title: Oral baclofen increases maximal voluntary neuromuscular activation of ankle plantar flexors in children with spasticity due to cerebral palsy.
abstract: Although spasticity is a common symptom in children with cerebral palsy, weakness may be a much greater contributor to disability. We explore whether a treatment that reduces spasticity may also have potential benefit for improving strength. Ten children with cerebral palsy and spasticity in the ankle plantar flexor muscles were treated with oral baclofen for 4 weeks. We tested voluntary ability to activate ankle plantar flexor muscles using the ratio of the surface electromyographic signal during isometric maximal voluntary contraction to the M-wave during supramaximal electrical stimulation of the tibial nerve and tested muscle strength using maximal isometric plantar flexion torque. Mean maximal voluntary neuromuscular activation increased from 1.13 +/- 1.02 to 1.60 +/- 1.30 ( P < .05) after treatment, corresponding to an increase in 9 of 10 subjects. Mean maximal plantar flexion torque did not change. We conjecture that antispasticity agents could facilitate strength training by increasing the ability to voluntarily activate muscle.
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA 94305-5235, USA.
authors.forename: Johan
authors.initials: J
authors.lastname: van Doornik
authors.forename: Sahana
authors.initials: S
authors.lastname: Kukke
authors.forename: Kevin
authors.initials: K
authors.lastname: McGill
authors.forename: Jessica
authors.initials: J
authors.lastname: Rose
authors.forename: Sara
authors.initials: S
authors.lastname: Sherman-Levine
authors.forename: Terence D
authors.initials: TD
authors.lastname: Sanger
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000843:Ankle Joint / Q000187:drug effects / Q000503:physiopathology; D001418:Baclofen / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004558:Electric Stimulation; D004576:Electromyography / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006181:H-Reflex / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007537:Isometric Contraction / Q000187:drug effects* / Q000502:physiology; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000503:physiopathology; D053580:Muscle Strength / Q000187:drug effects / Q000502:physiology; D018908:Muscle Weakness / Q000188:drug therapy* / Q000503:physiopathology; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000187:drug effects* / Q000502:physiology; D013979:Tibial Nerve / Q000503:physiopathology; D019415:Torque
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen