Peer-reviewed article
Children with unilateral spastic cerebral palsy have smaller and weaker tibias in the spastic limb compared to the non-spastic limb.
Stockhausen JL, Carballido-Gamio J, Carpenter D, Rhodes JT, Howell DR et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This peer-reviewed study compared bone structure in the legs of children with unilateral spastic cerebral palsy, examining whether spasticity affects bone development. Researchers used imaging scans to measure bone size and strength in 24 children (aged 7-9 years), comparing the affected leg to the unaffected leg. The spastic limb had smaller and weaker bones but similar bone density compared to the non-spastic limb. Physical activity levels were assessed but showed limited association with bone architecture differences.
Key points
- The spastic limb had significantly less total bone area, trabecular area, and cortical area than the non-spastic limb
- Cortical thickness, bone stiffness, and failure load were all significantly reduced in the spastic limb
- Bone density was similar between the two limbs, indicating differences were in bone geometry rather than density
- Physical activity measures showed minimal association with between-limb bone architecture differences
- Study included 18 children with usable imaging data from the original 24 participants
Limitations
This is a descriptive study comparing limbs within the same individuals; it does not explain the underlying mechanisms causing bone differences or provide intervention data. The study cannot determine whether smaller bones in the spastic limb are a cause or consequence of spasticity, or whether interventions could improve bone development.
Abstract
Cerebral palsy (CP) is associated with poor bone architecture. It is unclear if abnormal bone architecture is localized to the area affected by spasticity and whether these deficiencies are dependent on physical activity. This study aimed to examine differences in tibial bone architecture between the spastic and non-spastic limbs in children with unilateral spastic CP and the association between physical activity habits with spastic limb bone architecture. Twenty-four ambulatory children with CP (13 females, 11 males; 7.8 ± 1.7 years) completed bilateral high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal tibia metaphysis. The frequency of participation (FPS), bone specific physical activity questionnaire (BPAQ), and dynamic participation survey (DPS) were used to assess physical activity habits. Differences between limb architecture were assessed with paired t-tests. Linear regressions were performed on FPS/BPAQ/DPS scores with each HR-pQCT outcome separately. HR-pQCT data without significant motion artifacts were available for eighteen participants. The spastic limb had less total area (p = 0.013, 95%CI 4.87-35.13mm2), trabecular area (p = 0.035, 95%CI 1.22-29.96mm2), cortical area (p = 0.008, 95%CI 1.35-7.63mm2), cortical perimeter (p = 0.012, 95%CI 0.52-3.60 mm), cortical thickness (p = 0.046, 95%CI 0.001-0.112 mm), stiffness (p = 0.012, 95%CI 2065-13,429 N/mm), and failure load (p = 0.008, 95%CI 128-747 N) than the non-spastic limb. Only BPAQ was associated with limb length (p = 0.011, R = -0.584). The distal tibia metaphysis of the spastic limb had similar bone density but was smaller and weaker compared to the non-spastic limb. Differences in bone geometry likely accounted for between-limb differences in estimated bone strength.