Myotonometric evaluation of muscle spasticity in children with cerebral palsy and efficacy of electrical stimulation

The aim of this study was to evaluate the biomechenical properties (tone, elasticity, stifness) of gastrocnemius muscle using myotonometry in children with spastic cerebral palsy and to demonstrate therapeutic effectiveness of electrical stimulation on muscle tone, elasticity and stiffness. Forty patients with spastic cerebral palsy (11 diplegic, 16 quadriplegic, 13 hemiplegic) and 20 age, gender and body mass index matched healthy controls were evaluated. Myotonometry was used to measure the medial and lateral gastrocnemius muscle on bilateral sides of diplegic/quadriplegic patiens and healthy controls, whereas measurements were done from the paretic side of the hemiplegic patients. Spasticity was evaluated by Ashworth Scale and functional level was assessed by Gross Motor Function Classification System.The measurements of 66 extremities of 40 patients were compared with 40 extremities of 20 controls. The tone and stiffness values of medial gastrocnemius were found to be significantly higher in patients with spastic cerebral palsy than those in controls (p=0,027 and p=0,015, respectively). Although the measurements of lateral gastrocnemius were higher than controls, it was not statistically significant. The elasticity values of medial and lateral gastrocnemius were lower than controls, but it did not reach statistical significance level. Eighteen patients (31 extremities) with spastic cerebral palsy were treated for 5 days of electrical stimulation which was applied on gastrocnemius muscle. The muscle tone and stiffness of medial and lateral gastrocnemius decreased (p<0,01) and the elasticity values increased significantly (p<0,01) after the intervention. Although Ashworth scores were also decreased, no correlations between Ashworth scores and myotonometric values were detected (r<0,25). Muscle tone and stiffness were found to be significantly higher in patients with spastic cerebral palsy compared to healthy controls. Our results suggest that electrical stimulation for the treatment of spasticity had improvements on muscle tone, elasticity and stiffness. And Myotonometry can be used to measure the effects of treatment in spasticity. Key words:Cerebral palsy, spasticity,myotonometry, gastrocnemius, Ashworth scale