scholarly journals Neuromuscular Control before and after Independent Walking Onset in Children with Cerebral Palsy

Sensors ◽  
2021 ◽  
Vol 21 (8) ◽  
pp. 2714
Author(s):  
Annike Bekius ◽  
Coen S. Zandvoort ◽  
Jennifer N. Kerkman ◽  
Laura A. van de Pol ◽  
R. Jeroen Vermeulen ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Neuromuscular Control ◽  
Brain Lesions ◽  
Muscle Synergy ◽  
Walking Ability ◽  
Typically Developing ◽  
Leg Muscles ◽  
Affected Side ◽  
Before And After ◽  
Walking Group

Early brain lesions which produce cerebral palsy (CP) may affect the development of walking. It is unclear whether or how neuromuscular control, as evaluated by muscle synergy analysis, differs in young children with CP compared to typically developing (TD) children with the same walking ability, before and after the onset of independent walking. Here we grouped twenty children with (high risk of) CP and twenty TD children (age 6.5–52.4 months) based on their walking ability, supported or independent walking. Muscle synergies were extracted from electromyography data of bilateral leg muscles using non-negative matrix factorization. Number, synergies’ structure and variability accounted for when extracting one (VAF1) or two (VAF2) synergies were compared between CP and TD. Children in the CP group recruited fewer synergies with higher VAF1 and VAF2 compared to TD children in the supported and independent walking group. The most affected side in children with asymmetric CP walking independently recruited fewer synergies with higher VAF1 compared to the least affected side. Our findings suggest that early brain lesions result in early alterations of neuromuscular control, specific for the most affected side in asymmetric CP.

scholarly journals Children with Cerebral Palsy Return to Baseline Community Arm Movement after Constraint Induced Movement Therapy

2019 ◽  
Author(s):  
Brianna M. Goodwin ◽  
Emily K. Sabelhaus ◽  
Ying-Chun Pan ◽  
Kristie F. Bjornson ◽  
Kelly L. D. Pham ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Community Setting ◽  
Arm Movement ◽  
Movement Therapy ◽  
Tertiary Hospital ◽  
Typically Developing ◽  
Constraint Induced Movement Therapy ◽  
Transfer Of Skills ◽  
Before And After ◽  
Clinical Measures

AbstractImportanceConstraint Induced Movement Therapy (CIMT) is a common treatment for children with unilateral cerebral palsy (CP). While clinic-based assessments have demonstrated improvements in arm function after CIMT, quantifying if these changes are translated and sustained outside of a clinic setting remains unclear.ObjectiveAccelerometers were used to quantify arm movement for children with CP one week before, during, and 4+ weeks after CIMT and compared to typically-developing (TD) peers.DesignObservational during CIMTSettingClinical assessments and treatment occurred in a tertiary hospital and accelerometry data were collected in the communityParticipants7 children with CP (5m/2f, 7.4 ± 1.2 yrs) and 7 TD peers (2m/5f, 7.0 ± 2.3 yrs)Intervention30-hour CIMT protocolOutcomes and MeasuresThe use ratio, magnitude ratio, and bilateral magnitude were calculated from the accelerometry data. Clinical measures were evaluated before and after CIMT and surveys were used to assess the feasibility of using accelerometers.ResultsBefore CIMT, children with CP used their paretic arm less than their TD peers. During therapy, their frequency and magnitude of paretic arm use increased in the clinic and in daily life. After therapy, although clinical scores improved, children reverted to baseline accelerometry values. Additionally, children and parents in both cohorts had positive perceptions of wearing accelerometers.Conclusions and RelevanceThe lack of sustained improved accelerometry metrics following CIMT suggest therapy gains did not translate to increased movement outside the clinic. Additional therapy may be needed to help the transfer of skills to the community setting.What this Article AddsThis study compares the movement of children with CP undergoing CIMT in the community setting with their typically developing peers. Additional interventions may be needed in combination with or following CIMT to sustain the benefits of the therapy outside of the clinic.

scholarly journals Robot-Assisted Therapy Influence on Kinematic and EMG Activity in the Upper Limb for Children with Cerebral Palsy

2020 ◽  
Author(s):  
Sana Raouafi ◽  
Maxime Raison ◽  
Sofiane Achiche
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Upper Limb ◽  
Typically Developing ◽  
Typically Developing Children ◽  
Robot Assisted ◽  
Function Index ◽  
Children With Cerebral Palsy ◽  
Before And After ◽  
Inertial Measurements

Aim: To develop an index for quantitative assessment of the upper limb motor function in children with cerebral palsy before and after robot-assisted therapy. Method: An upper limb motor function index was developed using kinematic, surface electromyography and three-axis inertial measurements unit data collected from 15 children with cerebral palsy (CP) and 15 typically developed children. Children with CP underwent 18 robot-assisted therapy sessions with the REAplan device. All children were evaluated, using kinematic data from the REAplan, electromyography and three-axis inertial measurements unit readings from its accelerometer. A principal component analysis was conducted to produce an evaluation index, which is able to detect the deviation from the upper limb motor function of typically developing children group. Children with CP were evaluated twice before and after the intervention with Box and Blocks test and Finger-To-Nose test. The discriminative and concurrent validity of the upper limb motor function index were investigated. Results: The upper limb motor function index was higher in children with CP post therapy (p<0.001). Finger-To-Nose test values improved after robot-assisted therapy (p<0.03). A weak but positive correlation was observed between upper limb motor function index and clinical tests (r=0.012, p=0.95 and r=0.13, p= 0.54 for Box and Blocks test and Finger-To-Nose test respectively). Interpretation: The upper limb motor function index successfully differentiated between the typically developing children and children with CP and was effective in assessing the improvement of the upper limb motor function after robot-assisted therapy. The upper limb motor function index could be extended to assess and monitor rehabilitation therapies of other populations, such as those with stroke and Parkinson’s disease.

scholarly journals Wearable Robotic Ankle Resistance Training Improves Neuromuscular Control and Walking Efficiency in Cerebral Palsy

2020 ◽  
Author(s):  
Benjamin C. Conner ◽  
Michael H. Schwartz ◽  
Zachary F. Lerner
Keyword(s):  
Cerebral Palsy ◽  
Three Dimensional ◽  
Neuromuscular Control ◽  
Metabolic Cost ◽  
Gait Pattern ◽  
Muscle Synergy ◽  
Cost Of Transport ◽  
Activation Profile ◽  
Efficient Gait ◽  
Ankle Exoskeleton

AbstractCerebral palsy (CP) is characterized by deficits in motor function due to reduced neuromuscular control. We leveraged the guiding principles of motor learning theory to design a wearable robotic intervention intended to improve neuromuscular control of the ankle. The goal of this pilot clinical trial was to determine the response to four weeks of exoskeleton ankle resistance therapy (exo-therapy) in children with CP. Five children with CP (12 – 17 years, GMFCS I – II, four males and one female) were recruited for ten, 20-minute sessions of exo-therapy. Surface electromyography, three-dimensional kinematics, and metabolic data were collected at baseline and after training was complete. Changes in neural complexity (via muscle synergy analysis) and metabolic cost were compared to retrospective age- and GMFCS-matched controls who had undergone either single event multi-level orthopedic surgery (SEMLS) or selective dorsal rhizotomies (SDR). Participants displayed decreased co-contraction at the ankle (−29 ± 11%, p = 0.02) and a more typical plantar flexor activation profile (33 ± 13%, p = 0.01), and improvements in neuromuscular control led to a more mechanically-efficient gait pattern (58 ± 34%, p < 0.05) with a reduced metabolic cost of transport (−29 ± 15%, p = 0.02). There were significant increases in neural complexity (5 ± 3%, p = 0.03), where were significantly greater than those seen with SEMLS and SDR (p < 0.01 for both). Ankle exoskeleton resistance therapy shows promise for rapidly improving neuromuscular control for children with CP, and may serve as a meaningful rehabilitative complement to common surgical procedures.

