Publications by authors named "Anja Van Campenhout"

50 Publications

Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project.

J Child Orthop 2021 Jun;15(3):270-278

Universitäts-Kinderspital, Zürich, Switzerland.

Purpose: The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method.

Methods: The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached.

Results: Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade.

Conclusion: This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP.

Level Of Evidence: V.
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http://dx.doi.org/10.1302/1863-2548.15.210044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223080PMC
June 2021

ESB Clinical Biomechanics Award 2020: Pelvis and hip movement strategies discriminate typical and pathological femoral growth - Insights gained from a multi-scale mechanobiological modelling framework.

Clin Biomech (Bristol, Avon) 2021 Jul 5;87:105405. Epub 2021 Jun 5.

Human Movement Biomechanics Research Group, KU Leuven, Belgium.

Background: Many children with cerebral palsy (CP) develop skeletal deformities during childhood. So far, it is unknown why some children with CP develop bony deformities whereas others do not. The aims of this study were to (i) investigate what loading characteristics lead to typical and pathological femoral growth, and (ii) evaluate why some children with CP develop femoral deformities whereas other do not.

Methods: A multi-scale mechanobiological modelling workflow was used to simulate femoral growth based on three-dimensional motion capture data of six typically developing children and 16 children with CP. Based on the growth results, the participants with CP were divided into two groups: typical growth group and pathological growth group. Gait kinematics and femoral loading were compared between simulations resulting in typical growth and those resulting in pathologic growth.

Findings: Hip joint contact forces were less posteriorly-oriented in the pathological growth simulations compared to the typical ones. Compared to the typically developing participants, the CP group with pathological femoral growth presented increased knee flexion and no hip extension. The CP group with simulated typical growth presented similar sagittal plane joint kinematics but differed in the frontal plane pelvic and hip movement strategy, which normalized the hip joint contact force and therefore contributed to typical femoral growth trends.

Interpretation: Our simulation results identified specific gait features, which may contribute to pathological femoral growth. Furthermore, the hip joint contact force orientation in the sagittal plane seems to be the dominant factor for determining femoral growth simulations.
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http://dx.doi.org/10.1016/j.clinbiomech.2021.105405DOI Listing
July 2021

Proximal femoral derotation osteotomy in children with CP : long term outcome and the role of age at time of surgery.

Acta Orthop Belg 2021 Mar;87(1):167-173

The femoral derotation osteotomy (FDO) is seen as the golden standard treatment in children with cerebral palsy and internal rotated gait. This study provides quantitative evidence in support of the beneficial effect of FDO after long term follow up. Retrospective clinical and kinematic evaluation of 31 CP patients (55 operated limbs) pre-, 1 and 3 years postoperatively after proximal FDO was conducted for a minimal follow-up of 3 years. This group con- sisted of 20 men and 11 women, aged 10.68±3.31 years at the time of surgery. Minimum follow up was 3 years (3.16±0.53 years), with 22 patients (38 operated limbs) having an additional follow up at 5 years (5.02±0.49 years). Age at FU3 and FU5 was 14.06±3.52 years and 15.39±3.08 years respectively. A set of clinical and kinematic parameters were ana- lyzed and showed a significant correction of mean hip rotation and femoral anteversion after FDO. Further plotting of individual data comparing 3 or 5 year postoperative values to 1 year postoperative values showed no further significant changes, indicating sustained correction of internally rotted gait until end of our follow up. Plotting mean hip rotation in stance as well as kinematic knee parameters according to age grouped cohorts could not show age at time of surgery to be a significant factor in recurrence of internally rotated gait or preoperative disturbances of knee motion in the sagittal plane. This study provides quantitative evidence on the beneficial effect of FDO, a surgical technique to improve internally rotated gait in cerebral palsy patients with spastic diplegia. Pre- and postoperative clinical and kinematic para- meters are compared and results are discussed. Minimum follow up was 3 years with a mean follow up of 4.65±0.83 years. The effect of age at time of surgery on recurrence and kinematic parameters were studied.
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March 2021

Reliability of Processing 3-D Freehand Ultrasound Data to Define Muscle Volume and Echo-intensity in Pediatric Lower Limb Muscles with Typical Development or with Spasticity.

Ultrasound Med Biol 2021 Jun 7. Epub 2021 Jun 7.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium.

This investigation assessed the processer reliability of estimating muscle volume and echo-intensity of the rectus femoris, tibialis anterior and semitendinosus. The muscles of 10 typically developing children (8.15 [1.40] y) and 15 children with spastic cerebral palsy (7.67 [3.80] y; Gross Motor Function Classification System I = 5, II = 5, III = 5) were scanned with 3-D freehand ultrasonography. For the intra-processer analysis, the intra-class correlations coefficients (ICCs) for muscle volume ranged from 0.943-0.997, with relative standard errors of measurement (SEM%) ranging from 1.24%-8.97%. For the inter-processer analysis, these values were 0.853 to 0.988 and 3.47% to 14.02%, respectively. Echo-intensity had ICCs >0.947 and relative SEMs <4% for both analyses. Muscle volume and echo-intensity can be reliably extracted for the rectus femoris, semitendinosus and tibialis anterior in typically developing children and children with cerebral palsy. The need for a single processer to analyze all data is dependent on the size of the expected changes or differences.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2021.04.028DOI Listing
June 2021

Muscle Characteristics in Pediatric Hereditary Spastic Paraplegia vs. Bilateral Spastic Cerebral Palsy: An Exploratory Study.

Front Neurol 2021 26;12:635032. Epub 2021 Feb 26.

KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.

Hereditary spastic paraplegia (HSP) is a neurological, genetic disorder that predominantly presents with lower limb spasticity and muscle weakness. Pediatric pure HSP types with infancy or childhood symptom onset resemble in clinical presentation to children with bilateral spastic cerebral palsy (SCP). Hence, treatment approaches in these patient groups are analogous. Altered muscle characteristics, including reduced medial gastrocnemius (MG) muscle growth and hyperreflexia have been quantified in children with SCP, using 3D-freehand ultrasound (3DfUS) and instrumented assessments of hyperreflexia, respectively. However, these muscle data have not yet been studied in children with HSP. Therefore, we aimed to explore these MG muscle characteristics in HSP and to test the hypothesis that these data differ from those of children with SCP and typically developing (TD) children. A total of 41 children were retrospectively enrolled including (1) nine children with HSP (ages of 9-17 years with gross motor function levels I and II), (2) 17 age-and severity-matched SCP children, and (3) 15 age-matched typically developing children (TD). Clinically, children with HSP showed significantly increased presence and severity of ankle clonus compared with SCP ( = 0.009). Compared with TD, both HSP and SCP had significantly smaller MG muscle volume normalized to body mass ( ≤ 0.001). Hyperreflexia did not significantly differ between the HSP and SCP group. In addition to the observed pathological muscle activity for both the low-velocity and the change in high-velocity and low-velocity stretches in the two groups, children with HSP tended to present higher muscle activity in response to increased stretch velocity compared with those with SCP. This exploratory study is the first to reveal MG muscle volume deficits in children with HSP. Moreover, high-velocity-dependent hyperreflexia and ankle clonus is observed in children with HSP. Instrumented impairment assessments suggested similar altered MG muscle characteristics in pure HSP type with pediatric onset compared to bilateral SCP. This finding needs to be confirmed in larger sample sizes. Hence, the study results might indicate analogous treatment approaches in these two patient groups.
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http://dx.doi.org/10.3389/fneur.2021.635032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952873PMC
February 2021

Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: a Delphi consensus study.

J Child Orthop 2020 Oct;14(5):405-414

The Royal Children's Hospital, Melbourne, Australia.

Purpose: Equinus is the most common deformity in cerebral palsy (CP) and gastrocsoleus lengthening (GSL) is the most commonly performed surgery to improve gait and function in ambulatory children with CP. Substantial variation exists in the indications for GSL and surgical technique. The purpose of this study was to review surgical anatomy and biomechanics of the gastrocsoleus and to utilize expert orthopaedic opinion through a Delphi technique to establish consensus for surgical indications for GSL in ambulatory children with CP.

Methods: A 17-member panel, of Fellowship-trained paediatric orthopaedic surgeons, each with at least 9 years of clinical post-training experience in the surgical management of children with CP, was established. Consensus for the surgical indications for GSL was achieved through a standardized, iterative Delphi process.

Results: Consensus was reached to support conservative Zone 1 surgery in diplegia and Zone 3 surgery (lengthening of the Achilles tendon) was contraindicated. Zone 2 or Zone 3 surgery reached general agreement as a choice in hemiplegia and under-correction was preferred to any degree of overcorrection. Agreement was reached that the optimum age for GSL surgery was 6 years to 10 years and should be avoided in children aged under 4 years. Physical examination measures with the child awake and under anaesthesia were important in decision making. Gait analysis was supported both for decision making and for assessing outcomes, in combination with patient reported outcomes (PROMS).

Conclusions: The results from this study may encourage informed practice evaluation, reduce practice variability, improve clinical outcomes and point to questions for further research.

Level Of Evidence: V.
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http://dx.doi.org/10.1302/1863-2548.14.200145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666804PMC
October 2020

Muscle weakness has a limited effect on motor control of gait in Duchenne muscular dystrophy.

PLoS One 2020 2;15(9):e0238445. Epub 2020 Sep 2.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Aim: Our aim was to determine if synergy weights and activations are altered in Duchenne muscular dystrophy (DMD) and if these alterations could be linked to muscle weakness.

Methods: In 22 children with DMD and 22 typical developing (TD) children of a similar age, surface electromyography (sEMG) of the gluteus medius, rectus femoris (REF), medial hamstrings, tibialis anterior, and medial gastrocnemius (GAS) were recorded during gait. Muscle weakness was assessed with maximal voluntary isometric contractions (MVIC). Synergies were calculated with non-negative matrix factorization. The number of synergies explaining ≥90% of the variance in the sEMG signals (N90), were extracted and grouped with k-means cluster analysis. We verified differences in weights with a Mann-Whitney U test. Statistical non-parametric mapping (Hotelling's T2 test and two-tailed t-test) was used to assess group differences in synergy activations. We used Spearman's rank correlation coefficients and canonical correlation analysis to assess if weakness was related to modifications in weights and activations, respectively.

Results: For both groups, average N90 was three. In synergy one, characterized by activity at the beginning of stance, the DMDs showed an increased REF weight (p = 0.001) and decreased GAS weight (p = 0.007). Synergy activations were similar, with only a small difference detected in mid-swing in the combined activations (p<0.001). Weakness was not associated with these differences.

Conclusion: Despite the apparent weakness in DMD, synergy weights and activations were similar between the two groups. Our findings are in line with previous research suggesting non-neural alterations have limited influence on muscle synergies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238445PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467330PMC
October 2020

Interventions and lower-limb macroscopic muscle morphology in children with spastic cerebral palsy: a scoping review.

Dev Med Child Neurol 2021 Mar 2;63(3):274-286. Epub 2020 Sep 2.

Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.

Aim: To identify and map studies that have assessed the effect of interventions on lower-limb macroscopic muscle-tendon morphology in children with spastic cerebral palsy (CP).

Method: We conducted a literature search of studies that included pre- and post-treatment measurements of lower-limb macroscopic muscle-tendon morphology in children with spastic CP. Study quality was evaluated and significant intervention effects and effect sizes were extracted.

Results: Twenty-eight articles were identified. They covered seven different interventions including stretching, botulinum neurotoxin A (BoNT-A), strengthening, electrical stimulation, whole-body vibration, balance training, and orthopaedic surgery. Study quality ranged from poor (14 out of 28 studies) to good (2 out of 28). Study samples were small (n=4-32) and studies were variable regarding which muscles and macroscopic morphological parameters were assessed. Inconsistent effects after intervention (thickness and cross-sectional area for strengthening, volume for BoNT-A), no effect (belly length for stretching), and small effect sizes were reported.

Interpretation: Intervention studies reporting macroscopic muscle-tendon remodelling after interventions are limited and heterogeneous, making it difficult to generalize results. Studies that include control groups and standardized assessment protocols are needed to improve study quality and data synthesis. Lack or inconclusive effects at the macroscopic level could indicate that the effects of interventions should also be evaluated at the microscopic level.

What This Paper Adds: Muscle-targeted interventions to remodel muscle morphology are not well understood. Studies reporting macroscopic muscle remodelling following interventions are limited and heterogeneous. Passive stretching may preserve but does not increase muscle length. The effects of isolated botulinum neurotoxin A injections on muscle volume are inconsistent. Isolated strengthening shows no consistent increase in muscle volume or thickness.
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http://dx.doi.org/10.1111/dmcn.14652DOI Listing
March 2021

Movement History Influences Pendulum Test Kinematics in Children With Spastic Cerebral Palsy.

