Cerebral Palsy Archives - Page 5 of 16 - Neuromechanics & Mobility Lab

NL Zaino, KM Steele, JM Donelan, MH Schwartz (2020) “Energy consumption does not change after selective dorsal rhizotomy in children with spastic cerebral palsy” Developmental Medicine & Child Neurology

Nicole JournalArticle, News, Publications April 23, 2020October 12, 2021Cerebral Palsy, energy consumption, Gait, selective dorsal rhizotomy, Spasticity

Journal Article in Developmental Medicine & Child Neurology:

This retrospective analysis demonstrated that energy consumption is not reduced after rhizotomy when compared to matched controls with cerebral palsy.

Aim: To determine whether energy consumption changes after selective dorsal rhizotomy (SDR) among children with cerebral palsy (CP).

Method: We retrospectively evaluated net nondimensional energy consumption during walking among 101 children with bilateral spastic CP who underwent SDR (59 males, 42 females; median age [5th centile, 95th centile] 5y 8mo [4y 2mo, 9y 4mo]) compared to a control group of children with CP who did not undergo SDR. The control group was matched by baseline age, spasticity, and energy consumption (56 males, 45 females; median age [5th centile, 95th centile] 5y 8mo [4y 1mo, 9y 6mo]). Outcomes were compared at baseline and follow‐up (SDR: mean [SD] 1y 7mo [6mo], control: 1y 8mo [8mo]).

Results: The SDR group had significantly greater decreases in spasticity compared to matched controls (–42% SDR vs –20% control, p<0.001). While both groups had a modest reduction in energy consumption between visits (–12% SDR, –7% control), there was no difference in change in energy consumption (p=0.11) or walking speed (p=0.56) between groups.

Interpretation: The SDR group did not exhibit greater reductions in energy consumption compared to controls. The SDR group had significantly greater spasticity reduction, suggesting that spasticity had minimal impact on energy consumption during walking in CP. These results support prior findings that spasticity and energy consumption decrease with age in CP. Identifying matched control groups is critical for outcomes research involving children with CP to account for developmental changes.

YC Pan, B Goodwin, E Sabelhaus, KM Peters, KF Bjornson, KLD Pham, WO Walker, KM Steele (2020) “Feasibility of using acceleration-derived jerk to quantify bimanual arm use” Journal of NeuroEngineering and Rehabilitation

Dr. Steele JournalArticle, UbiquitousRehabilitation February 5, 2020October 12, 2021accelerometer, arm, Cerebral Palsy, CIMT, Rehabilitation, wearable sensors

Journal Article in Journal of NeuroEngineering & Rehabilitation

Two plots illustrating jerk ratio results. The plot on the left shows the probability distribution from one child with cerebral palsy before, during, and after constraint induced movement therapy. Before therapy, the probability distribution is shifted to the left of the center line, indicating that the individual relies much more on their non-paretic hand during daily life. During therapy, when their non-paretic hand is in a cast, the curve shifts to the right of the center line. This indicates they are using their paretic hand much more - which makes sense, since the other hand is in a cast. Unfortunately, after the cast is removed at the end of therapy, the curve is nearly identical to the curve before treatment, suggesting that after this intensive therapy the child did not use their paretic hand more during daily life. The figure on the right shows the summary metric from this plot, called jerk ratio 50 - which is just the 50% value of the probability density function - for all 5 children with cerebral palsy before, during, and after therapy. All the children have JR50 greater than 0.5 before therapy, which means they use their non-paretic hand more during daily life. During therapy, these values drop to 0.2 - 0.5, indicating that they use their paretic hand much more during CIMT. However, after therapy the JR50 values for all five participants return to close to their baseline value before therapy. — (Left) Example of jerk ratio distribution for one child with cerebral palsy before, during, and after constraint induced movement therapy. (Right) Summary metric of jerk ratio (jerk ratio-50) for all five children with cerebral palsy.

Background

Accelerometers have become common for evaluating the efficacy of rehabilitation for patients with neurologic disorders. For example, metrics like use ratio (UR) and magnitude ratio (MR) have been shown to differentiate movement patterns of children with cerebral palsy (CP) compared to typically-developing (TD) peers. However, these metrics are calculated from “activity counts” – a measure based on proprietary algorithms that approximate movement duration and intensity from raw accelerometer data. Algorithms used to calculate activity counts vary between devices, limiting comparisons of clinical and research results. The goal of this research was to develop complementary metrics based on raw accelerometer data to analyze arm movement after neurologic injury.

Method

We calculated jerk, the derivative of acceleration, to evaluate arm movement from accelerometer data. To complement current measures, we calculated jerk ratio (JR) as the relative jerk magnitude of the dominant (non-paretic) and non-dominant (paretic) arms. We evaluated the JR distribution between arms and calculated the 50^th percentile of the JR distribution (JR50). To evaluate these metrics, we analyzed bimanual accelerometry data for five children with hemiplegic CP who underwent Constraint-Induced Movement Therapy (CIMT) and five typically developing (TD) children. We compared JR between the CP and TD cohorts, and to activity count metrics.

