| Spasticity of the upper extremity that often results from cerebral palsy is a life-long burden to patients. In selected patients, surgery may increase the ability for every-day functioning. However, it is difficult to optimize surgery to the needs of the individual patient, as we hardly understand the mechanisms of muscles adapting to the spastic neurological input and we do not know all factors that determine muscle function. As a result, surgical outcome is unpredictable, and varies among clinically comparable patients. Knowledge of the behaviour, and biomechanics of the spastic muscles is imperative for correct surgical planning and optimization for the individual patient. Previously, we showed that muscle function is affected by the properties of adjacent connective tissues. We now want to prove that these connective tissues may be a co-determinant in the outcome of tendon transfer surgery, as well as to increase our understanding of the biomechanics of spastic muscles for a better prediction of the outcome. For that, four experiments are proposed. Mechanical and histological testing of isolated human spastic and non-spastic muscle fibres and -bundles show what specific connective tissues are involved in force transmission and muscle stiffness, intra-operative measurement of human muscle function in-situ indicate the acute effects of tendon transfer surgery on muscle function as a starting point for rehabilitation, and a study to develop a method for non-invasive evaluation of connective tissues within and around muscles using sophisticated MRI techniques will give the unique opportunity to show the in-vivo interaction of muscles and their adjacent connective tissues both in healthy subjects and in spastic patients. |
