Influence of gait analysis on decision-marketing for lower extremity surgery

Measurement of muscle volume in spastic cerebral palsy using magnetic resonance imaging


  1. 1. One Small Step Gait Laboratory;
  2. 2. Imaging Sciences, Guy’s Hospital, London, UK

Background: One of the characteristics impairments of spastic cerebral palsy (SCP) is weakness of the musculature of the affected limbs. The force that a muscle is able to generate is proportional to its volume. However, a comprehensive and controlled study of muscle volumes in the lower limbs of participants with SCP has not been conducted to date.

Objective: To compare the volume of 11 major muscles of the lower limb in adolescents and young adults with SCP with the muscle volumes of their typically developing peers.

Design: Case control study.

Participants: Seven typically developing participants (control group) aged 15 to 21 years and nine independently ambulant participants with SCP (case groups) aged 14 to 22 years were recruited to the study. Two of these participants had a diagnosis of hemiplegia and seven of diplegia. For participants with hemiplegia only data from the affected limb was included in the analysis.

Methods: Each participant underwent T 1- weighted spin echo MRI (slice thickness 4mm, no gaps between slices) from the iliac crest to the calcaneum. The volumes of 11 of the major muscles of the lower limb were calculated from 18 equally spaced cross-sections of each muscle.

Results: We found significant linear relationships between muscle volume and body mass for each muscle studied in both the controls and cases. When normalized to body mass, all muscles in the affected limbs were significantly reduced in volume. Figure SP:34 shows the average normalized volume of each muscle group for the control and case groups. The total normalized muscle volume of the case group was on average 65% of the control group.

Discussion: This study demonstrates that muscle volumes throughout the lower limb are reduced in ambulant adolescents/young adults with SCP. The origin of the morphological deficits are not yet known but it is likely that reduced muscle volumes contribute to the weakness observed in this group, and interventions that increase muscle volume may improve strength and function. During their childhood the case participants had undergone surgical and non-surgical interventions that may have contributed to the reduced muscle volumes that we noted. Studies of the effects of intervention and natural history on muscle morphology are needed.

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