Muscle Contractures in Adults With Cerebral Palsy Characterized by Combined Ultrasound-Derived Echo Intensity and Handheld Dynamometry Measures

Ultrasound Med Biol. 2022 Apr;48(4):694-701. doi: 10.1016/j.ultrasmedbio.2021.12.012. Epub 2022 Jan 19.


We used ultrasound-derived echo intensity and hand-held dynamometry to characterize plantar flexor muscle contractures in adults with cerebral palsy (CP). Eleven adults with CP (aged 41 ± 12 y, Gross Motor Function Classification System I-II) and 11 neurologically intact adults (aged 35 ± 10 y) participated in the study. Echo intensity was measured from the medial gastrocnemius muscle using brightness mode ultrasound. Hand-held dynamometry was used to quantify plantar flexor passive muscle stiffness and ankle joint passive range of motion (pROM). Echo intensity correlated with both passive muscle stiffness (r = 0.57, p = 0.006) and pROM (r = -0.56, p = 0.006). Ultrasound echo intensity (p = 0.02, standardized mean difference [SMD] = 1.13) and passive muscle stiffness (p < 0.001, SMD = 1.99) were higher and ankle joint pROM (p < 0.001, SMD = 2.69) was lower in adults with CP than in neurologically intact adults. We conclude that combined ultrasound-derived echo intensity and hand-held dynamometry may be used to provide an objective characterization of muscle contractures.

Keywords: Cerebral palsy; Contracture; Echo intensity; Grayscale; Intramuscular fat; Muscle composition; Muscle stiffness; Range of motion; Ultrasound.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ankle Joint / diagnostic imaging
  • Cerebral Palsy* / complications
  • Cerebral Palsy* / diagnostic imaging
  • Contracture*
  • Humans
  • Middle Aged
  • Muscle, Skeletal / diagnostic imaging
  • Range of Motion, Articular / physiology
  • Ultrasonography