Muscle-Adaptation in Children with Acquired Brain Injuries

Background: Muscles of children with spastic cerebral palsy show several changes using ultrasound. It is not known if and how early also children after acquired brain injuries show those alterations.

Methods: Prospective cohort study (March 2014 to March 2015) on children (0–18 years) after acquired brain injuries. Clinical examination included: passive range of motion (pRom), level of spasticity (modified Tardieu Scale, mTS 0–5), muscle force (MRC 0–5) on dorsal extensors and plantar flexors of the foot and gross motor function (GMFM 88). On ultrasound, the level of echo intensity of M. gastrocnemius medialis, M. soleus, and M. tibialis anterior was determined using the modified Heckmatt scale (mHS 1–4). Statistical analyses were run on possible correlations between clinical examination and ultrasound. The examinations took place during inpatient rehabilitation first every 4 and then every 8 weeks.

Results: 30 children (23 males, 3 months to 16 years [median: 7.7 years]). Seventy-seven percent of the children showed an increased echo intensity in at least one muscle. The results of mHS in M. gastrocnemius medialis correlated negatively with MRC in the plantar flexors. The correlation was stronger with a later time point of examination (correlation coefficient: t1 −0.480, t2 −0.555, t3 −0.705; p < 0.05). A correlation was seen between mTS at first examination and mHS at fourth examination in M. gastrocnemius medialis (0.787, p < 0.05) and M. soleus (0.701, p < 0.05).

Conclusion: Changes of muscles in children after acquired brain injuries can be detected using ultrasound. A decrease in muscle force and increase in muscle tone are correlated with an increase in muscle echo intensity using ultrasound.