Front Bioeng Biotechnol 2020 7;8:920. Epub 2020 Aug 7.

Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.

The pendulum test assesses quadriceps spasticity by dropping the lower leg of a relaxed patient from the horizontal position and observing limb movement. The first swing excursion (FS) decreases with increasing spasticity severity. Our recent simulation study suggests that the reduced initial swing results from muscle short-range stiffness and its interaction with reflex hyper-excitability. Short-range stiffness emerges from the thixotropic behavior of muscles where fiber stiffness upon stretch increases when the muscle is held isometric. Fiber stiffness might thus be higher during the first swing of the pendulum test than during consecutive swings. In addition, it has recently been suggested that muscle spindle firing reflects fiber force rather than velocity and therefore, reflex activity might depend on fiber stiffness. If this hypothesized mechanism is true, we expect to observe larger first swing excursions and reduced reflex muscle activity when the leg is moved rather than kept isometric before release, especially in patients with increased reflex activity. We performed the pendulum test in 15 children with cerebral palsy (CP) and 15 age-matched typically developing (TD) children in two conditions. In the hold condition, the leg was kept isometric in the extended position before release. In the movement condition, the leg was moved up and down before release to reduce the contribution of short-range stiffness. Knee kinematics and muscle activity were recorded. Moving the leg before release increased first swing excursion ( < 0.001) and this increase was larger in children with CP (21°) than in TD children (8°) ( < 0.005). In addition, pre-movement delayed reflex onset by 87 ms ( < 0.05) and reduced reflex activity as assessed through the area under the curve of rectus femoris electromyography ( < 0.05) in children with CP. The movement history dependence of pendulum kinematics and reflex activity supports our hypothesis that muscle short-range stiffness and its interaction with reflex hyper-excitability contribute to joint hyper-resistance in spastic CP. Our results have implications for standardizing movement history in clinical tests of spasticity and for understanding the role of spasticity in functional movements, where movement history differs from movement history in clinical tests.
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http://dx.doi.org/10.3389/fbioe.2020.00920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426371PMC
August 2020

Muscle Microbiopsy to Delineate Stem Cell Involvement in Young Patients: A Novel Approach for Children With Cerebral Palsy.

Front Physiol 2020 6;11:945. Epub 2020 Aug 6.

Stem Cell Biology and Embryology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.

Cerebral palsy (CP), the single largest cause of childhood physical disability, is characterized firstly by a lesion in the immature brain, and secondly by musculoskeletal problems that progress with age. Previous research reported altered muscle properties, such as reduced volume and satellite cell (SC) numbers and hypertrophic extracellular matrix compared to typically developing (TD) children (>10 years). Unfortunately, data on younger CP patients are scarce and studies on SCs and other muscle stem cells in CP are insufficient or lacking. Therefore, it remains difficult to understand the early onset and trajectory of altered muscle properties in growing CP children. Because muscle stem cells are responsible for postnatal growth, repair and remodeling, multiple adult stem cell populations from young CP children could play a role in altered muscle development. To this end, new methods for studying muscle samples of young children, valid to delineate the features and to elucidate the regenerative potential of muscle tissue, are necessary. Using minimal invasive muscle microbiopsy, which was applied in young subjects under general anaesthesia for the first time, we aimed to isolate and characterize muscle stem cell-derived progenitors of TD children and patients with CP. Data of 15 CP patients, 3-9 years old, and 5 aged-matched TD children were reported. The muscle microbiopsy technique was tolerated well in all participants. Through the explant technique, we provided muscle stem cell-derived progenitors from the Via fluorescent activated cell sorting, using surface markers CD56, ALP, and PDGFRa, we obtained SC-derived progenitors, mesoangioblasts and fibro-adipogenic progenitors, respectively. Adipogenic, skeletal, and smooth muscle differentiation assays confirmed the cell identity and ability to give rise to different cell types after appropriate stimuli. Myogenic differentiation in CP SC-derived progenitors showed enhanced fusion index and altered myotube formation based on MYOSIN HEAVY CHAIN expression, as well as disorganization of nuclear spreading, which were not observed in TD myotubes. In conclusion, the microbiopsy technique allows more focused muscle research in young CP patients. Current results show altered differentiation abilities of muscle stem cell-derived progenitors and support the hypothesis of their involvement in CP-altered muscle growth.
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http://dx.doi.org/10.3389/fphys.2020.00945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424076PMC
August 2020

Structural Brain Lesions and Gait Pathology in Children With Spastic Cerebral Palsy.

Front Hum Neurosci 2020 9;14:275. Epub 2020 Jul 9.

Department of Development and Regeneration, KU Leuven, Leuven, Belgium.

The interaction between brain damage and motor function is not yet fully understood in children with spastic cerebral palsy (CP). Therefore, a semi-quantitative MRI (sqMRI) scale was used to explore whether identified brain lesions related to functional abilities and gait pathology in this population. A retrospective cohort of ambulatory children with spastic CP was selected [ = 104; 52 bilateral (bCP) and 52 unilateral (uCP)]. Extent and location-specific scores were defined according to the sqMRI scale guidelines. The gross motor function classification system (GMFCS), the gait profile score (GPS), GPSs per motion plane, gait variable scores (GVS) and multiple-joint (MJ) gait patterns were related to brain lesion scores. In all groups, the global total brain scores correlated to the GPS (total: = 0.404, ≤ 0.001; bCP: = 0.335, ≤ 0.05; uCP: = 0.493, ≤ 0.001). The global total hemispheric scores correlated to the GMFCS (total: = 0.392, ≤ 0.001; bCP: = 0.316, ≤ 0.05; uCP: = 0.331, ≤ 0.05). The laterality scores of the hemispheres in the total group correlated negatively to the GMFCS level ( = -0.523, ≤ 0.001) and the GVS-knee sagittal ( = -0.311, ≤ 0.01). Lesion location, for the total group demonstrated positive correlations between parietal lobe involvement and the GPS ( = 0.321, ≤ 0.001) and between periventricular layer damage and the GMFCS ( = 0.348, ≤ 0.001). Involvement of the anterior part of the corpus callosum (CC) was associated with the GVS-hip sagittal in all groups (total: = 0.495, ≤ 0.001; bCP: = 0.357, ≤ 0.05; uCP: = 0.641, ≤ 0.001). The global total hemispheric and laterality of the hemispheres scores differentiated between the minor and both the extension ( ≤ 0.001 and ≤ 0.001) and flexion ( = 0.016 and = 0.013, respectively) MJ patterns in the total group. Maximal periventricular involvement and CC intactness were associated with extension patterns (p ≤ 0.05 and p ≤ 0.001, respectively). Current findings demonstrated relationships between brain structure and motor function as well as pathological gait, in this cohort of children with CP. These results might facilitate the timely identification of gait pathology and, ultimately, guide individualized treatment planning of gait impairments in children with CP.
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http://dx.doi.org/10.3389/fnhum.2020.00275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363943PMC
July 2020

The Effect of a Rehabilitation Specific Gaming Software Platform to Achieve Individual Physiotherapy Goals in Children with Severe Spastic Cerebral Palsy: A Randomized Crossover Trial.

