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Associations Between Muscle Synergies and Treatment Outcomes in Cerebral Palsy Are Robust Across Clinical Centers

Published:April 10, 2018DOI:https://doi.org/10.1016/j.apmr.2018.03.006

      Highlights

      • Synergies were associated with posttreatment gait outcomes.
      • This association was independent of treatment group at both centers.
      • Less impaired motor control was associated with faster walking posttreatment.
      • Less impaired motor control was associated with greater improvements in kinematics.
      • Associations were similar across 2 commonly used clinical muscle sets.

      Abstract

      Objective

      To determine whether patient-specific differences in motor control quantified using muscle synergy analysis were associated with changes in gait after treatment of cerebral palsy (CP) across 2 clinical centers with different treatments and clinical protocols.

      Design

      Retrospective cohort study.

      Setting

      Clinical medical center.

      Participants

      Center 1: children with CP (n=473) and typically developing (TD) children (n=84). Center 2: children with CP (n=163) and TD children (n=12).

      Interventions

      Standard clinical care at each center.

      Main Outcome Measures

      The Dynamic Motor Control Index During Walking (walk-DMC) was computed from electromyographic data during gait using muscle synergy analysis. Regression analysis was used to evaluate whether pretreatment walking speed or kinematics, muscle synergies, treatment group, prior treatment, or age were associated with posttreatment changes in gait at both clinical centers.

      Results

      Walk-DMC was significantly associated with changes in speed and kinematics after treatment with similar regression models at both centers. Children with less impaired motor control were more likely to have improvements in walking speed and gait kinematics after treatment, independent of treatment group.

      Conclusions

      Dynamic motor control evaluated with synergy analysis was associated with changes in gait after treatment at both centers, despite differences in treatments and clinical protocols. This study further supports the finding that walk-DMC provides additional information, not captured in traditional gait analysis, that may be useful for treatment planning.

      Keywords

      List of abbreviations:

      BTA (botulinum toxin type A), CP (cerebral palsy), GDI (Gait Deviation Index), SDR (selective dorsal rhizotomy), SEMLS (single-event multilevel orthopedic surgery), TD (typically developing), tVAF (total variance accounted for), walk-DMC (Dynamic Motor Control Index During Walking)
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