Muscle Contracture In Children Research Articles

Muscle contracture in children with cerebral palsy: Mechanosensitive pathways and cellular dysfunction.

Muscle contracture in children with cerebral palsy: Mechanosensitive pathways and cellular dysfunction.

Quantitative Assessment of Muscle Strength Following "Slow" Surgical Lengthening of the Medial Hamstring Muscles in Children With Cerebral Palsy.

Classic teaching for surgical lengthening of muscle contractures in children with cerebral palsy (CP) has emphasized complete correction of the deformity acutely, with immobilization of the targeted muscles in the fully corrected position. Clinical experience has led to the impression that the muscles are invariably weakened by this approach. We have developed an alternative technique for correction of contractures called slow surgical lengthening (SSL). The goal of the study was to determine the physical examination, kinematic, and muscle strength outcomes following SSL of the medial hamstring muscles in children with CP. The study group included 41 children with CP who underwent SSL of the medial hamstring muscles as part of a comprehensive single-event multilevel surgery, who had preoperative and 1-year postoperative evaluations in our Motion Analysis Center, which included quantitative assessment of isometric and isokinetic muscle strength. All subjects were Gross Motor Function Classification System I and II. Mean age at the time of surgery was 10.8 years. The mean popliteal angle improved by 16.2 degrees (P<0.001) following SSL of the medial hamstrings. Sagittal plane kinematics following SSL of the medial hamstrings showed improvement of knee extension at initial contact of 10.2 degrees (P<0.001), decrease of peak knee flexion in mid-swing of 3.6 degrees (P=0.014), improved minimum knee flexion in stance of 4.9 degrees (P=0.002), and no significant change in mean anterior pelvic tilt (P=0.123). Mean peak isometric knee flexion torque remained unchanged from preoperative to postoperative studies (P=0.154), whereas mean peak isokinetic knee flexion torque significantly increased by 0.076 Nm/kg (P=0.014) following medial hamstring SSL. SSL was developed based upon clinical experience and improved understanding of the pathophysiology of skeletal muscle in children with CP. The SSL technique allows the tendinous tissue to separate spontaneously at the time of recession, but does not force further acute lengthening by intraoperative manipulation, thereby minimizing the damage to the underlying muscle. It is broadly believed that muscle weakness is inevitable following surgical lengthening. The current study shows that the SSL technique does not cause weakness. Level IV-therapeutic.

Z-plasty for severe gluteal muscle contracture in children.

To review the records of 363 patients with severe gluteal muscle contracture to determine its mechanism, underlying pathology, and treatment outcome. Records of 136 males and 227 females aged 5 to 18 (mean, 12.2) years who underwent Z-plasty for bilateral (n=347) or unilateral (n=16) severe gluteal muscle contracture were reviewed. Severe gluteal muscle contracture was classified as typical (n=52) or special (n=311). The typical type is associated with symptoms of positive out-toe gait, Ober sign, back-extending test, cross-leg test, squatting with knee side-by-side test, and hip dysfunction. It is further subdivided into mild (n=0), moderate (n=40), or severe (n=12). The special type is associated with additional symptoms of pelvic tilt and leg length discrepancy (<2 cm in 181 hips, 2-4 cm in 82 hips, and >4 cm in 48 hips). 311 hips had pelvic tilt and 47 hips had lumbar compensatory scoliosis. Treatment outcome was assessed at 6 months. Hip functional score was assessed at the final follow-up. The mean hospitalisation period was 11 days. After a mean follow-up of 1.5 years, the mean hip functional score improved from 8.03 to 11.69; improvement was higher in children (age 5-13 years) than in adolescents (age 14-18 years) [3.7 vs. 2.9, p<0.001]. At 6 months, outcome was excellent in 280 hips, good in 80, fair in 3 hips, and poor in 0. The 3 hips with fair outcome had persistent slight pelvic tilt and swaying gait. Two of them had preoperative leg length discrepancy >4 cm, and intra-operatively the contracture band severely affected the joint capsule. The third patient did not comply with postoperative exercises. Surgical treatment for severe gluteal muscle contracture achieved good outcome.

