Examination Under Anaesthesia in children with Cerebral Palsy
Research type
Research Study
Full title
The development of a neuromuscular assessment tool to decouple neural and structural contributions to joint hyper-resistance and reduced range of motion in children with cerebral palsy.
IRAS ID
268450
Contact name
Jarred Gillett
Contact email
Sponsor organisation
Liverpool John Moores University
Duration of Study in the UK
1 years, 3 months, 2 days
Research summary
Cerebral palsy (CP) is the most common cause of childhood physical disability in the developed world. Children with CP commonly present with reduced joint range of motion (RoM), and increased resistance (hyper-resistance) to muscle stretch. Treatments are designed to increase joint RoM (e.g. orthopaedic surgery) and/or reduce the hyper-resistance to stretch (e.g. botulinum toxin-A injections) to improve functional outcomes.
At present, clinical diagnostic tests are unable to distinguish whether reduced RoM and joint hyper-resistance is due to structural or neural causes. Therefore, it is recommended to put the child under general anaesthesia, or administer test doses of medication, to exclude the neural contribution. These approaches are invasive, risky and impracticable for most children, meaning treatment planning is not fully informed and treatment outcomes are highly variable. A widely applicable, non-invasive but accurate diagnostic technique is required that can better distinguish the structural and neural contributions to reduced RoM and hyper-resistance in children with CP.
We will use non-invasive techniques to simultaneously measure the stiffness of the muscle and joint, and how much it is being neurally activated during fast and slow ankle joint rotations, in 30 children with CP and 30 typically developing children, while conscious (neural and structural contributions present) and under general anaesthesia (to assess stiffness and spasticity with minimal neural contribution). Data will then be used in a mathematical model to design a neuromuscular assessment tool, used to simulate interventions and predict outcomes from the data collected while awake. The assessment tool will contain a decision-making algorithm in a user-friendly interface to provide patient-specific information without exposing the child to risky, unnecessary and unpleasant clinical procedures. In the future, clinical teams will be better able to prescribe the most appropriate treatment, thereby improving treatment outcomes for children with CP.
REC name
North West - Preston Research Ethics Committee
REC reference
19/NW/0625
Date of REC Opinion
29 Nov 2019
REC opinion
Further Information Favourable Opinion