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To evaluate the clinical usefulness of sonoelastography in infants with congenital muscular torticollis (CMT).
The medical records of 215 infants clinically diagnosed with CMT were retrospectively reviewed. Fifty-three infants met the inclusion criteria as follows: 1) infants diagnosed as CMT with a palpable neck mass before 3 months of age, 2) infants who were evaluated initially by both B-mode ultrasonography and sonoelastography, and 3) infants who had received physical therapy after being diagnosed with CMT. We checked the thickness of the sternocleidomastoid (SCM) muscles in B-mode ultrasonography, strain ratio of the SCM muscles in sonoelastography, and treatment duration. We evaluated the correlation between the treatment duration and the following factors: SCM muscle thickness, ratio of SCM muscle thickness on the affected to unaffected side (A/U ratio), and strain ratio.
Both the thickness of the affected SCM muscle and the A/U ratio did not show significant correlation with the treatment duration (p=0.66, p=0.90). The strain ratio of the affected SCM muscle was significantly greater than that of the unaffected SCM muscle (p<0.001), and the strain ratio showed significant correlation with the treatment duration (p=0.001).
Sonoelastography may be a useful adjunctive tool to B-mode ultrasonography for evaluating infants with CMT, especially when predicting their rehabilitation outcomes.
Citations
To investigate the therapeutic effect of extracorporeal shockwave therapy (ESWT) according to treatment session on gastrocnemius muscle spasticity in children with spastic cerebral palsy (CP).
Twelve children with spastic CP underwent 1 ESWT and 2 sham ESWT sessions for gastrocnemius (group 1) or 3 ESWT sessions (group 2) once per week for 3 weeks. Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle plantar-flexor muscles with knee extension, and median red pixel intensity (RPI) of color histogram of medial gastrocnemius on real-time sonoelastography (RTS) were measured before ESWT, immediately after the first and third ESWT, and at 4 weeks after the third ESWT.
Mean ankle PROM was significantly increased whereas as mean ankle MAS and median gastrocnemius RPI were significantly decreased in both groups after the first ESWT. Clinical and RTS parameters before ESWT were not significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 1. However, they were significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 2. Mean ankle PROM, mean ankle MAS, and median gastrocnemius RPI in group 2 were significantly different from that in group 1 at 4 weeks or immediately after the third ESWT.
The therapeutic effect of ESWT on spastic medial gastrocnemius in children with spastic CP is dependent on the number of ESWT sessions.
Citations
To evaluate whether age influences a change in the spasticity of the ankle plantar flexor after botulinum toxin type A (BTA) injection in children with spastic cerebral palsy (CP).
Sixteen children with spastic CP were enrolled in the study. Seven children (group 1) were under 5 years of age, and nine (group 2) were over 5 years of age. They all received BTA injection in the gastrocnemius muscle (GCM) under ultrasound guidance. Passive range of motion (PROM) of ankle dorsiflexion, Modified Ashworth Scale (MAS) of the ankle plantar flexor, Gross Motor Function Measure (GMFM) and median red pixel intensity (RPI) of the medial GCM on real-time sonoelastography were measured at baseline (pre-injection) and 1-, 3-, and 6-month post-injection.
In both groups, the mean PROM, MAS, and RPI were significantly improved after injection until 6-month post-injection. The change of PROM of ankle dorsiflexion in group 1 was significantly greater than that in group 2, until 6-month post-injection. The change in the MAS and GMFM between baseline and 6-month post-injection in group 1 was greater than that in group 2. The changes in the median RPI between baseline and 3- and 6-month post-injections were greater in group 1 than in group 2.
Our pilot study demonstrated the different changes in spasticity of the ankle plantar flexor after BTA injection based on age. Therefore, age may be considered when establishing a treatment plan using BTA injection for children with spastic CP.
Citations
A recent study claimed that botulinum toxin A (BTX-A) injection into the calf muscle of cerebral palsy (CP) children did not change the intrinsic stiffness. Contrary to this recent report, in our case, decreased muscle spasticity, which was measured using a modified Ashworth scale, and increased Gross Motor Function Measure score were demonstrated at 4 weeks after intensive rehabilitation treatment (IRT) with BTX-A injection to the medial gastrocnemius muscle in a child with spastic CP. Additionally, we indentified decreased muscle stiffness which was demonstrated by a decrease in the color-coded scale and shear velocity, and an increase in the strain ratio using dynamic sonoelastography.
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