Projects & Collaborations 2 foundShow per page10 10 20 50 Muscle Function in Dynamic MRI in Patients with Cerebral Palsy Before and After Botulinum Toxin Injection Research Project | 4 Project MembersMuscle contractures are amongst the most frequently treated problems in children with cerebral palsy. They occur due to the aberrant muscle use under the neurological disorder and further impede function and daily activities. Foot equinus is one of the most frequent conditions, and treatment with injection of botulinum toxin has become a standard. In this study the functional properties of muscles - before and after the injection of botulinum toxin - in cerebral palsy patients will be assessed with a novel technique for the investigation of muscle function by MRI, based on synchronous electrical muscle stimulation (EMS). This approach provides information about muscle fibre length and angulation also in the active muscle, as well as contraction velocity and muscle strength. These data will be correlated with muscle pathology from needle biopsies and with gait function recorded by gait analysis. Synchronous EMS-MRI and gait analysis including dynamic superficial electromyography (EMG) will be applied three times to the patients: a) Before botulinum toxin injection, b) 6 weeks after botulinum toxin injection, and c) 3 months after botulinum toxin injection. Before botulinum toxin injection a needle biopsy of the selected muscle will be obtained from all patients. Muscle tissue is altered in cerebral palsy, and the biopsy provides the necessary histological data for understanding a possible atypical function before and after botulinum toxin injection assessed with EMS-induced MRI. For data comparison twelve healthy volunteers will be recruited whose data will serve as a normal reference. The volunteers will only obtain synchronous EMS-MRI and gait analysis including dynamic superficial EMG once. As we have histology data of normal muscles, biopsies and botulinum toxin injections are not required in these normal volunteers.The data of synchronous EMS-MRI from this study will be clinically relevant for several reasons:It may offer a non-invasive technique to obtain information on muscle pathophysiology in patients with cerebral palsy. A better knowledge of the function of the abnormal muscles during gait is essential for the adaptation of the current treatment options (e.g. less surgical lengthenings). It will further help to compute data from gait analysis more accurately as the parameters modifying the computations can be set according to the pathologies.Further, the information about the effect of botulinum toxin may help to explain some of the failures of current treatment procedures. It will be especially important to know how much of a muscle is affected and how the remaining part reacts. As a consequence of the study adaptations of the drug application may be required. Adaptation of functional control mechanisms when walking on uneven surface in patients with spastic hemiplegic cerebral palsy Research Project | 1 Project MembersPatients with unilateral (hemiplegic) cerebral palsy (CP) often report difficulties when walking on uneven surfaces. Motor control impairment associated with CP not only restricts patients' daily activities but also their integration into the society. For instance, patients with unilateral CP need more time for completing daily tasks such as shopping because of their difficulties in walking stairs and steps. Moreover, children with CP have trouble keeping up with their healthy peers playing outdoors where the ground is uneven. Therefore, therapy in these patients should mainly focus on restoring and developing the abilities to accomplish more demanding real life situations. Identifying and objectively quantifying motor control deficits and movement deviations is a prerequisite for developing a patient specific and task orientated therapy concept. However, these deficits cannot be discovered by analysing walking in a controlled laboratory setting with flat ground as done in a routine clinical gait analysis. The patients need to be assessed in a more demanding environment, such as walking on uneven ground to reveal the full dimension of their motor control deficits. The purpose of this study is to determine differences in the functional control mechanisms when walking on uneven ground between children with and without hemiplegic CP. I will identify gait parameters describing differences in functional control adaptations to walking on uneven ground between children with and without hemiplegic CP and determine if patients with hemiplegic CP require more time to adapt to the uneven ground during the transition from flat to uneven ground. A fast adaptation to a different surface is critical for preventing falls and beneficial when walking outside a laboratory or building. Gait patterns of 20 children with hemiplegic CP and 20 age-matched normally developing children will be compared when walking on flat and uneven ground. Three-dimensional joint kinematics, centre of mass movements, spatio-temporal parameters and muscle activity patterns derived by an instrumented gait analysis will be analysed. This study is a critical first step towards developing a new protocol for clinical gait analysis that includes walking on uneven surface. The knowledge gained in this study will be used for proposing a therapy concept aiming at training patient specific movement patterns to facilitate adaptation to uneven ground. 1 1
Muscle Function in Dynamic MRI in Patients with Cerebral Palsy Before and After Botulinum Toxin Injection Research Project | 4 Project MembersMuscle contractures are amongst the most frequently treated problems in children with cerebral palsy. They occur due to the aberrant muscle use under the neurological disorder and further impede function and daily activities. Foot equinus is one of the most frequent conditions, and treatment with injection of botulinum toxin has become a standard. In this study the functional properties of muscles - before and after the injection of botulinum toxin - in cerebral palsy patients will be assessed with a novel technique for the investigation of muscle function by MRI, based on synchronous electrical muscle stimulation (EMS). This approach provides information about muscle fibre length and angulation also in the active muscle, as well as contraction velocity and muscle strength. These data will be correlated with muscle pathology from needle biopsies and with gait function recorded by gait analysis. Synchronous EMS-MRI and gait analysis including dynamic superficial electromyography (EMG) will be applied three times to the patients: a) Before botulinum toxin injection, b) 6 weeks after botulinum toxin injection, and c) 3 months after botulinum toxin injection. Before botulinum toxin injection a needle biopsy of the selected muscle will be obtained from all patients. Muscle tissue is altered in cerebral palsy, and the biopsy provides the necessary histological data for understanding a possible atypical function before and after botulinum toxin injection assessed with EMS-induced MRI. For data comparison twelve healthy volunteers will be recruited whose data will serve as a normal reference. The volunteers will only obtain synchronous EMS-MRI and gait analysis including dynamic superficial EMG once. As we have histology data of normal muscles, biopsies and botulinum toxin injections are not required in these normal volunteers.The data of synchronous EMS-MRI from this study will be clinically relevant for several reasons:It may offer a non-invasive technique to obtain information on muscle pathophysiology in patients with cerebral palsy. A better knowledge of the function of the abnormal muscles during gait is essential for the adaptation of the current treatment options (e.g. less surgical lengthenings). It will further help to compute data from gait analysis more accurately as the parameters modifying the computations can be set according to the pathologies.Further, the information about the effect of botulinum toxin may help to explain some of the failures of current treatment procedures. It will be especially important to know how much of a muscle is affected and how the remaining part reacts. As a consequence of the study adaptations of the drug application may be required.
Adaptation of functional control mechanisms when walking on uneven surface in patients with spastic hemiplegic cerebral palsy Research Project | 1 Project MembersPatients with unilateral (hemiplegic) cerebral palsy (CP) often report difficulties when walking on uneven surfaces. Motor control impairment associated with CP not only restricts patients' daily activities but also their integration into the society. For instance, patients with unilateral CP need more time for completing daily tasks such as shopping because of their difficulties in walking stairs and steps. Moreover, children with CP have trouble keeping up with their healthy peers playing outdoors where the ground is uneven. Therefore, therapy in these patients should mainly focus on restoring and developing the abilities to accomplish more demanding real life situations. Identifying and objectively quantifying motor control deficits and movement deviations is a prerequisite for developing a patient specific and task orientated therapy concept. However, these deficits cannot be discovered by analysing walking in a controlled laboratory setting with flat ground as done in a routine clinical gait analysis. The patients need to be assessed in a more demanding environment, such as walking on uneven ground to reveal the full dimension of their motor control deficits. The purpose of this study is to determine differences in the functional control mechanisms when walking on uneven ground between children with and without hemiplegic CP. I will identify gait parameters describing differences in functional control adaptations to walking on uneven ground between children with and without hemiplegic CP and determine if patients with hemiplegic CP require more time to adapt to the uneven ground during the transition from flat to uneven ground. A fast adaptation to a different surface is critical for preventing falls and beneficial when walking outside a laboratory or building. Gait patterns of 20 children with hemiplegic CP and 20 age-matched normally developing children will be compared when walking on flat and uneven ground. Three-dimensional joint kinematics, centre of mass movements, spatio-temporal parameters and muscle activity patterns derived by an instrumented gait analysis will be analysed. This study is a critical first step towards developing a new protocol for clinical gait analysis that includes walking on uneven surface. The knowledge gained in this study will be used for proposing a therapy concept aiming at training patient specific movement patterns to facilitate adaptation to uneven ground.
