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Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?

  • Symposium: Current Approaches in Cerebral Palsy, A Focus on Gait Problems
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Individuals with spastic hemiplegic cerebral palsy are typically high functioning and walk without assistive devices. The involved limb is usually smaller and shorter, although it is not clear whether the difference in muscle volume has an impact on walking capacity.

Questions/purposes

We determined the volume of muscles important for propulsion and related that volume to concentric muscle work during walking on the hemiplegic and noninvolved sides in patients with cerebral palsy.

Patients and Methods

We studied 46 patients (mean age, 17.6 years; range, 13–24 years) with spastic hemiplegic cerebral palsy. We assessed muscle volume using MRI and concentric muscle work in the sagittal plane from the hip, knee, and ankle using three-dimensional gait analysis. Patients were classified by Winters’ criteria to assess the involvement of cerebral palsy and movement pattern during walking.

Results

On the hemiplegic side, muscles were smaller, except for the gracilis muscle, and concentric muscle work from the ankle plantar flexors, knee extensors, and hip flexors and extensors was lower compared to the noninvolved side. Hip extensor work was higher on the hemiplegic and the noninvolved sides compared to a control group of 14 subjects without cerebral palsy. Hemiplegic to noninvolved volume ratios correlated with work ratios (r = 0.40–0.66). The Winters classification and previous calf muscle surgery predicted work ratios.

Conclusions

Our observations of smaller muscles on the hemiplegic side and changes in muscle work on both sides can help us distinguish between primary deviations that may potentially be treatable and compensatory mechanisms that should not be treated.

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Acknowledgments

We thank Scott Coleman for help with illustrations; Mesfin Tessma with the statistics; Eleanor Kelly, Deepti Bajaj, Brianne Mulrooney, and K. Michael Rowley with image processing; and Joshua T. Kirby with technical assistance.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Skaraborg Hospital, Ädelstensvägen 3B, 541 42, Skövde, Sweden

    Jacques Riad MD

  2. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

    Jacques Riad MD, E. M. Gutierrez-Farewik PhD & Eva Broström PT, PhD

  3. Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA

    Christopher M. Modlesky PhD

  4. KTH Mechanics, Royal Institute of Technology, Stockholm, Sweden

    E. M. Gutierrez-Farewik PhD

Authors
  1. Jacques Riad MD
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  2. Christopher M. Modlesky PhD
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  3. E. M. Gutierrez-Farewik PhD
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  4. Eva Broström PT, PhD
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Corresponding author

Correspondence to Jacques Riad MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

The work was performed at Skaraborg Hospital and Karolinska Institutet.

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Riad, J., Modlesky, C.M., Gutierrez-Farewik, E.M. et al. Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?. Clin Orthop Relat Res 470, 1278–1285 (2012). https://doi.org/10.1007/s11999-011-2093-6

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  • DOI: https://doi.org/10.1007/s11999-011-2093-6

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