ClinicalTrials.gg
RecruitingNCT07293988MYOSPAS-IMCUpdated Dec 19, 2025

Spastic Myopathy in Adults With Cerebral Palsy

An interventional study of Guided Self-rehabilitation Contract and Conventional therapy group in Cerebral Palsy (CP), sponsored by Neuroloco. Recruiting at 1 site in France. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-12-19.

Sponsored by Neuroloco · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Registered 3 years 6 months after the study started (first participant enrolled May 2022, registered Nov 2025).
  • Started May 2022; still recruiting 4 years 5 months later.
Phase
Not applicable
Study type
Interventional
Enrollment
40
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-12

Among 91 studies in Cerebral Palsy with a site in France — 29 open to participants now, 30 under way, none of them phase 3. Cerebral Palsy · France.

Planned enrollment
26th of 59
40 · median 36
Started
2022
with 6 others
No phase
48 of 91
20 open now
Primary completion
2028-11
later than 20 of 29 live
Registered
81st of 91
by date

Among the 91 studies in Cerebral Palsy with a site in France, this one is the 26th largest by planned enrollment of the 59 interventional ones, is one of 7 that started in 2022, is one of 48 with no phase, reaches primary completion later than 20 of the 29 other live ones, and was the 81st registered.

By phase

91 studies; the count open now beside each. This study's row is marked.

No phasethis study48 · 20 open
Observational32 · 9 open
Phase 38 · 0 open
Phase 21 · 0 open
Phase 2/31 · 0 open
Phase 41 · 0 open

By the year they started

First in 2004; this study’s year is marked. 7 started in 2022.

Size and results

Median enrollment 36 across the 59 interventional studies, 58 across the 32 observational. Of the 54 that completed or were terminated, 3 (6%) have results posted.

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02

Study summary

Cerebral palsy (CP) is indeed the result of a central neurological lesion, but it also involves a lesser-known muscular condition that we refer to as spastic myopathy. This condition is likely the consequence of relative immobilization and underuse of the muscles in the affected limbs and, through a vicious cycle, it in turn plays a major role in movement difficulties. Among the muscles involved are the plantar flexors, whose extensibility decreases from the earliest years of the child's life.

The BIOTN research team (UR7377; Université Paris-Est Créteil; Dr M. Pradines, Prof. J.-M. Gracies, CHU Henri Mondor, Créteil), supported by the Fondation pour la Paralysie Cérébrale, is conducting a randomized controlled study aimed, on the one hand, at characterizing in these individuals the genetic, histological, radiological, mechanical, physiological, and clinical changes in the calf muscle, and on the other hand, at exploring the reversibility of these alterations by comparing the effects of two types of rehabilitation after one year.

This study will provide essential insights for the development of specific and adapted rehabilitation strategies designed to improve the living conditions of individuals with cerebral palsy.

Read the detailed description

Cerebral palsy (CP), resulting from a perinatal central neurological lesion, leads not only to lifelong motor impairment but also to a specific muscular disorder: spastic myopathy. This condition is characterized by early and progressive structural changes including decreased passive extensibility (XV1), reduced muscle fiber diameter, decreased number of sarcomeres in series, and hypertrophy of the endomysium and perimysium. In children, impaired gastrocnemius growth-quantified by reduced medial gastrocnemius muscle volume-appears before age 3 and precedes both hyperactivity and fixed stiffness. However, the long-term consequences of decades of underuse on the mechanical, histological, and morphometric properties of the gastrocnemius in adults with IP remain insufficiently explored.

Stretching, although widely prescribed, lacks standardized parameters, and its long-term effectiveness in adults with IP has never been formally evaluated. Evidence suggests that muscular plasticity requires high-load stretching and ≥10 minutes per muscle per day. Preliminary studies using Guided Self-Rehabilitation Contracts (GSCs) demonstrated significant gains in extensibility and function, while a randomized controlled trial in adults with acquired hemiparesis showed increased fascicle length, increased muscle thickness, and improved gait speed after one year of high-load self-stretching, supporting the reversibility of molecular pathways driving contracture.

