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Koussou A, Dumas R, Desailly E. A Velocity Stretch Reflex Threshold Based on Muscle-Tendon Unit Peak Acceleration to Detect Possible Occurrences of Spasticity during Gait in Children with Cerebral Palsy. Sensors (Basel) 2023; 24:41. [PMID: 38202903 PMCID: PMC10780611 DOI: 10.3390/s24010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
Spasticity might affect gait in children with cerebral palsy. Quantifying its occurrence during locomotion is challenging. One approach is to determine kinematic stretch reflex thresholds, usually on the velocity, during passive assessment and to search for their exceedance during gait. These thresholds are determined through EMG-Onset detection algorithms, which are variable in performance and sensitive to noisy data, and can therefore lack consistency. This study aimed to evaluate the feasibility of determining the velocity stretch reflex threshold from maximal musculotendon acceleration. Eighteen children with CP were recruited and underwent clinical gait analysis and a full instrumented assessment of their soleus, gastrocnemius lateralis, semitendinosus, and rectus femoris spasticity, with EMG, kinematics, and applied forces being measured simultaneously. Using a subject-scaled musculoskeletal model, the acceleration-based stretch reflex velocity thresholds were determined and compared to those based on EMG-Onset determination. Their consistencies according to physiological criteria, i.e., if the timing of the threshold was between the beginning of the stretch and the spastic catch, were evaluated. Finally, two parameters designed to evaluate the occurrence of spasticity during gait, i.e., the proportion of the gait trial time with a gait velocity above the velocity threshold and the number of times the threshold was exceeded, were compared. The proposed method produces velocity stretch reflex thresholds close to the EMG-based ones. For all muscles, no statistical difference was found between the two parameters designed to evaluate the occurrence of spasticity during gait. Contrarily to the EMG-based methods, the proposed method always provides physiologically consistent values, with median electromechanical delays of between 50 and 130 ms. For all subjects, the semitendinosus velocity during gait usually exceeded its stretch reflex threshold, while it was less frequent for the three other muscles. We conclude that a velocity stretch reflex threshold, based on musculotendon acceleration, is a reliable substitute for EMG-based ones.
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Affiliation(s)
- Axel Koussou
- Pôle Recherche & Innovation, Fondation Ellen Poidatz, 77310 Saint-Fargeau-Ponthierry, France;
- Laboratoire de Biomécanique et Mécanique des Chocs UMR T9406, University Lyon, University Gustave Eiffel, University Claude Bernard Lyon 1, 69622 Lyon, France;
| | - Raphaël Dumas
- Laboratoire de Biomécanique et Mécanique des Chocs UMR T9406, University Lyon, University Gustave Eiffel, University Claude Bernard Lyon 1, 69622 Lyon, France;
| | - Eric Desailly
- Pôle Recherche & Innovation, Fondation Ellen Poidatz, 77310 Saint-Fargeau-Ponthierry, France;
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Willaert J, Ting LH, Van Campenhout A, Desloovere K, De Groote F. Reduced reciprocal inhibition during clinical tests of spasticity is associated with impaired reactive standing balance control in children with cerebral palsy. medRxiv 2023:2023.11.07.23298160. [PMID: 37986791 PMCID: PMC10659464 DOI: 10.1101/2023.11.07.23298160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Joint hyper-resistance is a common symptom in cerebral palsy (CP). It is assessed by rotating the joint of a relaxed patient. Joint rotations also occur when perturbing functional movements. Therefore, joint hyper-resistance might contribute to reactive balance impairments in CP. Aim To investigate relationships between altered muscle responses to isolated joint rotations and perturbations of standing balance in children with CP. Methods & procedures 20 children with CP participated in the study. During an instrumented spasticity assessment, the ankle was rotated as fast as possible from maximal plantarflexion towards maximal dorsiflexion. Standing balance was perturbed by backward support-surface translations and toe-up support-surface rotations. Gastrocnemius, soleus, and tibialis anterior electromyography was measured. We quantified reduced reciprocal inhibition by plantarflexor-dorsiflexor co-activation and the neural response to stretch by average muscle activity. We evaluated the relation between muscle responses to ankle rotation and balance perturbations using linear mixed models. Outcomes & results Co-activation during isolated joint rotations and perturbations of standing balance was correlated across all levels. The neural response to stretch during isolated joint rotations and balance perturbations was not correlated. Conclusions & implications Reduced reciprocal inhibition during isolated joint rotations might be a predictor of altered reactive balance control strategies.
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Affiliation(s)
- Jente Willaert
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Lena H. Ting
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven – UZ Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven – UZ Leuven, Leuven, Belgium
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Koussou A, Dumas R, Desailly E. Common modelling assumptions affect the joint moments measured during passive joint mobilizations. Sci Rep 2023; 13:17782. [PMID: 37853085 PMCID: PMC10584879 DOI: 10.1038/s41598-023-44576-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
Joint resistance to passive mobilization has already been estimated in-vivo in several studies by measuring the applied forces and moments while manipulating the joint. Nevertheless, in most of the studies, simplified modelling approaches are used to calculate this joint resistance. The impact of these simplifications is still unknown. We propose a protocol that enables a reference 3D inverse dynamics approach to be implemented and compared to common simplified approaches. Eight typically developed children and eight children with cerebral palsy were recruited and underwent a passive testing protocol, while applied forces and moments were measured through a 3D handheld dynamometer, simultaneously to its 3D kinematics and the 3D kinematics of the different segments. Then, passive joint resistance was estimated using the reference 3D inverse dynamics approach and according to 5 simplified approaches found in the literature, i.e. ignoring either the dynamometer kinematics, the measured moments alone or together with the measured tangential forces, the gravity and the inertia of the different segments, or the distal segments kinematics. These simplifications lead to non-negligible differences with respect to the reference 3D inverse dynamics, from 3 to 32% for the ankle, 4 to 34% for the knee and 1 to 58% for the hip depending of the different simplifications. Finally, we recommend a complete 3D kinematics and dynamics modelling to estimate the joint resistance to passive mobilization.
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Affiliation(s)
- Axel Koussou
- Fondation Ellen Poidatz, Pôle Recherche and Innovation, 77310, Saint-Fargeau-Ponthierry, France.
