Guy Molenaers

• MD,Phd
• Head of Department at KU Leuven

Aim To identify the short‐term effects of selective dorsal rhizotomy (SDR) on gait and clinical impairments in children with bilateral spastic cerebral palsy (CP) and subgroups based on baseline gait patterns. Method Eighty‐nine children with bilateral spastic CP (55 males, mean age [SD] before SDR: 9 years 5 months [2 years 3 months]; Gross Motor...

Aim To investigate the effect of selective dorsal rhizotomy (SDR) on an integrated outcome set 1‐year post‐SDR, in a cohort of children with spastic cerebral palsy (CP). Method Fifteen children with bilateral spastic CP (median age 8 years 8 months [interquartile range 3 years 3 months], 11 males, four females, eight in Gross Motor Function Classi...

Different types of feedback are used during gait training in children with cerebral palsy (CP), including verbal (VB) and virtual reality (VR) feedback. Previous studies on VR feedback showed positive effects on the targeted gait parameter. However, both positive and negative side effects on other parameters were seen as well. The literature on the...

Purpose: To explore the impact of a selection of contributing factors on employment in adults with cerebral palsy (CP). Method: Eighty adults with CP (39 male, median age 31, IQ > 70) were evaluated using standardized tests and questionnaires for hand function, gross motor function, pain, depressive symptoms, fatigue, social participation, perfo...

Few studies have examined the effect of intensive therapy on gross motor function and trunk control in children with cerebral palsy (CP). This study evaluated the effects of an intensive burst of therapy on the lower limbs and trunk by comparing qualitative functional and functional approaches. This study was designed as a quasi-randomized, control...

This study investigated the reliability of 3‐dimensional freehand ultrasound (3DfUS) to quantify the size (muscle volume [MV] and anatomical cross‐sectional area [aCSA]), length (muscle length [ML], tendon length [TL], and muscle tendon unit length [MTUL]), and echo‐intensity (EI, whole muscle and 50% aCSA), of lower limb muscles in children with s...

Children with spastic cerebral palsy often present with muscle weakness, resulting from neural impairments and muscular alterations. While progressive resistance training (PRT) improves muscle weakness, the effects on muscle morphology remain inconclusive. This investigation evaluated the effects of a PRT program on lower limb muscle strength, morp...

Aim To determine if muscle synergy structure (activations and weights) differs between gait patterns in children with spastic cerebral palsy (CP). Method In this cross‐sectional study, we classified 188 children with unilateral (n=82) or bilateral (n=106) spastic CP (mean age: 9y 5mo, SD: 4y 3mo, range: 3y 9mo–17y 7mo; 75 females; Gross Motor Func...

Background Many patients with cerebral palsy present a pathologic gait pattern, which presumably induces aberrant musculoskeletal loading that interferes with natural bone growth, causing bone deformations on the long term. Botulinum toxin interventions and single-event multilevel surgeries are used to restore the gait pattern, assuming that a norm...

Constraint-induced movement therapy (CIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). Additional training targeting motor planning deficits might be of additional value. Here, we investigated the combined effect of action-observation training (AOT) to CIMT and identified factors influencing treatment response. For...

Introduction: Constraint-induced movement therapy (CIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children also show motor planning deficits, action-observation training (AOT) might be of additional value. Here, we investigated the combined effect of AOT to CIMT and identified factors influencing treatme...

Background: Upper limb (UL) deficits in children with unilateral cerebral palsy (uCP) have traditionally been targeted with motor execution treatment models, such as modified Constraint-Induced Movement Therapy (mCIMT). However, new approaches based on a neurophysiological model such as Action-Observation Training (AOT) may provide new opportuniti...

Background: Prolonged ambulation is considered important in children with Duchenne muscular dystrophy (DMD). However, previous studies analyzing DMD gait were sensitive to false positive outcomes, caused by uncorrected multiple comparisons, regional focus bias, and inter-component covariance bias. Also, while muscle weakness is often suggested to...

Cerebral palsy (CP) and Duchenne muscular dystrophy (DMD) are neuromuscular disorders characterized by muscle weakness. Weakness in CP has neural and non-neural components, whereas in DMD, weakness can be considered as a predominantly non-neural problem. Despite the different underlying causes, weakness is a constraint for the central nervous syste...

Aim The main goal of this validation study was to evaluate whether lower limb muscle weakness and plantar flexor rate of force development (RFD) related to altered gait parameters in children with cerebral palsy (CP), when weakness was assessed with maximal voluntary isometric contractions (MVICs) in a gait related test position. As a subgoal, we a...

Results of intra- or intertester reliability studies on the use of the HHD in CP and/or TD children between 5–15 years of age. Only studies employing the make test and using ICCs as reliability metrics are summarized. When left and right side were tested separately, data was averaged for clarity. In case of multiple test protocols or reliability as...

