NORMAL-LOAD · NORmalize MusculoskeletAL LOadings to Avoid bony Deformities in children with cerebral palsy

NORmalize MusculoskeletAL LOadings to Avoid bony Deformities in children with cerebral palsy

Cerebral palsy is a collection of clinical syndromes caused by a non-progressive lesion in the immature brain. This lesion alters neural patterns of muscle activation leading to progressive deterioration of the musculoskeletal system. Muscle contractions in children with cerebral palsy cause abnormal musculoskeletal loading, which can lead to bony deformities. Femoral deformities, e.g. increased neck-shaft angle and increased anteversion angle, are very common in children with cerebral palsy and can lead to pathological gait pattern due to abnormal muscle-moment arms. These deformities are usually corrected by de-rotation osteotomies, which are severe invasive orthopedic intervention. Growing bone is extremely responsive to mechanical loading. Hence, in children early clinical interventions, which aim to normalize the loading of the musculoskeletal system, could influence bone growth and prevent the development of bony deformities. Muscle and joint contact force cannot be measured in a non-invasive way but musculoskeletal simulations based on a person’s gait pattern can be used to calculate these forces. To investigate if clinical interventions have an impact on bone growth in children with cerebral palsy, a multi-scale modelling approach was developed and used to predict femoral growth trends before and after clinical interventions. The overall objective of this project was to evaluate if early clinical interventions have the potential to alter musculoskeletal loading conditions and therefore prevent femoral deformities in children with cerebral palsy. Importance for society Cerebral palsy is the most common pediatric neurologic disorder with a prevalence of 2-3 cases per 1,000 live births in Europe and has estimated healthcare and socio-economic lifetime costs of €800,000 to €860,000 for each affected person. This project aimed to develop a workflow to calculate femoral loadings and predict femoral growth trends in children with cerebral palsy. The promising results from this project (described below) are likely to have an influence on clinical decision-making in children with cerebral palsy in the future. If early load-modifying clinical interventions can be used to reduce the number of surgical corrections, it will decrease the burden on the child as well as decrease the socio-economic costs related to the treatment of children with cerebral palsy.

Data: CORDIS, © European Union