This single-blind randomized controlled trial includes 40 adults with IP, randomized to: (1) conventional physiotherapy alone, or (2) conventional physiotherapy + a one-year daily GSC-based high-load gastrocnemius self-stretching program (10 minutes/day + phasic maximal dorsiflexion efforts). Multi-scale assessments span six analytical domains: clinical measures (XV1, XV3, XA; gait speed; SF-36), in vivo tissue biomechanics (resistance torque, passive energy, fascicle length, muscle thickness), functional and neurophysiological biomechanics (agonist-antagonist recruitment during gait), MRI morphometry (volume, intramuscular fat, edema), in vitro biomechanics (compressibility, strain, rupture stress), and genetic/histological markers (satellite cells, expression profile of 57 myogenic genes). Micro-invasive biopsies of both limbs will be performed at J1 and M12.

The primary outcome is maximal barefoot 10-meter gait speed. Secondary outcomes will characterize, chronologically and mechanistically, the trajectory of spastic myopathy and the potential of long-term high-load stretching to partially reverse its pathogenic processes.

03

Conditions studied

  • Cerebral Palsy (CP)

Keywords

  • cerebral palsy
  • fascicle length
  • spastic myopathy
  • micro-invasive biopsy
  • daily self-stretch posture
  • muscle volume
  • muscle thickness
  • fiber diameter
  • fiber type
  • myosin isoform chain
  • MRI
  • elastography
  • stiffness
  • shear modulus
  • spastic cocontraction
  • paresis
  • gait speed
  • micro-tester
  • gastrocnemius
04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Hemiparesis or diparesis resulting from a cerebral lesion occurring during the perinatal period (cerebral palsy).
  • Gastrocnemius extensibility XV1 \< 100° (XV1, Tardieu Scale).
  • Maximum barefoot walking speed (AT10) between 0.3 and 1.2 m/s.
  • Written to participate in the study.

Exclusion criteria

Exclusion Criteria:

  • Botulinum toxin injections in the medial gastrocnemius within less than 3 months prior to study inclusion.
  • Cognitive impairment preventing participation in the GSC program or in the study.
  • Patients under legal guardianship or conservatorship.
  • Known hemostasis disorders.
  • to allergens.
  • Presence of a metallic intraocular foreign body (accidental fragments or others), a pacemaker, a neurostimulator (pain treatment), a cochlear implant, or, more generally, any implanted electronic medical device that cannot be removed; presence of a metallic cardiac valve in the study participant.
Terms in these criteria, in plain language(2)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
40 participants (estimated)

Study arms

  • Experimental
    Guided Self-rehab group

    In the interventional group, subjects will follow a Guided Self-rehabilitation program based on daily high-load gastrocnemius self-stretching postures (10 minutes/day) and phasic maximal dorsiflexion efforts

    Behavioral: Guided Self-rehabilitation Contract

  • Other
    Control group

    In the control group, subjects follow their rehabilitation sessions (conventional therapy) as before their enrollment

    Behavioral: Conventional therapy group

Interventions

  • BehavioralGuided Self-rehabilitation Contract

    Participants randomized to the intervention arm will receive a one-year individualized program based on the Guided Self-Rehabilitation Contract (GSC) method. A physiotherapist specifically trained in GSC will supervise all 20 patients. The therapist will conduct monthly 1.5-hour home visits, supplemented as needed by intermediate webcam or telephone consultations. The GSC method aims to increase the patient's knowledge, responsibility, and active involvement in their rehabilitation. Its core psychological mechanism is the use of a daily quantified logbook (paper, electronic, or the i-GSC™ smartphone/tablet application). Patients must record daily stretching time per muscle and the number of active movements performed in each series. The therapist explains that maintaining this logbook is a central component of the therapeutic contract. At each visit, the logbook is reviewed to enhance data accuracy, monitor motivation, reinforce adherence, and provide positive feedback-mechanisms show

