How Does Botulinum Toxin Injection and Physiotherapy Complement Each Other in Cerebral Palsy?

Abstract

Cerebral Palsy (CP) is a clinical condition that describes impairments of motor and sensory systems due to a lesion in immature brain. CP-related disorders effect movements, balance and posture of the child. Spasticity is most frequent motor disorder seen in CP and effects 70-80% of the children with CP. Spasticity can lead to abnormalities in all motor system levels involving muscles, joints, bones and tendons. If spasticity exists for long period of time, immobilization of muscles in short position and changes in the connective tissue around joints lead to shortening of the muscles and connective tissue. Various methods are used for spasticity management in children with CP. Botulinum neurotoxin (BoNT) injections, oral medications, selective dorsal rhizotomy and intrathecal baclofen applications are the foremost among them. BoNT injections are most prevalently used one among these applications. BoNT, which is a neurotoxin obtained from Clostridium botulinum bacteria, is frequently used in children with CP to decrease muscle tone for a certain period in the selected muscles, prevent contractures, postpone surgery and decrease frequency of surgeries. During this time frame that muscle tone decreased, it is very important to increase activity and participation levels of children. For achieving better motor outcomes and functional independence, BoNT injections should be combined with physiotherapy (PT) and occupational therapy (OT).