Acute Physical Exercise Affects Cognitive Functioning in Children With Cerebral Palsy

2016 ◽  
Vol 28 (2) ◽  
pp. 304-311 ◽  
Author(s):  
Désirée B. Maltais ◽  
Claire Gane ◽  
Sophie-Krystale Dufour ◽  
Dominik Wyss ◽  
Laurent J. Bouyer ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Cognitive Functioning ◽  
Acute Exercise ◽  
Typically Developing ◽  
Intense Exercise ◽  
Children With Cerebral Palsy ◽  
Before And After ◽  
Negative Effect ◽  
Acute Physical Exercise ◽  
Positive Effect

Little is known about the effects of acute exercise on the cognitive functioning of children with cerebral palsy (CP). Selected cognitive functions were thus measured using a pediatric version of the Stroop test before and after maximal, locomotor based aerobic exercise in 16 independently ambulatory children (8 children with CP), 6–15 years old. Intense exercise had: 1) a significant, large, positive effect on reaction time (RT) for the CP group (preexercise: 892 ± 56.5 ms vs. postexercise: 798 ± 45.6 ms, p < .002, d = 1.87) with a trend for a similar but smaller response for the typically developing (TD) group (preexercise: 855 ± 56.5 ms vs. postexercise: 822 ± 45.6 ms, p < .08, d = 0.59), and 2) a significant, medium, negative effect on the interference effect for the CP group (preexercise: 4.5 ± 2.5%RT vs. postexercise: 13 ± 2.9%RT, p < .04, d = 0.77) with no significant effect for the TD group (preexercise: 7.2 ± 2.5%RT vs. postexercise: 6.9 ± 2.9%RT, p > .4, d = 0.03). Response accuracy was high in both groups pre- and postexercise (>96%). In conclusion, intense exercise impacts cognitive functioning in children with CP, both by increasing processing speed and decreasing executive function.

scholarly journals RaceRunning training improves stamina and promotes skeletal muscle hypertrophy in young individuals with cerebral palsy

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Emma Hjalmarsson ◽  
Rodrigo Fernandez-Gonzalo ◽  
Cecilia Lidbeck ◽  
Alexandra Palmcrantz ◽  
Angel Jia ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Heart Rate ◽  
Cerebral Palsy ◽  
Gastrocnemius Muscle ◽  
Medial Gastrocnemius ◽  
Walking Ability ◽  
Maximum Heart Rate ◽  
Affected Side ◽  
Cardiorespiratory Endurance ◽  
Medial Gastrocnemius Muscle

Abstract Background Individuals with cerebral palsy (CP) are less physically active, spend more time sedentary and have lower cardiorespiratory endurance as compared to typically developed individuals. RaceRunning enables high-intensity exercise in individuals with CP with limited or no walking ability, using a three-wheeled running bike with a saddle and a chest plate for support, but no pedals. Training adaptations using this type of exercise are unknown. Methods Fifteen adolescents/young adults (mean age 16, range 9–29, 7 females/8 males) with CP completed 12 weeks, two sessions/week, of RaceRunning training. Measurements of cardiorespiratory endurance (6-min RaceRunning test (6-MRT), average and maximum heart rate, rate of perceived exertion using the Borg scale (Borg-RPE)), skeletal muscle thickness (ultrasound) of the thigh (vastus lateralis and intermedius muscles) and lower leg (medial gastrocnemius muscle) and passive range of motion (pROM) of hip, knee and ankle were collected before and after the training period. Results Cardiorespiratory endurance increased on average 34% (6-MRT distance; pre 576 ± 320 m vs. post 723 ± 368 m, p < 0.001). Average and maximum heart rate and Borg-RPE during the 6-MRT did not differ pre vs. post training. Thickness of the medial gastrocnemius muscle increased 9% in response to training (p < 0.05) on the more-affected side. Passive hip flexion increased (p < 0.05) on the less-affected side and ankle dorsiflexion decreased (p < 0.05) on the more affected side after 12 weeks of RaceRunning training. Conclusions These results support the efficacy of RaceRunning as a powerful and effective training modality in individuals with CP, promoting both cardiorespiratory and peripheral adaptations.

scholarly journals Children With Cerebral Palsy Have Greater Stride-to-Stride Variability of Muscle Synergies During Gait Than Typically Developing Children: Implications for Motor Control Complexity

