scholarly journals The Contribution of Decreased Muscle Size to Muscle Weakness in Children With Spastic Cerebral Palsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Britta Hanssen ◽  
Nicky Peeters ◽  
Ines Vandekerckhove ◽  
Nathalie De Beukelaer ◽  
Lynn Bar-On ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Muscle Weakness ◽  
Plantar Flexion ◽  
Joint Torque ◽  
Muscle Size ◽  
Spastic Cerebral Palsy ◽  
Regression Equations ◽  
Plantar Flexors ◽  
Cross Sectional ◽  
Large Variability

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.

Effects of plantar flexor muscle weakness on children with spastic cerebral palsy – Pilot study

2020 ◽  
Vol 81 ◽  
pp. 340-341
Author(s):  
R. Sert ◽  
N.E. Akalan ◽  
K. Onerge ◽  
C. Sardogan ◽  
F. Bilgili
Keyword(s):  
Cerebral Palsy ◽  
Pilot Study ◽  
Muscle Weakness ◽  
Spastic Cerebral Palsy ◽  
Plantar Flexor ◽  
Flexor Muscle

Effect of floor reaction ankle–foot orthosis on crouch gait in patients with cerebral palsy: What can be expected?

2017 ◽  
Vol 42 (3) ◽  
pp. 245-253 ◽  
Author(s):  
Harald Böhm ◽  
Hösl Matthias ◽  
Frank Braatz ◽  
Leonhard Döderlein
Keyword(s):  
Cerebral Palsy ◽  
Standard Deviation ◽  
Knee Extension ◽  
Spastic Cerebral Palsy ◽  
Foot Orthoses ◽  
Cross Sectional ◽  
Positive Effects ◽  
Foot Progression Angle ◽  
Ankle Foot Orthoses ◽  
Crouch Gait

Background: Floor reaction ankle–foot orthoses are commonly prescribed to improve knee extension of children with cerebral palsy having crouch gait. Their effectiveness is debated. Therefore, the objective of this study is to optimize current prescription criteria for the improvement of crouch gait. Study design: Cross-sectional interventional study. Methods: A total of 22 patients with bilateral spastic cerebral palsy, between 6 and 17 years, Gross Motor Function Classification System II–IV participated in this study. Instrumented gait analysis was done under three conditions: barefoot, shoed, and with orthotics. Patients were divided into two groups: good and non-responders with more and less than 8.8° improvement of knee extension during walking, respectively. A multiple predictor analysis was done on parameters that were different between groups. Results: In total, 12 of 22 patients showed good response in knee extension with a mean change of 17° (standard deviation = 5°). Good responders showed a significantly smaller walking velocity, knee extension strength, ankle plantarflexion strength, and greater external foot progression angle compared to non-responders. Foot progression angle together with ankle plantarflexion strength explained 37% of the variance in improvement of knee extension. Conclusion: With appropriate patient selection, an improvement of crouch gait by ankle–foot orthoses of 17° (standard deviation = 5°) can be expected. Patients with slow velocity, weak plantarflexors, and external foot progression benefit most. Joint contractures were no contraindications. Clinical relevance This study showed that gait in patients with low functional level benefit most from ankle–foot orthoses. Unlike in patients with higher functional status, contractures of hip, knee, and ankle did not reduce the positive effects on gait. The suggested prescription criteria may help to better select appropriate patients for orthotics.

scholarly journals Detection of body postures and movements in ambulatory adults with cerebral palsy: a novel and valid measure of physical behaviour

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Everett A. Claridge ◽  
Rita J. G. van den Berg-Emons ◽  
Herwin L. D. Horemans ◽  
Wilma M. A. van der Slot ◽  
Nick van der Stam ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Objective Measure ◽  
Correlation Coefficients ◽  
Criterion Validity ◽  
Spastic Cerebral Palsy ◽  
Relative Time ◽  
Primary Position ◽  
Cross Sectional ◽  
Body Postures ◽  
Physical Behaviour

Abstract Background Accurate measurement of physical behaviour is paramount to better understand lifestyle, health, and functioning, particularly in adults with physical disability as they may be at higher risk of sedentary lifestyle and subsequent negative health consequences. This study aimed: 1) to evaluate the criterion validity of a novel and clinically applicable activity monitor (AM, Activ8), in the detection of body postures and movements in adults with spastic cerebral palsy (CP); and 2) to evaluate the extent that the AM’s positioning affects validity. Methods In this cross-sectional study, 14 ambulatory adults with CP [9 men; mean (SD) age, 35.4 (13.1) years] performed standardized activities while wearing three Activ8 monitors - frontolateral thigh (primary position), frontal thigh, and pant pocket - and being video recorded (criterion measure). AM activity output was compared to synchronized video recordings. Absolute (seconds) and relative [(video time–AM time)/mean time, %] time differences between methods were calculated. Relative time differences of < 10% were indicative of good validity. Comparison of AM attachment positions was completed using Spearman Rho correlation coefficients and Meng’s tests. Results Criterion validity of the AM (frontolateral thigh) was good (average relative time differences: 0.25% for sitting, 4.69% for standing, 2.46% for walking, 1.96% for upright activity, 3.19% for cycling), except for running (34.6%). Spearman Rho correlation coefficients were greater between video/frontolateral thigh position than video/frontal thigh position and video/pant pocket position for body posture and movement categories sitting, standing, walking, and upright activity (p < 0.01 for all). Conclusions The AM, positioned on the frontolateral thigh, demonstrated good criterion validity in ambulatory adults with CP. Though the Activ8 offers potential as an objective measure of physical activity, appropriate positioning is paramount for valid measurement.

Skeletal muscle metabolism during short-term, high-intensity exercise in prepubertal and pubertal girls

1999 ◽  
Vol 87 (6) ◽  
pp. 2151-2156 ◽  
Author(s):  
S. R. Petersen ◽  
C. A. Gaul ◽  
M. M. Stanton ◽  
C. C. Hanstock
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Spectroscopy ◽  
Plantar Flexion ◽  
Work Capacity ◽  
Calf Muscle ◽  
Muscle Size ◽  
Resonance Spectroscopy ◽  
Supramaximal Exercise ◽  
Glycolytic Metabolism ◽  
Cross Sectional

To test the hypothesis that glycolytic metabolism in muscle is attenuated in prepubertal children,31P-magnetic resonance spectroscopy was used to determine calf muscle intracellular pH (pHi) in nine prepubertal (Pre) and nine pubertal female swimmers (Pub). Maximal plantar flexion work capacity (100% MWC) was established by using a graded exercise test. Between 5 and 10 days later, calf muscle images (magnetic resonance imaging) and phosphorus spectra were acquired at rest, during 2 min of light exercise (40% MWC), and during 2 min of supramaximal exercise (140% MWC) in a 3.0-T NMR system. End-exercise pHi was 6.66 ± 0.11 and 6.76 ± 0.17 for Pub and Pre, respectively. No significant differences in the mean values for pHi or the Pi-to-phosphocreatine ratio were observed between groups during the protocol; however, an interaction effect was found for the Pi-to-phosphocreatine ratio during the supramaximal exercise challenge. Cross-sectional area of gastrocnemius was 15.12 ± 0.46 and 9.37 ± 0.37 cm2 for Pub and Pre, respectively ( P < 0.05). Differences in muscle size must be considered when interpreting the unlocalized magnetic resonance spectroscopy data. These results suggest that glycolytic metabolism in physically active children is not maturity dependent.

scholarly journals Plantar flexor moment arm and muscle volume predict torque-generating capacity in young men

2014 ◽  
Vol 116 (5) ◽  
pp. 538-544 ◽  
Author(s):  
Josh R. Baxter ◽  
Stephen J. Piazza
Keyword(s):  
Plantar Flexion ◽  
Young Men ◽  
Knee Extensor ◽  
Muscle Volume ◽  
Joint Torque ◽  
Muscle Size ◽  
Plantar Flexor ◽  
Moment Arm ◽  
Joint Rotation ◽  
Moment Arms

Muscle volume is known to correlate with maximal joint torque in humans, but the role of muscle moment arm in determining maximal torque is less clear. Moderate correlations have been reported between maximal isometric knee extensor torque and knee extensor moment arm, but no such observations have been made for the ankle joint. It has been suggested that smaller muscle moment arms may enhance force generation at high rates of joint rotation, but this has not yet been observed for ankle muscles in vivo. The purpose of the present study was to correlate plantar flexor moment arm and plantar flexor muscle volume with maximal plantar flexor torque measured at different rates of plantar flexion. Magnetic resonance imaging was used to quantify the plantar flexor moment arm and muscle volume of the posterior compartment in 20 healthy young men. Maximal plantar flexor torque was measured isometrically and at three plantar flexion speeds using an isokinetic dynamometer. Plantar flexor torque was significantly correlated with muscle volume (0.222 < R2 < 0.322) and with muscle moment arm at each speed (0.323 < R2 < 0.494). While muscle volume was strongly correlated with body mass and stature, moment arm was not. The slope of the torque-moment arm regression line decreased as the rate of joint rotation increased, indicating that subjects with small moment arms experienced smaller reductions in torque at high speeds. The findings of this study suggest that plantar flexor moment arm is a determinant of joint strength that is at least as important as muscle size.

