Joint and muscle assessments of the separate effects of Botulinum NeuroToxin-A and lower-leg casting in children with cerebral palsy

Botulinum NeuroToxin-A (BoNT-A) injections to the medial gastrocnemius (MG) and lower-leg casts are commonly combined to treat ankle equinus in children with spastic cerebral palsy (CP). However, the decomposed treatment effects on muscle or tendon structure, stretch reflexes, and joint are unknown. In this study, BoNT-A injections to the MG and casting of the lower legs were applied separately to gain insight into the working mechanisms of the isolated treatments on joint, muscle, and tendon levels. Thirty-one children with spastic CP (GMFCS I-III, age 7.4 +/- 2.6 years) received either two weeks of lower-leg casts or MG BoNT-A injections. During full range of motion slow and fast passive ankle rotations, joint resistance and MG stretch reflexes were measured. MG muscle and tendon lengths were assessed at resting and at maximum dorsiflexion ankle angles using 3D-freehand ultrasound. Treatment effects were compared using non-parametric statistics. Associations between the effects on joint and muscle or tendon levels were performed using Spearman correlation coefficients (p < 0.05). Increased joint resistance, measured during slow ankle rotations, was not significantly reduced after either treatment. Additional joint resistance assessed during fast rotations only reduced in the BoNT-A group (-37.6%, p = 0.013, effect size = 0.47), accompanied by a reduction in MG stretch reflexes (-70.7%, p = 0.003, effect size = 0.56). BoNT-A increased the muscle length measured at the resting ankle angle (6.9%, p = 0.013, effect size = 0.53). Joint angles shifted toward greater dorsiflexion after casting (32.4%, p = 0.004, effect size = 0.56), accompanied by increases in tendon length (5.7%, p = 0.039, effect size = 0.57; r = 0.40). No associations between the changes in muscle or tendon lengths and the changes in the stretch reflexes were found. We conclude that intramuscular BoNT-A injections reduced stretch reflexes in the MG accompanied by an increase in resting muscle belly length, whereas casting resulted in increased dorsiflexion without any changes to the muscle length. This supports the need for further investigation on the effect of the combined treatments and the development of treatments that more effectively lengthen the muscle

Reliability of Processing 3-D Freehand Ultrasound Data to Define Muscle Volume and Echo-intensity in Pediatric Lower Limb Muscles with Typical Development or with Spasticity

This investigation assessed the processer reliability of estimating muscle volume and echo-intensity of the rectus femoris, tibialis anterior and semitendinosus. The muscles of 10 typically developing children (8.15 [1.40] y) and 15 children with spastic cerebral palsy (7.67 [3.80] y; Gross Motor Function Classification System I = 5, II = 5, III = 5) were scanned with 3-D freehand ultrasonography. For the intra-processer analysis, the intra-class correlations coefficients (ICCs) for muscle volume ranged from 0.943–0.997, with relative standard errors of measurement (SEM%) ranging from 1.24%–8.97%. For the inter-processer analysis, these values were 0.853 to 0.988 and 3.47% to 14.02%, respectively. Echo-intensity had ICCs >0.947 and relative SEMs <4% for both analyses. Muscle volume and echo-intensity can be reliably extracted for the rectus femoris, semitendinosus and tibialis anterior in typically developing children and children with cerebral palsy. The need for a single processer to analyze all data is dependent on the size of the expected changes or differences

Observations of cold-cloud properties in the Norwegian Arctic using ground-based and spaceborne lidar

Abstract. The role of clouds in the surface radiation budget is particularly complex in the rapidly changing Arctic. However, despite their importance, long-term observations of Arctic clouds are relatively sparse. Here, we present observations of cold clouds based on 7 years (2011–2017) of ground-based lidar observations at the Arctic Lidar Observatory for Middle Atmosphere Research (ALOMAR) in Andenes in the Norwegian Arctic. In two case studies, we assess (1) the agreement between a co-located cirrus cloud observations from the ground-based lidar and the spaceborne lidar aboard the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) satellite and (2) the ground-based lidar's capability to determine the cloud phase in mixed-phase clouds from depolarization measurements. We then compute multiyear statistics of cold clouds from both platforms with respect to their occurrence, cloud top and base height, cloud top temperature, and thermodynamic phase for the 2011–2017 period. We find that satellite- and ground-based observations agree well with respect to the coincident cirrus measurement and that the vertical phase distribution within a liquid-topped mixed-phase cloud could be identified from depolarization measurements. On average, 8 % of all satellite profiles were identified as single-layer cold clouds with no apparent seasonal differences. The average cloud top and base heights, combining the ground-based and satellite measurements, are 9.1 and 6.9 km, respectively, resulting in an average thickness of 2.2 km. Seasonal differences between the average top and base heights are on the order of 1–2 km and are largest when comparing fall (highest) and spring (lowest). However, seasonal variations are small compared with the observed day-to-day variability. Cloud top temperatures agree well between both platforms, with warmer cloud top temperatures in summer. The presented study demonstrates the capabilities of long-term cloud observations in the Norwegian Arctic from the ground-based lidar at Andenes

Can muscle morphology and internal composition of lower limb muscles explain strength and gait deficits in children with spastic cerebral palsy?

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Quantifying the separate effects of Botulinum toxin-A and lower leg casting on ankle joint hyper-resistance in children with cerebral palsy

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