The effect of botulinum-A toxin treatment in children with spastic cerebral palsy: Kinematic and kinetic aspects of ankle and knee joints

It is recognized that objective gait analysis is of great value in planning a multilevel botulinum toxin type A (BTX-A) treatment. After BTX-A treatment, objective outcome measures can provide new and interesting information for each individual child with cerebral palsy (CP). Moreover, by studying group results, we may evaluate our treatment hypotheses. The present prospective study attempts to document the effect of integrated multilevel BTX-A treatment 1 on objective gait parameters and to de®ne the optimal strategy for the combined treatment of BTX-A with casting in children with cerebral palsy. Objective three-dimensional gait analysis (3DGA) data were collected pre-and 2 months post-treatment, in two randomized patient groups: a ®rst group of 17 children treated with lower leg casting prior to BTX-A injections, and a second group of 17 patients who received casting immediately after injections. The present study demonstrates that improved gait can be achieved after a multilevel BTX-A treatment, combined with casting, using a set of 90 gait parameters. The most pronounced improvement was seen at the ankle joint. The results in the knee, hip and pelvis imply that multilevel treatment of the child with CP should start at an early age, in order to prevent development of muscle contractures. Slightly more pronounced bene®ts, mainly in the proximal joints, were seen for the children who were casted after injections as compared to the children who were casted before injections.

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“…, 1994; Sutherland et al. , 1996; Boyd and Graham, 1997; Motta, 1997; Corry et al. , 1998; Boyd et al.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies (Sutherland et al. , 1996; Motta, 1997; 1999; Wissel et al. , 1999) showed a significantly increased walking velocity and step length 3–12 months after BTX‐A treatment; however, these studies only included gastrocnemius muscle injections.…”

Section: Discussionmentioning

confidence: 99%

A randomized study of combined botulinum toxin type A and casting in the ambulant child with cerebral palsy using objective outcome measures

Desloovere

Molenaers

Jonkers

et al. 2001

Euro J of Neurology

126

108

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“…The present study confirms the benefit of both interventions in the correction of gait deviations in the ambulatory child who has spastic cerebral palsy. Accordingly, it supports the findings of other researchers who reported that gait improves after BTX‐A injections (Sutherland et al ., 1996; Boyd and Graham, 1997; Motta, 1997; Corry et al ., 1998; Boyd et al ., 2000; Graham et al ., 2000) and after multilevel surgery (Norlin and Tkaczuk, 1985; Deluca, 1991; Gage, 1991; Nene et al ., 1993; Ounpuu et al ., 2000).…”

Section: Discussionmentioning

confidence: 99%

Single event multilevel botulinum toxin type A treatment and surgery: similarities and differences

Molenaers

Desloovere

Cat

et al. 2001

Euro J of Neurology

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The present study attempts to provide objective evidence of two treatment options for children with cerebral palsy (CP): multilevel botulinum toxin type A (BTX-A) injections and multilevel surgery. The purpose of the study was to clarify the differences and the similarities, and common treatment principles of both treatment strategies. Objective three dimensional gait analysis data were studied retrospectively in two patient groups pre- and post-treatment (randomly selected from a group of children that were treated between 1998 and 1999). In the first group, 29 children with CP were managed with BTX-A injections according to an integrated multilevel approach (Molenaers et al., 1999a). A second group of 23 children with CP were managed by a more traditional single event multilevel surgery, also according to an integrated approach. Our aim was to evaluate the differences as well as the similarities between both patient groups, using a set of 56 parameters selected from three-dimensional gait analysis. The unifying concept between management with BTX-A injections and orthopaedic surgery was the adoption of a multilevel approach at one session. The groups demonstrated considerable differences with respect to age, pretreatment condition and amount and level of improvement after treatment. The children who received BTX-A were typically younger, and showed primary gait problems in the distal joints, whereas the children who underwent surgery demonstrated a higher frequency of gait deviations in the transverse plane and had more complications. Although the benefit of both treatments was confirmed by the present study, a difference in the amount and level of improvement was also demonstrated. In conclusion, these treatment modalities should be regarded as complementary rather than mutually exclusive treatments, with both calling for an integrated approach.

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The effect of botulinum-A toxin treatment in children with spastic cerebral palsy: Kinematic and kinetic aspects of ankle and knee joints

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A randomized study of combined botulinum toxin type A and casting in the ambulant child with cerebral palsy using objective outcome measures

A randomized study of combined botulinum toxin type A and casting in the ambulant child with cerebral palsy using objective outcome measures

Single event multilevel botulinum toxin type A treatment and surgery: similarities and differences

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