Diagnostic US in Children with CP Flashcards
Botox is….with? Can use? Con? There’s also? Why is US better? Most needed with?
- BOTOX (botulinum toxins) BTx is used to decrease spasticity in individuals with CP
- Safe and effective with accurate needle placement and injection technique
- Can Use palpation, anatomic guidelines,
- Greater incidence of errors
- EMG guidance Electrical Stimulation
- Ultrasound painless much better tolerated by children
- Most needed with deeper and smaller muscles, such as posterior tibialis, psoas, forearm and hand musculature
____ is generally sufficient to visualize the deeper muscles? Assists in recognizing? Identifying? Needle inserted how? Enables? Overall improves?
• Standard ultrasound system with 7.5 MHz linear transducer
- Recognizing characteristic patterns of individual muscles
- Identifies neighboring structure
- Needle inserted closely aligned with the middle of the broad side of the transducer
- Enables visualation of the injected bolus
- Overall improves accuracy of injections without the additional painful procures of EMG guidance or electrical stimulation
The article “In vivo muscle architecture and size of the rectus femoris and vastus lateralis in children and adolescents with cerebral Palsy” states CP results in? (2) This results in? (3) Which can further do what? This cycle continues and can lead to?
CP results in decreased activity and mobility levels which can then result in weakness, disuse muscle atrophy, and muscle shortening, which can further limit activity. This cycle continues and can lead to decreased mobility (especially ambulation as children become, adolescents, and then young adults
Previous research on muscle size in CP has focused on?
the gastrocnemius with inconclusive result and did not compare to a typically developing control group
Purpose of the Study was to? What was their hypothesis? Secondary purpose to?
• To compare muscle architecture of the RF and VL in children and adolescents with CP to those who are typically developing
o Hypothesis: that children and adolescents with CP would have decreased fascicle lengths and angles and decreased muscle size
• Secondary purpose to examine the intrasession reliability of the ultrasound / measures
The study had how many subjects? Who? Examined? No?
• 18 children and adolescents with Spastic CP
o GMFCS levels I-IV
No orthopedics surgery or Botox injections in the past 6 months
• 12 age matched typically developing peers
What was measured? (3)
- Muscle thickness = distance b’tween superficial and deep aponeurosis, in middle of image @ 90O angle From the deep aponeurosis
- Fascicle Angle = positive angle b’tween deep aponeurosis and line of fascicle
- Fascicle Length = Muscle thickness / sine of fascicle angle
What were the conclusions for RF? Suggesting? (2)
• In RF decreased muscle size and fascicle length
o Suggesting loss of sarcomeres in series (fiber shortening)
o And in parallel (muscle atrophy)
What were the conclusions for VL? Suggesting?
o In VL decreased muscle size and fascicle angle
o Suggesting a loss of sarcomeres in parallel only
Why were these findings of importance? (2)
o Altered muscle architecture of RF & VL can be reliably documented by Ultrasound
o This is Important as US is less invasive, more cost effective and can be easily used in laboratory and clinical settings
Clinical correlations - the muscle atrophy and decrease in fascicle length and angle are? Highlights?
o The muscle atrophy and decrease in fascicle length and angle are similar to what is seen in disuse and aging. Seen in CP due to decreased in activity and mobility level
o Highlights the importance of promoting activity and physical fitness in children and adolescents with CP to counteract the loss of function (mobility) seen as individuals with CP transition from adolescence to young adulthood
Clinical correlations - changes in RF can result in? As well as? What should be a part of CP rehab? Changes in the VL leads to? This may contribute to? Indication for?
o Changes in the RF can result in loss of muscle power: (force generation X velocity of contracture)
o as well as decreased ROM over which the muscle can act can affect function such as gait
o Rx power training or training of movement should be an important component of quad strengthening exercise in children and adolescents with CP
o Changes in the VL leads to decreased force generation
o This may contribute to development of crouch gait, decreased ability to climb stairs, sit to stand,
o Indication for strength training ( for force production)
