The impact of conservative interventions on morphological muscle and tendon properties of growing children with cerebral palsy

Cerebral palsy [CP] is the single largest cause of childhood physical disability. It is characterized primarily by neural deficits, caused by a brain lesion, and secondly by musculoskeletal problems that progress with age and contribute to a gradual loss of functional capacity. CP children experience significant alterations in soft tissue structures within the muscle and tendon unit, which are influenced by treatment. The impact of treatment appears to be patient specific. The aim of this PhD project is to study the impact of conservative treatment on the muscle and tendon morphology of the lower limb in children with CP. The main focus is on stretching (casting together with passive and active stretching) on one hand and tonus reduction by Botox infiltrations in combination with stretching and strength training on the other hand. In the first phase of this project we will evaluate the validity of an integrated and objective evaluation protocol that clinicians can use to quantify the different morphological aspects of muscle and tendon. Next we will create an extensive normative and clinical database of morphological muscle and tendon properties combined with clinical data (spasticity, muscle stiffness, muscle weakness and abnormal function) of growing children. In a second phase we will focus on patient-specific effects of the treatment on morphological muscle and tendon properties and related functional outcomes in kids with CP. Hereby the predictive value of morphological muscle and tendon properties on the result of treatment will be determined. In the final phase we will design treatment guidelines based on an international consensus study (Delphi technique).