- Email: [email protected]
Relation between brain lesions on MRI and gait pathology in children with cerebral palsy
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
Discussion and conclusions: Mechanical cost of walking was increased in CP compared to TD peers. The increases in cost were caused by increases in both positive and negative Wj . All three LL joints showed increases in negative work, where the increase in positive Wj was mainly caused by a large increase at the hip. In normal gait, eccentric muscle forces and energy transfer from one segment to the other by biarticular muscles are important to conserve energy during walking. The increases in negative work suggested that a lack of control of these energy conserving mechanisms plays an important role in decreased gait efficiency in CP. Reference [1] Van de Walle, et al. Gait & Posture 2010;31:495–501.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.155 P51 Relation between brain lesions on MRI and gait pathology in children with cerebral palsy Leen Van Gestel 1,2 , Els Ortibus 3 , Pieter Meyns 4 , Paul De Cock 3 , Stefan Sunaert 5 , Andrea Guzzetta 6 , Erwin Aertbeliën 7 , Hilde Feys 2 , Jaak Duysens 4 , Kaat Desloovere 2 1 Research assistant of the Research Foundation Flanders 2 Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium 3 University Hospitals Leuven, Department of Development and Regeneration, Leuven, Belgium 4 Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Department of Biomedical Kinesiology, Leuven, Belgium 5 University Hospitals Leuven, Department of Radiology, Leuven, Belgium 6 Stella Maris Scientific Institute, Department of Developmental Neuroscience, Pisa, Italy 7 Faculty of Engineering, KU Leuven, Production Engineering, Machine Design and Automation Section, Leuven, Belgium
Introduction: It is unclear how primary motor deficits and gait pathologies relate to the broad range of brain lesions in children with cerebral palsy (CP). This study combined conventional and innovative MRI imaging modalities evaluating lesions in different brain areas to identify relevant relationships with gait pathology in CP. Patients/materials and methods: Twenty-five children with spastic diplegia were enrolled according to these inclusion criteria: no surgery or recent BTX- A treatment, data available of (A) 3D gait analysis conducted between 3 and 12 year old, and (B) conventional MRI brain scans taken after the age of 3. A subgroup of 14 children also had diffusion tensor imaging (DTI) MRI brain
S73
scans. Median spasticity (modified Ashworth), and median strength (manual muscle testing) of the lower limb muscles (LL), GPS [1] and GPS-asymmetry scores were extracted from the 3D gait analysis. On conventional MRI scans, the integrity of several structures such as the posterior limb of the internal capsule (PLIC) was evaluated, as well as semi-quantitative scores detailing the severity of the lesion (such as the involvement of the subcortical (SC), middle (M) and periventricular (PV) white matter (WM)) [2] and volumetric analyses of e.g. corpus callosum (CC). DTI data reflect the integrity of the corticospinal tract (CST) through fractional anisotropy (FA) and average diffusion coefficients (ADC) calculated over (1) the full course of the CST (CSTf), and (2) its course through the PLIC (CSTp). Additionally, asymmetry indices and sums of the contraand ipsilateral CSTf/CSTp DTI variables were calculated [3]. Continuous variables were correlated through Spearman correlation coefficients. Continuous variables were related to nominal/ordinal variables through one-way ANOVA’s (significance set at p < .05). Results: CC length correlated moderately (r = −0.52), while involvement of the contralateral M WM and the mean CSTf ADC of both sides correlated mildly (r = 0.30/0.31 respectively) with median LL spasticity. Spasticity scores were significantly higher when the PLIC was affected. Correlations of r = 0.32/−0.35 were found between mean CSTp FA values of both sides/involvement of the contralateral M WM and median LL strength. Involvement of the contralateral SC WM, the mean CSTf FA of both sides, and the mean CSTp FA correlated mildly (0.30–0.46) with GPS. When the contralateral PLIC was affected, GPS was significantly higher. GPS asymmetry correlated mildly with CC volume, ventricular volume, asymmetry in mean CSTf FA and asymmetry in mean CSTp ADC values (−0.33–0.39). Asymmetric ventricular dilation was associated with higher GPS asymmetries while the opposite was observed for involvement of contralateral SC WM. Discussion and conclusions: This study identified new underlying relationships between the integrity of the contra- and bilateral white matter and motor tracts on the one hand and primary deficits and gait pathologies on the other hand in children with CP. References [1] Baker et al., 2009. [2] Guzzetta et al., 2010. [3] Bonekamp et al., 2007.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.156