Games Health J 2020 Jul 2. Epub 2020 Jul 2.

CP Reference Centre, University Hospital Leuven, Leuven, Belgium.

Cerebral palsy (CP) is the most common cause of permanent neurological disabilities in children. Many children require long-term daily physiotherapy (PT), and videogaming is a promising tool to increase motivation in rehabilitation. The short- and medium-term effects of an intervention with rehabilitation specific videogames were evaluated on individually defined therapy goals, gross motor function, and motivation. Thirty-two children with bilateral spastic CP, Gross Motor Function Classification level III-IV, and 6-15 years were randomized into an intervention group (regular PT and gaming) or a control group (regular PT), followed by a crossover. The effects of both training periods (each 12 weeks) were compared using the Goal Attainment Scale (GAS), Trunk Control Measurement Scale (TCMS), Pediatric Balance Scale (PBS), Gross Motor Function Measure-88 (GMFM-88), and Dimensions of Mastery Motivation Questionnaire (DMQ). After 3 months follow-up, children were retested using the GMFM, TCMS, and PBS. The GAS change scores were significantly higher after the intervention compared to the control period (8.5 and 2.4,  < 0.001). The change scores for standing exercises (3.85 and 0.22,  = 0.04) and dynamic sitting balance (5.9 and -1.7,  < 0.001) were also significantly higher. After 3 months follow-up the results did not persist. A combined approach of regular PT and rehabilitation specific gaming showed significant effects on individually defined therapy goals, dynamic sitting balance, and standing exercises. However, the lack of persistent effect indicates that continuous individual goal-oriented PT with the addition of gaming is needed.
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http://dx.doi.org/10.1089/g4h.2019.0097DOI Listing
July 2020

Treatment Response to Botulinum Neurotoxin-A in Children With Cerebral Palsy Categorized by the Type of Stretch Reflex Muscle Activation.

Front Neurol 2020 2;11:378. Epub 2020 Jun 2.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

While Botulinum NeuroToxin-A (BoNT-A) injections are frequently used to reduce the effects of hyperactive stretch reflexes in children with cerebral palsy (CP), the effects of this treatment vary strongly. Previous research, combining electromyography (EMG) with motion analysis, defined different patterns of stretch reflex muscle activation in muscles, those that reacted more to a change in velocity (velocity dependent -VD), and those that reacted more to a change in length (length dependent -LD). The aim of this study was to investigate the relation between the types of stretch reflex muscle activation in the semitendinosus with post-BoNT-A outcome as assessed passively and with 3D gait analysis in children with spastic CP. Eighteen children with spastic CP (10 bilaterally involved) between the ages of 12 and 18 years were assessed before and on average, 8 weeks post-treatment. EMG and motion analysis were used to assess the degree and type of muscle activation dependency in the semitendinosus during passive knee extensions performed at different joint angular velocities. Three-dimensional gait analysis was used to assess knee gait kinematics as a measure of functional outcome. Pre-treatment, 9 muscles were classified as VD and 9 as LD, but no differences between the groups were evident in the baseline knee gait kinematics. Post-treatment, stretch reflex muscle activation decreased significantly in both groups but the reduction was more pronounced in those muscles classified pre-treatment as VD (-72% vs. -50%, = 0.005). In the VD group, these changes were accompanied by greater knee extension at initial contact and during the swing phase of gait. In the LD group, there was significantly increased post-treatment knee hyperextension in late stance. Although results vary between patients, the reduction of stretch reflex muscle activation in the semitendinosus generally translated to an improved functional outcome, as assessed with 3D gait analysis. However, results were less positive for those muscles with pre-treatment length-dependent type of stretch reflex muscle activation. The study demonstrates the relevance of categorizing the type of stretch reflex muscle activation as a possible predictor of treatment response.
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http://dx.doi.org/10.3389/fneur.2020.00378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280486PMC
June 2020

Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy.

Front Neurol 2020 21;11:210. Epub 2020 Apr 21.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Botulinum NeuroToxin-A (BoNT-A) injections to the medial gastrocnemius (MG) and lower-leg casts are commonly combined to treat ankle equinus in children with spastic cerebral palsy (CP). However, the decomposed treatment effects on muscle or tendon structure, stretch reflexes, and joint are unknown. In this study, BoNT-A injections to the MG and casting of the lower legs were applied separately to gain insight into the working mechanisms of the isolated treatments on joint, muscle, and tendon levels. Thirty-one children with spastic CP (GMFCS I-III, age 7.4 ± 2.6 years) received either two weeks of lower-leg casts or MG BoNT-A injections. During full range of motion slow and fast passive ankle rotations, joint resistance and MG stretch reflexes were measured. MG muscle and tendon lengths were assessed at resting and at maximum dorsiflexion ankle angles using 3D-freehand ultrasound. Treatment effects were compared using non-parametric statistics. Associations between the effects on joint and muscle or tendon levels were performed using Spearman correlation coefficients ( < 0.05). Increased joint resistance, measured during slow ankle rotations, was not significantly reduced after either treatment. Additional joint resistance assessed during fast rotations only reduced in the BoNT-A group (-37.6%, = 0.013, effect size = 0.47), accompanied by a reduction in MG stretch reflexes (-70.7%, = 0.003, effect size = 0.56). BoNT-A increased the muscle length measured at the resting ankle angle (6.9%, = 0.013, effect size = 0.53). Joint angles shifted toward greater dorsiflexion after casting (32.4%, = 0.004, effect size = 0.56), accompanied by increases in tendon length (5.7%, = 0.039, effect size = 0.57; = 0.40). No associations between the changes in muscle or tendon lengths and the changes in the stretch reflexes were found. We conclude that intramuscular BoNT-A injections reduced stretch reflexes in the MG accompanied by an increase in resting muscle belly length, whereas casting resulted in increased dorsiflexion without any changes to the muscle length. This supports the need for further investigation on the effect of the combined treatments and the development of treatments that more effectively lengthen the muscle.
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http://dx.doi.org/10.3389/fneur.2020.00210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187925PMC
April 2020

Establishing surgical indications for hamstring lengthening and femoral derotational osteotomy in ambulatory children with cerebral palsy.

J Child Orthop 2020 Feb;14(1):50-57

UZ Leuven, Belgium.

Purpose: Surgical procedures, such as medial hamstring lengthening (MHL) and femoral derotational osteotomy (FDO), can improve the gait of children with cerebral palsy (CP); however, substantial variation exists in the factors that influence the decision to perform surgery. The purpose of this study was to use expert surgeon opinion through a Delphi technique to establish consensus for indications in ambulatory children with CP.

Methods: A 15-member panel, all established experts with at least nine years' experience in the surgical management of children with CP, was created (mean of 20.81 years' experience). All panel members also had expertise of the use of movement analysis for the assessment of gait disorders in children with CP. The group initially focused on two of the most commonly performed procedures, MHL and FDO, in an attempt to gain consensus (> 80%). This was obtained through a standardized, iterative Delphi process.

Results: For MHL, a total of 59 questions were surveyed: 41 indication questions and 18 outcome questions, for which there was consensus on ten indication questions and seven outcomes. For FDO, a total of 55 questions were surveyed: 43 indication questions and 12 outcome questions, for which there was consensus on 29 indication questions and eight outcomes.

Conclusion: This study is the first to use an expert panel to identify best-practice indications for common surgical procedures of children with CP. The results from this study will allow for more informed evaluation of practice and form the basis for future improvement efforts to standardize surgical recommendations internationally.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1302/1863-2548.14.190173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043128PMC
February 2020

Physics-Based Simulations to Predict the Differential Effects of Motor Control and Musculoskeletal Deficits on Gait Dysfunction in Cerebral Palsy: A Retrospective Case Study.

Front Hum Neurosci 2020 18;14:40. Epub 2020 Feb 18.

Department of Movement Sciences, KU Leuven, Leuven, Belgium.

Physics-based simulations of walking have the theoretical potential to support clinical decision-making by predicting the functional outcome of treatments in terms of walking performance. Yet before using such simulations in clinical practice, their ability to identify the main treatment targets in specific patients needs to be demonstrated. In this study, we generated predictive simulations of walking with a medical imaging based neuro-musculoskeletal model of a child with cerebral palsy presenting crouch gait. We explored the influence of altered muscle-tendon properties, reduced neuromuscular control complexity, and spasticity on gait dysfunction in terms of joint kinematics, kinetics, muscle activity, and metabolic cost of transport. We modeled altered muscle-tendon properties by personalizing Hill-type muscle-tendon parameters based on data collected during functional movements, simpler neuromuscular control by reducing the number of independent muscle synergies, and spasticity through delayed muscle activity feedback from muscle force and force rate. Our simulations revealed that, in the presence of aberrant musculoskeletal geometries, altered muscle-tendon properties rather than reduced neuromuscular control complexity and spasticity were the primary cause of the crouch gait pattern observed for this child, which is in agreement with the clinical examination. These results suggest that muscle-tendon properties should be the primary target of interventions aiming to restore an upright gait pattern for this child. This suggestion is in line with the gait analysis following muscle-tendon property and bone deformity corrections. Future work should extend this single case analysis to more patients in order to validate the ability of our physics-based simulations to capture the gait patterns of individual patients pre- and post-treatment. Such validation would open the door for identifying targeted treatment strategies with the aim of designing optimized interventions for neuro-musculoskeletal disorders.
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http://dx.doi.org/10.3389/fnhum.2020.00040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040166PMC
February 2020

Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy.

Neuropediatrics 2020 04 27;51(2):89-104. Epub 2019 Nov 27.

Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.

The aim of this paper is to provide a clinically applicable overview of different tone reducing modalities and how these can interact with or augment concurrent physical therapy (PT). Botulinum toxin (BoNT), oral tone-regulating medication, intrathecal baclofen (ITB), and selective dorsal rhizotomy are discussed within a physiotherapeutic context and in view of current scientific evidence. We propose clinical reasoning strategies to identify treatment goals as well as the appropriate and corresponding treatment interventions. Instrumented measurement of spasticity, standardized clinical assessment, and 3D clinical motion analysis are scientifically sound tools to help select the appropriate treatment and, when needed, to selectively target or spare individual muscles. In addition, particular attention is given to strength training as a necessary tool to tackle muscle weakness associated with specific modalities of tone reduction. More research is needed to methodologically assess the long-term effectiveness of such individualized tone treatment, optimize parameters such as medication dosage, and gain more insight into the kind of PT techniques that are essential in conjunction with tone reduction.
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http://dx.doi.org/10.1055/s-0039-3400987DOI Listing
April 2020

Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study.

PLoS One 2019 11;14(10):e0223363. Epub 2019 Oct 11.

KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.

This study aimed to identify the relationships between clinical impairments and gait deviations in children with cerebral palsy (CP). A retrospective convenience sample of 367 children with CP was selected (3-18 years old) and divided in two groups based on clinical symptomatology [unilateral (uCP) / bilateral CP (bCP), (n = 167/200)]. All children underwent a three-dimensional gait analysis and a standardized clinical examination. Gait was inspected on a vector level (all sagittal motions combined), and an individual joint level (pelvis, hip, knee and ankle joint motions). Statistical non-parametric mapping was applied to identify specific parts of the gait cycle displaying relationships between the gait deviations of both groups and the impairment scores of spasticity, weakness, selectivity, and passive range of motion. Impairment scores were summarized in two ways: a) composite impairment scores (e.g. combined spasticity of all assessed muscles acting around the hip, knee and ankle joints) and b) joint specific impairment scores (e.g. spasticity of the muscles acting around the knee joint). Results showed that the vector and most of the individual motions were related to the composite scores. Direct and carry-over relationships were found between certain individual motions and joint impairment scores (around the same or neighboring joints, respectively). All correlations were more prominent for children with bCP compared to uCP, especially regarding the relationships of gait deviations with weakness and reduced selectivity. In conclusion, this study enabled the mapping of relationships between clinical impairments and gait deviations in children with CP, by identifying specific parts of the gait cycle that are related to each of these impairments. These results provide a comprehensive description of these relationships, while simultaneously highlighting the differences between the two CP groups. Integration of these findings could lead to a better understanding of the pathophysiology of gait deviations and, eventually, support individualized treatment planning.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223363PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788679PMC
March 2020

The migration percentage measured on EOS® standing full-leg radiographs: equivalent and advantageous in ambulant children with cerebral palsy.

