Determinants of responsiveness to botulinum toxin, casting, and bracing in the treatment of spastic equinus in children with cerebral palsy

Abstract

AIM The objective was to determine whether specific intrinsic (age, pattern of cerebral palsy [CP], child's motivation) and extrinsic (number of treatments, parenting stress) characteristics were associated with responsiveness to botulinum toxin A (BoNT-A) injections in children with CP 3 months after injection into the gastrocnemius muscle.METHOD Children with hemiplegia or diplegia recruited from a BoNT-A programme were evaluated before and 3 months following injection of BoNT-A into the gastrocnemius. Outcome measures included muscle tone, range of motion, gait pattern, level of ambulation, gross motor function, and functional independence. Determinants of responsiveness to BoNT-A considered were age, number of treatments, distribution of CP, parenting stress, and motivation.RESULTS Thirty-one children were recruited (17 males, 14 females) -22 with hemiplegia and nine with diplegia. Twenty-eight were classified at Gross Motor Function Classification System (GMFCS) level I and three at level III. The mean age was 6 years 4 months (SD 2y 11mo). Younger age (p=0.015) and fewer number (p=0.024) of BoNT-A treatments were associated with greater change in gross motor function. Child's motivation and parenting stress were significantly associated with improvements in muscle tone (p=0.006-0.017), passive range of motion (p=0.008-0.033), gait pattern (p=0.005-0.042), level of ambulation (p=0.001-0.043), and functional independence (p=0.004-0.027). INTERPRETATIONThe results indicate that child, family, and treatment characteristics influence the degree of responsiveness to BoNT-A treatment. The contribution of contextual factors (personal and environmental) on responsiveness may be underappreciated in children with CP.

Mastery motivation in children with congenital hemiplegia: individual and environmental associations

“…'s study, our sample scored significantly higher on all DMQ subscales, except for general competence, which was similar (GMFCS levels I–V; Table ). When compared with a group of school‐aged children with diplegia and hemiplegia, no differences were identified across the five subscales. A comparison of the present study to earlier studies suggests that increasing limitations in gross motor function and hand use and greater topographical distribution of CP may be associated with decreasing levels of mastery motivation.…”

“…We hypothesized that children's mastery motivation would be positively associated with functional parenting styles and negatively associated with activity limitations, manifesting in gross motor function and hand use in everyday activities. The secondary aims of this study were to describe mastery motivation in school‐aged children with mild congenital hemiplegia and compare them to (1) a reference sample of typically developing school‐aged children and (2) two published samples of school‐aged children with CP …”

“…The secondary aims of this study were to describe mastery motivation in school-aged children with mild congenital hemiplegia and compare them to (1) a reference sample of typically developing school-aged children 2 and (2) two published samples of school-aged children with CP. 6,13 METHOD A cross-sectional study examined baseline data from a larger randomized trial (Constraint-induced Movement and Bimanual Therapy [COMBiT]) comparing constraintinduced movement and bimanual training with a distributed model of standard upper limb rehabilitation in children with congenital hemiplegia. 14…”

A Pilot Evaluation of the Test-Retest Score Reliability of the Dimensions of Mastery Questionnaire in Preschool-Aged Children

“…Higher mastery motivation has been linked to greater participation in social and recreational activities (Majnemer et al, 2008) and better functional outcomes in conjunction with rehabilitation in children with CP (Yap et al, 2010). There is evidence that motivation can change during a child's development (Bartlett, 1999;Gilmore, Cuskelly, & Purdie, 2003), although further study is needed to understand the factors and interventions that can influence these changes.…”

“…It has also been used to determine whether motivation is a trait that affects the outcomes of interventions with children who have a disability. For instance, Yap, Majnemer, Benaroch, & Cantin (2010) used the DMQ in a study of 31 children with CP (mean age 6 years 4 months, SD 2 years 11 months) to assess whether those who gained the most benefits from botulinum toxin therapy had similarities in motivation levels. Furthermore, Majnemer et al, (2008) concluded in their study with school-aged children with cerebral palsy (n = 67, mean age 9 years 7 months, SD = 2 years 7 months) that higher motivation, as measured by the DMQ, was linked with greater involvement in recreational activities, and mastery pleasure was higher in children who were more involved in social activities.…”