Ultrasonographic Measurement of Gastrocnemius Muscle Thickness in Spastic Cerebral Palsy and Influencing Factors

OBJECTIVE: To identify the thickness of gastrocnemius muscles (GCM) in normal children and children with spastic cerebral palsy using ultrasonography and to determine the influencing factors in order to increase the accuracy of intramuscular injection of botulinum toxin A. METHOD: Fifty-six children with spastic cerebral palsy (Group A) with no fixed contractures or operation history were involved in this study and they were compared with normal children (Group B). Children lay prone and one examiner measured the thickness of medial and lateral GCM using ultrasonography. Relationship between GCM thickness and clinical variables (age, height, weight, body mass index (BMI), calf circumference, Gross Motor Function Classification System (GMFCS) level, spasticity, number of botulinum toxin injections) were determined with Pearson's correlation. RESULTS: The thickness of medial and lateral GCM were 78.06+/-14.66 mm, 66.90+/-12.23 mm respectively, in Group A, and 103.44+/-12.04 mm, 79.95+/-9.76 mm respectively, in Group B. Medial GCM were thicker than lateral GCM in both groups. The age, height, weight, BMI, calf circumference and the thickness of GCM were higher in Group B. In group A, weight, BMI, calf circumference showed positive correlations with the thickness of medial GCM and GMFCS showed negative correlation with the thickness of medial GCM. CONCLUSION: To increase the accuracy of intramuscular injection of botulinum toxin A, we should keep in mind that the thickness of GCM may be influenced by several factors. Further controlled study including larger group is needed.

Comparisons of Spinal Stabilization Exercise and Lumbar Extensor Strengthening Exercise in Chronic Low Back Pain

OBJECTIVE: To compare the effects of spinal stabilization exercise against with lumbar extensor strengthening exercise. METHOD: Sixty patients with chronic low back pain were enrolled into the study and randomly classified into three groups. Groups were treated with spinal stabilization exercise (Group 1), lumbar extensor strengthening exercise using a MedX machine (Group 2), or with a combination program (Group 3) for 8 weeks. Patients were not given any other treatment modalities. Isometric peak torque of the lumbar extensors, pain rating score (PRS), Medical Outcomes Study Short Form-36 (SF-36) score, and the Oswestry low back pain disability questionnaire (OLBPD-Q) were assessed at 0, 4, and 8 weeks of exercise. RESULTS: 1) After 8 weeks, all groups showed incremental improvements in maximal isometric torque of the lumbar extensors and exhibited improvement in SF-36, PRS, and OLBD-Q scores (p<0.05). 2) There were no significant differences in the degree of improvement among the three groups after 8 weeks of exercise. 3) The percentage of patients with scores of good or excellent in Group 3 was higher than in Groups 1 and 2 according to all evaluation tools. CONCLUSION: In the treatment of chronic low back pain, all exercise groups showed decreased pain, improved quality of life, and increased lumbar extensor strength regardless of the exercise type employed. We suggest that exercise programs in general are effective for the treatment of chronic low back pain and a combination exercise program seems to be most beneficial.