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Interventions and lower-limb macroscopic muscle morphology in children with spastic cerebral palsy: a scoping review
Fenna Walhain1,2, Kaat Desloovere2,3, Marlies Declerck4
1Department of Anatomy, Anton de Kom University of Suriname, Paramaribo, Suriname.
Insights
Studies on interventions for lower-limb muscle changes in children with spastic cerebral palsy (CP) are limited. More research with control groups and standardized methods is needed to understand muscle remodeling effects.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Biomedical Engineering
Background:
- Children with spastic cerebral palsy (CP) often exhibit altered lower-limb muscle-tendon morphology.
- Understanding how interventions affect muscle structure is crucial for improving function and mobility.
- Current literature on macroscopic muscle-tendon changes in response to interventions is sparse and inconsistent.
Purpose of the Study:
- To systematically identify and map existing research on interventions targeting lower-limb muscle-tendon morphology in pediatric spastic CP.
- To evaluate the quality of studies assessing intervention effects on muscle structure.
- To synthesize findings on the efficacy of various interventions for muscle remodeling.
Main Methods:
- Conducted a comprehensive literature search for studies with pre- and post-intervention measurements of lower-limb muscle-tendon morphology in children with spastic CP.
- Assessed the methodological quality of included studies.
- Extracted data on intervention types, outcome measures, and reported effect sizes.
Main Results:
- Twenty-eight articles were reviewed, encompassing seven intervention types: stretching, botulinum neurotoxin A (BoNT-A), strengthening, electrical stimulation, whole-body vibration, balance training, and surgery.
- Study quality varied significantly, with a majority rated as poor to moderate.
- Inconsistent or small effect sizes were reported for interventions like strengthening and BoNT-A regarding muscle thickness, cross-sectional area, and volume.
Conclusions:
- Existing intervention studies on macroscopic muscle-tendon remodeling in pediatric spastic CP are limited and heterogeneous, hindering generalizable conclusions.
- Higher quality studies employing control groups and standardized assessment protocols are essential for robust data synthesis.
- The lack of clear macroscopic effects suggests a need to investigate microscopic-level changes and the combined effects of interventions.
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.
