Cerebral Palsy, Spastic
Conditions
Keywords
Medial gastrocnemius morphology, 3D ultrasonography, Functional power training
Brief summary
Spastic paresis (SP) is a common motor condition in children and is often caused by cerebral palsy. Skeletal muscles develop differently in children with SP due to brain damage in early development; muscle strength and muscle length are reduced compared to typically developing (TD) children. Especially, the calf muscles are affected, which particularly affects their ability to walk and to run, hindering participation in society. There are several treatments aimed to increase the range of motion of the joint by lengthening the muscle, for example botulinum toxin injections. However, these treatments can have a weakening effect on the muscle due to deconditioning from immobilization and due to paralysis. In rehabilitation centers in the Netherlands functional power training (MegaPower) is offered to children with SP who want to walk and run better. It has been shown that this training improves calf muscle strength and performance during functional walking tests. However, the effect of MegaPower training on muscle morphology (i.a. muscle volume and length) is still unknown. Therefore, the aim of this study is to assess the effect of MegaPower training on the muscle morphology of the medial gastrocnemius in children with SP using 3D ultrasonography. It is expected that MegaPower training results in an increase of muscle volume as well as elongation of the muscle belly. Muscle volume could increase due to hypertrophy of the muscle fibers induced by the training, which could elongate the muscle belly length due to the pennate structure of the medial gastrocnemius. A double-baseline design will be applied for this study with three different measurement times (T0-T1-T2) to compare the training period (12 weeks) with a period (12 weeks) of usual care.
Interventions
The training consists of weighted running and walking exercises performed at high-velocity and is given three times a week for 12 weeks.
Sponsors
Reade Rheumatology Research Institute
University Ghent
Amsterdam UMC, location VUmc
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
4 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Gross Motor Function Classification System I-III * Children should be able to lie on their stomach for min. one minute * Children should be able to follow instructions.
Exclusion criteria
* Received (one of) the following interventions within six months: * Casting * Botulinum toxin type-A injections * Orthopedic surgery.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Fascicle length in mm | 12 weeks before start training (week -12) |
| Muscle volume in dm^3 | 12 weeks before start training (week -12) |
| Muscle belly length in mm | 12 weeks before start training (week -12) |
| Tendon length in mm | 12 weeks before start training (week -12) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dynamic muscle strength | At the start of training (week 0) | Standing heel-rise test on one leg. Measured in amount of repetitions. |
| Functional Strength Measure (FSM) | At the start of training (week 0) | Measurement for lower and upper limb functionality. |
| 1-minute-walk-test | At the start of training (week 0) | Distance (m) covered in 1 min walking. |
| 6x15m sprint | At the start of training (week 0) | Measured as average time (s) over 6x15 m sprint. |
| Body length in m | 12 weeks before start training (week -12) | — |
| Lower leg length in mm | 12 weeks before start training (week -12) | Measured from the lateral malleolus and tibial plateau. |
| 10m Shuttle run test | At the start of training (week 0) | Measured in amount of steps reached. |
| Ankle range of motion | At the start of training (week 0) | Maximal dorsiflexion in degrees manually measured with a goniometer. |
| Body weight in kg | 12 weeks before start training (week -12) | — |
| Isometric muscle strength of the medial gastrocnemius | At the start of training (week 0) | Measured with a hand-held dynamometer in Nm. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Medical file information | 12 weeks before start training (week -12) | Age, gender, GMFCS-level, medical history |
Countries
Netherlands
Contacts
Primary ContactMarjolein M van der Krogt, Dr.
Outcome results
None listed