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Li S, Luo X, Zhang S, Tang Y, Sun J, Meng Q, Yu H, Sun C. Evaluation of Multilevel Surgeries in Children With Spastic Cerebral Palsy Based on Surface Electromyography. Front Neurosci 2021; 15:680645. [PMID: 34335161 PMCID: PMC8319621 DOI: 10.3389/fnins.2021.680645] [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: 03/15/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
The root mean square (RMS) of the surface electromyography (sEMG) signal can respond to neuromuscular function, which displays a positive correlation with muscle force and muscle tension under positive and passive conditions, respectively. The purpose of this study was to investigate the changes in muscle force and tension after multilevel surgical treatments, functional selective posterior rhizotomy (FSPR) and tibial anterior muscle transfer surgery, and evaluate their clinical effect in children with spastic cerebral palsy (SCP) during walking. Children with diplegia (n = 13) and hemiplegia (n = 3) with ages from 4 to 18 years participated in this study. They were requested to walk barefoot at a self-selected speed on a 15-m-long lane. The patient's joints' range of motion (ROM) and sEMG signal of six major muscles were assessed before and after the multilevel surgeries. The gait cycle was divided into seven phases, and muscle activation state can be divided into positive and passive conditions during gait cycle. For each phase, the RMS of the sEMG signal amplitude was calculated and also normalized by a linear envelope (10-ms running RMS window). The muscle tension of the gastrocnemius decreased significantly during the loading response, initial swing, and terminal swing (p < 0.05), which helped the knee joint to get the maximum extension when the heel is on the ground and made the heel land smoothly. The muscle force of the gastrocnemius increased significantly (p < 0.05) during the mid-stance, terminal stance, and pre-swing, which could generate the driving force for the human body to move forward. The muscle tension of the biceps femoris and semitendinosus decreased significantly (p < 0.05) during the terminal stance, pre-swing, and initial swing. The decreased muscle tension could relieve the burden of the knee flexion when the knee joint was passively flexed. At the terminal swing, the muscle force of the tibial anterior increased significantly (p < 0.05), which could improve the ankle dorsiflexion ability and prevent foot drop and push forward. Thus, the neuromuscular function of cerebral palsy during walking can be evaluated by the muscle activation state and the RMS of the sEMG signal, which showed that multilevel surgical treatments are feasible and effective to treat SCP.
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Affiliation(s)
- Sujiao Li
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Xueqin Luo
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Song Zhang
- Department of Functional Neurosurgery, Shanghai Punan Hospital, Shanghai Eber Medical Group, Shanghai, China.,Department of Pediatric Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuanmin Tang
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Jiming Sun
- Department of Functional Neurosurgery, Shanghai Punan Hospital, Shanghai Eber Medical Group, Shanghai, China
| | - Qingyun Meng
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Chengyan Sun
- Department of Functional Neurosurgery, Shanghai Punan Hospital, Shanghai Eber Medical Group, Shanghai, China
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Ma K, Zhu D, Zhang C, Lv L. Botulinum Toxin Type A Possibly Affects Ca v3.2 Calcium Channel Subunit in Rats with Spinal Cord Injury-Induced Muscle Spasticity. Drug Des Devel Ther 2020; 14:3029-3041. [PMID: 32801642 PMCID: PMC7395704 DOI: 10.2147/dddt.s256814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) often causes muscle spasticity, which can be inhibited by using calcium channel blocker. Botulinum toxin type A (BoT-A) shows therapeutic efficacy on spasticity and may exert inhibitory effects on the calcium channel. METHODS A rat model with muscle spasticity was established after SCI via contusion and compression. Different concentrations (0, 1, 3 and 6 U/kg) of BoT-A Botox were injected in the extensor digitorum longus (EDL) muscles of the right hindlimb in the muscle spasticity model. The changes of muscle spasticity and calcium level in EDL muscles were measured after the establishment of SCI-induced spasticity. Cav3.2 calcium channel subunit and its mutant (M1560V) were analyzed using Western blot before (input) or after immunoprecipitation with anti-FLAG antibody, and their currents were measured in motoneurons by using whole-cell voltage clamp recordings. RESULTS SCI induced muscle spasticity, whereas calcium level in EDL muscles and expression of Cav3.2 was increased in the SCI model when compared with the sham group (p < 0.05). BoT-A Botox treatment significantly reduced muscle spasticity and calcium level in EDL muscles and Cav3.2 expression in a dose-dependent way (p < 0.05). The ratio of biotinylated to total Cav3.2 was reduced in the mutant (M1560V) of Cav3.2 and lower than that in the wild Cav3.2. BoT-A Botox intervention also reduced the current values of calcium channel and the ratio in a dose-dependent way (p < 0.05). DISCUSSION BoT-A Botox possibly attenuates SCI-induced muscle spasticity by affecting the expression of Cav3.2 calcium channel subunit in the rat models. There may be multiple mechanisms for the function of BoT-A Botox. Further work is needed to be done to address these issues.
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Affiliation(s)
- Kening Ma
- Department of Pain Medicine, The First Hospital of Jilin University, Changchun130021, People’s Republic of China
| | - Dan Zhu
- Department of Neurologic Medicine, The First Hospital of Jilin University, Changchun130021, People’s Republic of China
| | - Chunguo Zhang
- Department of Pain Medicine, The First Hospital of Jilin University, Changchun130021, People’s Republic of China
| | - Lijie Lv
- Department of Medicine and Pension, The First Hospital of Jilin University, Changchun130021, People’s Republic of China
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