Description of gait classification patterns. Classifications are derived from the paper of Nieuwenhuys et al: Identification of joint pattern during gait in children with cerebral palsy: a Delphi consensus study, Developmental Medicine and Child Neurology 2016, 58: 306–313 [58]. (DOCX)

Custom made chair used for the MVIC measurements. Hip and knee joints are placed in 300 flexion. The ankle is placed in neutral position. (TIF)

Custom made chair used for the MVIC measurements, with fixed location of the hand-held dynamometer during knee-extension MVIC. The black + red lines represent the segment length (fibula head—lower border of lateral malleolus). The black line indicates the moment arm (75% of the segment length). (TIF)

Custom made chair used for the MVIC measurements, with fixed location of the hand-held dynamometer during dorsiflexion MVIC. The red line represents the segment length (projection of lateral malleolus on lateral border of the foot–distal metacarpal head V). The black line indicates the moment arm (75% of the segment length). (TIF)

Detailed subject characteristic of the children with CP regarding clinical outcome measures. Passive range of motion for dorsiflexion was performed with extended knee. Spasticity is graded with the Modified Ashworth scale. For the plantar flexors, this was done with flexed- (900) and extended knee (00). Abbreviations in alphabetic order: DF = dorsi...

Overview of characteristics of the studies analyzing the relationship between muscle weakness and gait in children with CP. Abbreviations in alphabetic order: allF = all strength measurements; aggF = aggregated strength measurements; avF = average of the strength measurements; DF = dorsiflexion; Habd = hip abduction; Hadd = hip adduction; HE = hip...

Detailed subject and measurement information of the typical developing (TD) children participating in part 2 of this study. (DOCX)

Detailed subject specifics regarding gait parameters for the children with CP participating in part 2 of this study. Abbreviations in alphabetic order: CP = cerebral palsy; GDI = gait deviation index; GMFCS = gross motor function classification scale. NB: Gait joint pattern descriptions can be found in S6 Table. (DOCX)

A clinically feasible method to reliably estimate muscle-tendon unit (MTU) lengths could provide essential diagnostic and treatment planning information. A 3-D freehand ultrasound (3-DfUS) method was previously validated for extracting in vivo medial gastrocnemius (MG) lengths, although the processing time can be considered substantial for the clin...

Upper limb three-dimensional movement analysis (UL-3DMA) offers a reliable and valid tool to evaluate movement patterns in children with unilateral cerebral palsy (uCP). However, it remains unknown to what extent the underlying motor impairments explain deviant movement patterns. Such understanding is key to develop efficient rehabilitation program...

Aim: This cross-sectional investigation evaluates the reliability of estimating medial gastrocnemius anatomical cross-sectional area (aCSA) in typically developing and spastic cerebral palsy (SCP) cohorts. It verifies whether muscle volume estimations based on aCSA improve when aCSA is multiplied by muscle-tendon unit (MTU) or muscle length, and w...

Study design: Prospective single-center study OBJECTIVE.: Study investigates how dynamic balance performance complements 2D static radiographic measurements and demographics in terms of understanding health-related quality of life in Adult Spinal Deformity (ASD) patients. Summary of background data: Recent insights suggest that demographic varia...

Introduction The clinical application of upper limb (UL) three-dimensional movement analysis (3DMA) in children with unilateral cerebral palsy (uCP) remains challenging, despite its benefits compared to conventional clinical scales. Moreover, knowledge on UL movement pathology and how this relates to clinical parameters remains scarce. Therefore, w...

Kinematic waveforms of all three MACS groups during HTH. Movement patterns of wrist, elbow, shoulder, scapula and trunk angles of children in MACS I (blue), MACS II (orange) and MACS III (yellow). The grey line indicates the average movement patterns of 60 typically developing children (shaded bar represents 1 standard deviation). Abbreviations: TD...

Descriptive statistics of clinical outcomes according to MACS levels. *, Kruskal Wallis; ¥, Fisher’s exact test; MACS, Manual Ability Classification System; N, number; TPD, two-point discrimination; AHA, Assisting Hand Assessment; MA2, Melbourne Assessment 2; ROM, range of motion; N, number; Me, median; IQR, interquartile range; significant differe...

Kinematic waveforms of all three MACS groups during HTM. Movement patterns of wrist, elbow, shoulder, scapula and trunk angles of children in MACS I (blue), MACS II (orange) and MACS III (yellow). The grey line indicates the average movement patterns of 60 typically developing children (shaded bar represents 1 standard deviation). Abbreviations: TD...

Kinematic waveforms of all three MACS groups during RGV. Movement patterns of wrist, elbow, shoulder, scapula and trunk angles of children in MACS I (blue), MACS II (orange) and MACS III (yellow). The grey line indicates the average movement patterns of 60 typically developing children (shaded bar represents 1 standard deviation). Abbreviations: TD...