BMC Musculoskelet Disord 2019 Aug 7;20(1):366. Epub 2019 Aug 7.

University Hospitals Leuven, Herestraat, 49 3000, Leuven, Belgium.

Background: During ambulatory follow-up of patients with cerebral palsy (CP) systematic radiographic screening is required firstly to evaluate hip migration and development in the prevention of hip dislocation and secondly to analyse lower limb alignment and leg length. The Migration Percentage (MP) is a radiographic measurement used to describe the extent of femoral head lateralisation on conventional supine pelvic radiographs. Our goal was to assess the comparability of the MP measured on low radiation dose EOS® standing full-leg radiographs with that of conventional supine pelvic radiographs.

Methods: Patients presenting with CP were prospectively selected from our outpatient follow-up consultation at our institutions CP reference centre and underwent conventional supine pelvic and EOS® standing full-leg radiographs the same day for diagnostic and screening reasons.

Results: Out of 28 prospectively selected patients we included 21 (42 hips), of which 10 were female, with a mean age of 9.25 years and GMFCS levels of I, II and III. Seven out of 28 patients were excluded due to insufficient quality of radiographic images. The absolute differences in MP measured on both conventional supine pelvic and EOS® standing full-leg radiographs ranged between - 8 and 6% with an absolute mean difference of 0% (SD ±3.5) and were not statistically significant (p = 0.99). A Bland-Altman plot showed acceptable agreement between both measurements without proportional bias.

Conclusion: There is no statistical significant difference between the Migration Percentage measured on conventional supine pelvic radiographs and EOS® standing full-leg radiographs in ambulant patients. These images use lower radiation doses and contain more radiographic information.

Trial Registration: Approved by the Medical Research Ethics committee of the University Hospitals Leuven ( MP001492 ).
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http://dx.doi.org/10.1186/s12891-019-2746-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686540PMC
August 2019

: A Simulation Platform to Predict Gait Performance Following Orthopedic Intervention in Children With Cerebral Palsy.

Front Neurorobot 2019 17;13:54. Epub 2019 Jul 17.

Department of Movement Sciences, KU Leuven, Leuven, Belgium.

Gait deficits in cerebral palsy (CP) are often treated with a single-event multi-level surgery (SEMLS). Selecting the treatment options (combination of bony and soft tissue corrections) for a specific patient is a complex endeavor and very often treatment outcome is not satisfying. A deterioration in 22.8% of the parameters describing gait performance has been reported and there is need for additional surgery in 11% of the patients. Computational simulations based on musculoskeletal models that allow clinicians to test the effects of different treatment options before surgery have the potential to drastically improve treatment outcome. However, to date, no such simulation and modeling method is available. Two important challenges are the development of methods to include patient-specific neuromechanical impairments into the models and to simulate the effect of different surgical procedures on post-operative gait performance. Therefore, we developed the SimCP framework that allows the evaluation of the effect of different simulated surgeries on gait performance of a specific patient and includes a graphical user interface (GUI) that enables performing virtual surgery on the models. We demonstrated the potential of our framework for two case studies. Models reflecting the patient-specific musculoskeletal geometry and muscle properties are generated based solely on data collected before the treatment. The patient's motor control is described based on muscle synergies derived from pre-operative EMG. The GUI is then used to modify the musculoskeletal properties according to the surgical plan. Since SEMLS does not affect motor control, the same motor control model is used to define gait performance pre- and post-operative. We use the capability gap (CG), i.e., the difference between the joint moments needed to perform healthy walking and the joint moments the personalized model can generate, to quantify gait performance. In both cases, the CG was smaller post- then pre-operative and this was in accordance with the measured change in gait kinematics after treatment.
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http://dx.doi.org/10.3389/fnbot.2019.00054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650580PMC
July 2019

Rectus femoris transfer improves stiff knee gait in hemiplegic adults following stroke or traumatic brain injury.

Acta Orthop Belg 2019 Mar;85(1):12-20

The aim of this study was to provide quantitative evidence of the effect of rectus femoris (RF) transfer surgery on improving gait in adults suffering from stiff knee gait (SKG) following stroke or traumatic brain injury (TBI). Retrospective cohort study University hospital, department of orthopaedic surgery Hemiplegic patients with decreased peak knee flexion in swing, reduced total knee range of motion and spasticity of the RF demonstrated by a positive Duncan Ely test and a pathologic dynamic electromyography of the RF. Ten right hemiplegic patients had a distal RF transfer. Pre- and postoperative kinematic, kinetic, and spatiotemporal parameters derived from 3D gait analysis and parameters from clinical examinations were retrospectively compared. All patients (average age 40 ± 29 years) had an improvement of their gait. Statistically significant improvements were observed in walking velocity and peak knee flexion in swing (19.93° ±11.80°), knee flexion velocity at toe-off (110.26° ± 65.74°) and total knee range of motion (20.78° ± 0.66°). RF transfer improves knee flexion in swing in adult patients suffering from SKG following stroke or TBI and is thus a reliable treatment option.
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March 2019

Selective dorsal rhizotomy improves muscle forces during walking in children with spastic cerebral palsy.

Clin Biomech (Bristol, Avon) 2019 05 20;65:26-33. Epub 2019 Mar 20.

Department of Kinesiology, KU Leuven, Leuven, Belgium.

Background: Selective dorsal rhizotomy aims to reduce spasticity in children with cerebral palsy. Early investigations indicated postoperative weakness, whereas more recent studies showed that selective dorsal rhizotomy either does not change or improves muscle strength. All previous studies assessed muscle strength in a static position, which did not represent the walking situation. The aim of this study was to analyze the influence of selective dorsal rhizotomy on muscle forces during gait.

Methods: Motion capture data of 25 children with spastic cerebral palsy and 10 typically developing participants were collected. A musculoskeletal OpenSim model was used to calculate joint kinematics, joint kinetics and muscle forces during gait. Static optimization and an electromyography-informed approach to calculate muscle forces were compared. A Muscle-Force-Profile was introduced and used to compare the muscle forces during walking before and after a selective dorsal rhizotomy.

Findings: Independent of the approach used (electromyography-informed versus static optimization), selective dorsal rhizotomy significantly normalized forces in spastic muscles during walking and did not reduce the contribution of non-spastic muscles.

