Skip to main content
SpringerLink
Log in

Quantitative assessment of muscle stiffness with acoustic radiation force impulse elastography after botulinum toxin A injection in children with cerebral palsy

  • Original Article
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Purpose

Our objective in this study was to assess the changes in medial gastrocnemius muscle (GCM) stiffness after botulinum toxin A (BTA) injection in children with cerebral palsy (CP) by using acoustic radiation force impulse (ARFI) elastography and to research the usability of this technique in clinical practice.

Materials and methods

Twenty-four spastic lower extremities of 12 children with CP were assessed. BTA injection treatment was applied to the medial GCM. Muscle stiffness was measured with the ARFI technique before the procedure and a month after the procedure. The patients were assessed with the modified Ashworth scale (MAS) in the physiotherapy department at about the same time. Shear wave velocity (SWV) values and MAS scores before and after the treatment were compared.

Results

Mean SWV values were measured as 3.20 ± 0.14 m/s before BTA and as 2.45 ± 0.21 m/s after BTA, and the difference between them was found to be statistically significant (p < 0.001). Mean MAS score (2.33 ± 0.70) after BTA decreased significantly when compared to the score before BTA (2.96 ± 0.62) (p = 0.001). SWV values positively correlated with MAS scores (ρ = 0.578, p = 0.003). The interobserver agreement expressed as interclass correlation coefficient (ICC) was 0.65 (95% CI 0.33–0.84, p < 0.001).

Conclusion

ARFI elastography for identifying structural changes that occur in the spastic muscle after BTA injection in children with CP can yield more valuable information with combined use of MAS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kerr Graham H, Selber P. Musculoskeletal aspects of cerebral palsy. J Bone Jt Surg Br. 2003;85:157–66.

    Article  CAS  Google Scholar 

  2. Cosgrove AP, Corry IS, Graham HK. Botulinum toxin in the management of the lower limb in cerebral palsy. Dev Med Child Neurol. 1994;36:386–96.

    Article  CAS  PubMed  Google Scholar 

  3. Langdon K, Blair E, Davidson SA, et al. Adverse events following botulinum toxin type A treatment in children with cerebral palsy. Dev Med Child Neurol. 2010;52:972–3.

    Article  PubMed  Google Scholar 

  4. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206–7.

    Article  CAS  PubMed  Google Scholar 

  5. Yam WK, Leung MS. Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy. J Child Neurol. 2006;21:1031–5.

    Article  PubMed  Google Scholar 

  6. Mutlu A, Livanelioglu A, Gunel MK. Reliability of ashworth and modified ashworth scales in children with spastic cerebral palsy. BMC Musculoskelet Disord. 2008;9:44.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Numanoğlu A, Günel MK. Intraobserver reliability of modified Ashworth scale and modified Tardieu scale in the assessment of spasticity in children with cerebral palsy. Acta Orthop Traumatol Turc. 2012;46:196–200.

    Article  PubMed  Google Scholar 

  8. Ruan Z, Zhao B, Qi H, et al. Elasticity of healthy Achilles tendon decreases with the increase of age as determined by acoustic radiation force impulse imaging. Int J Clin Exp Med. 2015;15:1043–50.

    Google Scholar 

  9. Brandenburg JE, Eby SF, Song P, et al. Ultrasound elastography: the new frontier in direct measurement of muscle stiffness. Arch Phys Med Rehabil. 2014;95:2207–19.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fahey BJ, Nightingale KR, Nelson RC, et al. Acoustic radiation force impulse imaging of the abdomen: demonstration of feasibility and utility. Ultrasound Med Biol. 2005;31:1185–98.

    Article  PubMed  Google Scholar 

  11. Nightingale K. Acoustic radiation force impulse (ARFI) imaging: a review. Curr Med Imaging Rev. 2011;7:328–39.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kwon DR, Park GY, Lee SU, et al. Spastic cerebral palsy in children: dynamic sonoelastographic findings of medial gastrocnemius. Radiology. 2012;263:794–801.

    Article  PubMed  Google Scholar 

  13. Boyaci A, Tutoglu A, Boyaci N, et al. Changes in spastic muscle stiffness after botulinum toxin A injections as part of rehabilitation therapy in patients with spastic cerebral palsy. NeuroRehabilitation. 2014;35:123–9.

    PubMed  Google Scholar 

  14. Lee SMS, Gaebler-Spira D, Zhanga LQ, et al. Use of shearwave ultrasound elastography to quantify muscle properties in cerebral palsy. Clin Biomech. 2016;31:20–8.

    Article  Google Scholar 

  15. Park GY, Kwon DR. Sonoelastographic evaluation of medial gastrocnemius muscles intrinsic stiffness after rehabilitation therapy with botulinum toxin a injection in spastic cerebral palsy. Arch Phys Med Rehabil. 2012;93:2085–9.

    Article  PubMed  Google Scholar 

  16. Picelli A, Dambruoso F, Bronzato M, et al. Efficacy of therapeutic ultrasound and transcutaneous electrical nerve stimulation compared with botulinum toxin type A in the treatment of spastic equinus in adults with chronic stroke: a pilot randomized controlled trial. Top Stroke Rehabil. 2014;21:S8–16.

    Article  PubMed  Google Scholar 

  17. Nightingale KR, McAleavey SA, Trahey GE. Shear wave generation using acoustic radiation force: in vivo and ex vivo results. Ultrasound Med Biol. 2003;29:1715–23.

    Article  PubMed  Google Scholar 

  18. Friedrich-Rust M, Wunder K, Kriener S, et al. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology. 2009;252:595–604.

    Article  PubMed  Google Scholar 

  19. Palmeri ML, Wang MH, Rouze NC, et al. Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease. J Hepatol. 2011;55:666–72.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Aşkın A, Kalaycı ÖT, Bayram KB, et al. Strain sonoelastographic evaluation of biceps muscle intrinsic stiffness after botulinum toxin-A injection. Top Stroke Rehabil. 2016;23:1–6.

    Article  Google Scholar 

  21. Cho KH, Nam JH. Evaluation of stiffness of the spastic lower extremity muscles in early spinal cord injury by acoustic radiation force impulse imaging. Ann Rehabil Med. 2015;39:393–400.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Booth CM, Cortina-Borja MJ, Theologis TN. Collagen accumulation in muscles of children with cerebral palsy and correlation with severity of spasticity. Dev Med Child Neurol. 2001;43:314–20.

    Article  CAS  PubMed  Google Scholar 

  23. Smith LR, Lee KS, Ward SR, et al. Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length. J Physiol. 2011;589:2625–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ondokuz Mayis University Faculty of Medicine, Department of Radiology, Samsun, Turkey

    Meltem Ceyhan Bilgici & Mustafa Bekir Selcuk

  2. Zonguldak State Hospital, Radiology Clinic, Zonguldak, Turkey

    Tumay Bekci

  3. Ondokuz Mayis University Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Samsun, Turkey

    Yasemin Ulus & Ayhan Bilgici

  4. Ondokuz Mayis University Faculty of Medicine, Department of Medical Biostatistics, Samsun, Turkey

    Leman Tomak

Authors
  1. Meltem Ceyhan Bilgici
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tumay Bekci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasemin Ulus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ayhan Bilgici
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leman Tomak
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mustafa Bekir Selcuk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tumay Bekci.

Ethics declarations

Conflict of interest

The authors have no commercial associations or sources of support that might pose a conflict of interest.

Ethical statement

The study was approved by the Medical Ethics Committee of the University Hospital, and all subjects provided written informed consent.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ceyhan Bilgici, M., Bekci, T., Ulus, Y. et al. Quantitative assessment of muscle stiffness with acoustic radiation force impulse elastography after botulinum toxin A injection in children with cerebral palsy. J Med Ultrasonics 45, 137–141 (2018). https://doi.org/10.1007/s10396-017-0780-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-017-0780-y

Keywords

Search

Navigation