In a randomised, double‐blind study, the effects of intramuscular injection of botulinum toxin type A (BtA) into the upper limb were compared with those of normal saline solution in 14 patients with cerebral palsy; their mean age was 9 years. Range of movement and function were assessed before injection and at 2 and 12 weeks after injection. BtA injection significantly increased maximum active elbow and thumb extension and significantly reduced tone at wrist and elbow. The hand grasp‐and‐release score improved, representing a modest functional change, but fine motor function, assessed by the ability to pick up coins, did not improve and in some cases deteriorated temporarily. The most notable subjective change was the cosmetic benefit of reduced involuntary elbow flexion. The tone‐reducing effect of BtA was clinically detectable in comparison with the placebo and patients and parents perceived the change as beneficial. The median of changes in the treatment group was small but the range Was large, suggesting that BtA can be useful in selected patients.
SUMMARY The authors looked for differences in the energy expenditure patterns of ambulant children with cerebral palsy and spina bifida. Oxygen consumption was measured according to type of cerebral palsy or level of spina bifida lesion, and in healthy children. The rate of oxygen consumption (mL/kg/min) was significantly higher in the children with diplegia than in those with hemiplegia or with spina bifida or the healthy children. Oxygen cost (mL/kg/m) was significantly higher and velocity was significantly slower in all the groups with disability than in the healthy children. The reason children with diplegia consumed more oxygen than other children when walking may be that their abnormal equilibrium reactions impaired their balance and their ability to control their walking speed. RÉSUMÉ Consoinmation énergétique compareée enlre spina bifida et IMC: tine étude comparative Les auteurs ont recherché des différences dans l' aillure de la dépense énergétique chez les enfants marchant. avec IMC ou spina bifida. La consommation d' oxygene a été rapportée au type d' IMC, au niveau dc la lésion du spina bifida, et au fait que les enfants témoins étaient en bonne samé. Le taux de consommation d' oxygene (mL/k'g/min) était significativement plus élevé en cas de diplegie qu'en cas d' hémiplégie, dc spina bifida ou d' intégrité neurologique. Le coût en oxygène était significativement plus élevé et la vitesse significativement moindre chez les enfants avec incapacityé motrice par rapport aux enfants sans incapacityé. La raison pour laquclle les enfants diplégiques consomment plus d' oxygène à la marche que les autres enfants pourrait être que leurs réactions d' équilibre anormales altèrent leur tenue et leur capacityéà contrôler leur vitesse de marche. ZUSAMMENFASSUNG Energieverbrauch bei Kindern mil Spina bifida mid Cerebralparese: Eine Vergleiclisstttdie Die Autoren untersuchten Unterschiedc im Energieverbrauch bei ambulaten Kindern mit Cerebralparese und Spina bifida. Der Sauerstoffverbrauch wurde je nach Typ der Cerebralparese und Höhe der Spina bifida Läsion und bei gesunden Kindern gemessen. Die Rate des Sauerstoffverbrauchs (mL/kg/min) war bei Kindern mit Diplegie signifikant höher als bei denen mit Hemiplegie oder Spina bifida oder bei gesunden Kindern. Bei alien Kindern mit Behinderung war der Sauerstoffbedarf (mL/kg/m) signifikant höher und die Geschwindigkcit signifikant langsamer als bei den gesunden Kindern. Der Grund weshalb Kinder mit Diplegie beim Laufcn mehr Sauersloff verbrauchten als andere Kinder, mag darin liegen, daß ihre abnormen Gleichgewichtsreaktionen ihre Balance und ihre Fähigkeit, die Gcschwindigkeit zu kontrollieren. Beeinträchtigtcn. RESUMEN Consumo de energiu en niños con espina bifida v parálisis cerebral: estndio comparativo Los autorcs investigaron las difcrencias de los patrones de gasto de energia de niñas ambulantes con parálisis cerebral y espina bífida. El consumo de oxígcno se midió de acuerdo con el tipo dc parálisis cerebral o el nivel de la lesion medular y en niños sanos. El...
The management of the upper limb in cerebral palsy is often complex and challenging. Effective treatment requires a multidisciplinary approach involving paediatricians, occupational therapists, physiotherapists, orthotists and upper extremity surgeons. Interventions are generally aimed at improving function and cosmesis by spasticity management, preventing contractures and correcting established deformities. Treatment objectives vary according to each child and range from static correction of deformities to ease nursing care, to improvements in dynamic muscle balance to augment hand function. Botulinum toxin A therapy has been shown to relieve spasticity and improve function in the short term. Surgery is also effective but requires careful patient selection, as many children with cerebral palsy are not candidates for surgery. Occupational therapy and physiotherapy have small treatment effects alone but are essential adjuncts to medical and surgical management.
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