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T9406, 69622, Lyon, France.
| | - Raphaël Dumas
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T9406, 69622, Lyon, France
| | - Eric Desailly
- Fondation Ellen Poidatz, Pôle Recherche and Innovation, 77310, Saint-Fargeau-Ponthierry, France
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Kruse A, Habersack A, Weide G, Jaspers RT, Svehlik M, Tilp M. Eight weeks of proprioceptive neuromuscular facilitation stretching and static stretching do not affect muscle-tendon properties, muscle strength, and joint function in children with spastic cerebral palsy. Clin Biomech (Bristol, Avon) 2023; 107:106011. [PMID: 37329655 DOI: 10.1016/j.clinbiomech.2023.106011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/05/2023] [Accepted: 05/22/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND While the effect of static stretching for individuals with cerebral palsy is questionable, recent results suggest that the combination with activation seems promising to improve muscle-tendon properties and function. Therefore, this study analyzed the effects of 8-week proprioceptive neuromuscular facilitation stretching on the gastrocnemius medialis muscle-tendon properties, muscle strength, and the ankle joint in children with spastic cerebral palsy in comparison to static stretching. METHODS Initially, 24 children with spastic cerebral palsy were randomly assigned to a static stretching (10.7 ± 1.8 years) or proprioceptive neuromuscular facilitation stretching group (10.9 ± 2.6 years). Plantar flexors were manually stretched at home for 300 s and ∼ 250-270 s per day four times a week for eight weeks, respectively. Assessments of ankle joint function (e.g., range of motion), muscle-tendon properties, and isometric muscle strength were conducted using 3D motion capture, 2D ultrasound, dynamometry, and electromyography. A mixed analysis of variance was used for the statistical analysis. FINDINGS Stretching adherence was high in the proprioceptive neuromuscular facilitation stretching (93.1%) and static stretching group (94.4%). No significant changes (p > 0.05) were observed in ankle joint function, muscle-tendon properties, and isometric muscle strength after both interventions. Moreover, no differences (p > 0.05) were found between the stretching techniques. INTERPRETATION The findings support the idea that manual stretching (neither proprioceptive neuromuscular facilitation stretching nor static stretching) performed in isolation for eight weeks may not be appropriate to evoke significant changes in muscle-tendon properties, voluntary muscle strength, or joint function in children with spastic cerebral palsy. CLINICAL TRIAL REGISTRATION NUMBER NCT04570358.
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Affiliation(s)
- Annika Kruse
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.
| | - Andreas Habersack
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria; Department of Othopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Guido Weide
- Department of Human Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Richard T Jaspers
- Department of Human Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Martin Svehlik
- Department of Othopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Markus Tilp
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
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Peeters N, Hanssen B, Bar-On L, De Groote F, De Beukelaer N, Coremans M, Van den Broeck C, Dan B, Van Campenhout A, Desloovere K. Associations between muscle morphology and spasticity in children with spastic cerebral palsy. Eur J Paediatr Neurol 2023; 44:1-8. [PMID: 36706682 DOI: 10.1016/j.ejpn.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/03/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Due to the heterogeneous clinical presentation of spastic cerebral palsy (SCP), which makes spasticity treatment challenging, more insight into the complex interaction between spasticity and altered muscle morphology is warranted. AIMS We studied associations between spasticity and muscle morphology and compared muscle morphology between commonly observed spasticity patterns (i.e. different muscle activation patterns during passive stretches). METHODS Spasticity and muscle morphology of the medial gastrocnemius (MG) and semitendinosus (ST) were defined in 74 children with SCP (median age 8 years 2 months, GMFCS I/II/III: 31/25/18, bilateral/unilateral: 46/27). Using an instrumented assessment, spasticity was quantified as the difference in muscle activation recorded during passive stretches at low and high velocities and was classified in mixed length-/velocity-dependent or pure velocity-dependent activation patterns. Three-dimensional freehand ultrasound was used to assess muscle morphology (volume and length) and echogenicity intensity (as a proxy for muscle quality). Spearman correlations and Mann-Whitney-U tests defined associations and group differences, respectively. RESULTS A moderate negative association (r = -0.624, p < 0.001) was found between spasticity and MG muscle volume, while other significant associations between spasticity and muscle morphology parameters were weak. Smaller normalized muscle volume (MG p = 0.004, ST p=<0.001) and reduced muscle belly length (ST p = 0.015) were found in muscles with mixed length-/velocity-dependent patterns compared to muscles with pure velocity-dependent patterns. DISCUSSION Higher spasticity levels were associated with smaller MG and ST volumes and shorter MG muscles. These muscle morphology alterations were more pronounced in muscles that activated during low-velocity stretches compared to muscles that only activated during high-velocity stretches.
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Affiliation(s)
- Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | | | - Marjan Coremans
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | | | - Bernard Dan
- Université Libre de Bruxelles (ULB), Faculty of Psychology and Education Science, Brussels, Belgium; Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Orthopedic Surgery, University Hospitals Leuven, Belgium.
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Belgium.
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Guo X, Wallace R, Tan Y, Oetomo D, Klaic M, Crocher V. Technology-assisted assessment of spasticity: a systematic review. J Neuroeng Rehabil 2022; 19:138. [PMID: 36494721 PMCID: PMC9733065 DOI: 10.1186/s12984-022-01115-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Spasticity is defined as "a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks". It is a highly prevalent condition following stroke and other neurological conditions. Clinical assessment of spasticity relies predominantly on manual, non-instrumented, clinical scales. Technology based solutions have been developed in the last decades to offer more specific, sensitive and accurate alternatives but no consensus exists on these different approaches. METHOD A systematic review of literature of technology-based methods aiming at the assessment of spasticity was performed. The approaches taken in the studies were classified based on the method used as well as their outcome measures. The psychometric properties and usability of the methods and outcome measures reported were evaluated. RESULTS 124 studies were included in the analysis. 78 different outcome measures were identified, among which seven were used in more than 10 different studies each. The different methods rely on a wide range of different equipment (from robotic systems to simple goniometers) affecting their cost and usability. Studies equivalently applied to the lower and upper limbs (48% and 52%, respectively). A majority of studies applied to a stroke population (N = 79). More than half the papers did not report thoroughly the psychometric properties of the measures. Analysis identified that only 54 studies used measures specific to spasticity. Repeatability and discriminant validity were found to be of good quality in respectively 25 and 42 studies but were most often not evaluated (N = 95 and N = 78). Clinical validity was commonly assessed only against clinical scales (N = 33). Sensitivity of the measure was assessed in only three studies. CONCLUSION The development of a large diversity of assessment approaches appears to be done at the expense of their careful evaluation. Still, among the well validated approaches, the ones based on manual stretching and measuring a muscle activity reaction and the ones leveraging controlled stretches while isolating the stretch-reflex torque component appear as the two promising practical alternatives to clinical scales. These methods should be further evaluated, including on their sensitivity, to fully inform on their potential.
