[en] [en] BACKGROUND: Children with cerebral palsy (CP) often experience gait impairments. Robot-assisted gait training (RGT) has been shown to have beneficial effects in this patient population. However, clinical outcomes of RGT vary substantially from patient to patient. This study explored the hypothesis that clinical outcomes are associated with changes in muscle synergies in response to RGT.
METHODS: Thirteen children with CP and Gross Motor Function Classification Scale (GMFCS) levels I-IV were recruited in the study. Children participated in a 6 week-RGT intervention and underwent clinical evaluations and gait studies-with focus on the analysis of electromyographic (EMG) data-pre- and post-training. Lower-limb muscle synergies were derived from the EMG recordings. Pre- vs. post-RGT clinical outcomes and muscle synergies were compared to explore potential relationships.
RESULTS: Three and, less often, two muscle synergies were detected in study participants pre-RGT. Linear mixed effect models showed that composition of the muscle synergies and their temporal activation coefficients present deviations from normative data proportional to the severity of functional limitations (i.e., GMFCS levels, p < 0.01). At a group level, changes in muscle synergies pre- vs. post-RGT did not significantly correlate with changes in clinical outcomes (p > 0.05). However, it was observed that participants who displayed prominent changes in muscle synergies also displayed large improvements in clinical scores.
CONCLUSIONS: Gait impairments in children with CP were associated with muscle synergies that deviated from normative. Participants who demonstrated the most substantial improvements in clinical scores following RGT exhibited multiple changes in the muscle synergies. However, no statistically significant correlations were identified at the group level. Future studies relying on larger datasets are needed to further investigate this observation and potential underlying mechanisms.
Disciplines :
Pediatrics
Author, co-author :
Vergara-Diaz, Gloria P; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA ; Department of Physical Medicine and Rehabilitation, Hospital Universitario Virgen del Rocío, Seville, Spain
SAPIENZA, Stefano ; University of Luxembourg > Luxembourg Centre for Systems Biomedicine (LCSB) > Digital Medicine ; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA ; Luxembourg Institute of Health (LIH), Strassen, Luxembourg
Daneault, Jean-François; Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, USA
Fabara, Eric; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
Adans-Dester, Catherine; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
Severini, Giacomo; School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
Cheung, Vincent C K; School of Biomedical Sciences, and The Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong, Hong Kong, China
de Vargas, Carmen Echevarría Ruiz; Department of Physical Medicine and Rehabilitation, Hospital Universitario Virgen del Rocío, Seville, Spain
Nimec, Donna; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
Bonato, Paolo; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA. pbonato@mgh.harvard.edu
External co-authors :
yes
Language :
English
Title :
Can muscle synergies shed light on the mechanisms underlying motor gains in response to robot-assisted gait training in children with cerebral palsy?
Fundación Alfonso Martín Escudero Real Colegio Complutense at Harvard Foundation for Physical Medicine and Rehabilitation Peabody Foundation
Funding text :
This work was supported by fellowships from the Fundaci\u00F3n Alfonso Martin Escudero and the Real Colegio Complutense at Harvard (RCC), and by the Peabody Foundation and the Foundation for Physical Medicine and Rehabilitation (PM&R). Vincent C. K. Cheung was supported by grants from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project Nos. R4022-18, N_CUHK456/21, 14114721, and 14119022 to VCKC).
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