Spasticity

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

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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.

Spasticity and net-nondimensionalized (NN) energy consumption for children with cerebral palsy (CP) who underwent a selective dorsal rhizotomy (SDR) and matched peers with CP who did not undergo SDR (control). (a) Baseline spasticity and NN energy consumption were similar between groups. Gray lines show normative values for typically developing (TD) peers from Gillette Children’s Specialty Healthcare. (b) Spasticity and NN energy consumption decreased significantly at follow-up for both groups. The SDR cohort had a significantly greater decrease in spasticity compared to the no-SDR group, but a similar decrease in NN energy consumption. Bars represent distributions for each group including outliers (*).

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.

Nicole Zaino wins the ESMAC Best Paper award

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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.

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ESMAC 2019: Award Finalists

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Congratulations to Nicole Zaino and our colleague Mike Schwartz at Gillette Children’s Specialty Healthcare for both being nominated as finalists for the Best Presentation Award at the upcoming ESMAC Conference in Amsterdam. Their abstracts are among the top 16 submissions to the conference and the final award will be determined based upon their presentations.

Logo for the 2019 ESMAC meeting overlaid on a classic Amsterdam scene, bikes lined up on a bridge over a canal with historic buildings in the background.

Nicole will be presenting her research:

Spasticity reduction in children with cerebral palsy is not associated with reduced energy during walking 

Selective dorsal rhizotomy reduces spasticity, but does it also reduce energy consumption during walking? In an analysis of over 300 children with cerebral palsy, Nicole demonstrated that although rhiztomy does reduce spasticity, it does not reduce energy consumption. These results provide further evidence that spasticity is not a main contributor to elevated energy among people with cerebral palsy. You can also learn more about this study from our recent submitted manuscript, available on bioRxiv.

Mike will be presenting his research:

The effects of walking speed and age on energy consumption in children with cerebral palsy and their typically developing peers

We know that walking energy is high among people with cerebral palsy, and that energy varies with speed and age. Using retrospective data of over 300 kids with cerebral palsy and 150 typically-developing peers, Mike used a statistical model to evaluate these speed and age effects. He found that energy decreases until 8-10 years of age for kids with CP, while it remains stable beyond age 5 for typically-developing peers. Kids with CP also have a greater elevation in energy with greater walking speeds. These results are important to help quantify and understand impacts of interventions, like surgery or assistive devices, which are often done during this time period when kids are still growing and developing.

They will both be presenting in the Optimizing Energy Cost session from 11:40-12:30 on Thursday, September 26th.

Best of luck to Nicole & Mike!

Spasticity Research Award Nominations

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Walking takes energy – but for kids with cerebral palsy, walking can be exhausting. The average child with cerebral palsy consumes two times the amount of energy during walking compared to typically-developing peers – that is the equivalent of jogging or climbing stairs!

The reasons for why walking takes so much energy for children with cerebral palsy remains largely unknown. The extra muscle activity caused by spasticity has often been theorized as a large contributing factor. If this was true, we would expect that treatments that reduce spasticity, like selective dorsal rhizotomy, could dramatically reduce energy during walking.

Led by Nicole Zaino, a new PhD student in the lab, and our collaborator Mike Schwartz at Gillette Children’s Specialty we have been investigating this question. By analyzing energy consumption for children with cerebral palsy who underwent rhizotomy and matched peers with cerebral palsy, we were determined that reducing spasticity does not lead to dramatic decreases in energy consumption.

This research has been nominated as a finalist for two awards at the International Society of Biomechanics Conference. This work was selected as one of 5 finalist for the Clinical Biomechanics Award. Nicole will also present as one of the finalists for the David Winter Young Investigator Award. The final awards will be announced at the conference in Calgary the first week of August. Good luck Nicole!

You can learn more about the study and read the preprint on BioRxiv:

Spasticity reduction in children with cerebral palsy is not associated with reduced energy consumption during walking