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Muscle Synergies During Walking in Children With Cerebral Palsy: A Systematic Review
Annike Bekius1,2, Margit M Bach1, Marjolein M van der Krogt2
1Department of Human Movement Sciences, Amsterdam Movement Sciences, Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Insights
Children with cerebral palsy (CP) use fewer and different muscle synergies when walking compared to typically developing children. Muscle synergy analysis may help predict treatment outcomes for CP.
Area of Science:
- Neuromuscular control
- Pediatric gait analysis
- Biomechanical studies
Background:
- Children with cerebral palsy (CP) exhibit impaired walking due to limited motor control.
- Muscle synergy analysis quantifies neuromuscular control during gait.
- Early brain injury in CP may alter muscle synergy development.
Approach:
- Systematic review of studies on lower limb muscle synergies during walking in children with CP.
- Searched bibliographic databases up to April 2019.
- Included studies using matrix factorization algorithms.
Key Points:
- Most studies found children with CP use fewer muscle synergies than typically developing (TD) children.
- Differences in spatial or temporal muscle synergy structures were observed.
- Greater variability in muscle synergies was noted in children with CP.
Conclusions:
- Children with CP appear to employ a simpler motor control strategy during walking.
- Muscle synergy analysis shows promise for quantifying CP-related motor deficits and predicting treatment success.
- Further research is needed to explore muscle synergies as therapeutic targets for CP.
Abstract:
Background: Walking problems in children with cerebral palsy (CP) can in part be explained by limited selective motor control. Muscle synergy analysis is increasingly used to quantify altered neuromuscular control during walking. The early brain injury in children with CP may lead to a different development of muscle synergies compared to typically developing (TD) children, which might characterize the abnormal walking patterns. Objective: The overarching aim of this review is to give an overview of the existing studies investigating muscle synergies during walking in children with CP compared to TD children. The main focus is on how muscle synergies differ between children with CP and TD children, and we examine the potential of muscle synergies as a measure to quantify and predict treatment outcomes. Methods: Bibliographic databases were searched by two independent reviewers up to 22 April 2019. Studies were included if the focus was on muscle synergies of the lower limbs during walking, obtained by a matrix factorization algorithm, in children with CP. Results: The majority (n = 12) of the 16 included studies found that children with CP recruited fewer muscle synergies during walking compared to TD children, and several studies (n = 8) showed that either the spatial or temporal structure of the muscle synergies differed between children with CP and TD children. Variability within and between subjects was larger in children with CP than in TD children, especially in more involved children. Muscle synergy characteristics before treatments to improve walking function could predict treatment outcomes (n = 3). Only minimal changes in synergies were found after treatment. Conclusions: The findings in this systematic review support the idea that children with CP use a simpler motor control strategy compared to TD children. The use of muscle synergy analysis as a clinical tool to quantify altered neuromuscular control and predict clinical outcomes seems promising. Further investigation on this topic is necessary, and the use of muscle synergies as a target for development of novel therapies in children with CP could be explored.
