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Title: Musculoskeletal and spinal cord imaging in bilateral spastic cerebral palsy
Author: Noble, Jonathan James
ISNI:       0000 0004 5368 0636
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2014
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Periventricular leucomalacia (PVL) is the most common brain injury in bilateral spastic cerebral palsy (BSCP). Cerebral palsy is a group of conditions that affect the development of the motor system, that are attributed to non-progressive lesions in the developing brain. In PVL, damage is caused by a primary arterial ischemic injury to the white matter in the posterior limb of the internal capsule, although other regions of the brain can also be affected including the spinal cord. Alterations in spinal cord development may lead to many of the clinical problems observed in BSCP, including altered motor control, co-contraction of agonist and antagonist muscle groups, progressive musculoskeletal deformities and weakness. Further to this, a heightened fracture risk of the long bones of the skeleton may be related to poor muscle development subsequent to the original brain injury. In the work contributing to this thesis, the fat content of five muscles and the volume of nine major muscles of the lower limbs of ambulant adolescents and young adults with and without BSCP are investigated using MRI. The relationship between bony geometry and muscle volume are also studied. Studies of spinal cord white matter organisation are also performed using diffusion tensor imaging (DTI) MRI techniques to investigate whether there are associations between spinal cord organisation and gross functional development in BSCP. Lower limb muscle volumes in BSCP were found to be smaller with increased intramuscular fat compared to their typically developing peers. Bone strength estimated from bony geometry was found to be significantly dependent on muscle volume independent of diagnosis. No differences were observed in spinal cord white matter microstructure between the subject groups, although a reduced white matter crosssectional area was observed in the BSCP group. The clinical implications of this work are discussed in detail.
Supervisor: Shortland, Adam ; Charles-Edwards, Geoffrey Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available