Essi Marttinen Rossi

Background: Maintaining and improving motor function is essential in the rehabilitation of children with cerebral palsy (CP). Stretching is traditionally used to prevent muscle tightness and contractures to improve movement patterns in children with CP. Fascial manipulation (FM) is an increasingly used manual therapy method for movement difficulties associated with CP. However, evidence for FM remains limited, and its benefits over conventional stretching are unclear. A pilot randomized controlled trial (RCT) is warranted to assess the feasibility and acceptability of a definitive trial comparing FM with stretching. This study protocol describes a pilot randomized controlled feasibility trial comparing FM and stretching in children with CP to inform the design and conduct of a future definitive RCT. Objective: The primary objective is to assess the feasibility and acceptability of the trial procedures and interventions. This includes evaluating recruitment and retention rates, intervention adherence, completion rates for outcome assessments, and the perceived impact of the interventions on children’s daily functioning and participation. The secondary objective is to explore the preliminary acute and longitudinal effects of FM, compared with traditional stretching, on walking performance, gait biomechanics, joint mobility, and the variability in these outcome measures. Methods: This pilot RCT will include 20 children aged 7 to 14 years with spastic CP, randomized to an FM intervention group (n=10) and a stretching group (n=10). Both groups will receive 1 treatment session per week for 8 weeks. Feasibility and acceptability will be assessed using quantitative measures of recruitment and retention, intervention adherence, and completion of outcome assessments, complemented by semistructured interviews with caregivers and the children’s regular physiotherapists to explore perceived changes in the children’s daily functioning and participation, and their experiences of the interventions. Secondary outcomes include the 6-minute walk test (6MWT), walking metabolic cost, gait biomechanics, ankle spasticity, muscle activity, joint stiffness, and functional mobility in daily life. Acute outcomes will be assessed before and after the first intervention session, while longitudinal outcomes will be assessed at baseline and following the 8-week intervention period. Results: Recruitment of participants began in October 2024, with 3 additional participants required to reach the target sample size. Results are expected to be published in 2027. Conclusions: This pilot RCT will provide essential feasibility data and preliminary estimates of potential treatment effects to inform the design of a future adequately powered RCT. To our knowledge, evidence regarding the effects of FM on gait, mobility, and function in children with CP remains limited. This study aims to contribute to the development of evidence-based rehabilitation strategies for children with CP.

Healthy people can walk nearly effortlessly thanks to their instinctively adaptive gait patterns that tend to minimize metabolic energy consumption. However, the economy of gait is severely impaired in many neurological disorders such as stroke or cerebral palsy (CP). Moreover, self-selected asymmetry of impaired gait does not seem to unequivocally coincide with the minimal energy cost, suggesting the presence of other adaptive origins. Here, we used hemiparetic CP gait as a model to test the hypothesis that pathological asymmetric gait patterns are chosen to equalize the relative muscle efforts between the affected and unaffected limbs. We determined the relative muscle efforts for the ankle and knee extensors by relating extensor joint moments during gait to maximum moments obtained from all-out hopping reference test. During asymmetric CP gait, the unaffected limb generated greater ankle (1.36±0.15 vs 1.17±0.16 Nm/kg, p = 0.002) and knee (0.74±0.33 vs 0.44±0.19 Nm/kg, p = 0.007) extensor moments compared with the affected limb. Similarly, the maximum moment generation capacity was greater in the unaffected limb versus the affected limb (ankle extensors: 1.81±0.39 Nm/kg vs 1.51±0.34 Nm/kg, p = 0.033; knee extensors: 1.83±0.37 Nm/kg vs 1.34±0.38 Nm/kg, p = 0.021) in our force reference test. As a consequence, no differences were found in the relative efforts between unaffected and affected limb ankle extensors (77±12% vs 80±16%, p = 0.69) and knee extensors (41±17% vs 38±23%, p = 0.54). In conclusion, asymmetric CP gait resulted in similar relative muscle efforts between affected and unaffected limbs. The tendency for effort equalization may thus be an important driver of self-selected gait asymmetry patterns, and consequently advantageous for preventing fatigue of the weaker affected side musculature.

Rationale Alcohol has been shown to impair involuntary attention studied by event-related potentials using mismatch negativity (MMN) and P3a. Objectives However, no studies have investigated whether alcohol affects the magnetic counterparts of N1 (N1m), MMN (MMNm) and P3a (P3am). Methods Auditory evoked potentials and magnetic fields elicited by infrequent deviant tones differing in frequency (5% and 20% change) and novel sounds were recorded with whole-head magnetoencephalography (MEG) and electroencephalography (EEG). Stimuli were presented separately to the left and right ear. Eleven right-handed subjects were studied in a double-blind, placebo-controlled (0.8 g/kg ethanol or juice), cross-over design. N1m, MMNm, and P3am were calculated from the channel pair at the temporal cortex showing the strongest responses in the hemisphere contralateral to the stimulation. N1, MMN and P3a were analyzed from 12 electrodes at the midline frontocentral area. Results Alcohol reduced bilaterally N1, N1m, MMN and MMNm amplitudes. P3a amplitudes, but not P3am amplitudes were also significantly decreased. No effects of alcohol on the latencies of N1, MMN and P3a or their magnetic counterparts were observed. Conclusions Alcohol impairs the processing of tones, frequency change and novel sounds at different phases of auditory processing similarly in both hemispheres. MEG provides us with additional information unobtainable with EEG about the effects of alcohol on the neural correlates of cognition.