The morphology of the medial gastrocnemius in typically developing children and children with spastic hemiplegic cerebral palsy

Malaiya, Ritu; McNee, Anne; Fry, Nicola; Eve, Linda; Gough, Martin; Shortland, Adam P

doi:10.1016/j.jelekin.2007.02.009

Cited by 172 publications

(268 citation statements)

References 24 publications

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“…Therefore, on the impaired side, the Achilles tendon elongates and become less stiff than that on the unimpaired side. Ultrasonography studies 4,6 have also shown that the gastrocnemius muscle has shorter, thinner fascicles, although similar pennation angles, in the paretic limbs of children with CP.Our findings are also in agreement with previous studies involving adults with neurological impairment. Sinkjaer and Magnussen 21 reported that non-reflex stiffness in the spastic limb of a group of patients with hemiparesis with plantarflexor muscle hypertonia was 278% greater than that seen in comparisons.…”

supporting

confidence: 92%

Section: Discussionmentioning

confidence: 98%

“…3 To some extent this may be due to adaptive changes occurring in the muscles. [4][5][6] Children with CP are usually less physically active than typically developing children and their physical activity levels tend to decrease with increasing age. 7 Progressive plantarflexor dysfunction is common in children with hemiplegia or spastic diplegia and may result from changes in muscle activation, myotendinous length, and stiffness.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical properties of the plantarflexor musculotendinous unit during passive dorsiflexion in children with cerebral palsy compared with typically developing children

Alhusaini

Crosbie

Shepherd

et al. 2010

Develop Med Child Neuro

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AIM To examine the passive length-tension relations in the myotendinous components of the plantarflexor muscles of children with and without cerebral palsy (CP) under conditions excluding reflex muscle contraction.METHOD A cross-sectional, non-interventional study was conducted in a hospital outpatient clinic.Passive torque-angle characteristics of the ankle were quantified from full plantarflexion to full available dorsiflexion in 26 independently ambulant children with CP (11 females, 15 males; mean age: 6y 11mo, range 4y 7mo-9y 7mo) and 26 age-matched typically developing children (18 females, 8 males; mean age 7y 2mo, range 4y 1mo-10y 4mo). In the children with CP, the affected (hemiplegia; n=21) or more affected (diplegia; n=5) leg was tested; in typically developing children, the leg tested was randomly selected. Gross Motor Function Classification System levels were I (n=15) and II (n=11). Care was taken to eliminate active or reflex muscle contribution to the movement, confirmed by the absence of electromyographic activity.RESULTS There were small but significant differences between the two groups for maximum ankle dorsiflexion (p=0.003), but large and significant differences in the torques required to produce the same displacement (p<0.001). Further, the hysteresis of the average loading cycle in the children with CP was over three times that of the typically developing children (p<0.001).INTERPRETATION We believe that the plantarflexor muscles of children with CP are stiffer and intrinsically more resistant to stretch, even though they retain near normal excursion. This increased stiffness is a non-neurally-mediated feature demonstrated by these children. The extent to which it influences function and predisposes the children to development of soft tissue contracture is unknown.Cerebral palsy (CP) occurs in 2 to 2.5 individuals per 1000 live births 1 and is associated with various movement disorders, usually with other impairments. 2 Although the brain lesion is usually non-progressive, the movement disorders resulting from the lesion become more evident over time and are progressive. 3 To some extent this may be due to adaptive changes occurring in the muscles. [4][5][6] Children with CP are usually less physically active than typically developing children and their physical activity levels tend to decrease with increasing age. 7 Progressive plantarflexor dysfunction is common in children with hemiplegia or spastic diplegia and may result from changes in muscle activation, myotendinous length, and stiffness. 8 When a non-contracting (resting) muscle is stretched in a child with CP, the force opposing the movement is due to tension originating through the passive mechanical properties of the muscle, as well as any abnormal muscle activation evoked in spastic muscle. This spasticity is broadly recognized as a manifestation of enhanced stretch reflex activity 9 and is often presented as the primary opponent to movement. The contributions of passive myotendinous stiffness to either passive or active joint...

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supporting

confidence: 92%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Mechanical properties of the plantarflexor musculotendinous unit during passive dorsiflexion in children with cerebral palsy compared with typically developing children

Alhusaini

Crosbie

Shepherd

et al. 2010

Develop Med Child Neuro

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“…Consistent with previous findings in human patients (1, 2, 13), we found reduced maximal active forces of GA and PL in spastic rats. Loss of muscle volume has been reported in humans with spasticity (4,31,34,35) and, therefore, atrophy is believed to be the main cause of muscle weakness. In the present study, maximal active force of GA was decreased by 31%, whereas GA muscle mass was decreased by only 14%, albeit not significantly.…”

