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Understanding muscle energy expenditure variations following selective dorsal rhizotomy while maintaining consistent
Emiliano Pablo Ravera1, Adam Rozumalski2
1Group of Analysis, Modeling, Processing and Clinician Implementation of Biomechanical Signals and Systems, Bioengineering and Bioinformatics Institute, CONICET-UNER, Oro Verde, Argentina; Human Movement Research Laboratory, School of Engineering, National University of Entre Ríos (UNER), Oro Verde, Argentina.
Insights
Selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP) did not change overall energy use but altered individual muscle energy expenditure during walking. Muscle tissue changes may explain energy deficits in CP.
Area of Science:
- Biomedical Engineering
- Neuroscience
- Pediatric Orthopedics
Background:
- Children with cerebral palsy (CP) exhibit increased energy demands during walking, often linked to spasticity.
- Selective dorsal rhizotomy (SDR) is a surgical intervention aimed at reducing spasticity.
- Previous research indicated minimal changes in overall energy consumption post-SDR, prompting further investigation into muscle-level energy expenditure.
Purpose of the Study:
- To evaluate the impact of SDR on individual muscle energy expenditure during walking in children with CP.
- To build upon prior findings of altered muscle force production post-SDR.
- To investigate the relationship between spasticity reduction, muscle mechanics, and energy expenditure.
Main Methods:
- Neuro-musculoskeletal simulations were employed to analyze muscle energy expenditure.
- A comparative study design matched 81 children with CP into SDR and non-SDR groups.
- Individual muscle force production, muscle activation, joint angles, and spasticity levels were assessed pre- and post-intervention.
Main Results:
- No significant changes in overall energy consumption or total muscle energy expenditure were observed post-SDR.
- Significant alterations in individual muscle energy expenditure were noted in the SDR group compared to controls.
- Post-SDR, a decrease in plantarflexor spasticity, improved ankle motion, and increased individual muscle force were observed, without significant changes in gastrocnemius and soleus energy expenditure.
Conclusions:
- SDR does not significantly alter overall walking energy consumption in children with CP.
- Changes in individual muscle energy expenditure and mechanics post-SDR suggest a more favorable dynamic scenario for muscle force production.
- Altered muscle tissue properties following SDR may contribute to the energy deficits observed in children with CP during gait.
Abstract:
Increased energy demands during walking is a recurrent issue for children with cerebral palsy (CP). Given the high incidence of spasticity in these children, several authors have analyzed the impact of selective dorsal rhizotomy (SDR) on energy consumption during walking, typically showing minimal changes post-SDR. To further investigate muscle behavior after SDR, our recent study identified alterations in individual muscle force production without changes in muscle activation during walking. This suggests that children with CP may experience a more favorable dynamic scenario for developing sub-maximal muscle forces after SDR, due to reduced spasticity unlocking joint movement. Thus, this raises questions about whether these changes in muscle force production could lead to increased muscle energy expenditure, which may not be fully reflected in overall energy consumption. The aim of this study was to build upon our previous research on muscle behavior after SDR by evaluating the surgery's impact on individual muscle energy expenditure during walking, using neuro-musculoskeletal simulations. Our research compared two matched groups comprising 81 children with CP: those who underwent SDR and those who did not. Our results showed no significant changes in overall energy consumption or total muscle energy expenditure in either group post-surgery. However, we observed alterations in individual muscle energy expenditure during walking in the SDR group compared to children with CP who received other treatments. Compared to the findings from our first study, we observed a significant decrease in spasticity of the plantarflexor muscles, an improvement in ankle joint angle, an increase in individual muscle force during walking, and no statistically significant changes in energy expenditure of the gastrocnemius and soleus muscles post-SDR. These findings, along with the absence of changes in muscle activity post-SDR, support the hypothesis that muscle tissue alterations contribute to energy deficits observed in children with CP during walking.
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