  • BehavioralConventional therapy group

    In this group, subjects follow their rehabilitation sessions as before their enrollment. Conventional physiotherapy will typically consist of one to three sessions per week, delivered either in a private outpatient practice or at the patient's home, depending on the medical prescription. Session duration and therapeutic content may vary, reflecting routine real-life practice. Quantitative and qualitative data regarding conventional physiotherapy will be collected for all subjects throughout the study

06

What researchers measure

Primary outcomes

  1. Maximal ambulation speed over 10 meters

    Maximal ambulation speed over 10 meters, barefoot

    Time frame: Day 1, Month 6, Month 12

Secondary outcomes

  1. Plantar flexor clinical extensibility (XV1)

    Passive ankle dorsiflexion were assessed using standardized Tardieu Scale procedures. XV1 was measured during a very slow, strong passive stretch of the gastrocnemius with the patient supine, knee extended. The stretch was performed over 3-5 seconds to minimize stretch-reflex activation, and the maximal angle at which soft-tissue resistance could no longer be overcome was recorded as the passive maximal dorsiflexion range (XV1).

    Time frame: Day 1, Month 6, Month 12

  2. Plantarflexor spasticity

    XV3 was obtained under identical positioning as XV1 but during a rapid stretch (V3). To ensure the muscle was fully relaxed prior to the fast movement, the examiner performed several quick oscillatory pre-movements in the opposite direction. The angle of catch or clonus during the fast stretch defined XV3.

    Time frame: Day 1, Month 6, Month 12

  3. Active dorsiflexion (XA)

    XA represented maximal active dorsiflexion, measured with the patient supine and knee extended, reflecting both passive and active constraints imposed by the gastrocnemius.

    Time frame: Day 1, Month 6, Month 12

  4. LG Young modulus

    Participants were assessed using a share wave elastography system while seated in an isokinetic ergometer (trunk at 60°, knee extended, ankle fixed). The lateral gastrocnemius (GL) shear modulus (µGL) were measured through nine sites (superior, middle, inferior, medial, medium, lateral). Measurements were performed under two ankle positions: 40° plantarflexion (non-stretched LG) and 80% of individual XV1-GAS (stretched LG). For each site and condition, 10-second cine loops were recorded (a validated acquisition method), yielding 10 videos per participant. Each video was then divided into 10 DICOM frames to obtain reliable µGL estimates. Image processing and µGL extraction were performed using MATLAB®.

    Time frame: Day 1, Month 6, Month 12

  5. LG fascicle length

    Participants were assessed using a high frequency ultrasound system while seated in an isokinetic ergometer (trunk at 60°, knee extended, ankle fixed). Structural ultrasound images at the middle/medium location were analyzed to derive fascicle length

    Time frame: Day 1, Month 6, Month 12

  6. LG Tickness

    Participants were assessed using a hifh frequency ultrasound system while seated in an isokinetic ergometer (trunk at 60°, knee extended, ankle fixed). Structural ultrasound images at the middle/medium location were analyzed to determine muscle thickness

    Time frame: Day 1, Month 6, Month 12

  7. LG Muscle volume

    A high-field 3T MRI examination of both the paretic and contralateral lateral gastrocnemius muscles will be performed using a flexible surface coil positioned around the patient's calves. Muscle volume will be quantified from a series of continuous axial T1-weighted slices acquired along the full length of the calf.

    Time frame: Day 1, Month 12

  8. Intramuscular fat percentage

    A high-field 3T MRI examination of both the paretic and contralateral lateral gastrocnemius muscles will be performed using a flexible surface coil positioned around the patient's calves. Intramuscular fat percentage will be estimated using a Dixon sequence, allowing reliable separation of water and fat signals.

