMIapp. METHODS The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation program. In total, 329 children with CP [148 females; Gross Motor Function Classification Scale (GMFCS) I, 32 children; GMFCS II, 73 children; GMFCS III, 133 children; GMFCS IV, 78 children; and GMFCS V, 13 children] were eligible for analysis. The mean age was 12.3 ± 2.75 y. Pediatric reference centiles for age-adjusted LMIapp were generated using data from NHANES 1999-2004. Low skeletal muscle mass was defined as a z score for DXA determined LMItot and LMIapp less than or equal to -2.0. RESULTS The z scores for LMIapp were significantly lower than LMItot in children with CP, GMFCS levels II-V (P < 0.001), with the exception of GMFCS level I (P = 0.121), where no significant difference was found. The prevalence of low LMItot (16.1%; 95% CI: 16.1, 20.1%) was significantly lower (P < 0.001) than the prevalence of LMIapp (42.2%; 95% CI: 36.9, 47.9%) in the study population. CONCLUSIONS The prevalence of low skeletal muscle mass in children with CP might be underestimated by LMItot. LMIapp is more suitable for the evaluation of skeletal muscle mass in children with CP.
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Affiliation(s)
- Ibrahim Duran
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Cologne, Germany
| | - Kyriakos Martakis
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany.,Maastricht University, Department of International Health, School CAPHRI, Care and Public Health Research Institute, Maastricht, Netherlands.,Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Mirko Rehberg
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany
| | - Christina Stark
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany.,University of Cologne, Medical Faculty and University Hospital, Cologne Centre for Musculoskeletal Biomechanics, Cologne, Germany
| | - Anne Koy
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany
| | - Eckhard Schoenau
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Cologne, Germany.,University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany
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Body Composition and Acquired Functional Impairment in Survivors of Pediatric Critical Illness. Crit Care Med 2019; 47:e445-e453. [DOI: 10.1097/ccm.0000000000003720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Gillett JG, Lichtwark GA, Boyd RN, Carty CP, Barber LA. The effect of combined functional anaerobic and strength training on treadmill gait kinematics and kinetics in ambulatory young adults with cerebral palsy. Gait Posture 2019; 70:323-329. [PMID: 30947107 DOI: 10.1016/j.gaitpost.2019.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/25/2019] [Accepted: 03/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Leg muscle weakness is a major impairment for individuals with cerebral palsy (CP) and is related to reduced functional capacity. Evidence is limited regarding the translation of strength improvements following conventional resistance training to improved gait outcomes. RESEARCH QUESTION Does a combined functional anaerobic and lower limb strength training intervention improve gait kinematics and kinetics in individuals with CP aged 15-30 years? 17 young adults (21 ± 4 years, 9 males, GMFCS I = 11, II = 6) were randomized to 12 weeks, 3 sessions per week, of high intensity functional anaerobic and progressive resistance training of the lower limbs (n = 8), or a waitlist control group (n = 9). Pre- and post-training outcomes included maximum ankle dorsiflexion angle at foot contact and during stance, gait profile score, ankle and hip power generation during late stance, and the ratio of ankle to hip power generation. RESULTS There were no between-group differences after the intervention for any kinematic or kinetic gait outcome variable. Within-group analysis revealed an increase in peak ankle power during late stance (0.31 ± 0.28 W·kg-1, p = 0.043) and ankle to hip power ratio (0.43 ± 0.37, p = 0.034) following training in the intervention group. SIGNIFICANCE We have previously reported increased overground walking capacity, agility and sprint power, in the training group compared to the control group at 12-weeks. These changes in overground measures of functional capacity occurred in the absence of changes in treadmill gait kinematics and kinetics reported here. ANZCTR 12614001217695.
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Affiliation(s)
- Jarred G Gillett
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia.
| | - Glen A Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia.
| | - Christopher P Carty
- School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Queensland Children's Motion Analysis Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia; Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.
| | - Lee A Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia; School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia.
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Sahrmann AS, Stott NS, Besier TF, Fernandez JW, Handsfield GG. Soleus muscle weakness in cerebral palsy: Muscle architecture revealed with Diffusion Tensor Imaging. PLoS One 2019; 14:e0205944. [PMID: 30802250 PMCID: PMC6388915 DOI: 10.1371/journal.pone.0205944] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/24/2019] [Indexed: 11/28/2022] Open
Abstract
Cerebral palsy (CP) is associated with movement disorders and reduced muscle size. This latter phenomenon has been observed by computing muscle volumes from conventional MRI, with most studies reporting significantly reduced volumes in leg muscles. This indicates impaired muscle growth, but without knowing muscle fiber orientation, it is not clear whether muscle growth in CP is impaired in the along-fiber direction (indicating shortened muscles and limited range of motion) or the cross-fiber direction (indicating weak muscles and impaired strength). Using Diffusion Tensor Imaging (DTI) we can determine muscle fiber orientation and construct 3D muscle architectures which can be used to examine both along-fiber length and cross-sectional area. Such an approach has not been undertaken in CP. Here, we use advanced DTI sequences with fast imaging times to capture fiber orientations in the soleus muscle of children with CP and age-matched, able-bodied controls. Cross sectional areas perpendicular to the muscle fiber direction were reduced (37 ± 11%) in children with CP compared to controls, indicating impaired muscle strength. Along-fiber muscle lengths were not different between groups. This study is the first to demonstrate along-fiber and cross-fiber muscle architecture in CP using DTI and implicates impaired cross-sectional muscle growth in children with cerebral palsy.
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Affiliation(s)
- Annika S. Sahrmann
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Ngaire Susan Stott
- Department of Orthopaedic Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Thor F. Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
| | - Justin W. Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
| | - Geoffrey G. Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- * E-mail:
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GILLETT JARREDG, LICHTWARK GLENA, BOYD ROSLYNN, BARBER LEEA. Functional Anaerobic and Strength Training in Young Adults with Cerebral Palsy. Med Sci Sports Exerc 2018; 50:1549-1557. [DOI: 10.1249/mss.0000000000001614] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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