2018 ◽  
Vol 32 (9) ◽  
pp. 834-844 ◽  
Author(s):  
Yushin Kim ◽  
Thomas C. Bulea ◽  
Diane L. Damiano
Keyword(s):  
Cerebral Palsy ◽  
Motor Control ◽  
Clinical Utility ◽  
Neuromuscular Control ◽  
Muscle Synergy ◽  
Neurological Deficits ◽  
Muscle Synergies ◽  
Children With Cerebral Palsy ◽  
The Central Nervous System ◽  
Potential Clinical Utility

Background. There is mounting evidence that the central nervous system utilizes a modular approach for neuromuscular control of walking by activating groups of muscles in units termed muscle synergies. Examination of muscle synergies in clinical populations may provide insights into alteration of neuromuscular control underlying pathological gait patterns. Previous studies utilizing synergy analysis have reported reduced motor control complexity during walking in those with neurological deficits, revealing the potential clinical utility of this approach. Methods. We extracted muscle synergies on a stride-to-stride basis from 20 children with cerebral palsy (CP; Gross Motor Function Classification System levels I-II) and 8 children without CP, allowing the number of synergies to vary for each stride. Similar muscle synergies across all participants and strides were grouped using a k-means clustering and discriminant analysis. Results. In total, 10 clusters representing 10 distinct synergies were found across the 28 individuals. Relative to their total number of synergies deployed during walking, synergies from children with CP were present in a higher number of clusters than in children with typical development (TD), indicating significantly greater stride-to-stride variability. This increased variability was present despite reduced complexity, as measured by the mean number of synergies in each stride. Whereas children with CP demonstrate some novel synergies, they also deploy some of the same muscle synergies as those with TD, although less frequently and with more variability. Conclusion. A stride-by-stride approach to muscle synergy analysis expands its clinical utility and may provide a method to tailor rehabilitation strategies by revealing inconsistent but functional synergies in each child with CP.

scholarly journals Effect of the Hybrid Assistive Limb on the Gait Pattern for Cerebral Palsy

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 673
Author(s):  
Yuki Mataki ◽  
Hirotaka Mutsuzaki ◽  
Hiroshi Kamada ◽  
Ryoko Takeuchi ◽  
Shogo Nakagawa ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Gait Analysis ◽  
Sagittal Plane ◽  
Gait Training ◽  
Gait Pattern ◽  
Walking Ability ◽  
Gait Symmetry ◽  
Motor Disability ◽  
Before And After ◽  
Hybrid Assistive Limb

Background and objectives: Cerebral palsy (CP) is the most frequent childhood motor disability. Achieving ambulation or standing in children with CP has been a major goal of physical therapy. Recently, robot-assisted gait training using the Hybrid Assistive Limb® (HAL) has been effective in improving walking ability in patients with CP. However, previous studies have not examined in detail the changes in gait pattern after HAL training for patients with spastic CP, including gait symmetry. This study aimed to evaluate the immediate effect of HAL training on the walking ability and the changes in gait pattern and gait symmetry in patients with spastic CP. Materials and Methods: We recruited 19 patients with spastic CP (13 male and six female; mean age, 15.7 years). Functional ambulation was assessed using the 10-Meter Walk Test and gait analysis in the sagittal plane before and after a single 20-min HAL intervention session. Results: The walking speed and stride length significantly increased after HAL intervention compared to the pre-intervention values. Two-dimensional gait analysis showed improvement in equinus gait, increase in the flexion angle of the swing phase in the knee and hip joints, and improvement in gait symmetry. Immediate improvements in the walking ability and gait pattern were noted after HAL training in patients with spastic CP. Conclusions: The symmetry of the joint angle of the lower limb, including the trunk, accounts for the improvement in walking ability after HAL therapy.