    Time frame: Day 1, Month 12

  9. LG hyperelastic behavior under compression

    A micro-invasive muscle biopsy using a Weil-Blakesley forceps will be performed twice, one year apart, on both the paretic and contralateral lateral gastrocnemius of each participant. This technique will be carried out by a trained investigator under local anesthesia. The biopsy will target the LG muscle belly, yielding approximately 30 mg of tissue for in vitro biomechanical analysis. Using an MTS Insight machine, fresh muscle fragments will undergo sequential uniaxial tensile and compressive relaxation tests. These procedures will enable detailed quantification of hyperelastic behavior under compression.

    Time frame: Day 1, Month 12

  10. LG fiber-type composition

    From biopsies, \~30 mg of tissue will be cryosectioned to visualize 400-500 fibers. Immunohistochemistry will determine fiber-type composition (fast/slow myosin)

    Time frame: Day 1, Month 12

  11. LG endo-/perimysial fibrosis

    From biopsies, \~30 mg of LG tissue will be cryosectioned to visualize 400-500 fibers. Standard stainings (H\&E, Gomori Trichrome, COX, Sirius Red) will assess endo-/perimysial fibrosis.

    Time frame: Day 1, Month 12

  12. LG genetic expression

    From biopsies, \~30 mg of LG tissue will be used to examine the expression of 57 genes related to skeletal muscle structure, myogenic differentiation, metabolic regulation, and atrophy pathways. RNA will be extracted with the Nano PreAMP kit (Qiagen), and gene expression profiled using the RT² Profiler™ PCR Array - Human Skeletal Muscle Development \& Disease. The targeted gene groups include markers of the dystrophin-glycoprotein and titin complexes, fast and slow fiber signatures, energy metabolism, myogenesis (MYOD1, MYOG, PAX3/7), atrophy/autophagy (FBXO32, TRIM63, TNF)

    Time frame: Day 1, Month 12

  13. LG spastic cocontraction

    Participants will be equipped with bilateral surface EMG electrodes on the tibialis anterior and lateral gastrocnemius (ME6000, 16-channel WiFi system; 1000 Hz). LG spastic cocontraction will be quantified during maximal dorsiflexion effort. When technically feasible, Mmax will be used as an alternative denominator of MVC in these ratios through tibial nerve stimulation

    Time frame: Day 1, Month 12

  14. Plantar/dorsiflexion strength

    Participants will be positioned in the ConTrex device, at two ankle positions (40° plantarflexion = relaxed GL; and 80% XV1-GAS = stretched GL). The maximal strength in dorsiflexion and plantarflexion will be quantified by the isokinetic ergometer.

    Time frame: Day 1, Month 6, Month 12

07

Study locations

1 of 1 sites recruiting
  • Maud Pradines
    Créteil, Île-de-France Region 94010, France
    Recruiting
08

References and documents

Individual participant data

Plan to share: Undecided

No publications or documents are linked to this record.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started May 2022 (actual). Primary completion is estimated for Nov 2028, 78 months after the start.

Of 902 non-industry interventional studies with no phase under Cerebral Palsy, half reached primary completion within 12 months of starting (the median), counting those still running; a quarter within 5 and three quarters within 31. This study's planned 78 months is above that.

Counting every sponsor, half of 921 studies reached it within 12 months; a quarter within 5 and three quarters within 31.

How these figures are worked out, and which studies are left out of them.

Registered
Nov 26, 2025
First posted
Dec 19, 2025
StartActual
May 19, 2022
Primary completionEst.
Nov 30, 2028
CompletionEst.
Nov 30, 2029
Last update
Dec 19, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Dec 19, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT07293988
Lead sponsor
Neuroloco
Responsible party
Sponsor
First posted
Dec 19, 2025
Start date
May 19, 2022
Primary completion
Nov 30, 2028 (estimated)
Completion
Nov 30, 2029 (estimated)
Last update
Dec 19, 2025

Study contacts

MAUD PRADINES, PT, PhD
Contact
maud.pradines@u-pec.fr
+33 676 845 339

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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