Impact of Altered Gastrocnemius Morphometrics and Fascicle Behavior on Walking Patterns in Children With Spastic Cerebral Palsy

Frontiers in Physiology

Adamantios Arampatzis¹  Annika Kruse²  Markus Tilp²  Harald Böhm⁴  Matthias Hösl⁵  Antonia Zehentbauer⁶  Martin Svehlik⁷ 

[1] Berlin School of Movement Science, Humboldt University of Berlin, Berlin, Germany;Department of Biomechanics, Movement and Training Sciences, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria;Department of Training and Movement Sciences, Humboldt University of Berlin, Berlin, Germany;Gait Laboratory, Orthopedic Children’s Hospital Aschau, Aschau im Chiemgau, Germany;Gait and Motion Analysis Laboratory, Schön Klinik Vogtareuth, Vogtareuth, Germany;Human Movement Science, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany;Paediatric Orthopaedics Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria;

关键词: cerebral palsy;    ultrasonography;    triceps surae;    muscle architecture;    paresis;    toe-walking;   

DOI  :  10.3389/fphys.2020.518134

来源: DOAJ

【 摘 要 】

Spastic cerebral palsy (SCP) affects neural control, deteriorates muscle morphometrics, and may progressively impair functional walking ability. Upon passive testing, gastrocnemius medialis (GM) muscle bellies or fascicles are typically shorter, thinner, and less extensible. Relationships between muscle and gait parameters might help to understand gait pathology and pathogenesis of spastic muscles. The current aim was to link resting and dynamic GM morphometrics and contractile fascicle behavior (both excursion and velocity) during walking to determinants of gait. We explored the associations between gait variables and ultrasonography of the GM muscle belly captured during rest and during gait in children with SCP [n = 15, gross motor function classification system (GMFCS) levels I and II, age: 7–16 years] and age-matched healthy peers (n = 17). The SCP children’s plantar flexors were 27% weaker. They walked 12% slower with more knee flexion produced 42% less peak ankle push-off power (all p < 0.05) and 7/15 landed on their forefoot. During the stance phase, fascicles in SCP on average operated on 9% shorter length (normalized to rest length) and displayed less and slower fascicle shortening (37 and 30.6%, respectively) during push-off (all p ≤ 0.024). Correlation analyses in SCP patients revealed that (1) longer-resting fascicles and thicker muscle bellies are positively correlated with walking speed and negatively to knee flexion (r = 0.60–0.69, p < 0.0127) but not to better ankle kinematics; (2) reduced muscle strength was associated with the extent of eccentric fascicle excursion (r = −0.57, p = 0.015); and (3) a shorter operating length of the fascicles was correlated with push-off power (r = −0.58, p = 0.013). Only in controls, a correlation (r = 0.61, p = 0.0054) between slower fascicle shortening velocity and push-off power was found. Our results indicate that a thicker gastrocnemius muscle belly and longer gastrocnemius muscle fascicles may be reasonable morphometric properties that should be targeted in interventions for individuals with SCP, since GM muscle atrophy may be related to decreases in walking speed and undesired knee flexion during gait. Furthermore, children with SCP and weaker gastrocnemius muscle may be more susceptible to chronic eccentric muscle overloading. The relationship between shorter operating length of the fascicles and push-off power may further support the idea of a compensation mechanism for the longer sarcomeres found in children with SCP. Nevertheless, more studies are needed to support our explorative findings.

【 授权许可】

Unknown