This observational cross-sectional study investigates the bilateral asymmetry of respiratory muscle activity during breathing in children with spastic cerebral palsy (CP). Children with CP often exhibit structural deformities, which may lead to impaired chest mobility and asymmetric respiratory function. The primary objective is to objectively evaluate the imbalance in the activation of bilateral respiratory muscles (intercostal, external oblique, and sternocleidomastoid) using non-invasive surface electromyography (sEMG). Muscle activity will be measured during resting breathing and active breathing tasks. The findings aim to provide clinical evidence for developing selective respiratory muscle training programs for this population.
Children with Gross Motor Function Classification System (GMFCS) Level I or II
Children with sufficient cognitive ability to understand instructions and voluntarily perform tasks
Children with a Trunk Appearance Clinical Evaluation (TRACE) score of 4 or higher out of a total of 12 points
Children who have undergone orthopedic surgery of the spine or lower extremities, or received botulinum toxin injection treatment within the past 6 months
Children with acute or chronic respiratory diseases, such as asthma or acute pneumonia
Children with severe cardiac disorders, intellectual disabilities, or visual and auditory impairments that may interfere with the experiment
Children aged 4 to 12 years diagnosed with spastic cerebral palsy who are receiving treatment at a local outpatient rehabilitation center (Easy Rehabilitation Medicine Clinic, Yongin-si, Gyeonggi-do, Republic of Korea).
Case-only
Cross-sectional
Surface Electromyography (sEMG) assessment
Diagnostic testMeasuring the bilateral activation of respiratory muscles (intercostal, external oblique, and sternocleidomastoid) using sEMG under two conditions: 30 seconds of resting breathing and active breathing tasks (blowing a pinwheel or bubbles).
Root Mean Square (RMS) of Respiratory Muscle Activity
Muscle activation amplitude of the intercostal, external oblique, and sternocleidomastoid muscles measured using surface electromyography (sEMG). The raw sEMG signals are full-wave rectified and smoothed using a 50ms moving window to calculate the RMS values during resting and active breathing tasks.
Asymmetry Index (AI) of Respiratory Muscle Activation
The asymmetry index will be calculated using the Root Mean Square (RMS) values obtained from surface electromyography (sEMG) . The formula used is (Right RMS - Left RMS) / (Right RMS + Left RMS) X 100 . The index evaluates the percentage of imbalance between the right and left respiratory muscles (intercostal, external oblique, and sternocleidomastoid) during resting breathing and active breathing tasks.
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