Clewes Kylie, Hammond Claire, Dong Yiwen, Meyer Mary, Lowe Evan, Rose Jessica
Motion and Gait Analysis Lab, Lucile Packard Children's Hospital, Stanford Medicine Children's Health, Palo Alto, CA, United States.
Department of Mechanical Engineering, Rice University, Houston, TX, United States.
Front Hum Neurosci. 2024 Sep 18;18:1445793. doi: 10.3389/fnhum.2024.1445793. eCollection 2024.
Identification of neuromuscular impairments in cerebral palsy (CP) is essential to providing effective treatment. However, clinical recognition of neuromuscular impairments in CP and their contribution to gait abnormalities is limited, resulting in suboptimal treatment outcomes. While CP is the most common childhood movement disorder, clinical evaluations often do not accurately identify and delineate the primary neuromuscular and secondary musculoskeletal impairments or their specific impact on mobility. Here we discuss the primary neuromuscular impairments of CP that arise from early brain injury and the progressive secondary musculoskeletal impairments, with a focus on spastic CP, the most common form of CP. Spastic CP is characterized by four primary interrelated neuromuscular impairments: 1. muscle weakness, 2. short muscle-tendon units due to slow muscle growth relative to skeletal growth, 3. muscle spasticity characterized by increased sensitivity to stretch, and 4. impaired selective motor control including flexor and extensor muscle synergies. Specific gait events are affected by the four primary neuromuscular impairments of spastic CP and their delineation can improve evaluation to guide targeted treatment, prevent deformities and improve mobility. Emerging information on neural correlates of neuromuscular impairments in CP provides the clinician with a more complete context with which to evaluate and develop effective treatment plans. Specifically, addressing the primary neuromuscular impairments and reducing secondary musculoskeletal impairments are important treatment goals. This perspective on neuromuscular mechanisms underlying gait abnormalities in spastic CP aims to inform clinical evaluation of CP, focus treatment more strategically, and guide research priorities to provide targeted treatments for CP.
识别脑瘫（CP）中的神经肌肉损伤对于提供有效治疗至关重要。然而，临床上对CP中神经肌肉损伤及其对步态异常的影响的认识有限，导致治疗效果欠佳。虽然CP是儿童期最常见的运动障碍，但临床评估往往无法准确识别和区分原发性神经肌肉损伤和继发性肌肉骨骼损伤，或它们对运动能力的具体影响。在此，我们讨论由早期脑损伤引起的CP原发性神经肌肉损伤以及进行性继发性肌肉骨骼损伤，重点关注痉挛型CP，这是CP最常见的形式。痉挛型CP的特征是四种主要的相互关联的神经肌肉损伤：1. 肌肉无力；2. 由于肌肉生长相对于骨骼生长缓慢导致肌肉 - 肌腱单位短缩；3. 以对拉伸敏感性增加为特征的肌肉痉挛；4. 包括屈肌和伸肌协同作用受损的选择性运动控制障碍。特定的步态事件受痉挛型CP的四种主要神经肌肉损伤影响，对它们的描述可以改善评估以指导针对性治疗、预防畸形并改善运动能力。关于CP中神经肌肉损伤的神经相关性的新信息为临床医生提供了更完整的背景，以便评估和制定有效的治疗计划。具体而言，解决原发性神经肌肉损伤并减少继发性肌肉骨骼损伤是重要的治疗目标。这种关于痉挛型CP步态异常潜在神经肌肉机制的观点旨在为CP的临床评估提供信息，更有策略地聚焦治疗，并指导研究重点，以便为CP提供针对性治疗。
