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Use of ultrasound shear wave to measure muscle stiffness in children with cerebral palsy

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Abstract

Purpose

Cerebral palsy (CP) is a disorder characterized by an increased muscle stiffness that can be contingent on both neurological and biomechanical factors. The neurological aspects are related to hyper-excitability of the stretch reflex, while the biomechanical factors are related to modifications in muscle structure. We used smart-shear wave elastography (S-SWE) to analyze muscle properties and to compare shear wave speed in soleus muscles of patients affected by CP and typically developing children.

Methods

We enrolled 21 children (15 males and 6 females; age range 3–16) with spastic hemiplegia CP and 21 healthy children (11 males and 10 females; age range 3–14). Measurements of soleus S-SWE were performed using a Samsung RS80A ultrasound scanner with Prestige equipment (Samsung Medison Co. Ltd., Seoul, Korea), with a convex array transducer (CA1-7; Samsung Medison Co. Ltd., Seoul, Korea). For each CP child clinical assessment included Modified Ashworth Scale (MAS) score.

Results

Children with CP showed greater S-SWE values than the healthy ones (p < 0.001). Our data suggest a significant correlation between the S-SWE values and the MAS scores (Spearman correlation coefficient 0.74; p < 0.001 at Kruskal–Wallis test) in children with CP.

Conclusions

Measuring muscle properties with SWE, a non-invasive and real-time technique, may integrate the physical exam. SWE may be a reliable clinical tool for diagnosis and longitudinal monitoring of muscle stiffness, as well as particularly suitable for grading and for assessing the response to treatments.

Sommario

Obiettivo

La paralisi cerebrale infantile (PCI) è un disturbo caratterizzato da un aumento del tono muscolare che dipende da fattori sia neurologici che biomeccanici. I primi comprendono un’aumentata eccitabilità del riflesso di stiramento; la componente biomeccanica è correlata a modifiche nella struttura muscolare. Abbiamo usato l’elastosonografia con tecnologia Smart-Shear Wave (S-SWE) per analizzare le proprietà del muscolo e per comparare la velocità dell’onda di taglio nei muscoli solei di pazienti affetti da PCI con quella misurata nei soggetti sani.

Metodi

Sono stati arruolati 21 bambini (15 maschi e 6 femmine; range di età 3–16 anni) con emiplegia spastica da esiti di PCI e 21 bambini sani (11 maschi e 10 femmine; range di età 3–14 anni). Le misurazioni S-SWE del soleo sono state effettuate usando un ecografo RS80 with Prestige (Samsung Medison Co. Ltd., Seoul, Korea), con una sonda convex (CA1-7; Samsung Medison Co. Ltd., Seoul, Korea). Per ogni paziente affetto da PCI è stato valutato anche il punteggio della Modified Ashworth Scale (MAS).

Risultati

I bambini affetti da PCI hanno mostrato valori di S-SWE più alti rispetto ai controlli sani (p < 0.001). I nostri dati suggeriscono una correlazione significativa tra i valori di S-SWE e i punteggi della MAS nei pazienti affetti da PCI (coefficiente di correlazione di Spearman 0.74; p < 0.001 al Kruskal–Wallis test).

Conclusioni

La misurazione delle proprietà elastiche dei muscoli mediante S-SWE, una metodica real-time e non invasiva, può integrare l’esame clinico. La S-SWE può essere uno strumento clinico affidabile per la diagnosi e per il follow-up della stiffness muscolare, particolarmente adatto per definirne il grado e per valutarne la risposta ad un trattamento.

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Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy

    E. A. Vola & G. Vallone

  2. Department of Public Health, University of Naples Federico II, Naples, Italy

    M. Albano, C. Di Luise, V. Servodidio, S. Russo, B. Corrado & C. Servodio Iammarrone

  3. Department of Electrical Engineering and Information Technology (DIETI), University of Naples Federico II, Naples, Italy

    M. Sansone

  4. Institute of Biostructure and Bioimaging, National Research Council of Italy, Naples, Italy

    M. G. Caprio

Authors
  1. E. A. Vola
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  2. M. Albano
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  3. C. Di Luise
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  4. V. Servodidio
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  5. M. Sansone
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  6. S. Russo
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  8. C. Servodio Iammarrone
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  9. M. G. Caprio
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  10. G. Vallone
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Correspondence to E. A. Vola.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Vola, E.A., Albano, M., Di Luise, C. et al. Use of ultrasound shear wave to measure muscle stiffness in children with cerebral palsy. J Ultrasound 21, 241–247 (2018). https://doi.org/10.1007/s40477-018-0313-6

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  • DOI: https://doi.org/10.1007/s40477-018-0313-6

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