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      Short-Term Effects of Combined Serial Casting and Botulinum Toxin Injection for Spastic Equinus in Ambulatory Children with Cerebral Palsy

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          Abstract

          Purpose

          The purpose of this paper is to test the hypothesis that combination therapy of serial cast and botulinum toxin type A (BTX-A) injection can further enhance the effects of a BTX-A injection in ambulant children with cerebral palsy (CP) who have an equinus foot.

          Materials and Methods

          Children in group A (30 legs of 21 children) received a serial casting application after an injection of BTX-A, and children in group B (25 legs of 17 children) received only a BTX-A injection. Assessments were performed before the intervention and 1 month after the intervention.

          Results

          After the intervention, there were significant improvements in tone, dynamic spasticity, and passive range of motion (ROM) in both groups. However, the changes were greater in group A than in group B. Dimension D (standing) in Gross Motor Function Measure (GMFM)-66 was significantly improved in group A but not in group B. On the other hand, there were no significant changes in di-mension E (walking, running, jumping) in GMFM-66 in either group.

          Conclusion

          The results of our study suggest that a serial casting application after BTX-A injection can enhance the benefits of BTX-A injection in children with cerebral palsy.

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          Most cited references25

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          Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity.

          Katharine Walter, R Palisano, Archana Raina … (2000)
          This study examined the reliability, validity, and responsiveness to change of measurements obtained with a 66-item version of the Gross Motor Function Measure (GMFM-66) developed using Rasch analysis. The validity of measurements obtained with the GMFM-66 was assessed by examining the hierarchy of items and the GMFM-66 scores for different groups of children from a stratified random community-based sample of 537 children with cerebral palsy (CP). A subset of 228 children who had been reassessed at 12 months was used to test the hypothesis that children who are young (<5 years of age) and have "mild" CP will demonstrate greater change in GMFM-66 scores than children who are older ((5 years of age) and whose CP is more severe. Data from an additional 19 children with CP who were assessed twice, one week apart, were used to examine test-retest reliability. The overall changes in GMFM-66 scores over 12 months and a time ( severity ( age interaction supported our hypotheses. Test-retest reliability was high (intraclass correlation coefficient=.99). This study demonstrated that the GMFM-66 has good psychometric properties. By providing a hierarchical structure and interval scaling, the GMFM-66 can provide a better understanding of motor development for children with CP than the 88 item GMFM and can improve the scoring and interpretation of data obtained with the GMFM.
          Article 0 comments Cited 91 times – based on 0 reviews     Review now
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            Passive extensibility of skeletal muscle: review of the literature with clinical implications.

            R Gajdosik (2001)
            The purpose of this article was to review the literature on passive extensibility of skeletal muscle with reference to its anatomic and physiologic properties, mechanisms of adaptations and clinical implications. Studies with animal muscles have shown that passive extensibility is influenced by the size (mass) and length of muscle fibers, and the amount and arrangement of the connective tissues of the muscle belly. The resistance to passive lengthening is influenced by the readily adaptable amount of muscle tissue, including the contractile proteins and the non-contractile proteins of the sarcomere cytoskeletons. The relationship of adaptable changes in the muscle tissue and in the extracellular connective tissues remains unclear. Muscle length adaptations result from changes in the number of sarcomeres in series, which depend on the imposed length of muscles, not on the level of muscle activation and tension. This mechanism of muscle length adaptations, termed 'myogenic', has not been demonstrated in human muscles, but it has been intimated by therapeutic lengthening studies showing that both healthy and neurologically impaired human muscles can undergo increased length adaptations in the presence of muscle activations. Studies have suggested that optimal muscle function is probably achieved by increasing muscle length, length extensibility, passive elastic stiffness, mass and strength, but additional studies are needed to investigate these relationships, particularly for aged muscles and for muscles affected by clinical disorders, disease and injury. Such studies could contribute to the development of new intervention strategies designed to promote the passive muscle extensibility that enhances total muscle function, and ultimately improves the ability to complete functional activities and excel in athletic performances.
            Article 0 comments Cited 47 times – based on 0 reviews     Review now
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              Botulinum toxin A versus fixed cast stretching for dynamic calf tightness in cerebral palsy.

              S. Gibson, P Flett, Peter Stern … (1999)
              To compare botulinum toxin A injections with fixed plaster cast stretching in the management of cerebral palsied children with dynamic (i.e. non-fixed) calf tightness. The settings were the Women's and Children's Hospital (WCH) and the Crippled Children's Association of South Australia (CCA), Adelaide, South Australia. Twenty children were selected by two paediatric rehabilitation specialists. A prospective, randomized, single-blind controlled study, was carried out, with 10 children in each arm. The clinicians were blinded as to the allocated interventions. The outcome measures for 6 months post intervention were clinical assessment, modified Ashworth Scale, Gross Motor Function Measure, 2 D-video ratings using a modified Physical Rating Scale and a global scoring scale and a parent satisfaction questionnaire. Botulinum toxin A injections were of similar efficacy to serial fixed plaster casting in improving dynamic calf tightness in ambulant or partially ambulant children with cerebral palsy. The ease of outpatient administration, reduction of muscle tone and safety with botulinum toxin A was confirmed. Parents consistently favoured botulinum toxin A and highlighted the inconvenience of serial casting.
              Article 0 comments Cited 21 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Yonsei Med J
                Journal ID (publisher-id): YMJ
                Title: Yonsei Medical Journal
                Publisher: Yonsei University College of Medicine
                ISSN (Print): 0513-5796
                ISSN (Electronic): 1976-2437
                Publication date (Print): 01 July 2010
                Publication date (Electronic): 24 May 2010
                Volume: 51
                Issue: 4
                Pages: 579-584
                Affiliations
                [1 ]Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
                [2 ]Departments of Physical Medicine and Rehabilitation, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
                Author notes
                Corresponding author: Dr. Won Hyuk Chang, Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-3723, Fax: 82-2-363-2795, iamchangwh@ 123456naver.com
                Article
                DOI: 10.3349/ymj.2010.51.4.579
                PMC ID: 2880273
                PubMed ID: 20499426
                SO-VID: 04a35308-9fa9-4d28-a1a5-98500b0ce69c
                Copyright © © Copyright: Yonsei University College of Medicine 2010
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 July 2009
                Date revision received : 10 September 2009
                Date accepted : 14 September 2009
                Categories
                Subject: Original Article
                Subject: Orthopedics & Rehabilitation

                ScienceOpen disciplines: Medicine
                Keywords: serial cast,cerebral palsy,equinus,botulinum toxin
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: serial cast, cerebral palsy, equinus, botulinum toxin

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