A combination of Botulinum Toxin A therapy and Functional Electrical Stimulation in children with cerebral palsy – A pilot study

Abstract

Background: Among the ambulant population of children with spastic cerebral palsy (CP), dynamic equinus is one of the most common form of gait deviation that is encountered.Objective: To investigate the combined effects of Functional Electrical Stimulation (FES) and Botulinum Toxin A (BTXA) therapy in children with spastic CP, and to demonstrate the feasibility of this combination therapy.Methods: A single-subject design with repeated measures was adopted. Eight children (six males, two females; mean age 7 y 9 mo, SD 1 y 5 mo; range 7 y to 11 y) diagnosed with hemiplegic (n = 6) or diplegic (n = 2) spastic CP completed the study. Each subject participated in the study for twenty weeks. This period consisted of baseline (one week), BTXA phase (three weeks), first FES phase (four weeks), first control phase (four weeks), second FES phase (four weeks) and second control phase (four weeks). Subjects were assessed at the end of each phase. The ankle angle at the end of swing phase was selected as the primary outcome measure. The secondary outcome measure recorded was the foot contact pattern.Results: There was an increase in ankle dorsiflexion at the end of the combined intervention in most subjects (n = 6), accompanied by an improvement in foot contact pattern.Conclusions: This pilot study demonstrated that it is feasible to combine BTXA therapy with FES in ambulant children with spastic CP.

Development and validation of a low-cost, portable and wireless gait assessment tool

“…The second most important advantage of the portable wireless device is its ease of use in a clinical environment. Although the wi-GAT is yet to be used in a clinical setting, the wired version of this device was successfully used to evaluate gait in a study on gait recovery in incomplete spinal cord injured subjects [12] and in an investigation of the combined effects of functional electrical stimulation and Botulinum toxin on walking in children with cerebral palsy [3]. The total duration to setup the portable wireless device and record the spatiotemporal gait parameters during a single trial is under 10 minutes, provided that insoles of various sizes are already instrumented and available.…”

“…Gait analysis is a commonly used assessment tool that helps to quantify human locomotion. It has been widely used as a research and/or a clinical tool to quantify movement in various neurological conditions such as stroke [1,2], cerebral palsy [3,4], spinal cord injury [5], and also among the elderly population to assess the risk of falls [6].…”

Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review

“…Van Galen et al. reported a therapeutic increase in the angle of ankle dorsiflexion at the end of the swing phase and a trend of therapeutic improvement in foot contact pattern (without p ‐values for the latter parameter) . The increase in active ankle dorsal flexion in the post‐BoNT‐A phase was not as large as in the post‐FES and post‐control phases.…”

“…Five included articles with evidence at level IV 9,11,49,51,54 hint at causal inferences, while four level V studies 40,43,50,52 only suggest the possibility of causal inferences. On the basis of the five remaining articles, which are based on two group design studies of level II 10,39,41,42 and one singlesubject design study of level I, 46 it can be concluded that the outcomes are attributable to FES.…”

How Botulinum Toxin Type A- Occupational Therapy (OT)-Functional Electrical Stimulation (FES) Modify Spasticity and Functional Recovery in Patients with Upper Limb Spasticity Post Stroke

“…It was observed that the activity of botulinum toxin, with functional electric stimulation as an adjunctive therapy, was very important to reduce the neurogenic component of spasticity and to increase calf inhibition and provide a mechanical stretching effect while strengthening the stimulate muscles [20]. Many case studies has been chosen to illustrate the combined effects of lower limb [21] FES or upper limb [22] FES and BTX-A therapy in children with spastic cerebral palsy, but in the absence of a control group in both trials. Recently, Tsuchiya M et al demonstrated for the first time the effect of combined use of BTX-A and FES in the treatment of spasticity in adults; they showed an improvement of active function in paretic hand [23].…”