Impaired muscle growth precedes development of increased stiffness of the triceps surae musculotendinous unit in children with cerebral palsy

Willerslev-Olsen, Maria; Lund, Mai Choe; Lorentzen, Jakob; Barber, Lee; Kofoed-Hansen, Mathilde; Nielsen, Jens Bo

doi:10.1111/dmcn.13729

Cited by 71 publications

(89 citation statements)

References 28 publications

(76 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Numerous studies have tried to establish the mechanisms that contribute to the development of ankle joint hyper-resistance in spastic CP. Recent literature indicates that hyperactive stretch reflexes, commonly labeled as spasticity, are considered to have less impact (2,3). Instead, alterations such as reduced muscle volume and atrophy, cellular and genetic factors have been related to the increased joint resistance (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy

et al. 2020

View full text Add to dashboard Cite

Botulinum NeuroToxin-A (BoNT-A) injections to the medial gastrocnemius (MG) and lower-leg casts are commonly combined to treat ankle equinus in children with spastic cerebral palsy (CP). However, the decomposed treatment effects on muscle or tendon structure, stretch reflexes, and joint are unknown. In this study, BoNT-A injections to the MG and casting of the lower legs were applied separately to gain insight into the working mechanisms of the isolated treatments on joint, muscle, and tendon levels. Thirty-one children with spastic CP (GMFCS I-III, age 7.4 ± 2.6 years) received either two weeks of lower-leg casts or MG BoNT-A injections. During full range of motion slow and fast passive ankle rotations, joint resistance and MG stretch reflexes were measured. MG muscle and tendon lengths were assessed at resting and at maximum dorsiflexion ankle angles using 3D-freehand ultrasound. Treatment effects were compared using non-parametric statistics. Associations between the effects on joint and muscle or tendon levels were performed using Spearman correlation coefficients (p < 0.05). Increased joint resistance, measured during slow ankle rotations, was not significantly reduced after either treatment. Additional joint resistance assessed during fast rotations only reduced in the BoNT-A group (−37.6%, p = 0.013, effect size = 0.47), accompanied by a reduction in MG stretch reflexes (−70.7%, p = 0.003, effect size = 0.56). BoNT-A increased the muscle length measured at the resting ankle angle (6.9%, p = 0.013, effect size = 0.53). Joint angles shifted toward greater dorsiflexion after casting (32.4%, p = 0.004, effect size = 0.56), accompanied by increases in tendon length (5.7%, p = 0.039, effect size = 0.57; r = 0.40). No associations between the changes in muscle or tendon lengths and the changes in the stretch reflexes were found. We conclude that intramuscular BoNT-A injections reduced stretch reflexes in the MG Peeters et al. Separate Effects of BoNT-A and Castingaccompanied by an increase in resting muscle belly length, whereas casting resulted in increased dorsiflexion without any changes to the muscle length. This supports the need for further investigation on the effect of the combined treatments and the development of treatments that more effectively lengthen the muscle.

show abstract

Section: Introductionmentioning

confidence: 99%

Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The force‐generating capabilities of a muscle are largely dependent on its gross‐morphological properties, such as volume. In children with spastic cerebral palsy (CP), fewer satellite cells, over‐lengthened sarcomeres, and abnormal motor unit recruitment and activation characterize the underlying pathophysiology of muscle growth and joint contractures . Consequently, deficits in medial gastrocnemius growth have been reported, which affects the important power generation function of the muscle during walking .…”

mentioning

confidence: 99%

Medial gastrocnemius volume and echo‐intensity after botulinum neurotoxin A interventions in children with spastic cerebral palsy

Schless

Cenni

Bar‐On

et al. 2018

Develop Med Child Neuro

View full text Add to dashboard Cite

first publication: reference 24 has been added and the ethical commission number has been corrected.] AIM This cross-sectional investigation evaluated whether recurrent botulinum neurotoxin A (BoNT-A) interventions to the medial gastrocnemius have an influence on muscle morphology, beyond Gross Motor Function Classification System (GMFCS) level.METHOD A cohort of typically developing children (n=67; 43 males, 24 females; median age 9y 11mo [range 7y 10mo-11y 6mo]), a cohort of children with spastic cerebral palsy (CP) naive to BoNT-A interventions (No-BoNT-A; n=19; 10 males, nine females; median age 9y 3mo [range 8y 5mo-10y 10mo]) and a cohort of children with spastic CP with a minimum of three recurrent BoNT-A interventions to the medial gastrocnemius (BoNT-A; n=19; 13 males, six females; median age 9y 8mo [range 7y 3mo-10y 7mo]) were recruited. Three-dimensional freehand ultrasound was used to estimate medial gastrocnemius volume normalized to body mass and echo-intensity.

show abstract

mentioning

confidence: 99%

“…Any model we construct will be a simplification of a complex reality, but this does not mean that our clinical model cannot develop and improve over time, with resulting functional benefits for children with CP. The study by Willerslev‐Olsen et al . is an important step in this process.…”

mentioning

confidence: 99%

“…The most effective way may be to appreciate that we use a model to deal with a complex phenomenon, and then assess the robustness of this model and the implications for intervention. The paper by Willerslev-Olsen et al 4 builds on previous investigations by this group on muscle characteristics in children with CP to help us to consider the clinical model we use. Typically developing children and children with CP between birth and the age of 4 years had measurements of medial gastrocnemius muscle volume and triceps surae stiffness, with electromyographic recording to assess muscle activity.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Spasticity in children with cerebral palsy: what are we treating?

Gough

2018

Develop Med Child Neuro

View full text Add to dashboard Cite

show abstract

Impaired muscle growth precedes development of increased stiffness of the triceps surae musculotendinous unit in children with cerebral palsy

Cited by 71 publications

References 28 publications

Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy

Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy

Medial gastrocnemius volume and echo‐intensity after botulinum neurotoxin A interventions in children with spastic cerebral palsy

Spasticity in children with cerebral palsy: what are we treating?

Contact Info

Product

Resources

About