Cerebral Palsy• Botulinum toxin type-A (BoNT-A) and strength training are available interventions that, on their own have found success in managing spasticity and muscle weakness (both significant motor impairments), respectively in children with Cerebral Palsy (CP). • This study has demonstrated that the concurrent treatment of BoNT-A and strength training can achieve positive outcomes in terms of strength, spasticity and for the achievement of set functional goals. • The results of this study show that the improved muscle strength can be associated with hypertrophy, which could indicate the potential role of strength training in altering the rate of muscle growth, in an aim to improve the failure of muscle growth associated with CP. • Home based strength training, based on a child's individual goals is shown to be successful in improving strength and goal attainment for children with CP.

Aim With evidence for an atrophic effect of botulinum toxin type A (BoNT‐A) documented in typically developing muscles, this study investigated the immediate morphological alterations of muscles in children with cerebral palsy (CP) after BoNT‐A treatment. Method Fifteen children (10 males, five females; age range 5–11y, mean age 8y 5mo, SD 1y 10mo) with spastic diplegic CP [Gross Motor Function Classification System Levels I (n=9) and II (n=6)] receiving BoNT‐A injections for spasticity management were included. None of the children was a first‐time receiver of BoNT‐A. Magnetic resonance imaging and Mimics software assessed muscle volume, timed 2 weeks before and 5 weeks after injection. All participants received BoNT‐A bilaterally to the gastrocnemius muscle, and five participants also received BoNT‐A bilaterally to the medial hamstring muscles. Functional assessment measures used were the 6‐Minute Walk Test (6‐MWT), the Timed Up and Go (TUG) test, and hand‐held dynamometry. Results Whilst total muscle group volume of the injected muscle group remained unchanged, a 4.47% decrease in the injected gastrocnemius muscle volume (p=0.01) and a 3.96% increase in soleus muscle volume (p=0.02) was evident following BoNT‐A. There were no statistically significant changes in function after BoNT‐A as assessed by the TUG. There was also no statistically significant change in distance covered in the 6‐MWT. Muscle strength, as assessed using hand‐held dynamometry was also not statistically different after BoNT‐A treatment. Interpretation Muscle volume decreases were observed in the injected muscle (gastrocnemius), with synergistic muscle hypertrophy that appeared to compensate for this decrement. The 4% to 5% decrease in the volume of BoNT‐A injected muscles are not dramatic in comparison to reports in recent animal studies, and are a positive indication for BoNT‐A, particularly as it also did not negatively alter function.

BackgroundWearable sensors are portable measurement tools that are becoming increasingly popular for the measurement of joint angle in the upper limb. With many brands emerging on the market, each with variations in hardware and protocols, evidence to inform selection and application is needed. Therefore, the objectives of this review were related to the use of wearable sensors to calculate upper limb joint angle. We aimed to describe (i) the characteristics of commercial and custom wearable sensors, (ii) the populations for whom researchers have adopted wearable sensors, and (iii) their established psychometric properties.MethodsA systematic review of literature was undertaken using the following data bases: MEDLINE, EMBASE, CINAHL, Web of Science, SPORTDiscus, IEEE, and Scopus. Studies were eligible if they met the following criteria: (i) involved humans and/or robotic devices, (ii) involved the application or simulation of wearable sensors on the upper limb, and (iii) calculated a joint angle.ResultsOf 2191 records identified, 66 met the inclusion criteria. Eight studies compared wearable sensors to a robotic device and 22 studies compared to a motion analysis system. Commercial (n = 13) and custom (n = 7) wearable sensors were identified, each with variations in placement, calibration methods, and fusion algorithms, which were demonstrated to influence accuracy.ConclusionWearable sensors have potential as viable instruments for measurement of joint angle in the upper limb during active movement. Currently, customised application (i.e. calibration and angle calculation methods) is required to achieve sufficient accuracy (error <  5°). Additional research and standardisation is required to guide clinical application.Trial RegistrationThis systematic review was registered with PROSPERO (CRD42017059935).

Children with CP have smaller, weaker muscles than their TD peers. However, muscle size may only partially explain their decreased torque capacity. MV appears to be a better predictor of muscle work in children with CP than aCSA. This is an important area of research particularly in regard to treatment(s) that target muscle and strength in children with CP. Implications for Rehabilitation This research adds to the evidence that children with CP have smaller, weaker knee flexor and extensor muscles than their TD peers. However, unlike their TD peers, muscle size does not necessarily relate to muscle strength. The weak correlation between MRI-derived muscle volume and isometric peak torque suggests children with CP are underpowered relative to their muscle size. For children with CP, muscle volume appears to be the best predictor of isokinetic muscle torque output. Therefore, when assessing the capacity of a muscle, it appears preferable to measure total muscle volume and torque development through a range of motion (isokinetic strength).