Interpretation: This study showed that selective dorsal rhizotomy improves dynamic muscle forces in children with cerebral palsy and leads to less gait pathology, as shown in the improvement in joint kinematics and joint kinetics. Individual muscle force analyses using the Muscle-Force-Profile extend standard joint kinematics and joint moment analyses, which might improve clinical-decision making in children with cerebral palsy in the future. The reference data of our participants and MATLAB code for the Muscle-Force-Profile are publicly available on simtk.org/projects/muscleprofile.
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http://dx.doi.org/10.1016/j.clinbiomech.2019.03.014DOI Listing
May 2019

Systematic review on gait classifications in children with cerebral palsy: An update.

Gait Posture 2019 03 29;69:209-223. Epub 2019 Jan 29.

KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium; University Hospitals Leuven, Department of Orthopedics, Clinical Motion Analysis Laboratory (CERM), Pellenberg, Belgium.

Background: Gait classification systems (GCSs) aim to aid clinicians and researchers in categorizing the gait of pathological populations, with the intent to improve the communication between them, to support treatment planning and enable the evaluation of patients over time. Throughout the years, various GCSs have been defined for children with cerebral palsy (CP), which were first summarized in a systematic review published in 2007.

Research Question: The current systematic review aimed to: a) identify GCSs that have been more recently developed, b) appraise their methodological quality and c) specify the most commonly used multiple joint gait patterns for children with CP reported in literature.

Methods: Four databases (Medline, EMBASE, CINAHL, Web of Science) were searched until July 2017. Several forms of validity and the reliability of these studies were assessed according to the principles of the consensus-based standards for the selection of health measurement instruments checklist or criteria defined in the original review. All published GCSs were also scrutinized in order to identify multiple joint patterns that have reached a predefined level of consensus.

Results: Thirty-six studies were considered in this review, 15 of them being GCSs that were not included in the original review. The validity, reliability and clinical applicability of all GCSs was reported, including 3 studies from the original review. Six multiple joint patterns for children with CP reached a consensus in literature.

Conclusion: Since the previous review, obvious progress has been made in the field of GCSs for CP, resulting in improved methodological quality of the majority of published GCSs. This encouraged the applicability of GCSs in clinical or research settings. The six reliable, valid and commonly used multiple joint patterns, emerging from this systematic review, may aid clinical and research applications and create a common language among healthcare providers.
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http://dx.doi.org/10.1016/j.gaitpost.2019.01.038DOI Listing
March 2019

Role of femoral derotation on gait after selective dorsal rhizotomy in children with spastic cerebral palsy.

Dev Med Child Neurol 2019 10 4;61(10):1196-1201. Epub 2019 Mar 4.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Aim: To evaluate the long-term outcome of selective dorsal rhizotomy (SDR) on gait and the influence of previous femoral derotation osteotomy (FDO).

Method: In a retrospective cohort study of 29 children (16 females, 13 males) with spastic diplegic cerebral palsy, 14 children received FDO before SDR, whereas 15 children with moderate or near-normal internal femoral rotation during gait received only SDR. Three-dimensional gait data were obtained pre-FDO, pre-SDR, 1 year post-SDR, and 3 to 5 years post-SDR, to study the Gait Profile Score (GPS), pelvic tilt, and knee and hip kinematics. A mixed analysis of variance with the repeated measure 'time' was performed between different time points for each group.

Results: Children who first underwent FDO and then SDR started with a more complex gait pathology but showed fewer gait deviations 3 to 5 years post-SDR, compared to children who only underwent SDR. This was reflected by a lower GPS and pelvic tilt, as well as less knee flexion in stance.

Interpretation: The effect of SDR on gait is only significant in the mid- to long-term if the bony lever arms are also corrected. Thus, the clinical outcome after SDR is dependent on good proximal alignment.

What This Paper Adds: Pelvic tilt remains stable after femoral derotation osteotomy (FDO)+selective dorsal rhizotomy (SDR). But pelvic tilt deteriorates after SDR only. Hip and knee extension is better after FDO+SDR than after SDR only. Spasticity reduction (by SDR) combined with bony lever arm correction (by FDO) improves gait.
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http://dx.doi.org/10.1111/dmcn.14192DOI Listing
October 2019

Medial gastrocnemius volume and echo-intensity after botulinum neurotoxin A interventions in children with spastic cerebral palsy.

Dev Med Child Neurol 2019 07 15;61(7):783-790. Epub 2018 Oct 15.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Aim: This cross-sectional investigation evaluated whether recurrent botulinum neurotoxin A (BoNT-A) interventions to the medial gastrocnemius have an influence on muscle morphology, beyond Gross Motor Function Classification System (GMFCS) level.

Method: A cohort of typically developing children (n=67; 43 males, 24 females; median age 9y 11mo [range 7y 10mo-11y 6mo]), a cohort of children with spastic cerebral palsy (CP) naive to BoNT-A interventions (No-BoNT-A; n=19; 10 males, nine females; median age 9y 3mo [range 8y 5mo-10y 10mo]) and a cohort of children with spastic CP with a minimum of three recurrent BoNT-A interventions to the medial gastrocnemius (BoNT-A; n=19; 13 males, six females; median age 9y 8mo [range 7y 3mo-10y 7mo]) were recruited. Three-dimensional freehand ultrasound was used to estimate medial gastrocnemius volume normalized to body mass and echo-intensity.

Results: Normalized medial gastrocnemius volume and echo-intensity significantly differed between the two spastic CP cohorts (p≤0.05), with the BoNT-A cohort having larger alterations. Associations between normalized medial gastrocnemius volume and echo-intensity were highest in the No-BoNT-A cohort, followed by the BoNT-A cohort. Multiple regression analyses revealed that both GMFCS level and BoNT-A intervention history were significantly associated with smaller normalized medial gastrocnemius volume and higher echo-intensity.

Interpretation: Recurrent BoNT-A interventions may induce alterations to medial gastrocnemius volume and echo-intensity beyond the natural history of the spastic CP pathology.

What This Paper Adds: In spastic cerebral palsy, medial gastrocnemius volumes are smaller and echo-intensities higher compared with typical development. Alterations after botulinum neurotoxin A intervention (BoNT-A) are larger than in no BoNT-A intervention. Gross Motor Function Classification System level and BoNT-A history significantly associate with medial gastrocnemius and echo-intensity alterations.
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http://dx.doi.org/10.1111/dmcn.14056DOI Listing
July 2019

Knee contracture in children with cerebral palsy: association with muscle lengths.

