Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
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.
Eur J Paediatr Neurol. 2023 May;44:1-8. doi: 10.1016/j.ejpn.2023.01.007. Epub 2023 Jan 10.
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.
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).
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.
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.
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.
由于痉挛性脑瘫（SCP）的临床表现具有异质性，使得痉挛的治疗具有挑战性，因此需要更深入地了解痉挛与肌肉形态改变之间的复杂相互作用。
我们研究了痉挛与肌肉形态之间的相关性，并比较了常见痉挛模式（即在被动伸展过程中不同的肌肉激活模式）之间的肌肉形态。
我们定义了 74 例 SCP 儿童的内侧腓肠肌（MG）和半腱肌（ST）的痉挛和肌肉形态（平均年龄 8 岁 2 个月，GMFCS I/II/III：31/25/18，双侧/单侧：46/27）。使用仪器评估，痉挛程度通过在低和高速度下被动伸展时记录的肌肉激活差异来量化，并分为混合长度/速度依赖性或纯速度依赖性激活模式。使用自由手三维超声评估肌肉形态（体积和长度）和回声强度（作为肌肉质量的替代指标）。Spearman 相关系数和 Mann-Whitney-U 检验分别用于定义相关性和组间差异。
发现痉挛与 MG 肌肉体积之间存在中度负相关（r=-0.624，p<0.001），而痉挛与肌肉形态参数之间的其他显著相关性较弱。与纯速度依赖性模式的肌肉相比，混合长度/速度依赖性模式的肌肉具有更小的归一化肌肉体积（MG p=0.004，ST p<0.001）和更小的肌腹长度（ST p=0.015）。
较高的痉挛程度与 MG 和 ST 体积较小以及 MG 肌肉较短有关。与仅在高速度伸展时激活的肌肉相比，在低速度伸展时激活的肌肉中，这些肌肉形态改变更为明显。
