Heterogeneity of muscle sizes in the lower limbs of children with cerebral palsy

Handsfield, Geoffrey G.; Meyer, Craig H.; Abel, Mark F.; Blemker, Silvia S.

doi:10.1002/mus.24972

Cited by 96 publications

(131 citation statements)

References 93 publications

(215 reference statements)

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“…This implies that the differing brain damage the children with CP have, has a greater impact on muscle growth than age and body size. This further supports the impression of great heterogeneity within CP previously reported (Handsfield et al, 2016) and underscores the need for structured, individualized longitudinal follow-up.…”

Section: Discussionsupporting

confidence: 88%

Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff

Walden

Jalaleddini

Evertsson

et al. 2017

Front. Comput. Neurosci.

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Children with cerebral palsy (CP) often develop reduced passive range of motion with age. The determining factor underlying this process is believed to be progressive development of contracture in skeletal muscle that likely changes the biomechanics of the joints. Consequently, to identify the underlying mechanisms, we modeled the mechanical characteristics of the forearm flexors acting across the wrist joint. We investigated skeletal muscle strength (Grippit®) and passive stiffness and viscosity of the forearm flexors in 15 typically developing (TD) children (10 boys/5 girls, mean age 12 years, range 8–18 yrs) and nine children with CP Nine children (6 boys/3 girls, mean age 11 ± 3 years (yrs), range 7–15 yrs) using the NeuroFlexor® apparatus. The muscle stiffness we estimate and report is the instantaneous mechanical response of the tissue that is independent of reflex activity. Furthermore, we assessed cross-sectional area of the flexor carpi radialis (FCR) muscle using ultrasound. Age and body weight did not differ significantly between the two groups. Children with CP had a significantly weaker (−65%, p < 0.01) grip and had smaller cross-sectional area (−43%, p < 0.01) of the FCR muscle. Passive stiffness of the forearm muscles in children with CP was increased 2-fold (p < 0.05) whereas viscosity did not differ significantly between CP and TD children. FCR cross-sectional area correlated to age (R2 = 0.58, p < 0.01), body weight (R2 = 0.92, p < 0.0001) and grip strength (R2 = 0.82, p < 0.0001) in TD children but only to grip strength (R2 = 0.60, p < 0.05) in children with CP. We conclude that children with CP have weaker, thinner, and stiffer forearm flexors as compared to typically developing children.

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Section: Discussionsupporting

confidence: 88%

Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff

Walden

Jalaleddini

Evertsson

et al. 2017

Front. Comput. Neurosci.

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“…cross-sectional growth of fibers) was attenuated. The substantial lower PCSA and the lower proximal and distal muscle volumes in children with SP is supported by previous studies reporting a lower ST muscle volume [26, 27, 29]. Note that the volume reduction in the current study (about 60%) exceeds that reported in previous studies (with about 35% volume reduction) [27, 29].…”

Section: Discussionsupporting

confidence: 87%

“…Given the relation between PCSA and force generation [69], the reduced PCSA observed in this study and the reduced muscle volume of ST (present study and [26, 27, 29]) suggest that, compared to TD children, in a majority of children with SP ST is weak. As lengthening of the ST tendon is presumed to induce even more ST weakness [16], a low preoperative PCSA of ST (i.e.…”

Section: Discussionmentioning

confidence: 54%

“…Because of its low degree of pennation, the ST exerts force over a large ROM in hip and knee joints [25]. Low muscle belly volume and short muscle belly length of ST have previously been shown for SP children [26–29]. We have recently described a freehand three-dimensional ultrasound method (3D US) to assess morphological variables of ST (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening

et al. 2016

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To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children.

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“…However, in the triceps surae of children with SCP, there is a degree of homogeneity to the relative atrophy of these muscles. Compared with age‐matched controls, the MG, soleus (SOL), and lateral gastrocnemius (LG) were found to be 42%, 39%, and 36% smaller, respectively . The calculation of specific force is therefore presented with the knowledge that, at least in terms of muscle ACSA, there seems to be some degree of similarity in the relative differences between SCP and controls in the triceps surae.…”

Section: Methodsmentioning

confidence: 99%

Medial gastrocnemius specific force of adult men with spastic cerebral palsy

et al. 2017

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Introduction: Muscle weakness determines functional impairment in spastic cerebral palsy (SCP). Measurement of specific force (SF) allows for strength comparison with unimpaired populations (controls) accounting for neural (activation and coactivation), architectural (fascicle length and pennation angle), and structural differences (moment arm length). Methods: Medial gastrocnemius (MG) SF (and its determinants) was assessed in both paretic and non‐paretic legs of 11 men with SCP and 11 age‐matched controls during plantarflexion maximal voluntary isometric contraction (MVIC). Results: SCP fascicles were 28% longer than control fascicles (P < 0.05). Pennation angle of SCP patients was 41% smaller than in controls. The physiological cross‐sectional area of SCP MG patients was 47% smaller than in controls (P < 0.05). There was no difference in SF between controls and SCP patients. Conclusions: Weakness in SCP is primarily attributable to deficits in agonist activation and muscle size; consequently, SF measured in the MG is similar between SCP and controls. Muscle Nerve 56: 298–306, 2017

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Heterogeneity of muscle sizes in the lower limbs of children with cerebral palsy

Abstract: Heterogeneity across muscles and across subjects reinforces the subject specificity of CP and the need for individualized treatment planning. Muscle Nerve 53: 933-945, 2016.

Cited by 96 publications

References 93 publications

Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff

Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff

Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening

Medial gastrocnemius specific force of adult men with spastic cerebral palsy

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