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Affiliation(s)
- Xinliang Guo
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Rebecca Wallace
- grid.416153.40000 0004 0624 1200Allied Health Department, The Royal Melbourne Hospital, Melbourne, Australia
| | - Ying Tan
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Denny Oetomo
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Marlena Klaic
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Vincent Crocher
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
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Aloraini SM, Alassaf AM, Alrezgan MM, Aldaihan MM. Spasticity Measurement Tools and Their Psychometric Properties Among Children and Adolescents With Cerebral Palsy: A Systematic Review. Pediatr Phys Ther 2022; 34:449-63. [PMID: 35943394 DOI: 10.1097/PEP.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify and appraise the literature on the psychometric properties of spasticity measures that have been used among children and adolescents with cerebral palsy (CP). METHODS A comprehensive literature search was conducted in 5 databases. Two independent reviewers screened the literature search results for relevant studies. Reviewers extracted the data using a standardized form and study quality was assessed using a critical appraisal tool. RESULTS A total of 44 studies met the selection criteria and were included. We identified 22 different spasticity assessment tools, with different levels of evidence regarding their psychometric properties. CONCLUSION The findings of the current review indicate that there is limited evidence to recommend 1 spasticity assessment method for children and adolescents with CP. Spasticity assessment in its current state lacks a method that possesses the necessary psychometric properties and is easily used in the clinical setting.
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Peeters N, Papageorgiou E, Hanssen B, De Beukelaer N, Staut L, Degelaen M, Van den Broeck C, Calders P, Feys H, Van Campenhout A, Desloovere K. The Short-Term Impact of Botulinum Neurotoxin-A on Muscle Morphology and Gait in Children with Spastic Cerebral Palsy. Toxins (Basel) 2022; 14:676. [PMID: 36287944 PMCID: PMC9607504 DOI: 10.3390/toxins14100676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 08/27/2023] Open
Abstract
Children with spastic cerebral palsy (SCP) are often treated with intramuscular Botulinum Neurotoxin type-A (BoNT-A). Recent studies demonstrated BoNT-A-induced muscle atrophy and variable effects on gait pathology. This group-matched controlled study in children with SCP compared changes in muscle morphology 8-10 weeks post-BoNT-A treatment (n = 25, median age 6.4 years, GMFCS level I/II/III (14/9/2)) to morphological changes of an untreated control group (n = 20, median age 7.6 years, GMFCS level I/II/III (14/5/1)). Additionally, the effects on gait and spasticity were assessed in all treated children and a subgroup (n = 14), respectively. BoNT-A treatment was applied following an established integrated approach. Gastrocnemius and semitendinosus volume and echogenicity intensity were assessed by 3D-freehand ultrasound, spasticity was quantified through electromyography during passive muscle stretches at different velocities. Ankle and knee kinematics were evaluated by 3D-gait analysis. Medial gastrocnemius (p = 0.018, -5.2%) and semitendinosus muscle volume (p = 0.030, -16.2%) reduced post-BoNT-A, but not in the untreated control group, while echogenicity intensity did not change. Spasticity reduced and ankle gait kinematics significantly improved, combined with limited effects on knee kinematics. This study demonstrated that BoNT-A reduces spasticity and partly improves pathological gait but reduces muscle volume 8-10 weeks post-injections. Close post-BoNT-A follow-up and well-considered treatment selection is advised before BoNT-A application in SCP.
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Affiliation(s)
- Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | | | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | | | - Lauraine Staut
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
| | - Marc Degelaen
- Inkendaal Rehabilitation Hospital, 1602 Vlezenbeek, Belgium
- Rehabilitation Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | | | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Orthopedic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, 3212 Leuven, Belgium
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Kruse A, Habersack A, Jaspers RT, Schrapf N, Weide G, Svehlik M, Tilp M. Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching of the Plantar Flexors on Ankle Range of Motion and Muscle-Tendon Behavior in Children with Spastic Cerebral Palsy-A Randomized Clinical Trial. Int J Environ Res Public Health 2022; 19:11599. [PMID: 36141875 PMCID: PMC9517397 DOI: 10.3390/ijerph191811599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Stretching is considered a clinically effective way to prevent muscle contracture development in children with spastic cerebral palsy (CP). Therefore, in this study, we assessed the effects of a single session of proprioceptive neuromuscular facilitation (PNF) or static stretching (SS) on ankle joint range of motion (RoM) and gastrocnemius muscle-tendon behavior in children with CP. During the SS (n = 8), the ankle joint was held in maximum dorsiflexion (30 s). During the PNF stretching (n = 10), an isometric contraction (3-5 s) was performed, followed by stretching (~25 s). Ten stretches were applied in total. We collected data via dynamometry, 3D motion capture, 2D ultrasound, and electromyography, before and after the stretching sessions. A mixed ANOVA was used for the statistical analysis. Both ankle RoM and maximum dorsiflexion increased over time (F(1,16) = 7.261, p < 0.05, η² = 0.312; and F(1,16) = 4.900, p < 0.05, η² = 0.234, respectively), without any difference between groups. An interaction effect (F(1,12) = 4.768, p = 0.05, η² = 0.284) was observed for muscle-tendon unit elongation (PNF: -8.8%; SS: +14.6%). These findings suggest a positive acute effect of stretching on ankle function. However, SS acutely increased muscle-tendon unit elongation, while this decreased after PNF stretching, indicating different effects on the spastic muscles. Whether PNF stretching has the potential to cause positive alterations in individuals with CP should be elucidated in future studies.
