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Associations between muscle morphology and spasticity in children with spastic cerebral palsy

Nicky Peeters, Britta Hanssen (UGent) , Lynn Bar-On (UGent) , Friedl De Groote, Nathalie De Beukelaer, Marjan Coremans, Christine Van den Broeck (UGent) , Bernard Dan, Anja Van Campenhout and Kaat Desloovere
(2023) EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY. 44. p.1-8
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Abstract
Introduction: Due to the heterogeneous clinical presentation of spastic cerebral palsy (SCP), which makes spas-ticity 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.
Keywords
Neurology (clinical), General Medicine, Pediatrics, Perinatology and Child Health, Children, Ultrasound, Muscle morphology, Spasticity, Cerebral palsy

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MLA
Peeters, Nicky, et al. “Associations between Muscle Morphology and Spasticity in Children with Spastic Cerebral Palsy.” EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY, vol. 44, 2023, pp. 1–8, doi:10.1016/j.ejpn.2023.01.007.
APA
Peeters, N., Hanssen, B., Bar-On, L., De Groote, F., De Beukelaer, N., Coremans, M., … Desloovere, K. (2023). Associations between muscle morphology and spasticity in children with spastic cerebral palsy. EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY, 44, 1–8. https://doi.org/10.1016/j.ejpn.2023.01.007
Chicago author-date
Peeters, Nicky, Britta Hanssen, Lynn Bar-On, Friedl De Groote, Nathalie De Beukelaer, Marjan Coremans, Christine Van den Broeck, Bernard Dan, Anja Van Campenhout, and Kaat Desloovere. 2023. “Associations between Muscle Morphology and Spasticity in Children with Spastic Cerebral Palsy.” EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY 44: 1–8. https://doi.org/10.1016/j.ejpn.2023.01.007.
Chicago author-date (all authors)
Peeters, Nicky, Britta Hanssen, Lynn Bar-On, Friedl De Groote, Nathalie De Beukelaer, Marjan Coremans, Christine Van den Broeck, Bernard Dan, Anja Van Campenhout, and Kaat Desloovere. 2023. “Associations between Muscle Morphology and Spasticity in Children with Spastic Cerebral Palsy.” EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY 44: 1–8. doi:10.1016/j.ejpn.2023.01.007.
Vancouver
1.
Peeters N, Hanssen B, Bar-On L, De Groote F, De Beukelaer N, Coremans M, et al. Associations between muscle morphology and spasticity in children with spastic cerebral palsy. EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY. 2023;44:1–8.
IEEE
[1]
N. Peeters et al., “Associations between muscle morphology and spasticity in children with spastic cerebral palsy,” EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY, vol. 44, pp. 1–8, 2023.
@article{01GPKMN2SE8NV0KWKAHQDPVHK7,
  abstract     = {{Introduction: Due to the heterogeneous clinical presentation of spastic cerebral palsy (SCP), which makes spas-ticity 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.}},
  author       = {{Peeters, Nicky and Hanssen, Britta and Bar-On, Lynn and De Groote, Friedl and De Beukelaer, Nathalie and Coremans, Marjan and Van den Broeck, Christine and Dan, Bernard and Van Campenhout, Anja and Desloovere, Kaat}},
  issn         = {{1090-3798}},
  journal      = {{EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY}},
  keywords     = {{Neurology (clinical),General Medicine,Pediatrics, Perinatology and Child Health,Children,Ultrasound,Muscle morphology,Spasticity,Cerebral palsy}},
  language     = {{eng}},
  pages        = {{1--8}},
  title        = {{Associations between muscle morphology and spasticity in children with spastic cerebral palsy}},
  url          = {{http://doi.org/10.1016/j.ejpn.2023.01.007}},
  volume       = {{44}},
  year         = {{2023}},
}
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