Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.

The definition of spasticity as a velocity-dependent activation of the tonic stretch reflex during a stretch to a passive muscle is the most widely accepted. However, other mechanisms are also thought to contribute to pathological muscle activity and, in patients post-stroke and spinal cord injury c...

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Autores principales:	Lynn Bar-On, Erwin Aertbeliën, Guy Molenaers, Kaat Desloovere
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0fd92527286c4b9ab214cdc90e36ecf3
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spelling	oai:doaj.org-article:0fd92527286c4b9ab214cdc90e36ecf32021-11-18T08:26:54ZMuscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.1932-620310.1371/journal.pone.0091759https://doaj.org/article/0fd92527286c4b9ab214cdc90e36ecf32014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24651860/?tool=EBIhttps://doaj.org/toc/1932-6203The definition of spasticity as a velocity-dependent activation of the tonic stretch reflex during a stretch to a passive muscle is the most widely accepted. However, other mechanisms are also thought to contribute to pathological muscle activity and, in patients post-stroke and spinal cord injury can result in different activation patterns. In the lower-limbs of children with spastic cerebral palsy (CP) these distinct activation patterns have not yet been thoroughly explored. The aim of the study was to apply an instrumented assessment to quantify different muscle activation patterns in four lower-limb muscles of children with CP. Fifty-four children with CP were included (males/females n = 35/19; 10.8 ± 3.8 yrs; bilateral/unilateral involvement n = 32/22; Gross Motor Functional Classification Score I-IV) of whom ten were retested to evaluate intra-rater reliability. With the subject relaxed, single-joint, sagittal-plane movements of the hip, knee, and ankle were performed to stretch the lower-limb muscles at three increasing velocities. Muscle activity and joint motion were synchronously recorded using inertial sensors and electromyography (EMG) from the adductors, medial hamstrings, rectus femoris, and gastrocnemius. Muscles were visually categorised into activation patterns using average, normalized root mean square EMG (RMS-EMG) compared across increasing position zones and velocities. Based on the visual categorisation, quantitative parameters were defined using stretch-reflex thresholds and normalized RMS-EMG. These parameters were compared between muscles with different activation patterns. All patterns were dominated by high velocity-dependent muscle activation, but in more than half, low velocity-dependent activation was also observed. Muscle activation patterns were found to be both muscle- and subject-specific (p<0.01). The intra-rater reliability of all quantitative parameters was moderate to good. Comparing RMS-EMG between incremental position zones during low velocity stretches was found to be the most sensitive in categorizing muscles into activation patterns (p<0.01). Future studies should investigate whether muscles with different patterns react differently to treatment.Lynn Bar-OnErwin AertbeliënGuy MolenaersKaat DeslooverePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e91759 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Lynn Bar-On Erwin Aertbeliën Guy Molenaers Kaat Desloovere Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.
description	The definition of spasticity as a velocity-dependent activation of the tonic stretch reflex during a stretch to a passive muscle is the most widely accepted. However, other mechanisms are also thought to contribute to pathological muscle activity and, in patients post-stroke and spinal cord injury can result in different activation patterns. In the lower-limbs of children with spastic cerebral palsy (CP) these distinct activation patterns have not yet been thoroughly explored. The aim of the study was to apply an instrumented assessment to quantify different muscle activation patterns in four lower-limb muscles of children with CP. Fifty-four children with CP were included (males/females n = 35/19; 10.8 ± 3.8 yrs; bilateral/unilateral involvement n = 32/22; Gross Motor Functional Classification Score I-IV) of whom ten were retested to evaluate intra-rater reliability. With the subject relaxed, single-joint, sagittal-plane movements of the hip, knee, and ankle were performed to stretch the lower-limb muscles at three increasing velocities. Muscle activity and joint motion were synchronously recorded using inertial sensors and electromyography (EMG) from the adductors, medial hamstrings, rectus femoris, and gastrocnemius. Muscles were visually categorised into activation patterns using average, normalized root mean square EMG (RMS-EMG) compared across increasing position zones and velocities. Based on the visual categorisation, quantitative parameters were defined using stretch-reflex thresholds and normalized RMS-EMG. These parameters were compared between muscles with different activation patterns. All patterns were dominated by high velocity-dependent muscle activation, but in more than half, low velocity-dependent activation was also observed. Muscle activation patterns were found to be both muscle- and subject-specific (p<0.01). The intra-rater reliability of all quantitative parameters was moderate to good. Comparing RMS-EMG between incremental position zones during low velocity stretches was found to be the most sensitive in categorizing muscles into activation patterns (p<0.01). Future studies should investigate whether muscles with different patterns react differently to treatment.
format	article
author	Lynn Bar-On Erwin Aertbeliën Guy Molenaers Kaat Desloovere
author_facet	Lynn Bar-On Erwin Aertbeliën Guy Molenaers Kaat Desloovere
author_sort	Lynn Bar-On
title	Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.
title_short	Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.
title_full	Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.
title_fullStr	Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.
title_full_unstemmed	Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.
title_sort	muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/0fd92527286c4b9ab214cdc90e36ecf3
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Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.

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