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Affiliation(s)
- Annika Kruse
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
| | - Andreas Habersack
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Richard T. Jaspers
- Department of Human Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 HZ Amsterdam, The Netherlands
| | - Norbert Schrapf
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
| | - Guido Weide
- Department of Human Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 HZ Amsterdam, The Netherlands
| | - Martin Svehlik
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Markus Tilp
- Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
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De Beukelaer N, Bar-On L, Hanssen B, Peeters N, Prinsen S, Ortibus E, Desloovere K, Van Campenhout A. Muscle Characteristics in Pediatric Hereditary Spastic Paraplegia vs. Bilateral Spastic Cerebral Palsy: An Exploratory Study. Front Neurol 2021; 12:635032. [PMID: 33716937 PMCID: PMC7952873 DOI: 10.3389/fneur.2021.635032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/26/2021] [Indexed: 01/14/2023] Open
Abstract
Hereditary spastic paraplegia (HSP) is a neurological, genetic disorder that predominantly presents with lower limb spasticity and muscle weakness. Pediatric pure HSP types with infancy or childhood symptom onset resemble in clinical presentation to children with bilateral spastic cerebral palsy (SCP). Hence, treatment approaches in these patient groups are analogous. Altered muscle characteristics, including reduced medial gastrocnemius (MG) muscle growth and hyperreflexia have been quantified in children with SCP, using 3D-freehand ultrasound (3DfUS) and instrumented assessments of hyperreflexia, respectively. However, these muscle data have not yet been studied in children with HSP. Therefore, we aimed to explore these MG muscle characteristics in HSP and to test the hypothesis that these data differ from those of children with SCP and typically developing (TD) children. A total of 41 children were retrospectively enrolled including (1) nine children with HSP (ages of 9–17 years with gross motor function levels I and II), (2) 17 age-and severity-matched SCP children, and (3) 15 age-matched typically developing children (TD). Clinically, children with HSP showed significantly increased presence and severity of ankle clonus compared with SCP (p = 0.009). Compared with TD, both HSP and SCP had significantly smaller MG muscle volume normalized to body mass (p ≤ 0.001). Hyperreflexia did not significantly differ between the HSP and SCP group. In addition to the observed pathological muscle activity for both the low-velocity and the change in high-velocity and low-velocity stretches in the two groups, children with HSP tended to present higher muscle activity in response to increased stretch velocity compared with those with SCP. This exploratory study is the first to reveal MG muscle volume deficits in children with HSP. Moreover, high-velocity-dependent hyperreflexia and ankle clonus is observed in children with HSP. Instrumented impairment assessments suggested similar altered MG muscle characteristics in pure HSP type with pediatric onset compared to bilateral SCP. This finding needs to be confirmed in larger sample sizes. Hence, the study results might indicate analogous treatment approaches in these two patient groups.
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Affiliation(s)
- Nathalie De Beukelaer
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Britta Hanssen
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Nicky Peeters
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Sandra Prinsen
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Els Ortibus
- KU Leuven Department of Development and Regeneration, Leuven, Belgium
| | - Kaat Desloovere
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.,KU Leuven Department of Development and Regeneration, Leuven, Belgium
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11
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Alhwoaimel N, Turk R, Hughes AM, Ferrari F, Burridge J, Wee SK, Verheyden G, Warner M. Instrumented trunk impairment scale (iTIS): A reliable measure of trunk impairment in the stroke population. Top Stroke Rehabil 2020; 28:456-463. [PMID: 33070742 DOI: 10.1080/10749357.2020.1834273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Trunk Impairment Scale (TIS) is recommended for use in clinical research to assess trunk impairment post-stroke. However, it is observer dependent and does not consider the quality of trunk movement. To address these challenges, this study proposes an instrumented TIS (iTIS). OBJECTIVE This study aims to investigate the intra-rater and inter-rater reliability of the iTIS in chronic stroke patients. METHOD Trunk impairment was assessed in 20 patients with stroke using the iTIS Valedo system; three sensors were fixed to the skin on the sternum, L1 and S1 levels. Interclass correlation coefficients were used to assess the inter-rater and intra-rater reliability (between days) with 95% CI. RESULTS Reliability for the dynamic subscale parameters was good to excellent (intra-rater ICC = 0.60-0.95; inter-rater ICC = 0.59-0.93); however, reliability for the coordination parameters was poor to good (intra-rater ICC = 0.05-0.72) and poor to excellent (inter-rater ICC = 0.04-0.78). CONCLUSION The iTIS demonstrates an acceptable level of reliability for dynamic subscale measurement in research and clinical practice. Further studies could use larger sample sizes and improve the iTIS methodology by employing additional sensors on the limbs to detect compensatory movements.
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Affiliation(s)
- Norah Alhwoaimel
- School of Health Sciences, University of Southampton, Southampton, UK.,Department of Physical Therapy and Rehabilitation, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ruth Turk
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Ann-Marie Hughes
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Ferrari
- Department of Neurosciences, Biomedecine and Movement Sciences, University of Verona, Verona, Italy.,Department of Rehabilitation, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Jane Burridge
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Seng Kwee Wee
- Centre for Advanced Rehabilitation Therapeutics (CART), Tan Tock Seng Hospital, Singapore, Singapore.,Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Martin Warner
- School of Health Sciences, University of Southampton, Southampton, UK
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12
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Cha Y, Arami A. Quantitative Modeling of Spasticity for Clinical Assessment, Treatment and Rehabilitation. Sensors (Basel) 2020; 20:E5046. [PMID: 32899490 PMCID: PMC7571189 DOI: 10.3390/s20185046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022]
Abstract
Spasticity, a common symptom in patients with upper motor neuron lesions, reduces the ability of a person to freely move their limbs by generating unwanted reflexes. Spasticity can interfere with rehabilitation programs and cause pain, muscle atrophy and musculoskeletal deformities. Despite its prevalence, it is not commonly understood. Widely used clinical scores are neither accurate nor reliable for spasticity assessment and follow up of treatments. Advancement of wearable sensors, signal processing and robotic platforms have enabled new developments and modeling approaches to better quantify spasticity. In this paper, we review quantitative modeling techniques that have been used for evaluating spasticity. These models generate objective measures to assess spasticity and use different approaches, such as purely mechanical modeling, musculoskeletal and neurological modeling, and threshold control-based modeling. We compare their advantages and limitations and discuss the recommendations for future studies. Finally, we discuss the focus on treatment and rehabilitation and the need for further investigation in those directions.
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Affiliation(s)
- Yesung Cha
- Neuromechanics and Assistive Robotics Laboratory, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada;
| | - Arash Arami
- Neuromechanics and Assistive Robotics Laboratory, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada;
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada
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13
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Fairhurst C, Kumar R, Checketts D, Tayo B, Turner S. Efficacy and safety of nabiximols cannabinoid medicine for paediatric spasticity in cerebral palsy or traumatic brain injury: a randomized controlled trial. Dev Med Child Neurol 2020; 62:1031-1039. [PMID: 32342496 DOI: 10.1111/dmcn.14548] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 01/24/2023]
Abstract
AIM To assess the efficacy, safety, and tolerability of oromucosal nabiximols cannabinoid medicine as adjunct therapy for children with spasticity due to cerebral palsy/traumatic central nervous system injury with inadequate response to existing treatment. METHOD Overall, 72 patients (mean [SD] age 12y 4mo [3y 1mo], range 8-18y) were randomized at a ratio of 2:1 to receive nabiximols (n=47; 29 males, 18 females) or placebo (n=25; 15 males, 10 females) for 12 weeks (12 sprays/day max. based on clinical response/tolerability). The primary outcome was change from baseline in level of spasticity on a 0 to 10 Numerical Rating Scale (NRS), assessed by the primary caregiver at 12 weeks. Secondary outcomes included additional measures for spasticity, sleep quality, pain, health-related quality of life, comfort, depression, and safety. RESULTS There was no significant difference in the spasticity 0 to 10 NRS between nabiximols versus placebo groups after 12 weeks. No statistically significant differences were observed for any secondary endpoint. Adverse events were predominantly mild or moderate in severity; however, three cases of hallucinations were reported. INTERPRETATION Nabiximols was generally well tolerated; however, neuropsychiatric adverse events were observed. No significant reduction in spasticity with nabiximols treatment versus placebo was observed. WHAT THIS PAPER ADDS Oromucosal nabiximols is generally well tolerated by paediatric patients. However, three cases of hallucinations were observed, one of which involved auditory hallucinations and a suicide attempt. Oromucosal nabiximols versus placebo did not reduce cerebral palsy/central nervous system injury-related spasticity.