The influence of osteopathic correction on the viscoelastic characteristics of the lower leg muscles

2019 ◽  
pp. 93-98
Author(s):  
E. M. Timanin ◽  
N. S. Sydneva ◽  
A. A. Zakharova
Keyword(s):  
Viscoelastic Properties ◽  
Gastrocnemius Muscle ◽  
Soft Tissues ◽  
Subjective Assessment ◽  
Lymphatic Drainage ◽  
Intercellular Substance ◽  
Leg Muscles ◽  
Before And After ◽  
Viscoelastic Characteristics ◽  
Instrumental Methods

Introduction. To date there is a lack of studies dedicated to the objectification of the palpation data obtained by a specialist during the osteopathic examination. The issue of the evidence of the results of osteopathic correction still remains important. Search for instrumental methods allowing to register and to measure various palpation phenomena and manifestations of somatic dysfunctions is very relevant for the development of osteopathy as a science. It is also very important to find objective characteristics of these methods.Goal of research — to study viscoelastic characteristics of the soft tissues of the lower legs by palpation and instrumental methods before and after osteopathic correction.Materials and methods. 22 volunteers (12 women and 10 men) aged 18–23 years without complaints of the musculoskeletal system were examined. Osteopathic diagnostics and measurement of the viscoelastic properties of muscles were carried out by the method of vibration viscoelastometry before and after osteopathic correction.Results. Correlation analysis by Spearman showed that the subjective assessment of an osteopath positively correlated with both elasticity (r=0,43, p<0,05) and viscosity of soft issues (r=0,29, p<0,05). For the gastrocnemius muscle, this pattern was even more pronounced — for elasticity r=0,51, p<0,05, for viscosity =0,34, p<0,05. After osteopathic correction no changes in the elasticity of the soft tissues were observed. The viscosity of the tissues reduced, but in the projection of the gastrocnemius muscle, these changes were not statistically significant (p=0,12), whereas in the projection of the soleus muscle statistically significant changes (p=0,034) were observed.Conclusion. Changes in the viscoelastic properties of tissues demonstrated that the effects of osteopathic correction with the use of myofascial mobilization techniques, articulation mobilization techniques, and lymphatic drainage techniques were not obvious. The elasticity of soft tissues of the lower legs did not change, while the viscosity decreased, especially in the projection of the soleus muscles. This effect of the osteopathic correction can be associated with the effect of thixotropy — the transformation of gel-like intercellular substance into sol. Thus, the research showed that vibration viscoelastometry can be used for the objectifi cation of the condition of soft tissues and of the effects of osteopathic correction.

scholarly journals Risk factors for hip dislocation in dyskinetic cerebral palsy

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110011
Author(s):  
Kyoko Okuno ◽  
Yukihiro Kitai ◽  
Toru Shibata ◽  
Hiroshi Arai
Keyword(s):  
Risk Factors ◽  
Cerebral Palsy ◽  
Birth Weight ◽  
Gestational Age ◽  
Brain Mri ◽  
Brain Lesion ◽  
Brain Lesions ◽  
Lesion Location ◽  
Hip Displacement ◽  
Gmfcs Level

Purpose: To investigate the risk factors for hip displacement in patients with dyskinetic cerebral palsy (DCP). Methods: We evaluated 81 patients with DCP, 45 males and 36 females, aged 10–22 years, risk factors for hip displacement were evaluated using multivariate logistic regression analysis with primary brain lesions, Gross Motor Function Classification System (GMFCS) level, gestational age, birth weight, Cobb’s angle, and complication of epilepsy as independent factors. Hip displacement was defined as migration percentage >30%. Primary brain lesions were classified into globus pallidus (GP), thalamus and putamen (TP), and others using brain magnetic resonance imaging (MRI). Perinatal and clinical features were compared between patients with GP lesions and those with TP lesions. Results: Hip displacement was observed in 53 patients (67%). Higher GMFCS levels (p = 0.013, odds ratio [OR] 2.6) and the presence of GP lesions (p = 0.04, OR 16.5) were independent risk factors for hip displacement. Patients with GP lesions showed significantly higher GMFCS levels, more frequent hip displacement, and lower gestational age and birth weight than those with TP lesions. Conclusion: Primary brain lesion location may be an important factor in predicting hip displacement among patients with DCP. Appropriate risk assessment using brain MRI may contribute to the early detection and intervention of hip displacement because brain lesion location can be assessed during infancy before GMFCS level is decided.

Sign in / Sign up

Export Citation Format

Share Document