Discussion and conclusions: Mechanical cost of walking was increased in CP compared to TD peers. The increases in cost were caused by increases in both positive and negative Wj . All three LL joints showed increases in negative work, where the increase in positive Wj was mainly caused by a large increase at the hip. In normal gait, eccentric muscle forces and energy transfer from one segment to the other by biarticular muscles are important to conserve energy during walking. The increases in negative work suggested that a lack of control of these energy conserving mechanisms plays an important role in decreased gait efficiency in CP. Reference [1] Van de Walle, et al. Gait & Posture 2010;31:495–501.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.155 P51 Relation between brain lesions on MRI and gait pathology in children with cerebral palsy Leen Van Gestel 1,2 , Els Ortibus 3 , Pieter Meyns 4 , Paul De Cock 3 , Stefan Sunaert 5 , Andrea Guzzetta 6 , Erwin Aertbeliën 7 , Hilde Feys 2 , Jaak Duysens 4 , Kaat Desloovere 2 1 Research assistant of the Research Foundation Flanders 2 Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium 3 University Hospitals Leuven, Department of Development and Regeneration, Leuven, Belgium 4 Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Department of Biomedical Kinesiology, Leuven, Belgium 5 University Hospitals Leuven, Department of Radiology, Leuven, Belgium 6 Stella Maris Scientific Institute, Department of Developmental Neuroscience, Pisa, Italy 7 Faculty of Engineering, KU Leuven, Production Engineering, Machine Design and Automation Section, Leuven, Belgium
Introduction: It is unclear how primary motor deficits and gait pathologies relate to the broad range of brain lesions in children with cerebral palsy (CP). This study combined conventional and innovative MRI imaging modalities evaluating lesions in different brain areas to identify relevant relationships with gait pathology in CP. Patients/materials and methods: Twenty-five children with spastic diplegia were enrolled according to these inclusion criteria: no surgery or recent BTX- A treatment, data available of (A) 3D gait analysis conducted between 3 and 12 year old, and (B) conventional MRI brain scans taken after the age of 3. A subgroup of 14 children also had diffusion tensor imaging (DTI) MRI brain
S73
scans. Median spasticity (modified Ashworth), and median strength (manual muscle testing) of the lower limb muscles (LL), GPS [1] and GPS-asymmetry scores were extracted from the 3D gait analysis. On conventional MRI scans, the integrity of several structures such as the posterior limb of the internal capsule (PLIC) was evaluated, as well as semi-quantitative scores detailing the severity of the lesion (such as the involvement of the subcortical (SC), middle (M) and periventricular (PV) white matter (WM)) [2] and volumetric analyses of e.g. corpus callosum (CC). DTI data reflect the integrity of the corticospinal tract (CST) through fractional anisotropy (FA) and average diffusion coefficients (ADC) calculated over (1) the full course of the CST (CSTf), and (2) its course through the PLIC (CSTp). Additionally, asymmetry indices and sums of the contraand ipsilateral CSTf/CSTp DTI variables were calculated [3]. Continuous variables were correlated through Spearman correlation coefficients. Continuous variables were related to nominal/ordinal variables through one-way ANOVA’s (significance set at p < .05). Results: CC length correlated moderately (r = −0.52), while involvement of the contralateral M WM and the mean CSTf ADC of both sides correlated mildly (r = 0.30/0.31 respectively) with median LL spasticity. Spasticity scores were significantly higher when the PLIC was affected. Correlations of r = 0.32/−0.35 were found between mean CSTp FA values of both sides/involvement of the contralateral M WM and median LL strength. Involvement of the contralateral SC WM, the mean CSTf FA of both sides, and the mean CSTp FA correlated mildly (0.30–0.46) with GPS. When the contralateral PLIC was affected, GPS was significantly higher. GPS asymmetry correlated mildly with CC volume, ventricular volume, asymmetry in mean CSTf FA and asymmetry in mean CSTp ADC values (−0.33–0.39). Asymmetric ventricular dilation was associated with higher GPS asymmetries while the opposite was observed for involvement of contralateral SC WM. Discussion and conclusions: This study identified new underlying relationships between the integrity of the contra- and bilateral white matter and motor tracts on the one hand and primary deficits and gait pathologies on the other hand in children with CP. References [1] Baker et al., 2009. [2] Guzzetta et al., 2010. [3] Bonekamp et al., 2007.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.156