Effects of Botulinum Toxin A on Upper Limb Spasticity in Children With Cerebral Palsy.Friedman A, Diamond M, Johnston MV, Daffner C (Physical Medicine and Rehabilitation physical medicine and rehabilitation or physiatry or physical therapy or rehabilitation medicine Medical specialty treating chronic disabilities through physical means to help patients return to a comfortable, productive life despite a medical Center, Englewood; Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School, Newark; Children's Specialized Hospital, Mountainside; Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ; Department of Occupational Therapy, Touro College, New York, NY), Am J Phys Med Rehabil. 2000;79:53-59. The purposes of this study were (1) to assess the effect of botulinum toxin A botulinum toxin A Oculinum Neurology One of several toxins produced by C botulinum, of which the 150 kD type A toxin has been purified and used to treat various neuromuscular junction disorders including strabismus, blepharospasm, spasmodic torticollis, (BTX-A) on upper-limb spasticity in children with spastic cerebral palsy and (2) to determine whether age is related to therapeutic response. Between October 1995 and April 1997, a prospective series of 32 children (average age=6.9 years, range=1-18 years) with hemiplegic or quadriplegic quadriplegic /quad·ri·ple·gic/ (-ple´jik) 1. of, pertaining to, or characterized by quadriplegia. 2. an individual with quadriplegia. cerebral palsy and significant spasticity received BTX-A injections. In each patient, specific muscle groups were selected for BTX-A injection based on that patient's function, pattern of spasticity, and caregiver management. Injected muscle groups included the deltoid muscle deltoid muscle n. A muscle with origin from the lateral third of the clavicle, the lateral border of acromion process, and the lower border of spine of scapula, with insertion to the side of the shaft of the humerus, with nerve supply from the axillary in 2 patients, the biceps brachii muscle
In human anatomy, the biceps brachii is a muscle located on the upper arm. The biceps has several functions, the most important simply being to flex the elbow and to rotate the forearm. in 23 patients, the wrist-forearm musculature (eg, pronator pro·na·tor n. A muscle that effects or assists in pronation. pronator a muscle that pronates an extremity. teres teres /te·res/ (te´rez) [L.] long and round. te·res adj. Being round and long. Used of certain muscles and ligaments. teres [L.] long and round. , flexor carpi car·pi n. Plural of carpus. radialis, flexor carpi ulnaris muscles) in 24 patients, and the thenar muscles in 18 patients. An occupational therapist, blinded to BTX-A injection sites, examined all patients for range of motion and spasticity using a modified Ashworth scale (MAS) before BTX-A injections and at the 1-, 3-, and 4-month follow-ups after the injections. Caregivers rated the patient's upperbody function, and the appearance, spasticity, management, and ease of motion at the designated joints at each follow-up. Patients continued in their established physical therapy and occupational therapy programs throughout the study. Significant results included improved MAS ratings for elbow extension at 1, 3, and 4 months after BTX-A injection; wrist extension at 1-month after injection; and wrist flexion at 1 and 3 months after injection. Ease of thumb movement was improved at 1 month. Wrist extension range of motion increased at 4 months. The authors concluded that BTX-A effectively reduces upper-limb spasticity among children with cerebral palsy, but they said that it is unclear how long the functional benefits of BTX-A injections last. Age did not affect responsiveness to the therapy. They recommended further investigation of BTX-A in combination with other therapeutic modalities. Mary Jean Gelsomino, PT Utica College Utica, NY |
|
||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion