Periodic Reporting for period 1 - I-SENS (Integrating SENSorimotor disorders with ankle hyper-resistance in cerebral palsy)
Berichtszeitraum: 2021-10-01 bis 2023-09-30
This project explored challenges faced by individuals with cerebral palsy, a condition affecting both the nervous and musculoskeletal systems. The main goal was to understand how these systems interact and impact walking ability in people with cerebral palsy, a prevalent childhood condition with lifelong effects. Given the absence of a cure, cerebral palsy leads to persistent motor difficulties, significantly affecting life quality and incurring substantial costs. Improving clinical treatments is crucial, and this project aimed to unveil fundamental insights for innovative approaches. It focused on three main objectives: 1) understanding the relationship between the motor and sensory systems, 2) exploring how muscle and bone features affect walking, and 3) figuring out the unique contributions of each system to walking ability. New mechanisms relating musculoskeletal properties and gait performance were unveiled, while processing for extracting motor and sensory system data is still underway.
The initial phase of the project focused on developing experimental methods to address the key objectives. New software tools were created to assess motor disorders and extract musculoskeletal properties. This involved extensive work, including the formulation of acquisition protocols for imaging muscle and tendon morphology using ultrasonography and magnetic resonance imaging. The protocols were applied in static and walking conditions. In addition, data collection was performed for analyzing stability and ankle joint proprioception from 12 children/young adults with cerebral palsy and 12 healthy peers. Results highlighted the vital role of musculoskeletal properties in gait performance, emphasizing the compensatory role of stiffer skeletal muscles when the Achilles tendon lacks energy storage. This underlines the importance of considering the mechanical balance between muscles and tendons in surgical and physiotherapy interventions. The project's findings were presented at international conferences, with notable recognition as the best Clinical Biomechanics paper by the International Society of Biomechanics in 2023. Two scientific papers have been published, and five more are in preparation. While the current focus is on musculoskeletal aspects, ongoing efforts will expand the evaluation to include the motor and sensory systems. The clinical nature of the work was shared through seminars at hospitals, YouTube videos, and social media posts to reach a broader audience and stimulate discussions about potential improvements in current treatments.
During this project, innovative protocols were developed to investigate the motor, musculoskeletal, and sensory systems, thereby opening new frontiers for investigating impairments in cerebral palsy. The findings went beyond the state of the art, revealing that skeletal muscles in the lower limbs affected by cerebral palsy exhibit energy storage capabilities, akin to tendons in healthy individuals, albeit to a lesser extent. This novel mechanism serves to compensate for inherent muscle damage, addressing the challenge of insufficient active force production. Once data processing is finalized, a comprehensive overview of how each system (motor, musculoskeletal, and sensory) influences gait ability will be presented. These insights will provide valuable tools for refining clinical treatments and unravelling the reasons behind unsuccessful interventions. Such advancements are pivotal for enhancing the quality of life for individuals with cerebral palsy and optimizing the allocation of medical resources. Furthermore, the knowledge gained from this project serves as a catalyst for inspiring new research initiatives, thus going deeper in understanding the causes of gait disability in cerebral palsy.