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Gastrocnemius medialis and Achilles tendon properties do not differ between children with unilateral or bilateral
Andreas Habersack1, Martin Svehlik2, Bernhard Guggenberger3
1Department of Othopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria; Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14/I, 8010 Graz, Austria.
Insights
Children with unilateral and bilateral spastic cerebral palsy (SCP) show similar gastrocnemius muscle-tendon properties. Activity levels may influence outcomes, warranting further investigation into gait parameters.
Area of Science:
- Pediatric Neurology
- Biomedical Engineering
- Rehabilitation Science
Background:
- Spastic cerebral palsy (SCP) is a prevalent neurodevelopmental disorder in children, with unilateral and bilateral subtypes.
- Understanding muscle-tendon properties is crucial for effective treatment strategies in SCP, yet subtypes are often not differentiated.
- Muscle morphology significantly impacts function in spastic conditions.
Purpose of the Study:
- To investigate and compare muscle-tendon properties of the gastrocnemius medialis (GM) muscle-tendon unit (MTU) between children with unilateral SCP and bilateral SCP.
- To determine if distinct pathological differences exist in GM MTU properties between SCP subtypes.
- To inform tailored treatment approaches by identifying subtype-specific muscle-tendon characteristics.
Main Methods:
- Retrospective analysis of 33 ambulatory children (15 unilateral SCP, 18 bilateral SCP, GMFCS Level I-III).
- Assessment of ankle range of motion and isometric strength using isokinetic dynamometry.
- Evaluation of GM MTU properties, including muscle volume and tissue lengthening, via 3D motion capture and ultrasound.
Main Results:
- No statistically significant differences were observed in any assessed GM MTU property between unilateral and bilateral SCP groups (p > 0.05).
- Effect sizes (Cohen's d) were below 0.57, indicating small differences that are not clinically significant.
- Functional and morphological characteristics of the GM MTU appear comparable across both SCP subtypes in the studied population.
Conclusions:
- The functional and morphological properties of the gastrocnemius muscle-tendon unit are similarly developed in children with unilateral and bilateral spastic cerebral palsy.
- Activity levels may play a more significant role in differentiating outcomes than the SCP subtype itself.
- Future research should incorporate gait parameters and associated tissue dynamics to further elucidate differences in SCP subtypes.
Abstract:
Spastic cerebral palsy (SCP) is a common neurodevelopmental disorder in children, which can be categorized into unilateral and bilateral subtypes. Most studies examining the muscle-tendon properties of the lower extremities in individuals with SCP do not distinguish between subtypes. However, spastic muscle morphology is an important determinant for its function. Therefore, differences in muscle-tendon pathology might lead to different treatment strategies. The aim of this retrospective study was to investigate the muscle-tendon properties between children with unilateral SCP and those with bilateral SCP. Overall, 33 ambulatory children (15 with unilateral SCP and 18 with bilateral SCP, Gross Motor Function Classification System Level I-III) were included. Ankle joint range of motion, isometric muscle strength, and muscle-tendon properties of the gastrocnemius medialis (GM) muscle-tendon unit (MTU) (e.g., muscle volume, tissue lengthening behavior) were assessed with isokinetic dynamometry, 3D motion capture, and ultrasound, respectively. Independent t-tests or Mann-Whitney tests were used to test for group differences (α = 0.05). Effect sizes (Cohen's d) were also calculated. No significant differences in any assessed parameter were found between children with unilateral SCP and children with bilateral SCP (p > 0.05, d < 0.57). Our findings suggest that the functional and morphological properties of the GM MTU are similarly developed in children with unilateral SCP and children with bilateral SCP. We assume that activity levels might be the decisive factor. Nonetheless, our investigations need be extended by including gait parameters and associated tissue dynamics.
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