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Combining muscle morphology and neuromotor symptoms to explain abnormal gait at the ankle joint level in cerebral palsy

(2019) GAIT & POSTURE. 68. p.531-537
Author
Organization
Abstract
Background: Individuals with spastic cerebral palsy (CP) have neuromotor symptoms contributing towards their gait patterns. However, the role of altered muscle morphology alongside these symptoms is yet to be fully investigated. Research question: To what extent can medial gastrocnemius and tibialis anterior volume and echo-intensity, plantar/dorsiflexion strength and selective motor control, plantarflexion spasticity and passive ankle dorsiflexion explain abnormal ankle gait. Method: In thirty children and adolescents with spastic CP (8.6 +/- 3.4 y/mo) and ten typically developing peers (9.9 +/- 2.4 y/mo), normalised muscle volume and echo-intensity were estimated. Both cohorts also underwent three-dimensional gait analysis, whilst for participants with spastic CP, plantar/dorsi-flexion strength and selective motor control, plantarflexion spasticity and maximum ankle dorsiflexion were also measured. The combined contribution of these parameters towards five clinically meaningful features of gait were evaluated, using backwards multiple regression analyses. Results: With respect to the typically developing cohort, the participants with spastic CP had deficits in normalised medial gastrocnemius and tibialis anterior volume of 40% and 33%, and increased echo-intensity values of 19% and 16%, respectively. The backwards multiple regression analyses revealed that the combination of reduced ankle dorsiflexion, muscle volume, plantarflexion strength and dorsiflexion selective motor control could account for 12-62% of the variance in the chosen features of gait. Significance: The combination of altered muscle morphology and neuromotor symptoms partly explained abnormal gait at the ankle in children with spastic CP. Both should be considered as important measures for informed treatment decision-making, but further work is required to better unravel the complex pathophysiology.
Keywords
Spastic cerebral palsy, Muscle volume, Echo-intensity, Three-dimensional freehand ultrasonography, Three-dimensional gait analysis, CHILDREN, ULTRASOUND, INDIVIDUALS, RELIABILITY, STRENGTH, WALKING, VOLUME, SCALE

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MLA
Schless, Simon-Henri, et al. “Combining Muscle Morphology and Neuromotor Symptoms to Explain Abnormal Gait at the Ankle Joint Level in Cerebral Palsy.” GAIT & POSTURE, vol. 68, 2019, pp. 531–37.
APA
Schless, S.-H., Cenni, F., Bar-On, L., Hanssen, B., Goudriaan, M., Papageorgiou, E., … Desloovere, K. (2019). Combining muscle morphology and neuromotor symptoms to explain abnormal gait at the ankle joint level in cerebral palsy. GAIT & POSTURE, 68, 531–537.
Chicago author-date
Schless, Simon-Henri, Francesco Cenni, Lynn Bar-On, Britta Hanssen, Marije Goudriaan, Eirini Papageorgiou, Erwin Aertbeliën, Guy Molenaers, and Kaat Desloovere. 2019. “Combining Muscle Morphology and Neuromotor Symptoms to Explain Abnormal Gait at the Ankle Joint Level in Cerebral Palsy.” GAIT & POSTURE 68: 531–37.
Chicago author-date (all authors)
Schless, Simon-Henri, Francesco Cenni, Lynn Bar-On, Britta Hanssen, Marije Goudriaan, Eirini Papageorgiou, Erwin Aertbeliën, Guy Molenaers, and Kaat Desloovere. 2019. “Combining Muscle Morphology and Neuromotor Symptoms to Explain Abnormal Gait at the Ankle Joint Level in Cerebral Palsy.” GAIT & POSTURE 68: 531–537.
Vancouver
1.
Schless S-H, Cenni F, Bar-On L, Hanssen B, Goudriaan M, Papageorgiou E, et al. Combining muscle morphology and neuromotor symptoms to explain abnormal gait at the ankle joint level in cerebral palsy. GAIT & POSTURE. 2019;68:531–7.
IEEE
[1]
S.-H. Schless et al., “Combining muscle morphology and neuromotor symptoms to explain abnormal gait at the ankle joint level in cerebral palsy,” GAIT & POSTURE, vol. 68, pp. 531–537, 2019.
@article{8594126,
  abstract     = {Background: Individuals with spastic cerebral palsy (CP) have neuromotor symptoms contributing towards their gait patterns. However, the role of altered muscle morphology alongside these symptoms is yet to be fully investigated. 
Research question: To what extent can medial gastrocnemius and tibialis anterior volume and echo-intensity, plantar/dorsiflexion strength and selective motor control, plantarflexion spasticity and passive ankle dorsiflexion explain abnormal ankle gait. 
Method: In thirty children and adolescents with spastic CP (8.6 +/- 3.4 y/mo) and ten typically developing peers (9.9 +/- 2.4 y/mo), normalised muscle volume and echo-intensity were estimated. Both cohorts also underwent three-dimensional gait analysis, whilst for participants with spastic CP, plantar/dorsi-flexion strength and selective motor control, plantarflexion spasticity and maximum ankle dorsiflexion were also measured. The combined contribution of these parameters towards five clinically meaningful features of gait were evaluated, using backwards multiple regression analyses. 
Results: With respect to the typically developing cohort, the participants with spastic CP had deficits in normalised medial gastrocnemius and tibialis anterior volume of 40% and 33%, and increased echo-intensity values of 19% and 16%, respectively. The backwards multiple regression analyses revealed that the combination of reduced ankle dorsiflexion, muscle volume, plantarflexion strength and dorsiflexion selective motor control could account for 12-62% of the variance in the chosen features of gait. 
Significance: The combination of altered muscle morphology and neuromotor symptoms partly explained abnormal gait at the ankle in children with spastic CP. Both should be considered as important measures for informed treatment decision-making, but further work is required to better unravel the complex pathophysiology.},
  author       = {Schless, Simon-Henri and Cenni, Francesco and Bar-On, Lynn and Hanssen, Britta and Goudriaan, Marije and Papageorgiou, Eirini and Aertbeliën, Erwin and Molenaers, Guy and Desloovere, Kaat},
  issn         = {0966-6362},
  journal      = {GAIT & POSTURE},
  keywords     = {Spastic cerebral palsy,Muscle volume,Echo-intensity,Three-dimensional freehand ultrasonography,Three-dimensional gait analysis,CHILDREN,ULTRASOUND,INDIVIDUALS,RELIABILITY,STRENGTH,WALKING,VOLUME,SCALE},
  language     = {eng},
  pages        = {531--537},
  title        = {Combining muscle morphology and neuromotor symptoms to explain abnormal gait at the ankle joint level in cerebral palsy},
  url          = {http://dx.doi.org/10.1016/j.gaitpost.2018.12.002},
  volume       = {68},
  year         = {2019},
}

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