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Affiliation(s)
- Charlie Fairhurst
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ram Kumar
- Department of Paediatric Neurology, Alder Hey Children's Hospital, Liverpool, UK
| | | | | | - Susie Turner
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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14
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Brookshaw M, Sexton A, McGibbon CA. Reliability and Validity of a Novel Wearable Device for Measuring Elbow Strength. Sensors (Basel) 2020; 20:E3412. [PMID: 32560409 DOI: 10.3390/s20123412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 11/27/2022]
Abstract
Muscle strength is an important clinical outcome in rehabilitation and sport medicine, but options are limited to expensive but accurate isokinetic dynamometry (IKD) or inexpensive but less accurate hand-held dynamometers (HHD). A wearable, self-stabilizing, limb strength measurement device (LSMD) was developed to fill the current gap in portable strength measurement devices. The purpose of this study was to evaluate the reliability and validity of the LSMD in healthy adults. Twenty healthy adults were recruited to attend two strength testing sessions where elbow flexor and extensor strength was measured with the LSMD, with HHD and with IKD in random order, by two raters. Outcomes were intra-rater repeatability, inter-rater reproducibility and inter-session reproducibility using intra-class correlation coefficients (ICC). Limits of agreement and weighted least products regression were used to test the validity of the LSMD relative to the criterion standard (IKD), and calibration formulas derived to improve measurement fidelity. ICC values for the LSMD were >0.90 for all measures of reliability and for both muscle groups, but over-predicted extensor strength and under-predicted flexor strength. Validity was established by transforming the data with the criterion standard-based calibration. These data indicate that the LSMD is reliable and conditionally valid for quantifying strength of elbow flexors and extensors in a healthy adult population.
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15
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Cenni F, Bar-On L, Monari D, Schless SH, Kalkman BM, Aertbeliën E, Desloovere K, Bruyninckx H. Semi-automatic methods for tracking the medial gastrocnemius muscle-tendon junction using ultrasound: a validation study. Exp Physiol 2019; 105:120-131. [PMID: 31677311 DOI: 10.1113/ep088133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/31/2019] [Indexed: 12/22/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is the proposed semi-automatic algorithm suitable for tracking the medial gastrocnemius muscle-tendon junction in ultrasound images collected during passive and active conditions? What is the main finding and its importance? The validation of a method allowing efficient tracking of the muscle-tendon junction in both passive and active conditions, in healthy as well as in pathological conditions. This method was tested in common acquisition conditions and the developed software made freely available. ABSTRACT Clinically relevant information can be extracted from ultrasound (US) images by tracking the displacement of the junction between muscle and tendon. This paper validated automatic methods for tracking the location of muscle-tendon junction (MTJ) between the medial gastrocnemius and the Achilles tendon during passive slow and fast stretches, and active ankle rotations while walking on a treadmill. First, an automatic algorithm based on an optical flow approach was applied on collected US images. Second, results of the automatic algorithm were evaluated and corrected using a quality measure that indicated which critical images need to be manually corrected. US images from 12 typically developed (TD) children, 12 children with spastic cerebral palsy (SCP) and eight healthy adults were analysed. Automatic and semi-automatic tracking methods were compared to manual tracking using root mean square errors (RMSE). For the automatic tracking, RMSE was less than 3.1 mm for the slow stretch and 5.2 mm for the fast stretch, the worst case being for SCP. The tracking results in the fast stretch condition were improved (especially in SCP) by using the semi-automatic approach, with an RMSE reduction of about 30%. During walking, the semi-automatic method also reduced errors, with a final RMSE of 3.6 mm. In all cases, data processing was considerably shorter using the semi-automatic method (2 min) compared to manual tracking (20 min). A quick manual correction considerably improves tracking of the MTJ during gait and allows to achieve results suitable for further analyses. The proposed algorithm is freely available.
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Affiliation(s)
- Francesco Cenni
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium
| | - Lynn Bar-On
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001, Leuven, Belgium.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Davide Monari
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium.,KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300b, 3001, Leuven, Belgium
| | - Simon-Henri Schless
- Alyn Hospital, Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - Barbara M Kalkman
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Erwin Aertbeliën
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300b, 3001, Leuven, Belgium
| | - Kaat Desloovere
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg, Belgium.,KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001, Leuven, Belgium
| | - Herman Bruyninckx
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300b, 3001, Leuven, Belgium
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16
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Yan Y, Fu X, Xie X, Ji S, Luo H, Yang F, Zhang X, Yang S, Xie P. Hip Adductor Intramuscular Nerve Distribution Pattern of Children: A Guide for BTX-A Treatment to Muscle Spasticity in Cerebral Palsy. Front Neurol 2019; 10:616. [PMID: 31258508 PMCID: PMC6587062 DOI: 10.3389/fneur.2019.00616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022] Open
Abstract
To investigate the intramuscular nerve distribution pattern in the hip adductors of children and to precisely locate the injection site for botulinum toxin type A (BTX-A) as a treatment for hip adductor spasticity in children with cerebral palsy. Modified Sihler's whole mount nerve staining technique was employed to observe the distribution of intramuscular nerves in hip adductors of children and to further locate zones where terminal nerves are concentrated. The terminal nerves of the adductor longus appeared in a longitudinal distribution band parallel to the line between the upper 1/3 point of the lateral boundary and the center of the medial boundary. In adductor brevis, the terminal nerves showed a sheet-like distribution with a nerve dense area located in the middle of the muscle belly that extends from the upper-inner region to the lower-outer region. Gracilis showed a dense area of terminal nerves in the middle of the muscle belly, closer to the posterior boundary. In adductor magnus, the dense area of terminal nerves showed a sheet-like distribution in the middle and lower region of the muscle belly. The dense area of terminal nerves in the pectineus was located in the middle of the muscle belly. This study is the first to systematically investigate the intramuscular nerve distribution pattern in the hip adductors. The results indicated that the best targets for BTX-A injection, when treating spasticity, are the dense regions of terminal nerves described above.
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Affiliation(s)
- Yan Yan
- Department of Anatomy, Zunyi Medical University, Zunyi, China.,Department of Critical Care Medicine of the Third Affiliated Hospital, Zunyi Medical University, Zunyi, China
| | - Xiaoyun Fu
- Department of Critical Care Medicine of the Affiliated Hospital, Zunyi Medical University, Zunyi, China
| | - Xiadan Xie
- Department of Biochemistry, Zunyi Medical University, Zunyi, China
| | - Songling Ji
- Department of Anatomy, Zunyi Medical University, Zunyi, China
| | - Huaixiang Luo
- Department of Anatomy, Zunyi Medical University, Zunyi, China
| | - Fangjiu Yang
- Department of Anatomy, Zunyi Medical University, Zunyi, China
| | - Xiaoming Zhang
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Shengbo Yang
- Department of Anatomy, Zunyi Medical University, Zunyi, China
| | - Peng Xie
- Department of Critical Care Medicine of the Third Affiliated Hospital, Zunyi Medical University, Zunyi, China
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17
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Kalkman BM, Bar-On L, Cenni F, Maganaris CN, Bass A, Holmes G, Desloovere K, Barton GJ, O'Brien TD. Muscle and tendon lengthening behaviour of the medial gastrocnemius during ankle joint rotation in children with cerebral palsy. Exp Physiol 2018; 103:1367-1376. [DOI: 10.1113/ep087053] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/08/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Barbara M. Kalkman
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
- Department of Mechanical Engineering; University of Sheffield; Sheffield UK
| | - Lynn Bar-On
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
- Amsterdam UMC; Vrije Universiteit Amsterdam; Department of Rehabilitation Medicine; Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Francesco Cenni
- Department of Mechanical Engineering; KU Leuven; Leuven Belgium
| | | | - Alfie Bass
- Alder Hey Children's NHS Foundation Trust; Liverpool UK
| | - Gill Holmes
- Alder Hey Children's NHS Foundation Trust; Liverpool UK
| | - Kaat Desloovere
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Gabor J. Barton
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
| | - Thomas D. O'Brien
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
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18
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Cenni F, Schless SH, Bar-On L, Aertbeliën E, Bruyninckx H, Hanssen B, Desloovere K. Reliability of a clinical 3D freehand ultrasound technique: Analyses on healthy and pathological muscles. Comput Methods Programs Biomed 2018; 156:97-103. [PMID: 29428080 DOI: 10.1016/j.cmpb.2017.12.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 11/24/2017] [Accepted: 12/21/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE 3D freehand Ultrasonography is a medical imaging technique that can be used to measure muscle and tendon morphological and structural properties, including volume, lengths and echo-intensity. These properties are clinically relevant in neurological disorders such as spastic cerebral palsy to monitor disease progression and evaluate the effect of treatment. This study presents a methodology for extracting these parameters along with a clinical reliability analysis for the data acquisition and processing. METHODS The medial gastrocnemius muscles and Achilles tendon of 10 typically developing children and 10 children with spastic cerebral palsy were assessed. An open-source in-house software library developed in Python (Py3DFreeHandUS) was used to reconstruct, into one 3D data set, the data simultaneously acquired from an US machine and a motion tracking system. US images were manually segmented and linearly interpolated by means of a new simplified approach which involved sequentially decreasing the total number of images used for muscle border segmentation from 100% to 5%. Acquisition and processing reliability was defined based on repeated measures from different data processers and from different data acquirers, respectively. RESULTS When only 10% of the US images were outlined, there was an average underestimation of muscle volume of 1.1% and 1.6% with respect the computation of all the available images, for the typically developing and spastic cerebral palsy groups, respectively. For both groups, the reliability was higher for data processing than for data acquisition. High inter-class correlation coefficient values were found for processing and acquisition reliability, with worst case values of 0.89 and 0.61, respectively. The standard error of measurement, expressed as a percentage of the average volumes, was smaller than 2.6 ml (4.8%) in all cases. CONCLUSIONS The present analysis demonstrates the effectiveness of applying 3D freehand ultrasonography in a clinical setting for analysing healthy and pathological paediatric muscle.
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Affiliation(s)
- Francesco Cenni
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300b, 3001 Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Simon-Henri Schless
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium
| | - Lynn Bar-On
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium
| | - Erwin Aertbeliën
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300b, 3001 Leuven, Belgium
| | - Herman Bruyninckx
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300b, 3001 Leuven, Belgium
| | - Britta Hanssen
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium
| | - Kaat Desloovere
- Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium
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19
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Kalkman BM, Bar-On L, Cenni F, Maganaris CN, Bass A, Holmes G, Desloovere K, Barton GJ, O'Brien TD. Medial gastrocnemius muscle stiffness cannot explain the increased ankle joint range of motion following passive stretching in children with cerebral palsy. Exp Physiol 2018; 103:350-357. [DOI: 10.1113/ep086738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/20/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Barbara M. Kalkman
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
| | - Lynn Bar-On
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Francesco Cenni
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
- Department of Mechanical Engineering; KU Leuven; Leuven Belgium
| | | | - Alfie Bass
- Alder Hey Children's NHS Foundation Trust; Liverpool UK
| | - Gill Holmes
- Alder Hey Children's NHS Foundation Trust; Liverpool UK
| | - Kaat Desloovere
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Gabor J. Barton
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
| | - Thomas D. O'Brien
- Research Institute for Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
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20
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Bar-On L, Kalkman BM, Cenni F, Schless SH, Molenaers G, Maganaris CN, Bass A, Holmes G, Barton GJ, O'Brien TD, Desloovere K. The Relationship Between Medial Gastrocnemius Lengthening Properties and Stretch Reflexes in Cerebral Palsy. Front Pediatr 2018; 6:259. [PMID: 30338247 PMCID: PMC6180247 DOI: 10.3389/fped.2018.00259] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022] Open
Abstract
Stretch reflex hyperactivity in the gastrocnemius of children with spastic cerebral palsy (CP) is commonly evaluated by passively rotating the ankle joint into dorsiflexion at different velocities, such as applied in conventional clinical spasticity assessments. However, surface electromyography (sEMG) collected from the medial gastrocnemius (MG) during such examination reveals unexplained heterogeneity in muscle activation between patients. Recent literature also highlights altered muscle tensile behavior in children with spastic CP. We aimed to document MG muscle and tendon lengthening during passive ankle motion at slow and fast velocity and explore its interdependence with the elicited hyperactive stretch reflex. The ankle of 15 children with CP (11 ± 3 years, GMFCS 9I 6II, 8 bilateral, 7 unilateral) and 16 typically developing children (TDC) was passively rotated over its full range of motion at slow and fast velocity. Ultrasound, synchronized with motion-analysis, was used to track the movement of the MG muscle-tendon junction and extract the relative lengthening of muscle and tendon during joint rotation. Simultaneously, MG sEMG was measured. Outcome parameters included the angular and muscle lengthening velocities 30 ms before EMG onset and the gain in root mean square EMG during stretch, as a measure of stretch reflex activity. Compared to slow rotation, the muscle lengthened less and stretch reflex activity was higher during fast rotation. These velocity-induced changes were more marked in CP compared to TDC. In the CP group, muscle-lengthening velocity had higher correlation coefficients with stretch reflex hyperactivity than joint angular velocity. Muscles with greater relative muscle lengthening during slow rotation had earlier and stronger stretch reflexes during fast rotation. These initial results suggest that ankle angular velocity is not representative of MG muscle lengthening velocity and is less related to stretch reflex hyperactivity than MG muscle lengthening. In addition, muscles that lengthened more during slow joint rotation were more likely to show a velocity-dependent stretch reflex. This interdependence of muscle lengthening and stretch reflexes may be important to consider when administering treatment. However, muscle and tendon lengthening properties alone could not fully explain the variability in stretch reflexes, indicating that other factors should also be investigated.
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Affiliation(s)
- Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Barbara M Kalkman
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Francesco Cenni
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | | | - Guy Molenaers
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Constantinos N Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Alfie Bass
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Gill Holmes
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Gabor J Barton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Thomas D O'Brien
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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21
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Miller MM, Ray JM, Van Zant RS. The Effects of Astym Therapy® on a Child With Spastic Diplegic Cerebral Palsy. Clin Med Insights Case Rep 2017; 10:1179547617746992. [PMID: 29270040 PMCID: PMC5731617 DOI: 10.1177/1179547617746992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/10/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Limited research exists regarding use of Astym® therapy with neurologic conditions. The purpose of this case was to describe using Astym therapy in treating spastic diplegic cerebral palsy (CP). Case description: A 6-year-old female was treated more than 9 months (36 sessions) for decreased flexibility, muscle weakness, spasticity, and abnormal gait. Examination findings: Gait performed with articulated ankle-foot orthoses (75% of the time) or foot orthosis (25%); lack of active dorsiflexion (DF); lack of heel strike during gait; spasticity in hamstrings, gastrocnemius, hip adductors; hamstring flexibility (90/90 test position) 50° right and 60° left; gastrocnemius flexibility neutral bilaterally; and Peabody Developmental Motor Scales, second edition (PDMS-2) age equivalence (in months) 23 locomotion, 25 object manipulation, and 21 stationary tasks. Therapeutic interventions included Astym therapy, stretching, strengthening, neuromuscular reeducation, and gait training. Outcomes: At 6 months, flexibility improved bilaterally to 10° past neutral in gastrocnemius and 0° in hamstrings. The PDMS-2 age equivalence scores were 27 locomotion, 32 object manipulation, and 28 stationary tasks. At discharge, patient ambulated full-time with foot orthosis, exhibiting improved stride length bilaterally with active ankle DF to initiate heel strike. Spasticity was unchanged. Discussion: Astym therapy was effective in treating a child with spastic diplegic CP, resulting in enhanced strength, flexibility, and gait.
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Affiliation(s)
- Mandi M Miller
- Physical Therapy Program, University of Findlay, Findlay, OH, USA
| | | | - R Scott Van Zant
- Physical Therapy Program, University of Findlay, Findlay, OH, USA
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22
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Germanotta M, Taborri J, Rossi S, Frascarelli F, Palermo E, Cappa P, Castelli E, Petrarca M. Spasticity Measurement Based on Tonic Stretch Reflex Threshold in Children with Cerebral Palsy Using the PediAnklebot. Front Hum Neurosci 2017; 11:277. [PMID: 28611612 PMCID: PMC5447033 DOI: 10.3389/fnhum.2017.00277] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
Nowadays, objective measures are becoming prominent in spasticity assessment, to overcome limitations of clinical scales. Among others, Tonic Stretch Reflex Threshold (TSRT) showed promising results. Previous studies demonstrated the validity and reliability of TSRT in spasticity assessment at elbow and ankle joints in adults. Purposes of the present study were to assess: (i) the feasibility of measuring TSRT to evaluate spasticity at the ankle joint in children with Cerebral Palsy (CP), and (ii) the correlation between objective measures and clinical scores. A mechatronic device, the pediAnklebot, was used to impose 50 passive stretches to the ankle of 10 children with CP and 3 healthy children, to elicit muscles response at 5 different velocities. Surface electromyography, angles, and angular velocities were recorded to compute dynamic stretch reflex threshold; TSRT was computed with a linear regression through angles and angular velocities. TSRTs for the most affected side of children with CP resulted into the biomechanical range (95.7 ± 12.9° and 86.7 ± 17.4° for Medial and Lateral Gastrocnemius, and 75.9 ± 12.5° for Tibialis Anterior). In three patients, the stretch reflex was not elicited in the less affected side. TSRTs were outside the biomechanical range in healthy children. However, no correlation was found between clinical scores and TSRT values. Here, we demonstrated the capability of TSRT to discriminate between spastic and non-spastic muscles, while no significant outcomes were found for the dorsiflexor muscle.
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Affiliation(s)
| | - Juri Taborri
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of RomeRome, Italy
| | - Stefano Rossi
- Industrial Engineering, Department of Economics and Management, University of TusciaViterbo, Italy
| | - Flaminia Frascarelli
- Neurorehabilitation Units, Movement Analysis and Robotics Laboratory, IRCCS Bambino Gesù Children's HospitalRome, Italy
| | - Eduardo Palermo
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of RomeRome, Italy
| | - Paolo Cappa
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of RomeRome, Italy
| | - Enrico Castelli
- Neurorehabilitation Units, Movement Analysis and Robotics Laboratory, IRCCS Bambino Gesù Children's HospitalRome, Italy
| | - Maurizio Petrarca
- Neurorehabilitation Units, Movement Analysis and Robotics Laboratory, IRCCS Bambino Gesù Children's HospitalRome, Italy
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23
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Kalkman BM, Bar-On L, Cenni F, Maganaris CN, Bass A, Holmes G, Desloovere K, Barton GJ, O'Brien TD. Achilles tendon moment arm length is smaller in children with cerebral palsy than in typically developing children. J Biomech 2017; 56:48-54. [PMID: 28318605 DOI: 10.1016/j.jbiomech.2017.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/29/2016] [Accepted: 02/26/2017] [Indexed: 11/24/2022]
Abstract
When studying muscle and whole-body function in children with cerebral palsy (CP), knowledge about both internal and external moment arms is essential since they determine the mechanical advantage of a muscle over an external force. Here we asked if Achilles tendon moment arm (MAAT) length is different in children with CP and age-matched typically developing (TD) children, and if MAAT can be predicted from anthropometric measurements. Sixteen children with CP (age: 10y 7m±3y, 7 hemiplegia, 12 diplegia, GMFCS level: I (11) and II (8)) and twenty TD children (age: 10y 6m±3y) participated in this case-control study. MAAT was calculated at 20° plantarflexion by differentiating calcaneus displacement with respect to ankle angle. Seven anthropometric variables were measured and related to MAAT. We found normalized MAAT to be 15% (∼7mm) smaller in children with CP compared to TD children (p=0.003). MAAT could be predicted by all anthropometric measurements with tibia length explaining 79% and 72% of variance in children with CP and TD children, respectively. Our findings have important implications for clinical decision making since MAAT influences the mechanical advantage about the ankle, which contributes to movement function and is manipulated surgically.
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Affiliation(s)
- Barbara M Kalkman
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Francesco Cenni
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Constantinos N Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Alfie Bass
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Gill Holmes
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gabor J Barton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Thomas D O'Brien
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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24
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Sloot LH, Bar-On L, van der Krogt MM, Aertbeliën E, Buizer AI, Desloovere K, Harlaar J. Motorized versus manual instrumented spasticity assessment in children with cerebral palsy. Dev Med Child Neurol 2017; 59:145-151. [PMID: 27363603 DOI: 10.1111/dmcn.13194] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 01/08/2023]
Abstract
AIM We compared the outcomes of manual and motorized instrumented ankle spasticity assessments in children with cerebral palsy (CP). METHOD Ten children with spastic CP (three males, seven females; mean age 11y [standard deviation 3y], range 6-14y; Gross Motor Function Classification System levels I-III) were included. During motorized assessments, fast (100°/s) rotations were imposed around the ankle joint by a motor-driven footplate; during manual assessments, rotations of comparable speed were applied by a therapist using a foot orthotic. Angular range of motion, maximum velocity, acceleration, work, and muscle activity (electromyography [EMG]) of the triceps surae and tibialis anterior were compared during passive muscle stretch between motorized and manual assessments. Both movement profiles were also compared to CP gait ankle movement profile. RESULTS The imposed movement profile differed between methods, with the motorized assessment reaching higher maximum acceleration. Despite equal maximum velocity, the triceps surae were more often activated in motorized assessments, with low agreement of 44% to 72% (κ≤0) for EMG onset occurrence between methods. The manually applied ankle velocity profile matched more closely with the gait profile. INTERPRETATION The differences in acceleration possibly account for the different muscle responses, which may suggest acceleration, rather than velocity-dependency of the stretch reflex. Future prototypes of instrumented spasticity assessments should standardize movement profiles, preferably by developing profiles that mimic functional tasks such as walking.
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Affiliation(s)
- Lizeth H Sloot
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.,Department of Rehabilitation Sciences, Research Group for Neuromotor Rehabilitation, KU Leuven, Leuven, Belgium
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Erwin Aertbeliën
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Research Group for Neuromotor Rehabilitation, KU Leuven, Leuven, Belgium
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
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Balaguier R, Madeleine P, Vuillerme N. Is One Trial Sufficient to Obtain Excellent Pressure Pain Threshold Reliability in the Low Back of Asymptomatic Individuals? A Test-Retest Study. PLoS One 2016; 11:e0160866. [PMID: 27513474 PMCID: PMC4981327 DOI: 10.1371/journal.pone.0160866] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/26/2016] [Indexed: 02/06/2023] Open
Abstract
The assessment of pressure pain threshold (PPT) provides a quantitative value related to the mechanical sensitivity to pain of deep structures. Although excellent reliability of PPT has been reported in numerous anatomical locations, its absolute and relative reliability in the lower back region remains to be determined. Because of the high prevalence of low back pain in the general population and because low back pain is one of the leading causes of disability in industrialized countries, assessing pressure pain thresholds over the low back is particularly of interest. The purpose of this study study was (1) to evaluate the intra- and inter- absolute and relative reliability of PPT within 14 locations covering the low back region of asymptomatic individuals and (2) to determine the number of trial required to ensure reliable PPT measurements. Fifteen asymptomatic subjects were included in this study. PPTs were assessed among 14 anatomical locations in the low back region over two sessions separated by one hour interval. For the two sessions, three PPT assessments were performed on each location. Reliability was assessed computing intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) for all possible combinations between trials and sessions. Bland-Altman plots were also generated to assess potential bias in the dataset. Relative reliability for both intra- and inter- session was almost perfect with ICC ranged from 0.85 to 0.99. With respect to the intra-session, no statistical difference was reported for ICCs and SEM regardless of the conducted comparisons between trials. Conversely, for inter-session, ICCs and SEM values were significantly larger when two consecutive PPT measurements were used for data analysis. No significant difference was observed for the comparison between two consecutive measurements and three measurements. Excellent relative and absolute reliabilities were reported for both intra- and inter-session. Reliable measurements can be equally achieved when using the mean of two or three consecutive PPT measurements, as usually proposed in the literature, or with only the first one. Although reliability was almost perfect regardless of the conducted comparison between PPT assessments, our results suggest using two consecutive measurements to obtain higher short term absolute reliability.
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Affiliation(s)
- Romain Balaguier
- Univ. Grenoble-Alpes, EA AGEIS, Grenoble, France
- Physical Activity and Human Performance group—SMI, Dept. of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Pascal Madeleine
- Physical Activity and Human Performance group—SMI, Dept. of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nicolas Vuillerme
- Univ. Grenoble-Alpes, EA AGEIS, Grenoble, France
- Physical Activity and Human Performance group—SMI, Dept. of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Institut Universitaire de France, Paris, France
- * E-mail:
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