Effect of various therapies on lower limb muscle morphology in children with spastic cerebral palsy
In this study, Belgian scientists reviewed studies examining the effect of various therapies on the macroscopic morphology of the muscles and tendons of the lower limbs in children with spastic cerebral palsy (CP). They analyzed the effects of, among others, whole-body vibration (WBV), which is often used to reduce muscle tension (spasticity), improve posture control, strength, gait and mobility in children with spastic CP.
- WBV in combination with balance training increases the thickness of various muscles in the lower limbs after 6-8 weeks of training.
- Passive stretching can prevent the muscles from shortening, but it does not lengthen them.
- The effect of botulinum neurotoxin A (BoNT-A) injection on muscle volume is not clear.
- Isolated muscle strengthening does not show a constant increase in muscle volume or thickness.
Prepared on the basis of:
Interventions and lower-limb macroscopic muscle morphology in children with spastic cerebral palsy: a scoping review. Walhain F, Desloovere K, Declerck M et al. Dev Med Child Neurol. 2021 Mar;63(3):274-286.
Study population
Children with spastic CP.
Test procedure
The presented literature review was based on 28 articles meeting the relevant qualitative criteria. Scientific publications on studies involving macroscopic morphology measurements of muscles and tendons in the lower limbs of children with spastic CP before and after various intervensions were analyzed. Interventions included:
- stretching
- BoNT-A injection
- strength training
- electrical stimulation
- WBV
- balance training
- orthopedic surgery.
The quality of the conducted research and the effects of individual therapies were assessed.
Use of vibration in the study
One good-quality study analyzed was WBV training. The influence of WBV on muscle thickness was assessed in children (mean age 10 years) with GMFCS (Gross Motor Function Classification System) levels from I to III. A single WBV treatment lasted 1 hour. Three such treatments were performed per week for a period of 8 weeks. Additional physiotherapeutic care was also implemented (no details provided).
Results
28 publications were qualified for this review. Overall, the quality of the research ranged from low (half a publication) to good (2 publications). The remaining 12 publications showed the almost good quality of the research. The research samples were small (from 4 to 32 patients), various muscles and macroscopic morphological parameters were examined. There have been inconsistent post-intervention effects, no effect or small effect sizes. It should be noted however, that no change over time “for the worse” is in many cases favorable.
WBV
One publication that analyzed the effects of 8 weeks of WBV vibrotherapy, mentioned in the section “Use of vibration in the study”, showed good quality results. There was an increase in the thickness of the anterior tibialis (d = 1.66) and soleus (d = 2.01) muscles, but not the gastrocnemius muscle.
Another study of the effects of WBV, of poor quality, showed similar effects to the above-cited results of WBV treatments (and balance training) – an increase in the thickness of various muscles of the lower limbs after 6 weeks of training.
Comment
As the presented review of the scientific literature shows, the effects of various therapies aimed at macroscopic remodeling of muscles and tendons are not well understood, limited and heterogeneous, which makes it difficult to generalize conclusions. Therefore, further better-quality research is needed – including control groups and standardized evaluation protocols, especially due to the potential of those therapies to support the treatment of CP is high.
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