Effect of addition of botulinum toxin-A to standardized therapy for dynamic manual skills measured with kinematic aiming tasks in children with spastic hemiplegia.

Abstract

OBJECTIVE:

To measure the effect of intensive therapy and the lasting effect of a standardized functional training programme with vs. without the addition of chemodernervation of the muscles of the forearm and hand.

PATIENTS AND METHODS:

Twenty children with spastic hemiplegia, aged 4-16 years, were matched for baseline characteristics and randomized to standardized task-oriented therapy for 6 months with or without botulinum toxin injections. Dynamic kinematic outcome measures were: speed, accuracy, end-point spread and performance. Measurements of active and passive range of motion, stretch-restricted angle of the elbow and wrist, Ashworth scores and Melbourne Assessment of Unilateral Upper Limb Function were made. All measures were performed at baseline, 2 weeks after injection of botulinum toxin and after 6 months (at the end of therapy), and 3 months after end of the therapy.

RESULTS:

Clinical measures showed improvement in both groups. However, no significant differences emerged between groups on functional measures. Directly after the botulinum toxin injection all kinematic outcome measures showed a decrease, but baseline values were re-established during the therapy period. After botulinum toxin injections a temporarily significant greater increase in speed and performance was found. These results illustrate the need for further quantitative research into the effects of botulinum toxin.

• Authors: Eugene A A Rameckers, Jacques Duysens, Lucianne A W M Speth, Hans J S Vles, Bouwien C M Smits-Engelsman
• Journal: Journal of rehabilitation medicine (J Rehabil Med) Vol. 42 Issue 4 Pg. 332-8 (Apr 2010) ISSN: 1651-2081 [Electronic] Sweden
• PMID: 20461335 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Activities of Daily Living
• Adolescent
• Botulinum Toxins, Type A (therapeutic use)
• Cerebral Palsy (drug therapy, physiopathology, rehabilitation)
• Child
• Child, Preschool
• Follow-Up Studies
• Hemiplegia (drug therapy, physiopathology, rehabilitation)
• Humans
• Motor Skills
• Neuromuscular Agents (therapeutic use)
• Outcome Assessment, Health Care
• Range of Motion, Articular (physiology)
• Task Performance and Analysis
• Treatment Outcome
• Upper Extremity (physiopathology)