Results

The JR50 differentiated between the CP and TD cohorts (CP = 0.578±0.041 before CIMT, TD = 0.506±0.026), demonstrating increased reliance on the non-dominant arm for the CP cohort. Jerk metrics also quantified changes in arm use during and after therapy (e.g., JR50 = 0.378±0.125 during CIMT, 0.591 ± 0.057 after CIMT). The JR was strongly correlated with UR and MR (r = -0.92, 0.89) for the CP cohort. For the TD cohort, JR50 was repeatable across three data collection periods with an average similarity of 0.945±0.015.

Conclusions

Acceleration-derived jerk captured differences in motion between TD and CP cohorts and correlated with activity count metrics. The code for calculating and plotting JR is open-source and available for others to use and build upon. By identifying device-independent metrics that can quantify arm movement in daily life, we hope to facilitate collaboration for rehabilitation research using wearable technologies.

Code

The algorithm for calculating jerk ratio, as well as user-friendly code to produce plots similar to the figure above are provided open-source as Python 3.6 code as a Python Jupyter Notebook within Google Colab. With this resource, research groups can use existing or newly created data from accelerometers to analyze jerk ratio as a complementary metric to existing measures, enabling comparison between research studies or centers that may rely on different sensors and activity count algorithms.

BR Shuman, M Goudriaan, K Desloovere, MH Schwartz, KM Steele (2019) “Muscle Synergy Constraints Do Not Improve Estimates of Muscle Activity From Static Optimization During Gait for Unimpaired Children or Children With Cerebral Palsy” Frontiers in Neurorobotics

Elijah JournalArticle, News, Publications, UbiquitousRehabilitation January 6, 2020October 12, 2021Cerebral Palsy, muscle synergies, musculoskeletal modeling, static optimization

Journal Article in Frontiers of Neurorobotics:

This study demonstrated that muscle activations estimated from static optimization using generic musculoskeletal modeling does not accurately predict EMG profiles for children with CP or TD peers. Constraining activation patterns to experimentally measured synergies increased estimated muscle stresses, but did not improve the estimation of muscle activations for either group.

figure depicting flow chart with modeling optimization and muscle activity — Constraining simulated activations in inverse dynamic simulations to subject-specific synergies alone does not improve estimation of muscle activations during gait for generic musculoskeletal models.

Background

Neuromusculoskeletal simulation provides a promising platform to inform the design of assistive devices or inform rehabilitation. For these applications, a simulation must be able to accurately represent the person of interest, such as an individual with a neurologic injury. If a simulation fails to predict how an individual recruits and coordinates their muscles during movement, it will have limited utility for informing design or rehabilitation. While inverse dynamic simulations have previously been used to evaluate anticipated responses from interventions, like orthopaedic surgery or orthoses, they frequently struggle to accurately estimate muscle activations, even for tasks like walking. The simulated muscle activity often fails to represent experimentally measured muscle activity from electromyographic (EMG) recordings. Research has theorized that the nervous system may simplify the range of possible activations used during dynamic tasks, by constraining activations to weighted groups of muscles, referred to as muscle synergies. Synergies are altered after neurological injury, such as stroke or cerebral palsy (CP), and may provide a method for improving subject-specific models of neuromuscular control.

Purpose

The aim of this study was to test whether constraining simulation to synergies could improve estimated muscle activations compared to EMG data.

Method

We evaluated modeled muscle activations during gait for six typically developing children (TD) and six children with CP. Muscle activations were estimated with: 1) static optimization (SO), minimizing muscle activations squared, and 2) synergy static optimization (SynSO), minimizing synergy activations squared using the weights identified from EMG data for 2-5 synergies.

Results

While SynSO caused changes in estimated activations compared to SO, the correlation to EMG data was not higher in SynSO than SO for either TD or CP groups . The correlations to EMG were higher in CP than TD for both SO (CP: 0.48, TD: 0.36) and SynSO (CP: 0.46, TD: 0.26 for 5 synergies). Constraining activations to SynSO caused the simulated muscle stress to increase compared to SO for all individuals, causing a 157% increase with two synergies.

Conclusions

These results suggest that constraining simulated activations in inverse dynamic simulations to subject-specific synergies alone does not improve estimation of muscle activations during gait for generic musculoskeletal models.

NBC Learn: Exoskeletons and Engineering

Dr. Steele Media, Orthoses November 12, 2019October 12, 2021Cerebral Palsy, engineering, Exoskeleton, Orthoses, prototype

We partnered with NBC Learn to share some of our work on exoskeletons to help encourage students to consider a career in engineering. What can be more exciting than musculoskeletal modeling, exoskeletons, horses, and stuffed animals?

Check out the video – a lesson plan will also be posted soon for classrooms to use.

Go team!

Nicole Zaino wins the ESMAC Best Paper award

Elijah Awards, MotorControl, News October 3, 2019October 12, 2021Award, Cerebral Palsy, conference, Energy, ESMAC, Pediatric, Spasticity, Walking

Congratulations to Nicole Zaino for being awarded the ESMAC (European Society of Movement Analysis for Adults and Children) Best Paper Award. Nicole received this award at the 2019 ESMAC conference in Amsterdam, September 23-28, 2019 where she gave her talk: “Spasticity reduction in children with cerebral palsy is not associated with reduced energy during walking.” For more information, visit ESMAC.