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Official Journal of the , , , ,
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
Paolicelli P. B., Ferrari A. *, Lodesani M. *, Muzzini S. *, Sassi S. *, Maoret A. *, Bianchini E., Cioni G.
From the Division of Child Neurology and Psychiatry University of Pisa and IRCCS Stella Maris - Pisa
*Children Regional Rehabilitation Unit S. Maria Nuova Hospital - Reggio Emilia
Background. Spasticity is the most frequent alteration in muscle tone in cerebral palsy (CP), but it can also represent a functional compensation. Moreover, apparently similar contraction disorders can be the final result of different pathophysiological mechanisms, requiring different treatments. The aim of this study was to verify the effectiveness of botulinum toxin (BTX-A) treatment for the management of walking disorders in a group of children with CP, selected following a functional interpretation of their spasticity.
Methods. Gastrocnemious, soleus, tibialis posterior, hamstring and medial adductor muscles of 54 ambulatory CP children were treated, singularly or in combination, with BTX-A. The protocol included: 1) clinical observation and statement of expected functional results according to GAS (Goal Attainment Scaling); 2) standardized video-recording of standing and walking; 3) Ashworth scale; 4) Gross Motor Function Measure (GMFM); 5) parental interview. All children had orthoses and physical therapy. Controls were carried out before injection, 4 months after, and then every 2 months.
Results. Mild and transitory side-effects were observed in about a quarter of the children. All subjects showed a reduction of spasticity and a global functional improvement. At GAS only 15% of the children did not achieve the expected results of the treatment. A significant increase in standing and walking dimensions was observed at the GMFM, but about a quarter of the children did not show any change. This finding was probably due to a “threshold effect” of the scale.
Conclusions. BTX-A has an effective role in the treatment of children with CP, but its use has to be 1) preceded by a functional interpretation of the pathophysiological mechanisms of child walking disorders, 2) carried out in association with other treatments and 3) followed by standardized evaluations of its results.