Retrospective analysis of temporalis muscle thickness as a biomarker of functional level in adults with cerebral palsy.
Hyun Iee Shin, Rajashree Srinivasan, Saylee Dhamdhere and 2 others
Thicker temporalis muscle on brain MRI was independently associated with being able to walk in 104 adults with cerebral palsy, even after accounting for age, sex, body size, and feeding method.
This could become a quick imaging check of functional level.
Key findings
1Greater temporalis muscle thickness was independently associated with higher odds of being ambulatory (adjusted OR 1.31, p=0.037), after adjusting for sex, age, BMI, parenteral nutrition, and MRI year.
2A significant negative correlation was found between GMFCS level and temporalis muscle thickness (Spearman's ρ = −0.402, p < 0.001), meaning worse motor function was associated with thinner temporalis muscle.
3In the 15 participants with unilateral hemiplegia, the affected side had significantly lower temporalis muscle thickness than the unaffected side (Z = −3.52, p < 0.001).
Still to come
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Retrospective, single-centre design with no randomisation; association does not prove that thicker temporalis causes ambulation or that strengthening it would restore walking. Modest sample of 104, with only 29 non-ambulatory participants, limiting statistical power for subgroup analyses. TMT was measured from MRI, which is not available to every patient; the authors note ultrasound is a validated alternative but did not test it here. Height measurement in non-ambulatory adults with contractures and spinal deformities is unreliable, which affects BMI as a covariate. The model explained only about a quarter of the variance (Nagelkerke R² = 0.264), so most of what determines ambulatory status is not captured here. Reduced temporalis thickness in CP may reflect developmental hypoplasia (smaller muscles from childhood) rather than acquired muscle loss, making it harder to interpret as a marker of current deconditioning. The 15-year MRI window means imaging technology and protocols may have varied across the study period, though the authors adjusted for MRI year.
Declared interests
The authors received no financial support and declared no conflicts of interest.
The easy way to misread this
Do not read the adjusted OR of 1.31 per mm of temporalis thickness as a treatment target or a prediction that a patient will start walking. This is a cross-sectional association in a retrospective chart review: it shows that people who walk tend to have thicker temporalis muscles, not that thickening the muscle will restore ambulation. The model also explains only about a quarter of the variation, and the thinner muscles in non-ambulatory adults with CP may reflect smaller muscles they were born with rather than muscle they have lost.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →