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In Vivo Architectural Properties of the Gastrocnemius Muscle in Cerebral Palsy

In Vivo Architectural Properties of the Gastrocnemius Muscle in Cerebral Palsy. Amir A Mohagheghi, PhD Institute for Biophysical & Clinical Research into Human Movement, MMU Cheshire, Alsager. Conventional Treatment Methods . Medical: Toxin injection Serial casting Surgery

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In Vivo Architectural Properties of the Gastrocnemius Muscle in Cerebral Palsy

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  1. In Vivo Architectural Properties of the Gastrocnemius Muscle in Cerebral Palsy Amir A Mohagheghi, PhD Institute for Biophysical & Clinical Research into Human Movement, MMU Cheshire, Alsager

  2. Conventional Treatment Methods • Medical: • Toxin injection • Serial casting • Surgery • Rehabilitation: • Positioning • Stretching • FES

  3. Why examine MTU adaptation to the physiological stimuli? • Muscles are adaptive tissues: • Response to the volume of exercise • Response to stretch/tenotomy • Muscle-Tendon Unit is the mean by which treatment is applied • Muscle-Tendon Unit is affected by the applied Treatment

  4. What to examine and at what level? • Structure and Mechanical Behaviour in vitro • Muscle Fibre (length, size, type, stiffness) • Architectural Parameters in vivo • Muscle (muscle, tendon, and MTU length) • Muscle Fascicles (fascicle length, pennation angle)

  5. Muscle Architectural Parameters

  6. CP Muscle Fibre Structural & Behavioural Properties • Short • Small (greater variability in size) • Stiff • Predominantly Type I

  7. InVivo CP Muscle Architectural Properties • Normal Fascicle Length (scaled to the leg length) • Shorter MTU Length (SIMM modelling) • Smaller Pennation Angle

  8. MMU Cheshire CP Project - CEREBRA • Aim: • determination of the medial gastrocnemius muscle (GM) architectural properties in vivo • Hypotheses: • MTU length will be shorter in the CP • Normal fascicle length • Smaller pennation angle

  9. MMU Cheshire CP Project - CEREBRA • Apparatus: • A linear array ALOKA ultrasound system (10.5 MHz; B-mode real-time) • Participants (6 M:1 F): • CP group: 7 ambulatory Hemiplegic participants (10.7 ± 5.1 years) • Healthy group: 7 participant (11.0 ± 3.7 years)

  10. MMU Cheshire CP Project - CEREBRA • Procedure: • Prone position • No correction of the posture • Hand goniometry of the ankle joint • Leg length • Determination of the knee joint line, MTJ, Achilles tendon insertion point: • Muscle length • Tendon length

  11. MMU Cheshire CP Project - CEREBRA • Procedure: • Sagittal scanning of the GM • ImageJ software • Statistical Analysis: • Paired t-test for within-groups comparisons • Un-paired t-test for between-groups comparisons • α = .05

  12. MMU Cheshire CP Project - CEREBRA • Results (between-groups comparisons): • Similar resting ankle joint angle (32) • Muscles were 11% shorter in CP • Tendons were 8% longer in CP • muscle and tendon length differences disappeared when muscle and tendon lengths were scaled to the leg length

  13. MMU Cheshire CP Project - CEREBRA • Results (between-groups comparisons): • Fascicles were 25% shorter in CP • Fascicle length difference disappeared when scaled to the leg length • Similar Pennation angles: • SPA: 14.5 ± 1.9 vs 14.5 ± 4.4 (CP) • DPA: 17.8 ± 1.6 vs 18.3 ± 4.6 (CP)

  14. MMU Cheshire CP Project - CEREBRA • Discussion: • Similarity of the architectural parameters at rest should not be generalised to the dynamic conditions: • Tonic Stretch Reflex • Mechanical behaviour of the spastic fibres • Mechanisms (neural and/or muscular) that control muscle length at rest are not altered in CP.

  15. THANK YOU

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