Quantitative Assessment Of The Therapeutic Efficacy In Children With Cerebral Palsy By Detecting The Muscular Stiffness Using Real-time Shear Wave Elastography

Objective:To explore the clinical value of SWE evaluating the effectiveness after botulinum toxin A(BTA)injection to the muscles by measuring quantificationally the muscle stiffness in children with spastic cerebral palsy(CP)using the real-time shear wave elastography(SWE),so as to provide an imaging basis for the plan of treatment and evaluation of clinical treatment effect.Methods:Thirty children with spastic CP and 39 healthy children of similar age were recruited.Patients were divided into the botulinum toxin A injection combined with rehabilitation training treatment group(A group)and rehabilitation treatment group(A group)by an experienced physical therapist.The Modified Ashworth Scale(MAS)was used for each patient before the procedure and 4 weeks after the procedure,at the same time,Young’s modulus of semimembranous muscle,soleus muscle and medial gastrocnemius muscle was measured with the SWE for eachpatient;Young’s modulus was also measured in counterpart muscle for each healthy child with the SWE.The difference of Young’s modulus of the muscles between patients with CP and healthy children was compared,and the results of each patient before and after treatment were compared,the correlation between Young’s modulus and MAS scores was analyzed.Results:(1)The Young’s modulus of semimembrane muscle,soleus muscle and medial gastrocnemius muscle of the affected side for patients before treatment was higher than that of healthy children,and the difference was statistically significant(P < 0.05).(2)The Young’s modulus of the semimembrane muscle,soleus muscle and medial gastrocnemius muscle of the affected side in the A group and the B group was lower after treatment than before treatment,and the difference was statistically significant(P <0.05).(3)The Young’s modulus of semimembrane muscle,soleus muscle and medial gastrocnemius muscle of the affected side in the A group was significantly positively correlated with the MAS scores(P<0.05).(4)The Young’s modulus of soleus muscle and medial gastrocnemius muscle of the affected side for the B group was significantly positively correlated with the MAS scores(P <0.05);there was no correlation between the Young’s modulus and MAS scores of the semimembrane muscle of affected side for the B group(P >0.05).Conclusion: Real-time shear wave elastography for identifying the difference in muscle stiffness between the patients with spastic CP andhealthy children and the changes that occur in the spastic muscle after treatment in children with spastic CP can yield more valuable information for clinical therapy combined with MAS.