Dev Med Child Neurol 2018 04 16;60(4):335-336. Epub 2018 Feb 16.

Department of Rehabilitation Sciences, Catholic University Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1111/dmcn.13690DOI Listing
April 2018

Evolution of self-care and functional mobility after single-event multilevel surgery in children and adolescents with spastic diplegic cerebral palsy.

Dev Med Child Neurol 2018 05 8;60(5):505-512. Epub 2018 Feb 8.

Department of Development and Regeneration, University Hospitals Leuven, KU Leuven, Leuven, Belgium.

Aim: To explore the evolution of self-care and functional mobility after multilevel surgery in children and adolescents with spastic diplegic cerebral palsy and to identify factors affecting these outcomes.

Method: Thirty-four participants (22 males, 12 females) were evaluated before surgery, and at 2 months, 6 months, 1 year, 18 months, and 2 years after surgery. Self-care was assessed with the Pediatric Evaluation of Disability Inventory Dutch edition. The Mobility Questionnaire47 (MobQues47) and Functional Mobility Scale (FMS) were used to measure functional mobility.

Results: All outcomes revealed a significant decrease 2 months after single-event multilevel surgery (SEMLS) (p-value between <0.001 and 0.02) followed by a significant increase at 6 months (p<0.001 and p=0.045). Between 6 months and 1 year, a significant increase was also revealed for Mobques47 (p<0.001), FMS (p≤0.008), and the Pediatric Evaluation of Disability Inventory Functional Skills Scale (PEDI-FSS) (p=0.001). Improvement continued until 18 months for the PEDI-FSS. Initial score, initial muscle strength, Gross Motor Function Classification System level, age, and number of surgical interventions significantly influenced time trends for self-care and/or functional mobility.

Interpretation: Most preoperative scores are regained at 6 months after SEMLS. Further improvement is seen until 18 months. Participants with a higher functional level before surgery will temporarily lose more than participants with lower initial functional ability, but they also fast regain their function.

What This Paper Adds: Self-care and functional mobility decrease significantly in the first months after single-event multilevel surgery (SEMLS). Six months after SEMLS most preoperative scores are regained. Impact of SEMLS is more pronounced for functional mobility than for self-care. Muscle strength and functionality at baseline are important influencing factors on the evolution after SEMLS.
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http://dx.doi.org/10.1111/dmcn.13683DOI Listing
May 2018

Can in Vivo Medial Gastrocnemius Muscle-Tendon Unit Lengths be Reliably Estimated by Two Ultrasonography Methods? A Within-Session Analysis.

Ultrasound Med Biol 2018 Jan 6;44(1):110-118. Epub 2017 Nov 6.

Clinical Motion Analysis Laboratory, University Hospital, Pellenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

A clinically feasible method to reliably estimate muscle-tendon unit (MTU) lengths could provide essential diagnostic and treatment planning information. A 3-D freehand ultrasound (3-DfUS) method was previously validated for extracting in vivo medial gastrocnemius (MG) lengths, although the processing time can be considered substantial for the clinical environment. This investigation analyzed a quicker and simpler method using the US transducer as a spatial pointer (US-PaP), where the within-session reliability of extracting the muscle-tendon unit (MTU) and tendon lengths are estimated. MG MTU lengths were extracted in a group of 14 healthy adults using both 3-DfUS and US-PaP. Two consecutive acquisitions were performed per participant, and the data processed by two researchers independently. The intra-class correlation coefficients were above 0.97, and the standard error of measurements below 3.6 mm (1.5%). This investigation proposes that the simplified US-PaP method is a viable alternative for estimating MG MTU lengths.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2017.09.018DOI Listing
January 2018

Sequential bilateral complete rupture of the rectus femoris muscle in a patient with hereditary spastic paraplegia.

Eur J Phys Rehabil Med 2017 Oct 6;53(5):794-797. Epub 2017 Mar 6.

Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.

Background: This case raises questions about the pathophysiology of muscle ruptures in highly functional patients with hereditary spastic paraplegia (HSP) who have only minor spasticity and no significant muscle shortening. Literature on the skeletal muscle changes secondary to spasticity or to the underlying disease, HSP, has been explored and compared with this clinical case. Two theoretical hypotheses are discussed. Firstly, chronic spasticity might be a risk factor for histopathological muscle alterations. Secondly, altered protein synthesis due to the underlying genetic mutation may play a role in the mechanical integrity of muscle tissue.

Case Report: This is the first case report of a sequential bilateral complete disruption of the rectus femoris muscle after minimal trauma, in a 55-year-old man with HSP. Pain was the main complaint, without significant increase in spasticity. Walking ability was not significantly impaired. Conservative treatment resulted in resolution of the complaints.

Clinical Rehabilitation Impact: This unique case of a bilateral complete rectus femoris muscle rupture after minimal trauma in a patient with HSP presenting with minor spasticity raises questions on the pathophysiology of the skeletal muscle changes in HSP patients and more generally in spastic patients.
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http://dx.doi.org/10.23736/S1973-9087.17.04513-0DOI Listing
October 2017

Identification of joint patterns during gait in children with cerebral palsy: a Delphi consensus study.

Dev Med Child Neurol 2016 Mar 28;58(3):306-13. Epub 2015 Aug 28.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Aim: This study aims to achieve an international expert consensus on joint patterns during gait for children with cerebral palsy (CP) by means of Delphi surveys.

Method: In Stage 1, seven local experts drafted a preliminary proposal of kinematic patterns for each lower limb joint in the sagittal, coronal, and transverse plane. In Stage 2, 13 experts from eight gait laboratories (four in the USA and four in Europe), participated in a Delphi consensus study. Consensus was defined by a pre-set cut-off point of 75% agreement among participants.

Results: After the first stage, 44 joint patterns were presented in a first survey and 29 patterns reached consensus. Consensus improved to 47 out of 48 patterns in the third survey. Only one pattern, 'abnormal knee pattern during loading response', did not reach consensus. The expert panel agreed to define six patterns for the knee during swing, most of them representing characteristics of a stiff knee pattern.

Interpretation: The defined joint patterns can support clinical reasoning for children with CP as joint patterns during gait might be linked to different treatment approaches. Automating the classification process and incorporating additional trunk, foot, and electromyography features should be prioritized for the near future.
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http://dx.doi.org/10.1111/dmcn.12892DOI Listing
March 2016
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