An ultrasonographic analysis of the activation patterns of abdominal muscles in children with spastic type cerebral palsy and in typically developing individuals: a comparative study

Saviour Kweku Adjenti,Graham Jacob Louw,Marianne Unger,Jennifer Jelsma

doi:10.1186/s40945-018-0048-x

Abstract

BackgroundAbdominal muscles have stiffer appearance in individuals with spastic type cerebral palsy (STCP) than in their typically developing (TD) peers. This apparent stiffness has been implicated in pelvic instability, mal-rotation, poor gait and locomotion. This study was aimed at investigating whether abdominal muscles activation patterns from rest to activity differ in the two groups.MethodFrom ultrasound images, abdominal muscles thickness during the resting and active stages was measured in 63 STCP and 82 TD children. The thickness at each stage and the change in thickness from rest to activity were compared between the two groups.ResultsRectus abdominis (RA) muscle was the thickest muscle at rest as well as in active stage in both groups. At rest, all muscles were significantly thicker in the STCP children (p < 0.001). From rest to active stages muscle thickness significantly increased (p < 0.001) in the TD group and significantly decreased (p < 0.001) in the STCP children, except for RA, which became thicker during activity in both groups. In active stages, no significant differences in the thickness in the four abdominal muscles were found between the STCP and the TD children.ConclusionApart from the RA muscle, the activation pattern of abdominal muscles in individuals with STCP differs from that of TD individuals. Further studies required for understanding the activation patterns of abdominal muscles prior to any physical fitness programmes aimed at improving the quality of life in individuals with STCP.Trial registrationHREC REF: 490/2011. Human Research Ethics Committee, Faculty of Health Sciences, University of Cape Town, South Africa. November 17, 2011.

Highlights

Abdominal muscles have stiffer appearance in individuals with spastic type cerebral palsy (STCP) than in their typically developing (TD) peers
From rest to active stages muscle thickness significantly increased (p < 0.001) in the TD group and significantly decreased (p < 0.001) in the STCP children, except for rectus abdominis (RA), which became thicker during activity in both groups
No significant differences in the thickness in the four abdominal muscles were found between the STCP and the TD children

Summary

Introduction

Abdominal muscles have stiffer appearance in individuals with spastic type cerebral palsy (STCP) than in their typically developing (TD) peers This apparent stiffness has been implicated in pelvic instability, mal-rotation, poor gait and locomotion. Targeting the trunk is common in those children who display an anterior pelvic tilt [4, 6]. This position places a prolonged stretch on the TrA and RA muscles needed to maintain a neutral pelvis and subsequently causes inhibition of the stretch reflex [7] thereby decreasing reactivity in these muscles. With regards to individuals with STCP, the muscle groups which appear to contribute to this fixation include the flexors, adductors and the internal rotators of the hip, which gives rise to the typical postural and gait patterns seen – couch gait in diplegia and equines gait in hemiplegia [11]

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