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PERSPECTIVE article
Front. Hum. Neurosci.
Sec. Motor Neuroscience
Volume 18 - 2024 |
doi: 10.3389/fnhum.2024.1445793
This article is part of the Research Topic Neurologic Correlates of Motor Function in Cerebral Palsy: Opportunities for Targeted Treatment, Volume II View all 6 articles
Neuromuscular impairments of cerebral palsy: contributions to gait abnormalities and implications for treatment
Provisionally accepted- 1 Stanford Medicine Children’s Health, Stanford, California, United States
- 2 Rice University, Houston, Texas, United States
- 3 Stanford University, Stanford, California, United States
Identification of neuromuscular impairments in cerebral palsy (CP) is essential to providing effective treatment. However, clinical recognition of neuromuscular impairments in CP and their contribution to gait abnormalities is limited, resulting in suboptimal treatment outcomes. While CP is the most common childhood movement disorder, clinical evaluations often do not accurately identify and delineate the primary neuromuscular and secondary musculoskeletal impairments or their specific impact on mobility. Here we discuss the primary neuromuscular impairments of CP that arise from early brain injury and the progressive secondary musculoskeletal impairments, with a focus on spastic CP, the most common form of CP. Spastic CP is characterized by four primary interrelated neuromuscular impairments: 1. muscle weakness, 2. short muscletendon units due to slow muscle growth relative to skeletal growth, 3. muscle spasticity characterized by increased sensitivity to stretch, and 4. impaired selective motor control including flexor and extensor muscle synergies. Specific gait events are affected by the four primary neuromuscular impairments of spastic CP and their delineation can improve evaluation to guide targeted treatment, prevent deformities and improve mobility. Emerging information on neural correlates of neuromuscular impairments in CP can provides the clinician with a more complete context with which to evaluate and develop effective treatment plans. Specifically, addressing the primary neuromuscular impairments and reducing secondary musculoskeletal impairments are important treatment goals. This perspective on neuromuscular mechanisms underlying gait abnormalities in spastic CP aims to inform clinical evaluation of CP, focus treatment more strategically, and guide research priorities to provide targeted treatments for CP.
Keywords: cerebral palsy, brain injury, neuromuscular impairments, musculoskeletal impairments, gait abnormalities. Abbreviations: BoNT-A, botulinum toxin-A, CP, cerebral palsy, CST, corticospinal tract, DTI, diffusion tensor imaging, EMG, electromyography, GM, gray matter, GMFCS, Gross Motor Function Classification Scale, MRI, magnetic resonance imaging
Received: 08 Jun 2024; Accepted: 19 Aug 2024.
Copyright: © 2024 Clewes, Hammond, Dong, Meyer, Lowe and Rose. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kylie M. Clewes, Stanford Medicine Children’s Health, Stanford, 94304, California, United States
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