Benefits of Tendon Transfer Surgery in Cerebral Palsy

Research Article| August 01 2015 Benefits of Tendon Transfer Surgery in Cerebral Palsy AAP Grand Rounds (2015) 34 (2): 17. https://doi.org/10.1542/gr.34-2-17 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Benefits of Tendon Transfer Surgery in Cerebral Palsy. AAP Grand Rounds August 2015; 34 (2): 17. https://doi.org/10.1542/gr.34-2-17 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: arm, botulinum toxins, cerebral palsy, tendon transfer procedure Source: Van Heest A, Bagley A, Molitor F, et al. Tendon transfer surgery in upper-extremity cerebral palsy is more effective than botulinum toxin injections or regular, ongoing therapy. J Bone Joint Surg. 2015; 97(7): 529– 536; doi: https://doi.org/10.2106/JBJS.M.01577Google Scholar Investigators from 7 Shriners Hospitals sought to determine the most effective treatment for upper extremity muscle contractures in children with spastic, hemiplegic cerebral palsy (CP). Patients with upper extremity CP, aged 4 to 16 years, were prospectively assigned randomly or by patient/family preference to 1 of 3 treatment groups: surgery (Group 1), botulinum toxin injections (Group 2), or regular ongoing therapy (Group 3). All 3 patient groups also received standard supervised occupational therapy (OT) followed by home therapy. Standardized validated outcome tools were used for assessment. Outcomes measurements included active range of motion, pinch and grip strength, stereognosis, and scores from 8 other functional or patient-orientated validated outcome tools including dynamic positional analysis (DPA), 5 domains in the Pediatric Quality of Life Inventory (PedsQL), and the Canadian Occupational Performance Measure (COPM-satisfaction score). Change from baseline for each of these outcomes was compared among children in the 3 treatment groups. Thirty-nine patients were enrolled in the study, 29 by randomization and 10 by patient/family preference. Thirty-four patients (25 randomized and 9 patient/family-preference) were evaluated 12 months post-treatment. This included 16 in Group 1, 9 in Group 2, and 9 in Group 3. Significantly greater improvement in DPA was seen among those in Group 1 (surgery) compared to the other 2 groups (P < .001). These changes reflected improvement in supination and wrist extension during functional activities after surgical treatment. Participants in Group 1 also showed more improvement in the PedsQL-CP module domain of movement compared to those in the other groups (P = .002). The mean increase in Group 1 was 26.4% while Group 2 and Group 3 both had a mean decrease of 3.3%. For the other 4 domains of the PedsQL-CP module – school, fatigue, eating, and speech – there were no significant differences among treatment groups. Group 1 also showed more improvement in the COPM score than Groups 2 and 3 (P = .002). Children in groups 1 and 3 showed significantly more improvement in pinch strength than those from Group 2. The authors conclude that for children with upper extremity CP, surgical treatment results in significantly greater functional improvement and satisfaction than botulinum toxin injections or regular therapy. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. In children with hemiplegic CP, the abnormal muscle tone patterns cause the arm and hand to be positioned in elbow flexion, forearm pronation, wrist flexion, and thumb in palm. These contractures limit function. Nonsurgical and surgical treatments exist to reduce the deformities and improve function. Nonsurgical treatments include botulinum toxin injections and OT.1–3 Botulinum toxin... You do not currently have access to this content.

Muscle Contractures in Children with Spastic Cerebral Palsy

Muscle Contractures in Children with Spastic Cerebral Palsy

Transcriptional abnormalities of hamstring muscle contractures in children with cerebral palsy.

Cerebral palsy (CP) is an upper motor neuron disease that results in a spectrum of movement disorders. Secondary to the neurological lesion, muscles from patients with CP are often spastic and form debilitating contractures that limit range of motion and joint function. With no genetic component, the pathology of skeletal muscle in CP is a response to aberrant complex neurological input in ways that are not fully understood. This study was designed to gain further understanding of the skeletal muscle response in CP using transcriptional profiling correlated with functional measures to broadly investigate muscle adaptations leading to mechanical deficits.Biospsies were obtained from both the gracilis and semitendinosus muscles from a cohort of patients with CP (n = 10) and typically developing patients (n = 10) undergoing surgery. Biopsies were obtained to define the unique expression profile of the contractures and passive mechanical testing was conducted to determine stiffness values in previously published work. Affymetrix HG-U133A 2.0 chips (n = 40) generated expression data, which was validated for selected transcripts using quantitative real-time PCR. Chips were clustered based on their expression and those from patients with CP clustered separately. Significant genes were determined conservatively based on the overlap of three summarization algorithms (n = 1,398). Significantly altered genes were analyzed for over-representation among gene ontologies and muscle specific networks.The majority of altered transcripts were related to increased extracellular matrix expression in CP and a decrease in metabolism and ubiquitin ligase activity. The increase in extracellular matrix products was correlated with mechanical measures demonstrating the importance in disability. These data lay a framework for further studies and development of novel therapies.

Factors influencing the treatment of severe gluteal muscle contracture in children

Usually the treatment of severe gluteal muscle contracture in children does not achieve a satisfactory clinical result and the disease is prone to recurrence after surgery. The aim of this study was to analyze the factors influencing the recovery of children with severe gluteal muscle contracture. Between 1997 and 2008, 428 children (mean age: 8 years) were subjected to surgical operations combined with functional exercises and physical therapy and were followed for 12-24 months with satisfactory clinical outcomes. In this series, the outcomes were found to be excellent in 400 cases, good in 22 cases, and fair in six cases with no patient having a poor result. No serious complications, such as sciatic nerve injury, dislocation, or osteonecrosis of the femoral head were found in the patients. Unsteadiness in walking and positive Trendelenburg sign were found in postoperative functional exercises in 16 patients, which may be the result of excessive resection of the gluteus medius and the gluteus minimus. However, the symptoms in all the cases disappeared within 3 months by rigorous functional exercise. We evaluated the factors that potentially influence the clinical outcome retrospectively and it was concluded that the surgery was highly beneficial for the treatment of the patients. Postoperative functional exercise and physical therapy could reduce the complications and maintain the favorable effects of surgery. In addition, the identification of the disease, the age of patients, and the rehabilitation procedures after hospital discharge were found to be very important for the successful treatment of this condition.

Classification of gluteal muscle contracture in children and outcome of different treatments

BackgroundGluteal muscle contracture (GMC) is a clinical syndrome due to multiple etiologies in which hip movements may be severely limited. The aim of this study was to propose a detailed classification of GMC and evaluate the statistical association between outcomes of different management and patient conditions.MethodsOne hundred fifty-eight patients, who were treated between January 1995 and December 2004, were reviewed at a mean duration of follow-up of 4.8 years. Statistical analyses were performed using X2 and Fisher's exact tests.ResultsNon-operative management (NOM), as a primary treatment, was effective in 19 of 49 patients (38.8%), while operative management was effective in all 129 patients, with an excellence rating of 83.7% (108/129). The outcome of NOM in level I patients was significantly higher than in level II and III patients (P < 0.05). The results of NOM and operative management in the child group were better than the adolescent group (P < 0.05). Complications in level III were more than in level II.ConclusionNOM was more effective in level I patients than in level II and III patients. Operative management was effective in patients at all levels, with no statistical differences between levels or types. We recommend NOM as primary treatment for level I patients and operative management for level II and III patients. Either NOM or operative management should be carried out as early as possible.

Treatment of severe gluteal muscle contracture in children

To investigate the efficacy of a combination therapy on gluteal muscle contracture, 286 definitely diagnosed patients were subjected to surgical treatment, and then functional exercises and physical therapy. The patients with severe symptoms were asked to have a set of specially-designed functional exercises. All the patients were followed up for 3 to 24 months by hospital visit, correspondence or telephone interview. The effective rate was 100%, and the curative rate was up to 94.6%. Few patients developed complications and relapse was rare. It is concluded that the combination therapy, including surgical removal of diseased tissues, functional exercises and physical therapy, is an effective approach for the treatment of severe juvenile gluteal muscle contracture.

Stretching with Children with Cerebral Palsy: What Do We Know and Where Are We Going?

To review research regarding mechanisms of muscle contracture in cerebral palsy (CP) and the effectiveness of stretching, and to discuss current physical therapy stretching practices. Community-based recreation opportunities that encourage flexibility and fitness are explored as alternatives to traditional therapy stretching approaches. Mechanisms of muscle contracture in children with CP are unclear and clinical research evaluating the effects of stretching is inconclusive. Recent shifts in thinking about the management of children with CP suggest an increased emphasis on flexibility, fitness, and participation in activities that are meaningful to children and families. Additional research is needed to explore the structural changes that occur in the shortened muscles of children with CP and the effects of stretching practices used in pediatric physical therapy. Physical therapists can consider innovative alternatives that integrate flexibility and fitness goals with community-based recreation programs.

CT diagnosis of gluteal muscle contracture in children

目的 探讨儿童臀肌挛缩症的CT表现.方法对61例经CT诊断为臀肌挛缩症,并经手术病理证实的患儿进行研究,并与20例正常臀肌的CT表现作对照.结果在61例臀肌挛缩症中,57例(93.4%)是双侧挛缩,4例(6.6%)是单侧;CT主要表现:(1)臀肌体积缩小,118侧(100.0%)臀大肌体积缩小,16侧(13.6%)臀中肌体积缩小;12侧(10.2%)梨状肌体积缩小;4侧(3.4%)臀小肌体积缩小;4侧(3.4%)髋关节后方关节囊挛缩.(2)注射点区臀肌钙化、坏死.95侧(80.5%)臀肌有钙化,24侧(20.3%)臀肌有斑片状坏死.(3)条索状挛缩带,81条位于臀大肌外侧,从臀大肌外上缘到髂筋束,36条位于臀大肌骶骨侧.(4)肌间隙增宽,轻度38侧(32.2%),中度 53侧(44.9%),重度27侧(22.9%).结论 CT扫描能正确诊断臀肌挛缩症,明确病变范围及程度,对术前评估有重要价值。