Background and purpose: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous...

During a Delphi consensus study, a new joint gait classification system was developed for children with cerebral palsy (CP). This system, whose reliability and content validity have previously been established, identified 49 distinct joint patterns. The present study aims to provide a first insight toward the construct validity and clinical relevan...

Aim: This cross-sectional study aimed to map the functional profile of individuals with dyskinetic cerebral palsy (CP), to determine interrelationships between the functional classification systems, and to investigate the relationship of functional abilities with dystonia and choreoathetosis severity. Methods: Fifty-five children (<15y) and youn...

Background: We aimed to study the contribution of upper limb movements to propulsion during walking in typically developing (TD) children (n = 5) and children with hemiplegic and diplegic cerebral palsy (CP; n = 5 and n = 4, respectively). Methods: Using integrated three-dimensional motion capture data and a scaled generic musculoskeletal model tha...

Aim: This study aimed to quantify the inter- and intrarater clinician agreement on joint motion patterns in children with spastic cerebral palsy (CP), which were recently specified by a Delphi consensus study. It also examined whether experience with three-dimensional gait analysis (3DGA) is a prerequisite for using the patterns. Method: The exp...

Experts recently identified 49 joint motion patterns in children with cerebral palsy during a Delphi consensus study. Pattern definitions were therefore the result of subjective expert opinion. The present study aims to provide objective, quantitative data supporting the identification of these consensus-based patterns. To do so, statistical parame...

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Final overview of joint patterns and their criteria after last Delphi survey. (PDF)

Objective: Impaired balance is disabling for children with cerebral palsy (CPc), especially for CPc who recently underwent lower limb surgery. Positive results of using virtual reality (VR) in balance rehabilitation have been published in several outpatient populations. We investigated the feasibility of applying additional VR training focused on...

The prevalence of childhood overweight and obesity is increasing in the last decades, also in children with Cerebral Palsy (CP). Even though it has been established that an increase in weight can have important negative effects on gait in healthy adults and children, it has not been investigated what the effect is of an increase in body weight on t...

Background: The direct anterior approach on a regular operating room table has been reported with low dislocation rates. This might be beneficial for complex primary total hip arthroplasty (THA) such as in patients with cerebral palsy or following femoral or pelvic osteotomies. Extending the approach is often required to overcome problems such as...

Introduction: The use of botulinum toxin (BTX) for spasticity-reduction in children with spastic cerebral palsy (SCP) is controversial. There is little doubt regarding the effectiveness of BTX inhibiting the hyperactive stretch reflex, but long-term muscular-alterations due to repeat chemo-denervation is a concern. This stemmed from an investigatio...

Aim This study aimed at comparing two statistical approaches to analyze the effect of Botulinum Toxin A (BTX-A) treatment on gait in children with a diagnosis of spastic cerebral palsy (CP), based on three-dimensional gait analysis (3DGA) data. Through a literature review, the available expert knowledge on gait changes after BTX-A treatment in chil...

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Kinematic knee features extracted from 26 papers, identified through systematic literature search. (PDF)

Kinematic hip features extracted from 26 papers, identified through systematic literature search. (PDF)

Kinematic ankle features extracted from 26 papers, identified through systematic literature search. (PDF)

Kinetic hip features extracted from 26 papers, identified through systematic literature search. (PDF)

Kinematic features of the foot in the transverse plane extracted from 26 papers, identified through systematic literature search. (PDF)

Kinetic ankle features extracted from 26 papers, identified through systematic literature search. (PDF)

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Kinematic pelvic features extracted from 26 papers, identified through systematic literature search. (PDF)

Kinetic knee features extracted from 26 papers, identified through systematic literature search. (PDF)

Children with cerebral palsy (CP) often present aberrant hip geometry, more specifically increased femoral anteversion and neck-shaft angle. Furthermore, altered gait patterns are present within this population. This study analyzed the effect of aberrant femoral geometry, as present in subjects with CP, on the ability of muscles to control hip and...

AimThis study aims to achieve an international expert consensus on joint patterns during gait for children with cerebral palsy (CP) by means of Delphi surveys.Method In Stage 1, seven local experts drafted a preliminary proposal of kinematic patterns for each lower limb joint in the sagittal, coronal, and transverse plane. In Stage 2, 13 experts fr...

Cerebral Palsy (CP) is characterized by a heterogeneous nature with a variety of problems. Therefore, individualized physical therapy might be more appropriate to address the needs for these children. The first aim was to compare the effectiveness of an individually-defined therapy program (IT) and a general therapy program (GT) on gait and gross m...

Botulinum toxin type A (BTX) injections are frequently used in children with cerebral palsy (CP) to control spasticity. Injection variables still lead to variable outcomes of this treatment. Using instrumented spasticity assessment and muscle volume assessment the most effective location of the injection was demonstrated for gracilis and psoas musc...