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Mechanical and Morphological Changes of the Plantar Flexor Musculotendinous Unit in Children with Unilateral Cerebral
Ragab K Elnaggar1,2, Mohammed S Alghamdi3, Aqeel M Alenazi1
1Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia.
Insights
Plyometric exercise (PLYO-Ex) significantly improved the plantar flexor musculotendinous unit in children with unilateral cerebral palsy. This intervention enhanced both muscle and tendon morphometrics and mechanical properties, suggesting improved physical function.
Area of Science:
- Pediatric Rehabilitation
- Sports Medicine
- Biomedical Engineering
Background:
- Unilateral cerebral palsy (UCP) often impairs motor function, particularly in the lower extremities.
- The plantar flexor musculotendinous unit is crucial for mobility and is frequently affected in children with UCP.
- Understanding the effects of targeted exercise interventions on this unit is vital for improving functional outcomes.
Purpose of the Study:
- To evaluate the impact of plyometric exercise (PLYO-Ex) on the morphometrics and mechanics of the plantar flexor musculotendinous unit in children with UCP.
- To compare the effects of PLYO-Ex with traditional physical therapy.
Main Methods:
- 38 children (10-16 years) with UCP were randomized into a PLYO-Ex group (24 sessions over 3 months) or a control group (traditional physical therapy).
- Ultrasound imaging assessed morphometrics (muscle/tendon dimensions, fascicle length, pennation angle).
- An isokinetic dynamometer measured maximum voluntary isometric plantar flexor contraction (IVCmax) and tendon mechanical properties (elongation, stiffness, stress, strain).
Main Results:
- The PLYO-Ex group showed significant improvements in morphological measures, including tendon length, belly length, tendon thickness, muscle thickness, fascicle length, and pennation angle.
- Significant enhancements were also observed in mechanical and material properties: IVCmax, tendon elongation, stiffness, stress, and strain.
- These changes favored the PLYO-Ex group compared to the control group, even after controlling for pre-treatment values.
Conclusions:
- Plyometric exercise induces significant positive adaptations in the plantar flexor musculotendinous unit in children with UCP.
- These adaptations in muscle and tendon structure and function can potentially improve muscular efficiency.
- Optimized muscular efficiency through PLYO-Ex may lead to enhanced physical and functional performance in this population.
Abstract:
To investigate how plyometric exercise (PLYO-Ex) affects mechanics and morphometrics of the plantar flexor musculotendinous unit in children with unilateral cerebral palsy, 38 participants (aged 10-16 years) were allocated at random to either the PLYO-Ex group (n = 19; received 24 sessions of plyometric muscle loading, conducted 2 times a week for 3 months in succession) or the control group (n = 19; underwent traditional physical therapy for the same frequency and duration). Measurements were taken pre- and post-intervention. Standard ultrasound imaging was applied to evaluate morphometrics of the gastrocnemius muscle and Achilles tendon unit and an isokinetic dynamometer was used to evaluate maximum voluntary isometric plantar flexors contraction (IVCmax). With controlling for pre-treatment values, significant post-treatment changes favoring the PLYO-Ex group were observed for morphological (tendon (p = 0.003, η2p = 0.23) length; belly length (p = 0.001, η2p = 0.27); tendon thickness (p = 0.035, η2p = 0.35); muscle thickness (p = 0.013, η2p = 0.17); fascicle length (p = 0.009, η2p = 0.18); pennation angle (p = 0.015, η2p = 0.16)) and mechanical and material properties (IVCmax (p = 0.009, η2p = 0.18); tendon's elongation (p = 0.012, η2p = 0.17), stiffness (p = 0.027, η2p = 0.13); stress (p = 0.006, η2p = 0.20); strain (p = 0.004, η2p = 0.21)). In conclusion, plyometric exercise induces significant adaptations within the musculotendinous unit of the plantar flexors in children with unilateral cerebral palsy. These adaptations could improve muscular efficiency and consequently optimize physical/functional performance.
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