Section: Discussionmentioning

confidence: 99%

Muscle-specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat

Olesen

Jensen

Uhlendorf

et al. 2014

Journal of Applied Physiology

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Olesen AT, Jensen BR, Uhlendorf TL, Cohen RW, Baan GC, Maas H. Muscle-specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat. J Appl Physiol 117: 989-997, 2014. First published September 4, 2014 doi:10.1152/japplphysiol.00587.2014.-The purpose of the present study was to investigate muscle mechanical properties and mechanical interaction between muscles in the lower hindlimb of the spastic mutant rat. Length-force characteristics of gastrocnemius (GA), soleus (SO), and plantaris (PL) were assessed in anesthetized spastic and normally developed Han-Wistar rats. In addition, the extent of epimuscular myofascial force transmission between synergistic GA, SO, and PL, as well as between the calf muscles and antagonistic tibialis anterior (TA), was investigated. Active length-force curves of spastic GA and PL were narrower with a reduced maximal active force. In contrast, active length-force characteristics of spastic SO were similar to those of controls. In reference position (90°ankle and knee angle), higher resistance to ankle dorsiflexion and increased passive stiffness was found for the spastic calf muscle group. At optimum length, passive stiffness and passive force of spastic GA were decreased, whereas those of spastic SO were increased. No mechanical interaction between the calf muscles and TA was found. As GA was lengthened, force from SO and PL declined despite a constant muscle-tendon unit length of SO and PL. However, the extent of this interaction was not different in spastic rats. In conclusion, the effects of spasticity on length-force characteristics were muscle specific. The changes observed for GA and PL muscles are consistent with the changes in limb mechanics reported for human patients. Our results indicate that altered mechanics in spastic rats cannot be attributed to differences in mechanical interaction, but originate from individual muscular structures. muscle spasticity; mechanical properties; myofascial force transmission; muscle stiffness MUSCLE SPASTICITY HAS BEEN defined as a "velocity-depended resistance to stretch" (24) and arises secondary to upper motoneuron lesions with cerebral palsy and stroke as the most common examples (12). Individuals suffering from spasticity typically experience muscle weakness, enhanced joint stiffness, increased muscle tone, reduced range of joint motion, increased antagonistic co-contraction, and exaggerated reflexes (1,3,6,12,13,32,41,48). These effects severely impair the ability to perform daily activities, and treatment is often needed.To asses whether some of these symptoms are related to altered mechanical properties of muscle-tendon units (MTUs), passive and active length-force characteristics have been estimated as joint moment as a function of gastrocnemius (GA) fascicle length. Spastic GA was found to be stiffer than normally developed in such studies (2, 3). The active lengthforce curve of the spastic GA was narrower and the optimum length was shifted to a shorter fascicle length than in normally deve...

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“…A recent systematic review [20] concluded, on the basis of cross-sectional studies, that there was consistent evidence for reduced calf muscle size in the paretic limb in spastic CP compared to typically developing (TD) peers [21][22][23][24][25]. Barber et al [26] subsequently showed that medial gastrocnemius (MG) muscle physiological crosssectional area (PCSA), but not fascicle length, was reduced by 27 % in children aged 2-5 years with spastic CP who had not commenced BoNT-A treatment compared to TD peers.…”

mentioning

confidence: 99%

The effects of botulinum toxin injection frequency on calf muscle growth in young children with spastic cerebral palsy: A 12-month prospective study

Barber

Hastings-Ison

Baker

et al. 2013

Journal of Children's Orthopaedics

101

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Purpose This study was a 12-month prospective investigation of changes in the medial gastrocnemius (MG) muscle morphology in children aged 2-5 years with spastic cerebral palsy (CP) who had received no previous intramuscular injections of botulinum neurotoxin type-A (BoNT-A) and were randomised to receive either single or multiple (three) BoNT-A injections to the gastrocsoleus. MG morphological changes were compared to age-matched typically developing (TD) peers. Methods Thirteen children with spastic CP with a mean age of 45 (15) months and 18 TD children with a mean age of 48 (14) months participated in the study. The principal outcome measures were MG muscle volume, fascicle length, pennation angle and physiological cross-sectional area (PCSA), which were obtained using 2D and 3D ultrasound.Results The single and multiple injection frequency groups significantly increased MG muscle volume at 12 months relative to the baseline by 13 and 15 %, respectively. There were no significant differences in the MG muscle volume 28.5 (12.3) versus 30.3 (3.8) ml, fascicle length 48.0 (10.4) versus 44.8 (1.2) mm or PCSA 7.0 (1.2) versus 6.6 (1.7) cm 2 between the single and multiple injection groups, respectively, at 12 months follow-up. The change in MG muscle volume in the single and multiple injection groups was significantly lower than the TD peers by 66 and 60 %, respectively. Interpretation In young children with spastic CP, naive to BoNT-A treatment, MG muscle growth over 12 months does not appear to be influenced by intramuscular BoNT-A injection frequency. However, MG muscle growth in the spastic CP groups was significantly lower than the agematched TD peers. It is unclear whether this is an effect of intramuscular BoNT-A injections or reduced growth rates in children with spastic CP in general. 123J Child Orthop (2013) 7:425-433 DOI 10.1007 investigations and longitudinal studies with multiple measurement time points are required in order to determine the influence of BoNT-A treatment on muscle physiological and mechanical growth factors in young children with spastic CP.

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The morphology of the medial gastrocnemius in typically developing children and children with spastic hemiplegic cerebral palsy

Cited by 172 publications

References 24 publications

Mechanical properties of the plantarflexor musculotendinous unit during passive dorsiflexion in children with cerebral palsy compared with typically developing children

Mechanical properties of the plantarflexor musculotendinous unit during passive dorsiflexion in children with cerebral palsy compared with typically developing children

Muscle-specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat

The effects of botulinum toxin injection frequency on calf muscle growth in young children with spastic cerebral palsy: A 12-month prospective study

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