scholarly journals CEREBRAL PALSY;

2014 ◽  
Vol 21 (06) ◽  
pp. 1166-1170
Author(s):  
Naeem Mohammad Mansha ◽  
Sumair Anwar ◽  
Itaat Ullah Khan Afridi ◽  
Shazia Maqbool
Keyword(s):  
Cerebral Palsy ◽  
Developmental Delay ◽  
Postural Balance ◽  
Cross Sectional Study ◽  
Spastic Cerebral Palsy ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Different Types ◽  
The Brain

Background: Cerebral Palsy is a disorder of movement and postural balance due to insult to the brain. The injury to the developing brain may be prenatal, natal or postnatal. The diagnosis is clinical mainly. The spastic Cerebral Palsy is classified into monoplegic, hemiplegic, diplegic, and quadriplegic types. There is a difference in the frequency of these types of Cerebral Palsy in different studies. The patterns of various forms of Cerebral Palsy emerge gradually with a delay in developmental milestones. A spectrum of associated developmental disabilities has been found to be common in these children. Management is through a multi-disciplinary approach. Objectives: To find out the frequency of different types of Cerebral Palsy and degree of associated developmental delay. Methodology: A cross sectional study was carried out for a period of six months (October 1, 2006 to March 31, 2007) at The Children’s Hospital & Institute of Child Health Lahore. 100 Cases diagnosed as Cerebral Palsy on clinical basis were assessed for the type of cerebral palsy and the degree of associated developmental delay. Results: Out of the total 100 patients 54% had quadriplegia, 32% had diplegia, 10% had himiplegia and 4% had monoplegia. The total fifty-four cases of quadriplegic cerebral palsy 54 had developmental delay and amongst them 4 (7%) had mild delay, 16 (30%) had moderate delay while 34 (63%) had severe delay. Amongst the total forty-six other three types of cerebral palsy 12 (26%) had mild delay, 6 (13%) had moderate delay and 28 (61%) had severe delay. The P-value was >0.05. Conclusions: Quadriplegic is the commonest type of CP, associated with the factors (peri-natal more than socio-demographic) and had significant effect on the developmental parameters.

scholarly journals Restoration of Heel–Toe Gait Patterns for the Prevention of Asymmetrical Hip Internal Rotation in Patients with Unilateral Spastic Cerebral Palsy

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 773
Author(s):  
Reinald Brunner ◽  
William R. Taylor ◽  
Rosa M. S. Visscher
Keyword(s):  
Cerebral Palsy ◽  
Standard Deviation ◽  
Internal Rotation ◽  
Plantar Flexion ◽  
Gait Pattern ◽  
Spastic Cerebral Palsy ◽  
Forward Modelling ◽  
Gait Patterns ◽  
Hip Internal Rotation ◽  
Toe Walking

Forward modelling has indicated hip internal rotation as a secondary physical effect to plantar flexion under load. It could therefore be of interest to focus the treatment for patients with unilateral spastic cerebral palsy on achieving a heel–toe gait pattern, to prevent development of asymmetrical hip internal rotation. The aim of this preliminary retrospective cohort investigation was to evaluate the effect of restoring heel–toe gait, through use of functional orthoses, on passive hip internal rotation. In this study, the affected foot was kept in an anatomically correct position, aligned to the leg and the gait direction. In case of gastrosoleus shortness, a heel raise was attached to compensate for the equinus and yet to provide heel–floor contact (mean equinus = −2.6 degrees of dorsiflexion). Differences in passive hip internal rotation between the two sides were clinically assessed while the hip was extended. Two groups were formed according to the achieved correction of their gait patterns through orthotic care: patients with a heel-toe gait (with anterograde rocking) who wore the orthosis typically for at least eight hours per day for at least a year, or patients with toe-walking (with retrograde rocking) in spite of wearing the orthosis who used the orthosis less in most cases. A Student’s t-test was used to compare the values of clinically assessed passive hip rotation (p < 0.05) between the groups and the effect size (Hedges’ g) was estimated. Of the 70 study participants, 56 (mean age 11.5 y, majority GMFCS 1, similar severity of pathology) achieved a heel-toe gait, while 14 remained as toe-walkers. While patients with heel–toe gait patterns showed an almost symmetrical passive hip internal rotation (difference +1.5 degrees, standard deviation 9.6 degrees), patients who kept toe-walking had an increased asymmetrical passive hip internal rotation (difference +10.4 degrees, standard deviation 7.5 degrees; p = 0.001, Hedges’s g = 0.931). Our clinical findings are in line with the indications from forward modelling that treating the biomechanical problem might prevent development of a secondary deformity. Further prospective studies are needed to verify the presented hypothesis.

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