Skeletal Muscle Structure in Spastic Cerebral Palsy

  • Adam Shortland
Reference work entry


The structure of skeletal muscle in cerebral palsy (CP) is altered at the molecular level, at the cellular level, and at the level of the tissue. These abnormalities in structure have implications for active and passive muscle performance and for the functional capacity of the individual, particularly in the long term. Appreciating the deficits of muscle structure may well encourage clinicians to focus on muscle growth when managing this group and lead researchers to novel therapeutics targeted at normalizing muscle structure.


Skeletal muscle Growth Functional reserve Cerebral palsy 


  1. Barber L, Hastings-Ison T, Baker R, Barrett R, Lichtwark G (2011) Medial gastrocnemius muscle volume and fascicle length in children aged 2 to 5 years with cerebral palsy. Dev Med Child Neurol 53(6):543–548. Scholar
  2. Braun T, Gautel M (2011) Transcriptional mechanisms regulating skeletal muscle differentiation, growth and homeostasis. Nat Rev Mol Cell Biol 12(6):349–361. Scholar
  3. Castle ME, Reyman TA, Schneider M (1979) Pathology of spastic muscle in cerebral palsy. Clin Orthop Relat Res 142:223–232. Accessed 1 Apr 2012Google Scholar
  4. Clowry GJ (2007) The dependence of spinal cord development on corticospinal input and its significance in understanding and treating spastic cerebral palsy. Neurosci Biobehav Rev 31(8):1114–1124. Scholar
  5. Dayanidhi S, Lieber RL (2014) Skeletal muscle satellite cells: mediators of muscle growth during development and implications for developmental disorders. Muscle Nerve 50(5):723–732. Scholar
  6. Downing AL, Ganley KJ, Fay DR, Abbas JJ (2009) Temporal characteristics of lower extremity moment generation in children with cerebral palsy. Muscle Nerve 39(6):800–809. Scholar
  7. Eken T, Elder GCB, Lømo T (2008) Development of tonic firing behavior in rat soleus muscle. J Neurophysiol 99(4):1899–1905. Scholar
  8. Foran JRH, Steinman S, Barash I, Chambers HG, Lieber RL (2005) Structural and mechanical alterations in spastic skeletal muscle. Dev Med Child Neurol 47(10):713–717. Scholar
  9. Fry NR, Gough M, McNee AE, Shortland AP (2007) Changes in the volume and length of the medial gastrocnemius after surgical recession in children with spastic diplegic cerebral palsy. J Pediatr Orthop 27(7):769–774. Scholar
  10. Fukunaga T, Roy RR, Shellock FG et al (1992) Physiological cross-sectional area of human leg muscles based on magnetic resonance imaging. J Orthop Res 10(6):928–934. Scholar
  11. Gantelius S, Hedström Y, Pontén E (2012) Higher expression of myosin heavy chain IIx in wrist flexors in cerebral palsy. Clin Orthop Relat Res.
  12. Gough M, Shortland AP (2012) Could muscle deformity in children with spastic cerebral palsy be related to an impairment of muscle growth and altered adaptation? Dev Med Child Neurol 54(6):495–499. Scholar
  13. Handsfield GG, Meyer CH, Abel MF, Blemker SS (2016) Heterogeneity of muscle sizes in the lower limbs of children with cerebral palsy. Muscle Nerve 53(6):933–945. Scholar
  14. Herskind A, Ritterband-Rosenbaum A, Willerslev-Olsen M et al (2016) Muscle growth is reduced in 15-month-old children with cerebral palsy. Dev Med Child Neurol 58(5):485–491CrossRefGoogle Scholar
  15. Ito J, Araki A, Tanaka H, Tasaki T, Cho K, Yamazaki R (1996) Muscle histopathology in spastic cerebral palsy. Brain and Development.
  16. Johnson DL, Miller F, Subramanian P, Modlesky CM (2009) Adipose tissue infiltration of skeletal muscle in children with cerebral palsy. J Pediatr 154(5):715–720. Scholar
  17. Mohagheghi AA, Khan T, Meadows TH, Giannikas K, Baltzopoulos V, Maganaris CN (2008) In vivo gastrocnemius muscle fascicle length in children with and without diplegic cerebral palsy. Dev Med Child Neurol 50(1):44–50. Scholar
  18. Lampe R, Grassl S, Mitternacht J, Gerdesmeyer L, Gradinger R (2006) MRT-measurements of muscle volumes of the lower extremities of youths with spastic hemiplegia caused by cerebral palsy. Brain and Development 28(8):500–506. Scholar
  19. Lemon RN (2008) Descending pathways in motor control. Annu Rev Neurosci 31:195–218. Scholar
  20. Lieber RL, Fridén J (2000) Functional and clinical significance of skeletal muscle architecture. Muscle Nerve 23:1647–1666.<1647::AID-MUS1>3.0.CO;2-M. [pii]CrossRefGoogle Scholar
  21. Malaiya R, McNee AE, Fry NR, Eve LC, Gough M, Shortland AP (2007) The morphology of the medial gastrocnemius in typically developing children and children with spastic hemiplegic cerebral palsy. J Electromyogr Kinesiol 17(6):657–663. Scholar
  22. Mathewson MA, Ward SR, Chambers HG, Lieber RL (2015) High resolution muscle measurements provide insights into equinus contractures in patients with cerebral palsy. J Orthop Res.
  23. McNee AE, Gough M, Morrissey MC, Shortland AP (2009) Increases in muscle volume after plantarflexor strength training in children with spastic cerebral palsy. Dev Med Child Neurol 51(6):429–435. Scholar
  24. Moreau NG, Teefey SA, Damiano DL (2009) In vivo muscle architecture and size of the rectus femoris and vastus lateralis in children and adolescents with cerebral palsy. Dev Med Child Neurol 51(10):800–806CrossRefGoogle Scholar
  25. Noble JJ, Chruscikowski E, Fry NR, Lewis AP, Gough M, Shortland AP. Reduced lower limb muscle growth in relation to body mass in a cross-sectional study of ambulant individuals with bilateral cerebral palsy aged 10 to 23. Article in reviewGoogle Scholar
  26. Noble JJ, Fry NR, Lewis AP, Keevil SF, Gough M, Shortland AP (2014a) Lower limb muscle volumes in bilateral spastic cerebral palsy. Brain and Development 36:294–300. Scholar
  27. Noble JJ, Charles-Edwards GD, Keevil SF, Lewis AP, Gough M, Shortland AP (2014b) Intramuscular fat in ambulant young adults with bilateral spastic cerebral palsy. BMC Musculoskelet Disord 15:236. Scholar
  28. Pillen S, Scholten RR, Zwarts MJ (2003) Verrips a. Quantitative skeletal muscle ultrasonography in children with suspected neuromuscular disease. Muscle Nerve 27(6):699–705. Scholar
  29. Rose J, Haskell WL, Gamble JG, Hamilton RL, Brown DA, Rinsky L (1994) Muscle pathology and clinical measures of disability in children with cerebral palsy. J Orthop Res 12(6):758–768. Scholar
  30. Shortland A (2009) Muscle deficits in cerebral palsy and early loss of mobility: can we learn something from our elders? Dev Med Child Neurol 51(Suppl 4):59–63. Scholar
  31. Shortland AP, Fry NR, Eve LC, Gough M (2004) Changes to the muscle architecture of the medial gastrocnemius after surgical intervention in spastic diplegia. Dev Med Child Neurol 46:667–673Google Scholar
  32. Smith LR, Lee KS, Ward SR, Chambers HG, Lieber RL (2011) Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length. J Physiol 589(Pt 10):2625–2639. Scholar
  33. Smith LR, Chambers HG, Subramaniam S, Lieber RL (2012) Transcriptional abnormalities of hamstring muscle contractures in children with cerebral palsy. PLoS One 7(8):e40686. Scholar
  34. Smith LR, Chambers HG, Lieber RL (2013) Reduced satellite cell population may lead to contractures in children with cerebral palsy. Dev Med Child Neurol 55:264–270. Scholar
  35. Steele KM, van der Krogt MM, Schwartz MH, Delp SL (2012) How much muscle strength is required to walk in a crouch gait? J Biomech 45(15):2564–2569. Scholar
  36. Ward SR, Eng CM, Smallwood LH, Lieber RL (2009) Are current measurements of lower extremity muscle architecture accurate? Clin Orthop Relat Res 467:1074–1082. Scholar
  37. Zogby AM, Dayanidhi S, Chambers HG, Schenk S, Lieber RL (2016) Skeletal muscle fiber-type specific succinate dehydrogenase activity in cerebral palsy. Muscle Nerve.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.One Small Step Gait LaboratoryEvelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation TrustLondonUK

Personalised recommendations